Background: The long-term success of implant supported prosthesis depends on many variables. In addition to the osseointegration rules, a clinician should consider also the biomechanical factors like angulation of the abutment that may have a profound influence on the stress levels on bone for long-term function of implant-supported prosthesis. Purpose : A 3D finite element method was used to evaluate the von Mises stresses (Σ_Emax ) generated in varying thickness of cortical bone under axial and combined loading conditions by four angulated abutments in the anterior esthetic zone. Materials and Methods: The model resembles the maxillary bone, and the material properties similar to the bone are introduced in the model and clinical loading conditions were simulated. Von mises stresses occurring for four angulated abutments (0, 15, 20, 25 degree) in (a) compact and cancellous bone, (b) thick and thin compact bone, (c) subjected to axial and combined loading, were calculated. Results: ( a) Von Mises stresses (∑E _max ) were higher in the cortical bone compared to the cancellous bone and were concentrated in the crestal (facial) region in both types of bone. (b) The ∑E _max values of 0, 15 degree abutments in thin bone and 0, 15, 20 degree abutments in thick bone were within the physiological remodeling zone. (c) Stress values for a 25 degree abutment in both types of bone were above the resorption limit. (d) Stress values were higher due to combined loading compared to axial loading irrespective of the angulation or quality of bone present. (e) Clinically, within a load of 178 N angulated abutments up to 20 degrees can be placed in the anterior maxillary zone.

Introduction: Long-term clinical evaluation of dental implants and their surrounding structures is necessary to acquire more knowledge about the reasons for success and failure of implants. However, accurate and reproducible results are difficult to obtain. The aim of this study was to evaluate bone height around endosseous implants using digital conventional radiographs (DCR) and direct digital subtraction images (DSI) prior to loading. Materials and Methods: In this study, 10 dental implants from 6 patients were studied. Standardized digital radiographs were obtained one week and 3 months postoperatively and subtracted by means of EMAGO software. Then two radiologists evaluated bone height on digital conventional radiographs and digital subtraction images . Data was analyzed with paired t-test using the MINITAB 1.4 software program. Results: Comparative evaluation of bone height indicated significantly higher values on DCR than on DSI (p value = 0.002). The observers also had statistically significant variability in this assessment (p value = 0.00003). Conclusion: The problem in evaluating bone height was the inevitable effect of the operator which should be taken into consideration in follow ups. Additionally, DSI technique can be effective in predicting the dental implant success because it can show lower amounts and less differences in evaluation of bone height reported by different operators.

Objective: The aim of this review is to reveal whether there is a risk of failure of previously osseointegrated dental implants in women with estrogen deficiency status. Background: It is well known that estrogen deficiency can provoke bone alterations leading to bone loss, bone fragility and increased risk of fractures. Consequently, these changes in bone metabolism can affect the surrounding bone tissue of osseointegrated dental implants implicating estrogen deficiency status as a risk factor for their maintenance. Materials and Methods: Databases were searched (MEDLINE/PubMed) using different combinations of various keywords. Titles and abstracts that satisfied the eligibility criteria were screened by the authors and checked for agreement. Results: Five studies were included. All studies used rats as models. Two studies reported that estrogen deficiency may cause a negative effect on osseointegration around dental implants. Two studies suggested that estrogen privation results in a negative influence on bone around implants but this effect mainly appears in the cancellous region leaving cortical bone slightly affected. There is only one study that cited that estrogen deficiency may not be accused of being a risk factor for the failure of osseointegrated dental implants in ovariectomized rats. Conclusion: Estrogen deficiency status in rats seems to affect the success rates of previously osseointegrated dental implants but this situation seems to concern implants located in maxilla. Further investigation needs to be made in order to reveal whether the same results can be shown in women.

Purpose: Autogenous bone grafts are commonly used for pre-implant bone augmentation or defect coverage in the maxillofacial region. Particulate bone or bone blocks without a vascular pedicle are normally used for this purpose. The objective of this study was to investigate the effects of hyperbaric conditions on the cell activity of augmented bone under pressure changes such as those to which combat divers and mine clearance divers are exposed. Materials and Methods: Systematic studies were performed using an animal model (isogeneic Lewis rats). We collected bone chips (n = 4) from rat femurs with a Safescraper^; and obtained isogeneic bone blocks (n = 4) with a bone rongeur. Bone samples were exposed to three simulated 45-min dives to 5.0 bar using oxygen or compressed air. Bone chips and blocks that were not exposed to pressure served as controls. After 9 and 15 days of in vitro cultivation, osteoblast proliferation rates were assessed in a Neubauer counting chamber and the results were statistically analyzed. Results: Irrespective of the atmospheric conditions, bone blocks showed significantly higher proliferation rates (P = 0.05) than bone chips. When exposed to compressed air during simulated dives, both groups showed considerably lower proliferation rates than the control groups. When exposed to oxygen, both groups showed significantly higher proliferation rates than the control groups. Conclusion: Depending on the breathing gas used, changes in atmospheric conditions during simulated dives can lead to a decrease in osteoblast activity. Patients who underwent bone augmentation should therefore be advised not to dive using compressed air until osseointegration is complete.

Background: Due to the morphologic alteration, that occur following tooth extraction, augmentation procedures are often necessary. In the upper jaw, submucosa of palate can be used for soft-tissue reconstruction in implant dentistry. Materials and Methods: Thirty eight VIP-CT flaps in 37 patients were used for small maxillary reconstruction. In 97.3% of events, unilateral VIP-CT flap for each patient was used. Complications occur in this study include of flap necrosis in one case (2.7%), palatal sloughing in twenty four cases (63%) and donor site deformity in one patient (2.7%) respectively. Results: Patients, that VIP-CT flap was used for preparation of the mouth before implant insertion or during and after dental fixture insertion to preventing esthetic or functional problems, were selected. Indications, extension of palatal incision, donor site morbidity in the form of mucosal sloughing as well as deformity were reported. Sloughing of mucosa was evaluated at 1st week and palate was checked for deformity at 2 month after operation. The flap survival or necrosis was recorded. Conclusion: VIP-CT flap is a reliable source of soft-tissue for replacement of mucosa in the maxilla for implant dentistry.

Background: Treatment with dental implants has become increasingly important in the range of prosthodontic treatment. Significant improvements in oral rehabilitation particularly in edentulous individuals have been seen. A nationwide survey was made to evaluate public awareness among patients for dental implants, their level of knowledge and attitude toward replacement of missing teeth by dental implants. Materials and Methods: A survey of 1500 people was conducted through a printed and online questionnaire and completed by willing respondents. The questionnaires were prepared in English and Malay language to enable better understanding and completion. Results: Of the 1500 people surveyed, 1013 responses were retrieved, of which 772 were aware of dental implant treatment in Malaysia. Among them, 816 respondents were aware that implants can be used for replacement of missing teeth. Most of the respondents stated that dental implants were placed in the gums, followed by jawbone. 46.2% respondents assumed that implants last for a lifetime. 59% of respondents believe that poor oral hygiene was the most common cause of implant failure. Conclusion: It is important to raise the awareness of dental implant treatment in Malaysia as majority of the patients had inappropriate level of information about dental implants.

Aim: To evaluate the 5-year follow up of implants placed in partially edentulous patients restored with removable partial dentures. Materials and Methods: In this retrospective study, survival rates and clinical outcomes of implants placed for retention of removable partial dentures in 36 partially edentulous patients were observed. Results: The survival rate of the implants after a 5-year follow up was 98%. The clinical mean scores for plaque, calculus, gingivitis and bleeding were very low at all evaluation periods. Significant differences between results at successive time periods can be observed only between the plaque index at 1 year and the plaque index at 5 years. Peri-implant probing demonstrated a deepening of pockets over time. However, the changes were not statistically significant between the two evaluation periods. During the first year of function an average attachment loss of 0.4 mm was observed. During the next 4 years the average progression of PPD was about 0.1 mm per year. Conclusion: After 5 years, implants retaining removable partial dentures showed good survival rates and clinical stability. Using implants is a good solution to improve the satisfaction of patients with removable partial dentures; nonetheless this prosthetic solution demands strict surveillance of the patient and is time consuming for the clinician.

Purpose: Patients with moderate to severe atrophy challenge the surgeon to discover alternative ways to use existing bone or resort to augmenting the patient with autogenous or alloplastic bone materials. The objective of the following study was to review the published literature to evaluate treatment success with zygomatic implants in patients with atrophic posterior maxilla. Study Selection: Medline/PubMed searches were conducted using the terms atrophic maxilla, zygomatic implant, zygomatic bone, grafts, maxillary sinus, as well as combinations of these and related terms. The few articles judged to be relevant were reviewed. Results: Based on the current literature review, zygomatic implants show excellent survival rates (>90%) and a low incidence of complications. Conclusion: With proper case selection, correct indication and knowledge of the surgical technique, the use of zygomatic implants associated with standard implants offers advantages in the rehabilitation of severely resorbed maxillae, especially in areas with inadequate bone quality and volume, without needing an additional bone grafting surgery, wherefore shortening or avoiding hospital stay and reducing surgical morbidity.

Objective: The objectives of this survey were to determine the attitude of private dental practitioners (PDPs) toward implant dentistry and how they were acquiring and integrating the knowledge of implant dentistry into their everyday practice. Materials and Methods: A postal questionnaire, of a closed response format, in a reply-paid envelope was sent to 150 private dental clinics of five different regions of Gujarat state. Returned responses were subjected to descriptive analysis. Results: The results indicated that 95.91% of the surveyed dentists offered implants as a treatment option to their patients, but only 30.61% of surveyed dentists chose to actively practice Implant Dentistry themselves. The remaining PDPs chose to call consultants or refer the patients for the management of such cases. With the increasing popularity of courses in osseointegrated implants, a large number of PDPs are getting inclined toward Implant Dentistry. Conclusion: From this survey, it can be concluded that as the number of PDPs doing implants are rising, there is a parallel need to organize continuing dental education programs to create awareness related to various aspects of implant dentistry.

The ideal goal of modern dentistry is to restore the patient to normal contour, function, comfort, esthetics, speech, and health. A dentist provides restoration either by removing caries from a tooth or by replacing several teeth. Implant dentistry is unique because of its ability to achieve this goal regardless of the atrophy, disease or injury of the stomatognathic system. Endosseous dental implants are used to retain and/or support for fixed or removable prosthesis in completely or partially edentulous patients. Successful long-term results of dental implants have led to an increase in their usage in many clinical situations. Although Implantology has advanced, failures also may occur with this type of treatment. The clinical success of an implant treatment is largely determined by the manner in which the mechanical stresses are transferred from implant to surrounding bone without generating forces of magnitude that would jeopardize the longevity of implant and prostheses. The present study was done to evaluate the strain around Endosseous Threaded and Non-Threaded implant opposing maxillary natural tooth with Regular and Altered occlusion by using 3-D Finite Element Analysis.

Dental implants have revolutionized oral rehabilitation in partially and fully edentulous patients. High implant success rates in healthy as well as medically compromised individuals are reported by various studies. Nevertheless, a failure rate of 1.5-6.7% is also evident. Titanium (Ti) alloys are considered the material of choice in implantology due to their high strength, biocompatibility and corrosion resistance in a physiological environment. This metal has been somewhat surrounded by mysticism in the world of dentistry to the extent that there is a general belief, though biologically inexplicable, that it cannot cause allergic reactions. However, this phenomenon, which seems to be either overlooked by clinicians or weakly researched upon, exists and may have a worrying correlation to implant failure. This is an attempt to review the literature on allergy to Ti and its relevance in dental implantology.

Pure titanium (Ti) and Ti alloys are well-established standard materials in dental implants due to their favorable combination of mechanical strength, chemical stability and biocompatibility. The concept of osseointegration was discovered by Brεnemark and his co-worker and has had a dramatic influence on clinical treatment of oral implants. The first generation of successfully used clinical Ti implants, which were machined with a smooth surface texture, now approach 50 years in the clinical use. Since then, implant surfaces have long been recognized to play a vital role in molecular interactions, cellular response and osseointegration and scientists all over the world have developed the second generation implants with surfaces which can accelerate and improve implant osseointegration.

Several techniques have been developed to improve the bone volume for the placement of dental implants in an effort to shorten the length of treatment, avoid a second surgical appointment, reduce the use of additional surgical sites, reduce challenges to the patient and decrease patient morbidity. This article will review these surgical procedures for both hard and soft tissue grafting in the placement of endosseous dental implants.

A method is presented describing the laboratory fabrication and clinical use of an innovative template. This template was designed to function as a radiographic implant positioning guide, accurate bone sounding guide, surgical guide, an aid in flap reflection and as a pick-up impression tray.

Oral implants represent hard, non-shedding surfaces in a fluid system, as do teeth. As such, they are subjected to biofilm formation and if left unattended may lead to peri-implant infections and ultimately failure of implants. Proper utilization of diagnostic tools may help in predicting the prognosis of implants during the maintenance visits. Depending on continuing diagnosis during maintenance, developing peri-implant lesions should be treated according to the cumulative interceptive supportive therapy protocols.

Implant overdenture (OD) is the common treatment modality for the rehabilitation of complete mandibular edentulism with dental implants. The purpose of this review was to collect the data regarding various factors contributing to the selection of implant OD design and to provide comprehensive guidelines for the clinicians in planning the OD design.

Peri-implantitis is defined as an inflammatory process which affects the tissues around an osseointegrated implant in function, resulting in bleeding, suppuration, increased probing depth, mobility and radiographic bone loss. This case report is on two cases of peri-implantitis and their treatment by using lasers. The aim of the article is to describe the added clinical benefits of laser as an adjunct in the treatment of peri-implantitis. This case series showed that the Irradiation with a diode soft laser had positive biostimulating effects, which might be used in treatment of peri-implantitis and osseointegration of dental implants.

Odontogenic cysts are the most common form of cystic lesions that affect the maxillofacial region. After removal of cysts, large defects can occur in the cyst region. Due to occurrence of large defects before dental implantation different grafting methods should be used to make the bone adequate for implant operation. The purpose of this study is to show the healing of bone defects in young patients without grafting is unexpectedly as well as grafted defects.

The mental nerve is a somatic afferent sensory nerve of the mandibular nerve that emerges from the mental foramen and which presents as a single circular, or elliptical, bilateral radiolucent area in the premolar region. The mental foramen is an important anatomical structure of particular importance in local anesthesia and surgical procedures in terms of achieving effective mandibular nerve blocks and avoiding injuries to the neurovascular bundles. Accessory mental foramen is a rare anatomical variation. Even so, in order to avoid neurovascular complications, particular attention should be paid to the possible occurrence of one or more mental foramen during surgical procedures involving the mandible. The purpose of the present report was to present a case the bilateral accessory mental foramina observed on cone-beam computed tomography and review the relevant literature.