Research

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EDITORIAL
Issue: 01/2012
Résumé and outlook

Résumé and outlook

Dear Colleagues,

The first issue of a new year provides the opportunity on the one hand to analyze our current position and, on the other hand, to develop strategies for the future.

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Issue: 02/2012
DGI – SGI – ÖGI:
joint activities,
symbol for cooperation

DGI – SGI – ÖGI:
joint activities,
symbol for cooperation

At the beginning of May 2011 the Austrian Society of Implantology (ÖGI) invited 40 “young” scientists from Austrian hospitals and practices to an innovative conference in Saalfelden, Austria, on the topic of “Implantology 2020” and analyzed and discussed future challenges. Within the framework of interactive workshops the ÖGI committee organized two dynamic days, the aim of which was to provide an opportunity for young “implantologists” to network. The main focus of the conference was to promote young implantologists and the future activity of the ÖGI. Provocative questions and interesting topics covering all aspects of implantology and the future of implantological training and advanced training were discussed at a national level by prosthodontists, maxillofacial surgeons, periodontists and oral surgeons. The meeting of the ÖGI was mainly a powerful signal that young and “older” scientifically active clinicians and practitioners from all over Austria were coming together. Due in particular to the interaction between traditional implantological schools of thought and new, innovative approaches it proved to be appropriate to extend our implantological horizons in the areas of training and advanced training, future trends as well as challenges and demands regarding patients and operators. As a result, a junior delegate was appointed to the ÖGI committee to implement new ideas and to look after the concerns of young implantologists.

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Issue: 04/2012
Put down new roots for the sake of safety and patient confidence

Put down new roots for the sake of safety and patient confidence

Implant survival rates of well over 90 percent over a period of ten years are a clear sign of success. Do we not have every reason to be satisfied? There must be some areas in (dental) medicine that are envious of such treatment results. Should we have any concerns about the routine use of implants, for example also in general dental practice?

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Issue: 04/2012
Dear Colleagues

Dear Colleagues

The three-country congresses held in a rotation system since 1999, have been remarkable not only due to the logistical demands for the organisers but also by the professional and human interaction of all involved. Lively and regular transborder contact between the individual specialist associations was established and remains to this day the impulse for exciting collaboration. Even if we, as a German-speaking professional association with mutual interests, can share many common viewpoints, general cultural differences within the developments in Germany, Austria and Switzerland also account for different characteristics and divergent approaches. These differing approaches require all those involved to show understanding, respect and a certain amount of tolerance and find a synthesis, a common denominator, and in this way allow synergies to flow, which facilitate collaboration and continually motivate with new ideas. An example of this was the call to establish an institutional platform for protagonists of a young generation within the associations with the intention of refreshing and extending the views of the board, which has already been in office for many years. In this way impulses will not only extend beyond national borders but also lead to integral approaches within our own generations. It is self-evident that the respective young generations will then interact with new ideas.

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FROM PRACTITIONER TO PRACTITIONER
Issue: 04/2012 - M. Degidi - D. Nardi - A. Piattelli
Prospective five-year follow-up of immediate definitive rehabilitation of the edentulous patient using an intraoral welded titanium framework

Objectives: The aim of this prospective study was to evaluate the concept of intraoral welding as a suitable technique for the placement of a final restoration in the edentulous patient on the same day as surgery.

Materials and Methods: Any patient with a completely edentulous arch received a fixed restoration supported by an intraoral welded titanium bar. Definitive abutments were connected to the implants and then welded to a titanium bar using an intraoral welding unit. This framework was used to support the definitive acrylic restoration, which was fitted on the same day as implant placement. Restoration and implant success, mean marginal bone loss, pocket probing depth and bleeding on probing were assessed over a 60-month follow-up period.

Results: 36 patients with an edentulous maxilla and 44 patients with an edentulous mandible, with an average age of 58.1 years (SD=16.8; n=80), were consecutively treated with 320 immediately-loaded implants. No fractures or radiographically detectable alteration of the welded framework were evident. 317 (99.06%) implants osseointegrated and were clinically stable at the six-month follow-up. At the 60-month follow-up the accumulated mean marginal bone loss was respectively 0.967 mm (SD=0.361) for the maxillary cases and 1.016 mm (SD=0.413) for the mandible cases.

Conclusions: It is possible on the same day of surgery to successfully rehabilitate the edentulous patient with a fixed, definitive prosthesis supported by an intraoral welded titanium framework.

One sentence summary: It is possible to successfully rehabilitate edentulous patients on the same day as implant placement with a definitive fixed restoration supported by an intraoral welded titanium framework without jeopardizing osseointegration and implant success.

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ORIGINAL STUDY
Issue: 01/2012 - P.W. Kämmerer - E. Stender - S. Telkes - E. Schiegnitz - F.G. Draenert
Morphological evaluation of circular osteotomies by two different
trephine bur systems in vitro

Introduction: The harvesting of bone grafts with trephine burs plays an important role in oral and maxillofacial surgery. The integrity of the bone graft and the local donor site should be preserved as much as possible. The aim of this study was therefore a comparative in vitro study of the bone donor site after cylindrical osteotomy with a standard trephine and a diamond hollow drill.

Material and Methods: Bovine pelvic bone was drilled using a standard trephine and a diamond hollow drill at different rotational speeds (20, 40, 60, 80, 100%). Impressions of the drill holes were prepared and the bone samples were processed for histomorphometrical analysis.

Results: In this study the diamond hollow drill demonstrated a better quality of the drill hole and gentler bone removal with fewer artifacts in both the impressions and the histological studies.

Conclusion: For gentle and atraumatic bone graft harvesting, the diamond hollow drill shows advantages compared with the standard trephine.

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Issue: 01/2012 - Ph. Streckbein - H. Eymer - F.A.Preusse - F.E. Preusse
Sinus lift and simultaneous insertion of dental implants
with a residual bone height less than 5 mm

Introduction: Sinus lift with simultaneous placement of dental implants is commonly performed on residual maxillary sinus floors with more than 5mm vertical height. There is a risk of implant failure in situations with less residual bone (5mm) due to initial mobility during healing.

Objectives: The aim of this retrospective study is to present the surgical procedure of simultaneous sinus lift and implant placement in a sandwich technique in patients with less than 5mm residual vertical bone height and to assess the risk of implant failure.

Material and methods: In the period between 1998 and 2005 39 patients underwent 55 sinus lift procedures with simultaneous placement of 78 dental implants (Semados S and RI implants, BEGO Implant Systems GmbH Co. KG, Bremen, Germany) in residual maxillary sinus floors below 5mm. To increase primary stability, additional lateral bone condensation was performed with osteotomes. The subantral space was filled with bone substitutes. Autogenous bone enriched with platelet-rich plasma (PRP) was applied through the implant cavity next to the implant site. Finally a PRP wetted implant was placed. Clinical examination and follow-up x-rays were performed in 2010.

Results: After exposure, 75 of 78 implants withstood a torque of 30Ncm, which equates to an initial survival rate of 96.2%. One patient with one implant was lost to follow-

up and another two implants had to be removed due to bisphosphonate-related osteonecrosis. All other implants were bland in situ and satisfactorily integrated in the prosthetic reconstruction. This leads to a survival rate of 92.3% after a follow-up of up to 12 years (median 8 years, mean 8.12 years; n = 78).

Conclusion: This study shows that simultaneous insertion of dental implants and augmentation in the vertically reduced sinus floor following the described surgical protocol leads to predictable and good results. The simultaneous approach allows considerable acceleration of the implant treatment and spares the patient a further surgical procedure, thus reducing the cost of treatment.

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Issue: 02/2012 - W. Spitzer - L. v. Müller - A. Schindler - A. Lehmann - F. Nothdurft - M. Hannig - N. Umanskaya - A. N. Idlibi - S. Rupf
Disinfection and removal of biofilms on microstructured titanium by cold atmospheric plasma

Introduction: Biofilms on dental implants play an important role in the genesis of inflammatory periimplant disease. Decontamination of microstructured titanium (mTi) is still a challenge for the dental practitioner. Cold atmospheric plasma jets offer disinfecting capabilities at biologically acceptable temperatures. This experimental study investigated disinfective and destructive effects of cold atmospheric plasma on oral biofilms formed in situ on mTi surfaces.

Material and Methods: mTi discs (sandblasted/etched, N=120) were exposed to the oral environment of two healthy volunteers for 24 hours to produce biofilms. Plasma treatment was carried out by means of a meander like CC line by line scanning with a pulsed microwave-driven (2.45GHz) plasma jet (2.5s/mm², 2.0l/min He, 3W or 5W microwave mean power). Following plasma treatment some specimens were air/water sprayed and subsequently subjected to a second plasma treatment. Non-irradiated biofilms, biofilms treated with chlorhexidine and mTi discs without biofilms served as controls. Disinfection of biofilms was assessed by contact agar samples (RODAC technique) and fluorescence microscopy (vital/dead staining). Biofilm morphology was visualized by scanning electron microscopy; biofilm coverage was measured by fluorescence microscopy. Total protein was quantified colorimetrically.

Results: Depending on the plasma jet power the mTi surface temperature at the plasma contact point varied between 39 and 43°C. After plasma treatment only, disintegration as well as reduction of biofilm viability and of total protein were observed. The additional application of air/water spray resulted in a further reduction of biofilm viability and of total protein. Fluorescence and protein amounts were reduced comparable to control specimens without biofilms after a second plasma treatment. The microstructured surface of the samples was not altered by plasma treatment.

Conclusions: In this experimental study cold atmospheric plasma technology combined with air/water spray enabled complete elimination of oral biofilms from mTi. This new approach may enable new routes for the therapy of inflammatory periimplant disease, while preserving microstructured surfaces.

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Issue: 02/2012 - P. Rammelsberg - A. J. Hassel - W. Bömicke - C. Schröder - S. Schwarz
A retrospective study on the incidence of chipping of zirconia-based and metal-ceramic implant-supported single crowns and splinted crowns*

Aim: To compare the influence of chipping on the survival and success rates of implant-supported single crowns and splinted crowns within a retrospective study design.

Material and methods: 161 patients (50.8% male, mean age 55.2 years) received 232 cemented implant-supported single crowns and 14 splinted crowns. 179 crowns and twelve splinted crowns had a metal framework (gold alloy). The other 53 single crowns and two splinted crowns were all-ceramic (zirconia framework and glass-ceramic veneer material). A total of 54.7% of the single crowns and 50% of the splinted crowns were fixed by semipermanent cementation.

Results: During the implant-observation period of in mean 2.8 years (standard deviation 1.4) one implant was lost, resulting in a survival rate of 99.6%. Seven further implants had clinical signs of moderate peri-implantitis and bone loss, so the success rate was 96.9%. During the superstructure-observation period of in mean 2.2 years (standard deviation 1.4) a total of 78.2% of the single crowns and 91.7% of the splinted crowns made of metal-ceramic, and 69.8% of the single crowns and 50% of the splinted crowns made of all-ceramic had no technical complication at all. The most common complication, fracture of the veneer material, occurred significantly more often on all-ceramic restorations (p0.001). A total of ten single crowns had to be remade, resulting in survival rates of 98.3% (metal-ceramic) and 88.7% (all-ceramic). The survival rates of the splinted crowns were 100% in both groups.

Conclusion: Chipping was found to be more frequent for all-ceramic implant-supported single crowns, the survival and complication rates were significantly lower. The survival rates for splinted crowns were the same in both groups, no failures occurred. Nevertheless, within the limitations of this retrospective study, zirconia-based suprastructures veneered with glass ceramic cannot be generally recommended.

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Issue: 03/2012 - R. Streckbein - P. Streckbein - J.-F. Wilbrand - H.-P. Howaldt - M. Flach
Bionic design of small diameter dental implants

Introduction: Optimization strategies are an established part of product design processes in various industrial fields (automotive engineering, aerospace construction etc.). The bionic design method provides an efficient process to optimize the mechanical and biomechanical behaviour of dental implants following the example of nature. Optimization of dental implants using this method could result in a higher resistance to fracture and reduced strain in peri-implant bone.

Material and method: The bionic design method is applied to an axisymmetric finite element model to optimize the geometry of the implant. Stress distributions are calculated and analyzed for the optimized geometry of a reduced-diameter dental implant (BEGO Semados Mini-Implant, BEGO Implant Systems, Bremen, Germany) and the peri-implant bone. The optimized geometry is adopted in a CAD (computer-aided design) model and verified in a three-dimensional finite element analysis. The durability limits are determined by a final fatigue test according to the ISO 14801 standard “Dentistry – Fatigue test for endosseous dental implants”.

Results and discussion: By applying the bionic design method to the axisymmetric model, the stresses in the respective implant and the peri-implant bone can be reduced by at least 34%. The verification of the CAD model shows an improvement to a more homogenous stress distribution. The ISO 14801 fatigue test shows high durability limits. The disadvantage of an expensive production process caused by complex bionic design geometries can be reduced using modern CAM (computer-aided manufacturing) production technologies.

Conclusion: The bionic design method is a very effective and easy to use procedure to design and optimize dental implants. The presented method provides a definite improvement for the construction process of dental implants.

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