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Loading Protocol (loading + protocol)

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Medical Sciences	90%

Selected Abstracts

Report of a Case Receiving Full-Arch Rehabilitation in Both Jaws Using Immediate Implant Loading Protocols: A 1-Year Resonance Frequency Analysis Follow-Up

CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 1 2006
Michael Portmann DDS
ABSTRACT Background:, Immediate occlusal implant loading has been documented as a viable treatment option for various indications. However, documentations related to full-arch rehabilitation are usually limited to treatment of one jaw at a time, thereby leaving the opposing dentition unchanged. Furthermore, clinical documentation using traditional, well-accepted measuring techniques may not be adequate when it comes to short-term evaluation of the success or failure of implants subjected to immediate occlusal loading. Purpose:, The purpose of this case report is to (1) present an implant stability follow-up of a patient receiving an immediate, implant-supported full-arch rehabilitation in both jaws and (2) evaluate the patient's acceptance of this rehabilitation. Materials and Methods:, A 68-year-old patient scheduled for implant treatment was selected for an immediate implant loading protocol in both jaws. During two surgical events 3 weeks apart, eight maxillary and four mandibular Brånemark System® Mk IV TiUniteTM fixtures (Nobel Biocare AB, Göteborg, Sweden) were inserted and subsequently used to immediately support a cross-arch fixed prosthesis in the maxilla and a bar-retained overdenture in the mandible. Implant stability was recorded from the day of surgery periodically during a 1-year follow-up using resonance frequency analysis (RFA). Results:, At the 1-year follow-up, based on clinical, RFA, and radiographic evaluations, all implants and the reconstructions were classified as successful. All maxillary implants showed a decrease in the implant stability quotient (ISQ) value from the measurement at the time of surgery to the first follow-up, whereas two of four mandibular implants revealed an initial drop in stability. Irrespective of a specific ISQ level measured at implant surgery (ISQ range 53,74) and despite an initial decrease in stability, measurements recorded at the 12-month follow-up indicated similar stability levels for all maxillary implants (ISQ range 64,68) or the group of mandibular implants (ISQ range 72,75) but with a higher ISQ level for mandibular implants. Furthermore, the patient's acceptance of the immediate full-arch rehabilitation in both jaws was high. Conclusions:, The present case report demonstrates that a slightly staged approach for full-arch rehabilitation in both jaws using immediate implant loading protocols is a realistic treatment option. Furthermore, RFA follow-up indicates that immediately occlusally loaded implants placed in reduced bone quality and quantity are more prone to loose stability in the early healing period compared with implants placed in dense bone quality. [source]

Analysis of the possibility of the relationship between various implant-related measures: an 18-month follow-up study

JOURNAL OF ORAL REHABILITATION, Issue 2 2008
T. F. TÖZÜM
Summary, Better clarification of the long-term relationship among the various implant-related measures could improve the evaluation process for dental implants. Thus, the aim of the present study was to determine the potential correlations among the volumetric features and nitric oxide content of peri-implant sulcus fluid (PISF) and measures of implant stability, and the marginal bone loss. Completely edentulous patients (n = 15) treated with dental implants and ball attachment mandibular over dentures were included. Resonance frequency analysis (RFA), marginal bone level measurements, PISF volume and spectrophotometrically determined nitrite levels were recorded for all dental implant sites. Measures for early (n = 16) and delayed (n = 14) loaded dental implants were comparatively analysed for a period of 18 months. Some random correlations between PISF volume and marginal bone level, PISF nitrite level and marginal bone level and PISF volume and PISF nitrite content, and RFA and PISF volume were observed. However, the only constant correlation was noticed between implant stability (RFA scores) and marginal bone level. This correlation was negative and significant for all dental implants and for delayed loaded implants (P < 0·05). The pattern of loading seemed to affect the extent, but not the pattern of this relationship. While some of the implant-related measures may be strongly associated (e.g. dental implant stability and marginal bone level), not all measures from a single implant site are likely to be related. Such associations may be under the influence of a variety of factors including the loading protocol of dental implants. [source]

Induction of a neoarthrosis by precisely controlled motion in an experimental mid-femoral defect

JOURNAL OF ORTHOPAEDIC RESEARCH, Issue 3 2002
Dennis M. Cullinane
Bone regeneration during fracture healing has been demonstrated repeatedly, yet the regeneration of articular cartilage and joints has not yet been achieved. It has been recognized however that the mechanical environment during fracture healing can be correlated to the contributions of either the endochondral or intramembranous processes of bone formation, and to resultant tissue architecture. Using this information, the goal of this study was to test the hypothesis that induced motion can directly regulate osteogenic and chondrogenic tissue formation in a rat mid-femoral bone defect and thereby influence the anatomical result. Sixteen male Sprague Dawley rats (400 ± 20 g) underwent production of a mid-diaphyseal, non-critical sized 3.0 mm segmental femoral defect with rigid external fixation using a custom designed four pin fixator. One group of eight animals represented the controls and underwent surgery and constant rigid fixation. In the treatment group the custom external fixator was used to introduce daily interfragmentary bending strain in the eight treatment animals (12°s angular excursion), with a hypothetical symmetrical bending load centered within the gap. The eight animals in the treatment group received motion at 1.0 Hz, for 10 min a day, with a 3 days on, one day off loading protocol for the first two weeks, and 2 days on, one day off for the remaining three weeks. Data collection included histological and immunohistological identification of tissue types, and mean collagen fiber angles and angular conformity between individual fibers in superficial, intermediate, and deep zones within the cartilage. These parameters were compared between the treatment group, rat knee articular cartilage, and the control group as a structural outcome assessment. After 35 days the control animals demonstrated varying degrees of osseous union of the defect with some animals showing partial union. In every individual within the mechanical treatment group the defect completely failed to unite. Bony arcades developed in the experimental group, capping the termini of the bone segments on both sides of the defect in four out of six animals completing the study. These new structures were typically covered with cartilage, as identified by specific histological staining for Type II collagen and proteoglycans. The distribution of collagen within analogous superficial, intermediate, and deep zones of the newly formed cartilage tissue demonstrated preferred fiber angles consistent with those seen in articular cartilage. Although not resulting in complete joint development, these neoarthroses show that the induced motion selectively controlled the formation of cartilage and bone during fracture repair, and that it can be specifically directed. They further demonstrate that the spatial organization of molecular components within the newly formed tissue, at both microanatomical and gross levels, are influenced by their local mechanical environment, confirming previous theoretical models. © 2002 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved. [source]

Oral implants , the future

AUSTRALIAN DENTAL JOURNAL, Issue 2008
A Jokstad
Abstract The current and future application of implants to support intra- and extra-oral prostheses is a function not primarily of a current or eventual future, e.g., implant surface configuration, treatment procedure or loading protocol. In contrast, it must be understood by a more complex conceptualization of the practical application of the osseointegration phenomenon. This review will attempt to address the future use of oral implants based on current cutting edge research within the fundamentals that constitute the practical applications of the osseointegration concept. [source]

Report of a Case Receiving Full-Arch Rehabilitation in Both Jaws Using Immediate Implant Loading Protocols: A 1-Year Resonance Frequency Analysis Follow-Up

Early cortical bone healing around loaded titanium implants: a histological study in the rabbit

CLINICAL ORAL IMPLANTS RESEARCH, Issue 2 2009
Elke Slaets
Abstract Objectives: To identify the role of immediate implant loading on the early phases of the bone healing responses. Material and methods: Implants were placed in rabbit tibial diaphyses and left to heal for 3, 7, 14, 28 or 42 days. Half of the animals received an immediate loading protocol of 2.2 N at 3 Hz for 1800 cycles and 5 days/week, whereas the others served as unloaded controls. Histological assessment was combined with histomorphometrical measurements. Results: At early time-points, an endosteal and periosteal new bone formation was found, while the cortex itself contained damaged osteocytes. At later time-points, new bone formation was also found at the cortical level itself. Differences between groups were found mainly in this new bone formation process, with larger reactions for the endosteal and periosteal bone in the loaded group after 28 and 42 days, respectively. At the end-point of the experiment, bone formation at the cortical level was reduced in the loaded group compared with the control group. Conclusions: These results show that the immediate loading protocol caused no differences in the sequential events leading to osseointegration in cortical bone. However, the processes of new bone formation originating from the endosteum and the periosteum lasted longer compared with the unloaded controls. [source]

Immediate occlusal loading of Osseotite implants in the lower edentulous jaw

CLINICAL ORAL IMPLANTS RESEARCH, Issue 3 2004
A multicenter prospective study
Abstract Objective: This paper reports the results of a prospective multicenter clinical study on immediately fully occlusally loaded full-arch screw-retained prostheses with distal extensions (hybrid prostheses) supported by Osseotite implants inserted in edentulous lower jaws. Method and material: Sixty-two patients were enrolled in four clinical centers. Three hundred and twenty-five Osseotite implants were inserted and occlusally loaded according to an immediate loading protocol. The temporary prosthesis was delivered 4 h from surgery. The final prosthesis was delivered after 6 months. Marginal bone loss was monitored from periapical radiographs using a computerized technique. Results: Two implants failed to integrate within 2 months of occlusal loading. A cumulative implant success rate of 99.4% was achieved for a period of 12,60 months postplacement (mean 28.6±14.1 (SD) months). Crestal bone loss around the immediately loaded implants was similar to that reported for standard delayed loading protocols. Conclusion: The results of this study suggest that the rehabilitation of the edentulous mandible by an immediate occlusally loaded hybrid prosthesis supported by five to six Osseotite implants represents a viable alternative treatment to classic delayed loading protocols. Résumé Cette étude rapporte les résultats d'une étude clinique multicentrique prospective sur la charge occlusale complète immédiate de l'ensemble de la mâchoire sur des prothèses retenues par des implants-vis avec une extension distale supportée par des implants Osséotite insérés dans la mandibule de patients édentés. Soixante-deux patients ont été inclus dans quatre centres cliniques et 325 implants Osséotite ont été insérés et mis en charge occlusale suivant le protocole de charge immédiate. La prothèse temporaire était placée quatre heures après la chirurgie. La prothèse finale était placée après six mois. La perte osseuse marginale était enregistrée à partir de radiographies périapicales via l'utilisation d'une technique informatisée. Deux implants ne se sont pas intégrés dans les deux mois de la mise en charge occlusale. Un taux de succès cumulatif des implants de 99,4% a été atteint pendant une période de douze à soixante mois après le placement (moyenne 28±14,1 mois). La perte osseuse crestale autour des implants mis en charge immédiatement était semblable à celle rapportée pour les protocoles de mise en charge retardée. Les résultats de cette étude suggèrent que la réhabilitation de la mandibule chez l'édenté par des prothèses placées sur des implants immédiatement mis en charge placées sur cinq ou six implants Osséotite représente un traitement alternatif au protocole classique avec une mise en charge retardée. Zusammenfassung Ziele: Diese Arbeit präsentiert die Daten einer longitudinalen klinischen Multizenterstudie über sofort mit Kaukräften belastete und verschraubte Totalprothesen mit distalen Extensionen (Hybridprothesen). Als Verankerung dienten Osseotiteimplantate in einem zahnlosen Unterkiefer. Methode und Material: Für diese Studie behandelte man in vier klinischen Zentren 62 Patienten. Gemäss einem vorgegebenen Protokoll setzte man 325 Osseotite-Implantate und belastete sie sofort mit Kaukräften. Die provisorischen Prothesen konnten vier Stunden nach der Chirurgie eingegliedert werden. Die definitiven Hybridprothesen setzte man sechs Monate später ein. Den marginalen Knochenverlust beurteilte man mit periapicalen Röntgenbildern, die komputerunterstützt vermessen wurden. Resultate: Bei zwei Implantaten kam es in den ersten zwei Monaten der okklusalen Sofortbelastung zu Misserfolgen. Daraus errechnete sich zwischen dem zwölften und 60. Monat nach Implantation eine kumulative Erfolgsrate aller Implantate von 99.4% (Mittelwert/SD 28.6±14.1 Monate). Der crestale Knochenverlust um die sofortbelastete Implantate war ähnlich wie in anderen Arbeiten mit standartmässig verzögert belasteten Implantaten. Schlussfolgerung: Die Resultate dieser Arbeit lassen vermuten, dass die Rekonstruktion eines zahnlosen Unterkiefers mit okklusal sofortbelasteten Hybridprothesen, abgestützt auf 5 bis 6 Osseotite-Implantaten, eine brauchbare Alternative zu den klassischen Protokollen mit einer verzögerten Belastung darstellt. Resumen Intención: Este trabajo informa sobre los resultados de un estudio prospectivo multicéntrico de prótesis de arco completo implantorretenidas inmediatamente cargadas con extensiones distales (prótesis híbridas) soportadas por implantes Osseotite insertados en mandíbulas edéntulas. Método y Material: Se enroló a 62 pacientes en cuatro centros clínicos. Se insertaron 325 implantes Osseotite y se cargaron oclusalmente de acuerdo con un protocolo de carga inmediata. La prótesis temporal se suministró a las cuatro horas de la cirugía. La prótesis definitiva se suministró a los seis meses. La pérdida de hueso marginal se monitorizó de radiografías periapicales usando una técnica computarizada. Resultados: Dos implantes fracasaron al integrarse dentro de los dos meses de carga oclusal. Se logró un índice de éxito acumulado de implantes del 99.4% durante un periodo de 12 a 60 meses tras el tratamiento (media 28.6±14.1 (SD) meses). La pérdida de hueso crestal alrededor implantes cargados inmediatamente fue similar a aquellos informados para protocolos de carga diferida estándar. Conclusión: Los resultados de este estudio sugieren que la rehabilitación de la mandíbula edéntula por medio de una prótesis híbrida de carga oclusal inmediata soportada por 5,6 implantes Osseotite representa una alternativa viable de tratamiento frente a los protocolos clásicos de carga diferida. [source]

Report of a Case Receiving Full-Arch Rehabilitation in Both Jaws Using Immediate Implant Loading Protocols: A 1-Year Resonance Frequency Analysis Follow-Up

Immediate Provisional for Single-Tooth Implant Replacement with Brånemark System: Preliminary Report

CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 2 2001
Edward Hui MDS, FDSRCS, FRCDC
Abstract: Background: The success of osseointegrated implants ad modum Brånemark for single-tooth restorations is documented. Future developments should aim at improving the benefits to patients by decreasing treatment time, minimizing surgical stages, and maximizing esthetic outcomes. Using knowledge from studies of immediate implant placement, one-stage, immediate loading protocols, the authors developed the immediate provisional. Purpose: The purpose of this study was to develop a protocol to provide an immediate solution for restoring a single missing tooth in the esthetic zone. The protocol should be simple, predictable, cost effective, and allow the use of other techniques to improve esthetic outcome. Materials and Method: This prospective clinical study included 24 patients treated from August 1999 to October 2000. Single-tooth implant replacement was done according to immediate provisional protocol. Thirteen of the 24 patients had immediate implant placement after tooth extraction. All implants were placed in the esthetic zone. During surgery, emphasis was placed on obtaining primary stability by achieving bicortical anchorage and maximum insertion torque of at least 40 Ncm. CeraOne (Nobel Biocare) abutments were used, and provisional crowns were fabricated immediately before wound closure. The occlusion was protected by adjacent teeth. Results: Within the follow-up period of between 1 month and 15 months, all fixtures in the 24 patients were stable. Crestal bone loss greater than one thread-width was not detected. The esthetic result was considered satisfactory by all patients. Conclusions: The implant placement and restoration protocol used in this study showed promising initial results for both the immediate implant and healed extraction site groups. The desirable goals of patient satisfaction, excellent esthetic outcomes, and no increase in treatment cost were achieved in this protocol. Further studies to elucidate the potential of the immediate provisional protocol are justified. [source]

Predicting osseointegration by means of implant primary stability

CLINICAL ORAL IMPLANTS RESEARCH, Issue 5 2004
A resonance-frequency analysis study with delayed, immediately loaded ITI SLA implants
Abstract: The purpose of the present clinical study was (1) to evaluate the Osstell as a diagnostic tool capable of differentiating between stable and mobile ITI implants, (2) to evaluate a cut-off threshold implant stability quotient (ISQ) value obtained at implant placement (ISQitv) that might be predictive of osseointegration, (3) to compare the predictive ISQitv of immediately loaded (IL) implants and implants loaded after 3 months (DL). Two patient groups were enrolled, 18 patients received 63 IL implants and 18 patients were treated with 43 DL implants. The ISQ was recorded at implant placement, after 1, 2, 4, 6, 8, 10 and 12 weeks. All implants passed the 1-year loading control. Two implants failed, one DL implant with ISQ at placement (ISQi) of 48 and one IL implant with ISQi of 53. The resonance-frequency analysis (RFA) method was not a reliable diagnostic tool to identify mobile implants. However, implant stability could be reliably determined for implants displaying an ISQ,47. After 1 year of loading, all DL implants with an ISQi,49 and all IL implants with an ISQi,54 achieved and maintained osseointegration. By the end of 3 months, implants with ISQi<60 had an increase of stability. Implants with ISQi 60,69 had their stability decrease during 8 weeks before returning to their initial values. Implants with ISQ>69 had their stability decrease during the first 4 weeks before remaining stable. Although preliminary, these data might orient the practitioner to choose among various loading protocols and to selectively monitor implants during the healing phase. Résumé Le but de l'étude clinique présente a été 1) d'évaluer l'Osstell comme machine de diagnostic capable de différencier l'implant ITI stable et du mobile, 2) d'évaluer un niveau seuil de la valeur du quotient de stabilité implantaire obtenue lors du placement de l'implant (ISQitv) qui pourrait être prophétique pour l'ostéoïntégration, 3) de comparer le jugement ISQitv d'implants immédiatement mis en charge (IL) et d'implants chargés trois mois après leur placement(DL). Deux groupes de patients ont participéà cette étude : 18 patients ont reçu 63 implants IL et 18 autres ont été traités avec 43 implants DL. Le ISQ a été enregistré lors du placement de l'implant et après 1, 2, 4, 6, 8, 10 et 12 semaines. Tous les implants ont passé le contrôle de mise en charge d'une année. Deux implants ont échoué, un DL avec un ISQ lors de son placement de 48 et un implant IL avec un ISQi de 53 lors de son placement. La méthode RFA n'était pas un outil de diagnostic fiable pour identifier les implants mobiles. Cependant la stabilité implantaire pouvait être déterminée de manière sûre pour les implants qui avaient un ISQi 47. Après une année de mise en charge, tous les implants DL avec un ISQi 49 et tous les implants IL avec un ISQi 54 atteignaient et maintenaient l'ostéoïntégration. Après trois mois, les implants avec ISQi 60 montraient une augmentation de stabilité. Les implants avec ISQi de 60 à 69 avaient une diminution de la stabilité durant huit semaines avant de revenir à leur valeur initiale. Les implants avec ISQ>69 voyaient leur stabilité diminuée durant les premières quatre semaines avant de rester stables. Bien que préliminaires, ces données peuvent orienter le praticien pour choisir parmi différents protocoles de mise en charge et de suivre de manière sélective les implants durant la phase de guérison. Zusammenfassung Das Ziel dieser klinischen Studie war, 1) das Osstell als diagnostisches Werkzeug zur Unterscheidung von stabilen und beweglichen ITI-Implantaten zu untersuchen, 2) einen verbindlichen Grenzwert zu bestimmen, der in Form eines Implantatstabilitätsquotienten zum Zeitpunkt der Implantation (ISQitv) erhoben wird, und der als Voraussagewert für die Osseointegration dienen könnte, 3) den ISQitv von sofortbelasteten Implantaten (IL) und von erst nach 3 Monaten belasteten Implantaten (DL) zu vergleichen. Es waren zwei Patientengruppen beteiligt, 18 Patienten erhielten 63 IL-Implantate und 18 Patienten wurden mit 43 DL-Implantaten behandelt. Den ISQ-Wert bestimmte man sofort nach der Implantation, sowie nach 1, 2, 4, 6, 8, 10 und 12 Wochen. Alle Implantate konnten nach einem Jahr überprüft und kontrolliert werden. 2 Implantate gingen verloren, ein DL-Implantat mit einem ISQ bei der Implantation (ISQi) von 48 und ein IL-Implantat mit einem ISQi von 53. Die RFA-Methode war kein verlässliches diagnostisches Werkzeug, um bewegliche Implantate zu erkennen. Man konnte aber für Implantate mit einem ISQ von>47 die Implantatstabilität verlässlich bestimmen. Nach einer Belastung über ein Jahr erreichten alle DL-Implantate mit einem ISQi von>49 und alle IL-Implantate mit einem ISQi von>54 eine stabile Osseointegration. Nach 3 Monaten, erreichten Implantate mit einem ISQi von<60 eine zunehmende Stabilität. Implantate mit einem ISQi von 60-69 verloren in den ersten 8 Wochen einen Teil ihrer Stabilität, bevor sie wieder zu den Anfangswerten zurückkehrten. Implantate mit einem ISQ>69 hatten ihre Stabilitätsabnahme in den ersten 4 Wochen, bevor sie wiederum dauerhaft stabil wurden. Obwohl es erste Daten sind, können sie dem Praktiker helfen, um zwischen den verschiedenen Belastungsprotokollen zu wählen, und um die Implantate ganz individuell durch die Heilungsphase hindurch zu betreuen. Resumen El propósito del presente estudio fue, 1) evaluar el Osstell como herramienta diagnóstica capaz de de diferenciar entre implantes ITI estables y móviles, 2) evaluar un valor de cociente de umbral de corte de estabilidad de implante obtenido al colocar el implante (ISQitv) que pueda ser predictivo de osteointegración, 3) comparar la predictibilidad del ISQitv de los implantes de carga inmediata (IL) e implantes cargados tras 3 meses (DL). Se enroló a dos grupos de pacientes, 18 pacientes recibieron 63 implantes IL y 18 pacientes se trataron con 43 implantes DL. Se recogieron los ISQ al colocar los implantes, tras 1, 2, 4, 6, 8, 10 y 12 semanas. Todos los implantes superaron el control del año. 2 implantes fracasaron, un implante DL con un ISQ al colocarlo (ISQi) de 48 y un implante IL con un ISQi de 53. El método RFA no fue una herramienta fiable para identificar implantes móviles. De todos modos, la estabilidad de los implantes pudo ser determinada con fiabilidad para los implantes que mostraron un ISQ,47. Tras 1 año de carga, todos los implantes DL con un ISQi,49 y todos los IL con ISQi,54 lograron y mantuvieron la osteointegración. Al final de los 3 meses, los implantes con ISQ<60 tuvieron un incremento en la estabilidad. Los implantes con un ISQi de 60-69 tuvieron un descenso de la estabilidad durante 8 semanas antes de volver a sus valores iniciales. Los implantes con ISQ>69 tuvieron un descenso de la estabilidad durante la primeras 4 semanas antes de estabilizarse. Aunque preliminares, estos datos pueden orientar al clínico a escoger entre varios protocolos de carga y monitorizar selectivamente los implantes durante la fase de cicatrización. [source]