Variability of hydroxyapatite-coated dental implants

Uniformity, surface roughness, and chemical phase structure are all important features of implant coatings. While the first two variables are important for implant placement, the phase structure affects implant fixation. This study examined the coating morphology and the amount, size, and distribution of crystalline regions of press-fit and screw-type dental implants. Implants obtained from five commercial vendors were sectioned sagittally, mounted, and polished to reveal the coating microstructure. The crystalline phase content varied depending on the implant supplier; however, general trends were observed. Amorphous regions were predominantly found at the metal interface and decreased toward the outside of the coating, producing a crystallinity graded coating. The distal end of the implant, where heat build-up was more likely during the coating procedure, displayed a higher crystalline content and larger crystalline regions. Similarly, the thread apex consisted of more of a crystalline phase. The results of this study of coating microstructure may be used to improve the quality and performance of implants and may help to explain different in vivo responses to the many available varieties of hydroxyapatite-coated dental implants.     

Rapid bone resorption adjacent to hydroxyapatite-coated implants

This paper describes rapid bone resorption in the peri-implantitis of HA implants based on both our clinical observations of and histological research on extracted dense hydroxyapatite (HA) implants. The surfaces of extracted HA implants were rough, although they were smooth at fixture placement. Plaque formed on the necks of the implants, whereas little plaque was seen on the bottoms. The plaque consisted of cocci and rods, including filamentous bacteria. Few spirochetes were observed. Although surrounding bone was formed rapidly around the HA implant, bone thickness gradually decreased compared with the titanium implant. These facts suggest that the rigid biointegration of HA with the thin surrounding bone--that is, the overstressing of the bone--causes rapid bone resorption rather than plaque accumulation on HA.     

Effects of guided bone regeneration around commercially pure titanium and hydroxyapatite-coated dental implants. II. Histologic analysis

The purpose of this study was to determine which treatment of a large osseous defect adjacent to an endosseous dental implant would produce the greatest regeneration of bone and degree of osseointegration: barrier membrane therapy plus demineralized freeze-dried bone allograft (DFDBA), membrane therapy alone, or no treatment. The current study histologically assessed changes in bone within the healed peri-implant osseous defect. In a split-mouth design, 6 implants were placed in edentulous mandibular ridges of 10 mongrel dogs after preparation of 6 cylindrical mid-crestal defects, 5 mm in depth, and 9.525 mm in diameter. An implant site was then prepared in the center of each defect to a depth of 5 mm beyond the apical extent of the defect. One mandibular quadrant received three commercially pure titanium (Ti) screw implants (3.75 x 10 mm), while the contralateral side received three hydroxyapatite (HA) coated root-form implants (3.3 x 10 mm). Consequently, the coronal 5 mm of each implant was surrounded by a circumferential defect approximately 3 mm wide and 5 mm deep. The three dental implants in each quadrant received either DFDBA (canine source) and an expanded polytetrafluoroethylene membrane (ePTFE), ePTFE membrane alone, or no treatment which served as the control. Clinically, the greatest increase in ridge height and width was seen with DFDBA/ePTFE. Histologically, statistically significant differences in defect osseointegration were seen between treatment groups (P < 0.0001: DFDBA/ePTFE > ePTFE alone > control). HA-coated implants had significantly greater osseointegration within the defect than Ti implants (P < 0.0001). Average trabeculation of newly formed bone in the defect after healing was significantly greater for HA-coated implants than for titanium (P < 0.0001), while the effect on trabeculation between treatments was not significantly different (P = 0.14). Finally, there were significantly less residual allograft particles in defect areas adjacent to HA-coated implants than Ti implants (P = 0.0355). The use of HA-coated implants in large size defects with DFDBA and ePTFE membranes produced significantly more osseointegration histologically than other treatment options and more than Ti implants with the same treatment combinations. The results of this study indicate that, although the implants appeared osseointegrated clinically after 4 months of healing, histologic data suggest that selection of both the implant type and the treatment modality is important in obtaining optimum osseointegration in large size defects.     

Functional osseointegration of hydroxyapatite-coated implants in a weight-bearing canine model

The serotonin3 receptor antagonist ICS 205-930 (ICS) may act peripherally to attenuate the anorectic response of rats given an imbalanced amino acid (IMB) diet. Rats were divided into four groups: SHAM+saline (sal); SHAM+ICS; total liver denervation (TLD) + sal; and TLD+ICS. Rats were then given a purified basal diet for 16 days. Next, the groups were injected with sal or 9 mg/kg BW of ICS at 0800 h and at 0900 h (lights out) an isoleucine IMB diet was presented. By 12 h postinjection, the food intake (FI) of TLD and SHAM rats receiving ICS was similarly higher (p < 0.02) than sal-injected counterparts whose FI was also similar; BW followed FI. By day 3, the SHAM groups had similar low FI, whereas the FI of the TLD groups was increasing. The above study was repeated with similar results. Liver innervation is not required for ICS attenuation of IMB diet-induced hypophagia. Also, while sal-injected TLD rats show a normal attenuation of consumption of the IMB diet on the first day of exposure, they subsequently consume more of the IMB diet than SHAM rats. The reason for this difference in TLD rats is not clear but may be related to metabolism of the IMB diet or possibly learning.     

The regeneration of soft tissue and bone around implants with and without membranes

The popularity of osseointegration for the replacement of anterior teeth has placed an increased demand on the preservation of normal gingival anatomy. This has led to the development of a variety of soft-tissue and bone-augmentation techniques that either prevent tissue collapse or restore previously damaged areas of the alveolus. With bone grafts, barrier membranes, and autogenous connective-tissue grafts used in combination with each other or separately, lost structures can be reconstructed into a normal configuration for optimum esthetic restorations.     

Histological and biomechanical analysis of bone and interface reactions around hydroxyapatite-coated intramedullary implants of different stiffness: a pilot study on the goat

We hypothesized that reduced stem stiffness of orthopaedic implants contributes to a high risk of loosening, since interface stresses and relative motions may exceed a tolerable range. To study this hypothesis, three types of load-bearing implant with different stiffnesses were inserted into the tibia of the goat. Histological analysis was performed of bone repair after insertion of the implant, bone ingrowth, interface disruption and loosening. A finite element model of the configuration provided the quantitative range of interface stresses and relative motions for the present experiment. The implants were made out of stainless steel, hollow titanium and a thin titanium core covered with a polyacetal coating. The stiffness ratios of these implants were approximately 10:4:1, respectively. All implants were coated with a layer of hydroxyapatite (HA) in order to minimize the possible biological effects of the different implant materials. Irrespective of the type of implant, there was a repair phase that lasted 6-12 weeks. The stiff implants functioned well. Large areas of bone bonding to the HA layer were found after the repair phase at 12 weeks postoperatively. After 24 weeks, some signs of loosening were observed. More loosening occurred with the hollow titanium and polyacetal implants, mainly during the repair phase. Three hollow titanium and three polyacetal coated implants survived this period, and were killed after 24 weeks. The integrity of the HA layer at the bone-implant interface of the titanium implants was good. In the polyacetal implants, the repair reaction of the cortical bone was incomplete. Bone ingrowth into HA was largely lacking. In conclusion, we found significant differences in the repair and interface reactions around implants of different stiffness. Stiff implants showed favourable initial interface conditions for bone ingrowth. Intermediate and flexible implants provoked unfavourable interface conditions for initial bone ingrowth. The finite element study showed that the flexible stems produce larger micromotions and higher interface stresses at the bone-prosthesis interface than the stiff stems, indicating an explanation for the histological findings.     

Loaded and nonloaded titanium versus hydroxyapatite-coated threaded implants in the canine mandible

A commercially pure titanium threaded implant was compared to a hydroxyapatite-coated threaded implant of similar geometric design and dimensions in the canine model. Bilateral posterior implants supported fixed prostheses, and some implants in the same mandibles served as unloaded control implants. Implants were evaluated clinically, radiographically, and histomorphometrically at the light microscope level to detect any differences in bone response to loaded conditions. No statistically significant differences were found between the two implant designs under loaded or nonloaded conditions with regard to mobility, probing depth, percentage of osseointegration, and crestal bone position.     

Post-insertion peri-implant tissue assessment: a longitudinal study

The peri-implant gingivae act as a biological barrier that prevents the ingress of plaque bacteria, oral debris, and saliva components into the internal environment of the jaw. The integrity of this barrier around a total of 163 Steri-Oss HA-coated threaded root-form implants placed in 48 patients was examined at six-month intervals over a 42-month time period, beginning at the time of final prosthetic placement. Five clinical parameters for tissue assessment were used: Mean Implant Sulcus Readings (MISR), Mühlemann Sulcus Bleeding Index (SBI), Miller's Mobility Index (MI), bone loss readings (BL), and gingival condition (GI). Bone loss and mobility were negligible throughout the 42-month study period. At six months post-insertion, 58.6% of the Mean Implant Sulcus Readings exceeded 4 mm. Gingival conditions and bleeding response also were non-ideal in a significant number of cases (52.9 and 62.1%, respectively). However, all three of these assessments later showed dramatic improvement. Patients' inability to "deplaque" their newly acquired implant prostheses effectively may be a factor contributing to the high incidence of undesirable pocket depths and non-optimal gingival appearance at the first six-month assessment point. Attainment of the necessary skills may account for the improved readings at the later evaluations.     

Bone remodeling around cementless hip implants

Bone remodeling results from the adaptation of bone to the stresses that act upon it. The insertion of an endoprosthesis into a femur changes the stress distribution within the femur, causing the bone to remodel. In this paper, we show how radiographic bone remodeling changes can be used to determine implant fixation and how bone remodeling changes can be quantitated by using dual-energy x-ray absorptiometry analysis as well as computer-assisted videodensitometry.     

Histological and mechanical comparison of hydroxyapatite-coated cobalt-chrome and titanium implants in the rabbit femur

The purpose of this study was to compare hydroxyapatite (HA)-coated titanium (Ti) and HA-coated cobalt-chrome (CoCr) implants in the distal femur of the rabbit by evaluating bone apposition and interfacial shear strength. Bilateral cylindrical implants with a plasma sprayed 50-microns thick HA coating were press-fit into the metaphyseal cancellous bone of the lateral femoral condyles in a transverse fashion, and the animals were sacrificed at 2, 4, and 8 weeks postimplantation. Mechanical strength of the interface between HA and bone was measured using the pushout method. For histologic analysis, the fractional linear extent of bone apposition was quantitated. No differences were found in the interfacial shear strength between the Ti and CoCr at any time period. The amount of bone apposition increased significantly at each time interval for both substrate metals, but there were no significant differences between the two substrates at any of the time periods studied. The HA-coated CoCr implants performed in a similar manner to the HA-coated Ti implants, both mechanically and histologically, suggesting that HA-coated CoCr implants deserve further study as a viable alternative to Ti for the biological fixation of total joint components in orthopaedic surgery.     

The relationship of smoking on peri-implant tissue: a retrospective study

The term "peri-implantitis" is used to describe the formation of deep mucosal pockets around dental implants, inflammation of the peri-implant mucosa, and increased resorption of peri-implant bone. It has been speculated that when left untreated, peri-implantitis can result in implant failure. This retrospective study examines a possible correlation between smoking and the appearance of peri-implantitis. The clinical and radiographic observations of 366 implants in 107 patients who smoke were compared with those of a group of 1000 implants in 314 nonsmoking patients. Despite the retrospective nature of this study, a comparison between the two groups was possible. The mean follow-up period, mean patient age, implant locations, and percentages of fixed partial dentures and overdentures were consistent in both groups. There was no significant difference in the mean maxillary and mandibular hygienic indices between the group of smokers and that of nonsmokers. However, the group of smokers showed a higher score in the bleeding index, the mean peri-implant pocket depth, the degree of peri-implant mucosal inflammation, and radiographically discernible bone resorption mesial and distal to the implant. In the maxilla of the smoking group, these observations were significantly higher than both the mandibular observations for smokers and the maxillary observations of the group of nonsmokers (p < 0.01). No differences between the two groups were observed in the mandible. Aside from the systemic effects of tobacco smoking on the human organism, local cofactors seem to be responsible for the higher incidence of peri-implantitis in smokers and have a particularly negative effect on the maxilla. These findings confirm that smokers treated with dental implants have a greater risk of development of peri-implantitis.     

On closed compression to rupture capsules around breast implants

Pseudosheath formation secondary to post-traumatic hematoma is described in a patient following blunt trauma to the lateral thigh. The theory of its formation and progression is discussed.     

Neutrophil response and microbiological findings around teeth and dental implants

DESIGN: Envelope protein-specific antiviral peptides, called mucibodies, that can specifically recognize and bind to the surface unit protein gp120 of HIV-1 were designed. The initial mucibody binding target was the V3 loop of HIV-1 gp120. Here, the gp120-CD4 binding domain was chosen as the site of mucibody binding. The CD4 binding domain of gp120 is known to be a conformational epitope and is involved in the earliest events of viral entry into many cells. METHODS: The design of the mucibody antivirals was based on previous observations that antibody complementarity determining regions (CDR) are generally similar to the repeating loops or knob structures found in the 20-residue tandem repeat domain of human mucin MUC1. The heavy chain CDR3 from the bacteriophage display antibody b12 was used to construct two mucibodies, b12-CDR1 and b12-26. RESULTS: Peptides corresponding to three tandem repeats were shown to bind directly to the CD4 binding domain of HIV-1 gp120 in a solid-phase enzyme-linked immunosorbent assay. These mucibody peptides also disrupted the gp120-CD4 interaction in a solution-phase inhibition assay. Finally, mucibodies neutralized primary and laboratory macrophage-tropic isolates of HIV-1. CONCLUSIONS: There is a potential for medical use of these peptides as topical vaginal microbicides in preventing HIV-1 transmission during sexual contact. These results also suggest that multivalent, non-immunogenic binding proteins of virtually any specificity could be constructed for use in therapeutic applications involving infectious diseases and immune system dysfunction.     

Quantitative monitoring of capsular contraction around smooth and textured implants

The purpose of this study was to assess the efficacy of textured silicone implants in reducing the incidence of capsular contracture. Each of 10 female New Zealand, albino rabbits received 2 saline-filled implants, 1 on either side of the lateral chest wall. The surface of 1 implant was smooth silicone, whereas the other implant's surface was textured silicone. Magnetic resonance imaging (MRI) scans of the implants were performed at 0, 9, 17, 26, 34, and 40 weeks after implantation. Data from the MRI scans were used to calculate the effective surface area of implants at each analysis interval. This technique provided a noninvasive method of monitoring implant contraction as a function of time. Eight rabbits completed the study. Four of 8 smooth implants developed contractures, whereas none of the textured implants developed contracture. For the 4 smooth implants that developed contractures, MRI scans calculated 72 +/- 12% contraction at 17 weeks, but the Baker palpation test detected only mild firmness. From 17 to 40 weeks, the mean percentage of contraction for these implants changed minimally, but their mean Baker score increased from mild to severe (II to IV). Quantitative data from MRI scans were much more predictive of final implant contraction than palpation (Baker test), applanation tonometry, or indentation tonometry. The latter two tests only detected the final stages of severe implant contraction.     

Tetracyclines inhibit connective tissue breakdown by multiple non-antimicrobial mechanisms

A seminal experiment involving a germ-free rat model of connective tissue breakdown (followed soon thereafter by a series of in vitro studies) identified an unexpected non-antimicrobial property of tetracyclines (TCs). This ability of TCs to inhibit matrix metalloproteinases (MMPs) such as collagenase was found to reflect multiple direct and indirect mechanisms of action, and to be therapeutically useful in a variety of dental (e.g., adult periodontitis) and medical (e.g., arthritis, osteoporosis, cancer) diseases. The site on the TC molecule responsible for its MMP-inhibitory activity was identified which led to the development of a series of chemically modified non-antimicrobial analogs, called CMTs, which also have therapeutic potential but do not appear to induce antibiotic side-effects. Longitudinal double-blind studies on humans with adult periodontitis have demonstrated that a sub-antimicrobial dose of doxycycline (previously reported to suppress collagenase activity in the periodontal pocket) is safe and effective and has recently been approved by the FDA as an adjunct to scaling and root planing.     

Reproducibility of automated periodontal probing around teeth and osseointegrated oral implants

The Trk family, a group of high-affinity neurotrophin receptors, is divided into three subtypes, TrkA, TrkB and TrkC. These were originally found in neural elements, and are involved in neural development, maintenance and survival. Recent studies have shown that non-neural cells in vitro also express mRNA encoding some neurotrophin receptors. In our preliminary study, TrkB-like immunoreactivity (LI) was found in the various non-neural cells in the rat periodontal ligament. The present study was undertaken to clarify which cell types express Trk-LI, in particular two types of TrkB-LI, in the periodontal ligament of mature rats, using an immunocytochemical technique with polyclonal antibodies. Intense full-length TrkB-LI was clearly recognized in non-neural cells such as fibroblasts, osteoclasts, odontoclasts and cementoblasts as well as in neural elements. Relatively large cells with many cytoplasmic processes were also frequently immunopositive for full-length TrkB. Immunocytochemistry for TrkB[TK-], a truncated type, also demonstrated a similar immunostaining pattern to that of full-length TrkB in non-neural periodontal cells, and intense positive reactions in endothelial cells. Some non-neural cells were positive for TrkA and TrkC. These findings suggest that neurotrophic factors, the ligands of the Trk family, have certain effects on the proliferation and/or differentiation of non-neural cells, as well as on their neurotrophic functions.     

Analysis of sweat during soft tissue breakdown following pressure ischaemia

This paper examines the nature of tissue metabolites collected in thermally induced sweat following the application of different loading regimes on the soft tissues of able-bodied subjects. Loading was produced by 1) external application on the forearm via both a tourniquet and a uniaxial indenter system, and 2) ischial support on a wheelchair and sacral support on an examination bed. In each case sweat pads were attached to the tissue areas of a group of able-bodied subjects and interface pressures were recorded. After a prescribed period, the pads were removed and a quantitative analysis of a range of metabolites was performed. Results indicated that tissues subjected to pressure ischemia produced a general increase in concentrations of lactate, chloride, urea, and urate associated with a decreased sweat rate. In the reperfusion phase, some of these metabolites returned to unloaded levels. It is proposed that specific metabolites may be used as an indicator of soft tissue damage.     

Spherical contracture of fibrous capsules around breast implants. Prevention and treatment

A follow-up of 82 patients who had had augumentation mammaplasties is reported. Though the number of patients having had each form of ancillary treatment is small, we believe that intraoperative instillation of triamcinolone and postoperative "expansion exercises" are of value in decreasing the incidence of capsular contracture around the implants. When such spherical contracture does occur, the capsule can usually be ruptured simply and quickly by external pressure with the surgeon's hands. This is usually done as an office procedure, without anesthesia. The results are so beneficial that we believe this should be done on many patients. In some it may need to be done repeatedly.     

Analysis of cell types and mediator production from tissues around loosening joint implants

Quantitative immunophenotypic analysis of cell types present in peri-prosthetic tissue [pseudosynovial membrane (PSM)] from aseptically loose joint implants revealed considerable heterogeneity between tissues from different individuals. The monocyte/macrophage was the commonest leucocyte type; however, its proportion varied widely. T cells normally accounted for approximately 5% of cells, but in a few cases formed > 20% of cells. In all cases, there was a high ratio of CD4 to CD8 cells. PSM leucocytes were activated in most PSMs as judged by surface expression of CD23, CD25 and CD71. Analysis of the proportions of cell types in PSM, OA synovium and RA synovium revealed similarities between the different tissue types. The levels of IL-1, IL-6 and prostaglandin E produced by the PSM were correlated, but only IL-1 and IL-6 levels correlated with markers of the monocyte/macrophage lineage. This result suggests that prostaglandin E is produced in vivo by many PSM cell types.