The use of dental implants has revolutionized the treatment procedure for over last 25 years. Implants now have been widely accepted by patients as their treatment plan and have become a routine procedure by dental surgeons. Owing to the remarkable success, there have been various researches going on to find out factors responsible for the failure of implants. With the growing use of tobacco among patients, its ill effects on bone quality and quantity it arises a keen interest to associate effect on the success of implants. To establish a relationship between smoking and implant success and its long term survival and compare the result with non-smokers based on the literature. Relevant clinical studies and reviews published in English literature published between 1990 and 2012 were reviewed. The articles were located through EBSCO host and manually through the references of peer reviewed literature. Most of the literatures supported the fact that smoking is a prominent risk factor affecting the success of implants. Studies reported that implant failure and its complications associated are twice in smokers as compared to non-smokers. Literatures also revealed that maxillary implant are more affected than mandibular in smokers. Studies suggested that effects of smoking were reversible in smokers who followed the smoking cessation protocol prior to the procedure. Smokers have a greater chances of implant failure and more prone to the complications following implants and related procedures. Surgeons should stress on counseling of patient willing for implant for smoking cessations protocols.

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Dental implants are commonly used in clinical situations for replacement of natural teeth. Despite many advances in materials, techniques, and implant design, implant failure is a significant concern for the dentist and patient. Peri-implantitis and lack of osseointegration are considered to be the major factors leading to implant failure. Occlusal overloading, medical status of the patient, smoking, and implant characteristics are among the other causes for implant failure. The purpose of this concise review is to discuss the etiology of implant failures by highlighting the various classification put forth by different authors and formulating a new classification.

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Background: The long-term success of an implant depends on the stability of bone support for the implant. Most crestal bone loss occurs in the first year of implant placement. Platform switching is an approach which can be clinically applied to preserve the crestal bone. Purpose: The purpose of this review is to discuss the literature dealing with the platform switching concept to preserve the crestal bone, the mechanism by which it contributes to maintenance of marginal bone, its clinical applications, advantages and disadvantages, in order to assess its survival rates. Materials and Methods: PubMed and Google Scholar were used to find studies involving platform switching concept from 2005 up to October 2009. Results: Literature search revealed studies involving concepts of platform switching, comparison of platform-switched and non-platform-switched implants, case reports on platform switching and studies with histological and finite element analyses regarding platform switching. Conclusion: Platform switching helps preserve crestal bone around the implants and this concept should be followed when clinical situations in implant placement permit.

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Achieving and maintaining implant stability are prerequisites for a dental implant to be successful. Implant stability can be defined as the absence of clinical mobility, which is also the suggested definition of osseointegration. Primary implant stability at placement is a mechanical phenomenon that is related to the local bone quality and quantity, the type of implant and placement technique used. Secondary implant stability is the increase instability attributable to bone formation and remodeling at the implant/tissue interface and in the surrounding bone. There are many ways in which the implant stability can be evaluated such as clinical measurement of cutting resistance during implant placement, reverse torque test, the periotest. This article aims to throw light on the various methods to determine implant stability.

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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.

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Dental specialists today are facing a major influx of completely edentulous patients and patients with generalized compromised teeth who ask for cost-effective full mouth rehabilitation. The choice of overdenture as a treatment modality is significantly less expensive and is within the reach of many patients who are on a limited financial support. Various types of attachment systems are currently available to restore implant-supported over-denture. Clinicians have selected various attachment systems based on factors such as durability, patient demand, cost-effectiveness, technical simplicity, and retention. The decision-making process to select certain types of attachment system still remains unclear. This article explains about various attachment system available, their advantages and disadvantages and their use in different clinical conditions.

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Esthetics has taken a prime position in dentistry today.People are getting more diverged to tooth coloured materials for good esthetics.This article stresses on newer metal free implant materials which have been developed due to increased demand for improved esthetics and biocompatibility along with the preference among the general population for non-metal implant materials.

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Overdenture treatment provides an esthetic and functional result that allows proper access for hygiene and maintenance. In addition, with their improved strength, zirconia ceramics may be used to restore removable partial denture abutments in areas previously limited to metal or metal-ceramic restorations. The electroforming process makes for a viable, convenient, and economic alternative to cast metal substructures. However, limited data are available on the use of telescopic crowns on implants. Compared with the use of fixed implant-supported dentures, this treatment modality may improve esthetics and oral hygiene access, reduce the need for implants, and provide sufficient denture support in cases where single abutments have failed. Furthermore, the high retention obtained with telescopic crowns leads to good mastication and phonetics.

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Spark erosion is a metal removal process using electric current under carefully controlled conditions. It is used for precise and accurate fabrication in the field of fixed, removable and implant prostheses. The scope of this article is to discuss the mechanism of action of the process and its significance in implant dentistry along with critical evaluation of its merits and demerits.

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This article is a case report of removal of a dental implant using electrosurgery. A discussion will outline a possibly less invasive method to remove the dental implant. This involves the use of electrosurgery unit to cause a thermo-necrosis of the bone and therefore a weakening of the bone-implant interface. It is suggested that a controlled laboratory experiment be carried out to look at the effects of mono-polar electrosurgery on osseointergration on dental implants and the possible use of this method to allow for simple removal of poorly positioned fixtures and also fixtures with significant bone loss but no mobility.

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Improved skills, techniques and materials, case selections and proved designs have witnessed higher rates of success and survivals of osteointegration with dental implants. But prosthesis failures especially mechanical types have been constantly reported. These prostheses have been secured to the integrated implants with cement or screws. Controversies are rife in literature regarding the choice of retention. This review article provides an overview of the various clinical aspects, abutment designs and materials and procedures used, which contribute to selection of type of retention whether screw or cement and highlighting their clinical significance. The clinician can then use these information for optimizing the retention in an given clinical condition and minimize the risk of complications.

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Morphology of the peri-implant soft tissue adjoining the implant components plays a pivotal role in displaying the implant esthetics. Creating an implant restoration that cannot be distinguished from the rest of the natural dentition is the ultimate goal. Second stage surgery is often overlooked and is considered non essential phase but actually could determine the health of the peri-implant tissue .This phase gives an excellent opportunity to preserve, reconstruct and even maneuver the soft tissue to optimize the soft tissue profile around the implant components. The article aims at enumerating the various modalities available to contour the soft tissue profile around implants and thus help the practioners in optimizing esthetics during second stage surgery.

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The dental implant therapy has a phenomenal rise and has occupied the summit in today's dentistry. The scientific societies and researchers are in constant effort toward improvement, excellence, and simplification of implant therapy. Today, the practitioners are enthusiastic to imbibe the simplified implant procedures and techniques and would like to carry out the same in their private practice. Implant design, bone biology, primary stability, osseointegration, prosthetic options etc., are the several issues taken into account for successful implant therapy. The factors which influence integration are design of implant, material composition of implant, variance in the bone quality (soft or hard), and type of surgical procedure employed (simple or complex). The primary stability is the initial engagement between the bone and implant and one has to ensure that it should be strong and paramount. Implantologists completely monitor the primary stability by synchronizing the above factors. The primary stability is unique and having singular expression is considered as the "password of Implant Integration Account." If the primary stability is good, implant can be loaded quickly and to the maximum.

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Introduction: To accelerate the process of restoring dental implants, achieving primary stability is of prime importance for effective osseointegration. The various bone substitute materials such as autograft (golden standard), allograft, xenograft, and alloplast are used to improve the stability of an implant and also as an aid in bone formation. The use of bone cements, among the alloplast material, is a relatively new premise in oral implantology. These have been extensively used in orthopedic surgery to secure an implanted prosthesis and to replace or bind bone fragments, resulting from trauma, and to fill cavities. This article aims to review the literature for the use of bone cements in oral implantology and evaluate its prospective use in future to secure dental implants. Materials and Methods: PubMed search was carried out using keywords such as “Bone Cements,” “Oral Implantology,” “Cements Fix Implants with Bone,” and “Cements to Grow Bone.” Of the 1422 articles, 1015 were selected after eliminating the duplicates. After applying the inclusion and exclusion criteria, 383 abstracts were assessed for relevance, of which 17 full-text articles were selected. Five articles were excluded with reasons and 12 eligible articles were included in the systematic review. Results: Eight studies out of the 12 concluded that bone cement could be a viable alternative to allogenic or other graft materials tested. Four articles were inconclusive or showed no significant difference. However, the quality of available evidence was poor as 10 out of the 12 studies were animal trials and 2 were in vitro studies. Due to considerable heterogeneity of data, meta-analysis could not be done. Conclusion: Bone cements can be considered a possible alternative to the existing graft materials. However, further research including controlled trials with human subjects needs to be undertaken to establish its potential.

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Prosthetically driven implant prosthesis assures good aesthetics, function and more importantly hygiene maintenance enabling long time success. Accuracy in treatment planning and implementation of planned treatment is vital for this success. Following advancements that have occurred in treatment planning (virtual software) for implant prosthesis; an equal rise is to be expected in transferring the planned therapy to surgical fruition. In this regard, surgical templates have enabled clinician to deliver predictable surgical & prosthetic rehabilitation. Surgical guides have not only decreased the chances of iatrogenic damage of critical anatomic structures; they also increase the esthetic and functional advantages of prosthodontic-driven implant. Within the constraints of this article, the authors describes an over view of use of surgical guides in clinical situation. If clinician is considered a pilot, then surgical guide is his navigator.

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Aim: The aim was to evaluate and compare retention forces of all-zirconia (ZrO₂), all-polyetheretherketone (PEEK), and ZrO₂-PEEK Computer-Aided-Designing computer-Aided -Manufacturing (CAD-CAM) telescopic attachments for two implant-retained mandibular overdentures. Materials and Methods: Fifteen identical acrylic resin models of the edentulous mandibular arch without alveolar undercuts were fabricated. Two implants were inserted in the canine region of each model. According to the material of telescopic attachment, models were divided into three groups: all ZrO₂ (ZZ): primary and secondary crowns were made of ZrO₂, all PEEK (PP): primary and secondary crowns were made of PEEK, and ZrO₂-PEEK (ZP): primary crowns were made of ZrO₂ and secondary ones were made of PEEK. Identical experimental overdentures were constructed for all models. For measuring the retention force, a universal testing machine was used to apply a pull-off test in presence of artificial saliva between the crowns. The achieved maximum values of retention force were recorded at the beginning of the study (initial retention) and after 540 cycles of insertion and removal simulating 6 months of the clinical service (final retention). Results were statistically analyzed, analysis of variance (P < 0.05). Results: ZP group reported the highest initial force values for all groups. The final retention values of PP and ZP groups were significantly decreased than initial values, while the insignificant loss of retention was observed with ZZ group (P = 0.06). Independent samples test showed a significant difference in both initial and final retentions between each two groups. Conclusion: Within the limitations of this study, ZrO₂ is more preferred as a secondary telescopic crown against a primary ZrO₂ one. Despite the loss of retention by time, PEEK can still be used as a secondary telescopic crown against ZrO₂ or PEEK primary crowns regarding the acceptable initial and final retention values.

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The immediate load procedures in immediate implants have become routine in dental offices because of high esthetics demand by clients. Nevertheless, in some cases, it is not possible to perform immediate load procedures. The purpose of this article was describing the technique for creating a customized healing abutment to preserve the contours of peri-implant soft tissues and maximize peri-implant esthetics in immediate implants when it is not possible to place provisional crowns directly onto the implant. This technique is simple and easily performed and is an interesting alternative treatment for maintaining the stability of the peri-implant tissues while the osseointegration time.

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Rehabilitation of edentulous posterior maxillary regions by means of implant placement often poses challenging situations due to inadequate alveolar ridge height and poor bone quality. Since resorption of posterior residual ridge is caused by sinus pneumatization or traumatic extractions, maxillary sinus floor elevation (SFE) and bone augmentation with graft materials remains the method of choice. This scientific, evidence-based, preprosthetic procedure is a corrective technique available for almost two decades in such surgically compromised cases. In this article, we will discuss and review instrumentation by lateral window approach for SFE in conjunction with bone augmentation for delayed implant placement postgraft maturation in the healing period.

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Among the numerous functions of melatonin, the control of survival and differentiation of mesenchymal stem cells (MSCs) has been recently proposed. MSCs are a heterogeneous population of multipotent elements resident in tissues such as bone marrow, muscle, and adipose tissue, which are primarily involved in developmental and regeneration processes, gaining thus increasing interest for tissue repair and restoration therapeutic protocols. Melatonin directly accelerated the differentiation of human stem cells into osteoblasts and also suggested that melatonin could be applied as a pharmaceutical agent to promote bone regeneration. Inflammatory cytokines and adipokines, proangiogenic/mitogenic stimuli, and other mediators that influence the differentiation processes may affect the survival and functional integrity of these mesenchymal precursor cells. In this scenario, melatonin seems to regulate signaling pathways that drive commitment and differentiation of MSC into osteogenic, chondrogenic, adipogenic, or myogenic lineages. Common pathways suggested to be involved as master regulators of these processes are the Wnt/β-catenin pathway, the mitogen-activated protein kinases and the, transforming growth factor-β signaling. In this respect, melatonin emerges a novel and potential modulator of MSC lineage commitment and adipogenic differentiation. This review recognizes and critically examines the available information on the effect of melatonin as a regulator of MSC differentiation and protection in different organs and tissues.

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Purpose: This study aimed to compare the effect of two different implants' position (lateral incisors and canine areas) to retain mandibular complete overdenture on the ridge base contact relation after 6 months of overdenture use. Materials and Methods: Ten completely edentulous patients were selected from the Outpatient Clinic of Removable Prosthodontics Department, Faculty of Dentistry, Mansoura University. According to the position of implant placement, patients were randomly classified into two equal groups; Group I where two implants were placed in the lateral incisors' area and Group II where two implants were placed in the canines' area. Positioner attachment was connected to the implant fixture to retain the mandibular implant overdenture. Periodic monitoring of ridge base contact relation was carried out at the time of insertion (T0) and 6 months (T6) later using cone-beam computed tomography (the dual scan technique procedures). Results: There was a statistically insignificant difference between the two groups (lateral incisors' position group and canines' position group) regarding the ridge base contact relationship. Conclusion: Within the limitations of this study (patient number and study period), the ridge base relationship of two implants retained mandibular overdenture is maintained regardless of the implants' position.

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Temporary anchorage devices popularly called mini-implants or mini-screws are the latest addition to an orthodontist's armamentarium. The following case report describes the treatment of a 16-year-old girl with a pleasant profile, moderate crowding and Class II molar relationship. Maxillary molar distalization was planned and mini-implants were used to preserve the anterior anchorage. After 13 months of treatment Class I molar and canine relation was achieved bilaterally and there was no anterior proclination. Thus mini-implants provide a viable option to the clinician to carry out difficult tooth movements without any side effects.

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Objectives: To study the efficacy of pre-evaluation of implant sites by Dentascans. Materials and Methods: Twenty five patients between age groups of 15 -and 80 years requiring implant placement were selected for this study. The computed tomography (CT) scan machine used for this study was Siemens Somatom Sensation 64. This has multidetector technology with 32 detector array and 64 data channels. Dental software used was Syngo Dental CT 2006 A-W VB20B-W. Axial, paraxial and panoramic images obtained were evaluated for available ridge height and width at implant sites, proximity to maxillary sinus and inferior alveolar canal, easy identification of inferior alveolar canal, radiographic presence of bony concavities and density at implant sites. Results: Dentascan was an effective software in pre-evaluation of available height and width at the implant sites. There was a co-relation between the available bone at the implant sites and region of jaw, sex and age of patients. Proximity to maxillary sinus and inferior alveolar canal was clearly demonstrated by Dentascans. Inferior alveolar canal was identified in 85.71% cases. Bony concavities were identified in 22.95% cases. Dentascans provide subjective evaluation of bone density in Hounsfield units (symbol HU). Conclusion: Dentascans are a rapid, time saving, effective, safe and indispensable procedure in dental implantology. Dentascans determines the available bone at the implant sites accurately without any magnification or distortion that is observed in panoramic radiography. Osseous morphology variations like knife edge ridges, which cannot be demonstrated on conventional radiography, could be appreciated on Dentascans. Bony concavities may not be observed on panoramic radiography; Dentascans provide the opportunity to appreciate such details. Critical anatomical landmarks can be clearly demonstrated on Dentascans. Dentascans provide a subjective evaluation of the density at the implant site.

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The control of anchorage is one of the most crucial factor in orthodontic treatment planning. Traditionally, headgears have been used to be one of the most efficient means to gain anchorage but they have their own limitations and so these methods are limited in delivering results, which commensurate with our idealistic goals. Recently, a number of case reports have appeared in the orthodontic literature documenting the possibility of overcoming anchorage limitations via the use of temporary anchorage devices-biocompatible devices fixed to bone for the purpose of moving teeth. Although skeletal anchorage is here to stay in orthodontics, there are still many unanswered questions. So the purpose of this article is to provide an overview of the current status of orthodontic implants and a discussion of established techniques.

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Aim: This in vitro study was performed to evaluate and compare stresses applied to the implants retaining mandibular complete overdenture with telescopic attachments of different materials. Materials and Methods: Three identical clear acrylic resin models of completely edentulous mandibular arch were selected for this study. One implant was installed in each canine region of each model. The models were scanned to design telescopic attachment using computer-aided design/computer-aided manufacturing technology. According to material used for telescopic attachments fabrication, models were categorized as follows: All Zirconia (ZrO₂) telescopic group (zz): Primary and secondary crowns were made of ZrO₂, all polyetheretherketone (PEEK) telescopic group (pp): Primary and secondary crowns were made of PEEK, and Zirconia-PEEK telescopic group (zp): Primary crown was made of ZrO₂, and secondary one was made of PEEK. Three identical mandibular complete overdentures were constructed. The secondary telescopic crowns were picked up within the intaglio surface of each overdenture. Four strain gauges were installed parallel to each implant. Bilateral and unilateral loads were applied, and strain values were recorded. Results: Comparison of recorded stresses values revealed a significant difference between groups where the highest stresses were recorded with all-PEEK group, followed by all-zircon group and the lowest stresses were noted with Zirconia-PEEK group for both bilateral and unilateral loading tests. Conclusion: Within the limitation of this in vitro study, it could be concluded that: telescopic attachments that fabricated from ZrO₂ primary crown and PEEK secondary crown is a promising attachment regarding reductions of stresses transmitted to the implants retaining mandibular complete overdenture.

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