Search

Grit basting is the most common process applied to titanium dental implants to give them a roughness that favors bone colonization. There are numerous studies on the influence of roughness on osseointegration, but the influence of the compressive residual stress associated with this treatment on biological behavior has not been determined. For this purpose, four types of surfaces have been studied using 60 titanium discs: smooth, smooth with residual stress, rough without stress, and rough with residual stress. Roughness was studied by optic interferometry; wettability and surface energy (polar and dispersive components) by contact angle equipment using three solvents; and residual stresses by Bragg–Bentano X-ray diffraction. The adhesion and alkaline phosphatase (ALP) levels on the different surfaces were studied using Saos-2 osteoblastic cultures. The bacterial strains Streptococcus sanguinis and Lactobacillus salivarius were cultured on different surfaces, determining the adhesion. The results showed that residual stresses lead to increased hydrophilicity on the surfaces, as well as an increase in surface energy, especially on the polar component. From the culture results, higher adhesion and higher ALP levels were observed in the discs with residual stresses when compared between smooth and roughened discs. It was also found that roughness was the property that mostly influenced osteoblasts’ response. Bacteria colonize rough surfaces better than smooth surfaces, but no changes are observed due to residual surface tension.

La Diabetes Mellitus Tipo 1 (T1DM) es una enfermedad autoinmune órganoespecífica que conduce a un metabolismo anormal de grasas, carbohidratos y proteínas debido a la ausencia de insulina. El inicio de la enfermedad suele producirse a una edad temprana, aunque también puede aparecer en adultos y ancianos. La enfermedad periodontal (PD) es una enfermedad inflamatoria crónica causada por la presencia de patógenos anaerobios específicos contenidos en el biofilm subgingival. El mecanismo de interacción implica la posible inducción de inflamación sistémica a partir de los tejidos periodontales, aumentando el nivel de marcadores inflamatorios circulantes que desempeñan un papel importante en el inicio y la progresión de la PD. La PD no sólo afecta a la salud oral, sino también a la salud sistémica. El desarrollo y la progresión de la PD están directamente relacionados con la higiene oral, y mantener una buena higiene oral reduce el riesgo de periodontitis. Una higiene bucal deficiente maximiza el riesgo de periodontitis entre dos y cinco veces, respectivamente. Según la bibliografía, existe una relación entre la diabetes y la enfermedad periodontal, siendo la PD la sexta complicación de la diabetes. Las pruebas sugieren una relación bidireccional entre la PD y la diabetes mellitus, ya que la diabetes aumenta el riesgo de enfermedad periodontal y la enfermedad periodontal afecta al control glucémico y aumenta la gravedad de las complicaciones de la diabetes. La PD y la diabetes mellitus son dos enfermedades crónicas que influyen en la salud y la calidad de vida del paciente. Se ha demostrado que la gravedad de ambas enfermedades depende de diversos factores de riesgo, como el control metabólico y la duración de la diabetes mellitus, así como de la edad del paciente, su comportamiento social, su nivel de higiene bucal y factores agravantes como el tabaquismo. Entre los pacientes con diabetes, un mal control metabólico se asoció a una mayor prevalencia y gravedad de la PD. E

Statement of problem: Implant-supported rehabilitations are an increasingly frequent practice to replace lost teeth. Before clinical application, all implant components should demonstrate suitable durability in laboratory studies, through fatigue tests. Objective: The purpose of this in vitro study was to evaluate the integrity and wear of implant components using SEM, and to assess the axial displacement of the implant–abutment assembly by Micro-CT, in different implant connections, after three distinct mechanical requests. Materials and methods: Four KLOCKNER implants (external connection SK2 and KL; and internal connection VEGA and ESSENTIAL) were submitted to three different mechanical requests: single tightening, multiple tightening, and multiple tightening and cyclic loading (500 N × 100 cycles). A total of 16 samples were evaluated by SEM, by the X-ray Bragg–Brentano method to obtain residual stresses, and scratch tests were realized for each surface and Micro-CT (4 control samples; 4 single tightening; 4 multiple tightening; 4 multiple tightening and cyclic loading). All dental implants were fabricated with commercially pure titanium (grade 3 titanium). Surface topography and axial displacement of abutment into the implant, from each group, were evaluated by SEM and Micro-CT. Results: In the manufacturing state, implants and abutments revealed minor structural changes and minimal damage from the machining process. The application of the tightening torque and loading was decisive in the appearance and increase in contact marks on the faces of the hexagon of the abutment and the implant. Vega has the maximum compressive residual stress and, as a consequence, higher scratch force. The abutment–implant distances in SK2 and KL samples did not show statistically significant differences, for any of the mechanical demands analyzed. In contrast, statistically significant differences were observed in abutment–implant distance in the internal connection implants Vega a

Hoy en día, un gran número de sistemas de implantes con diferentes componentes están disponibles y, con frecuencia, se introducen continuamente nuevos materiales y diseños. Antes de su aplicación clínica, todos los componentes del implante deben demostrar una durabilidad adecuada en los estudios in vitro de laboratorio. Este trabajo tiene como objetivo, evaluar en diferentes tipos de conexiones, el mantenimiento de la precarga después de varias demandas mecánicas de apriete (apriete único y 10 múltiples aprietes); el mantenimiento de la precarga después de la aplicación de carga cíclica; la valoración de las posibles deformaciones en las diferentes interfases tras la aplicación repetida del torque de apretamiento; verificar y cuantificar la existencia de un espacio en la conexión implante - pilar. El diseño experimental tomó en cuenta los cuatro tipos de conexiones existentes en el sistema de implantes Klockner, originadas por la evolución de dicho sistema de implantes a lo largo de los últimos 25 años: conexión externa Implante SK2, conexión externa Implante KL, conexión interna Implante Vega y conexión interna Implante Essential. Los implantes para el estudio son, en una primera fase, colocados en un suporte metálico con la porción más coronal 3 mm por fuera del mismo. Los pilares del implante se insertan siguiendo las instrucciones del fabricante (SOADCO, Andorra) y mediante el uso de una llave dinamométrica calibrada al torque sugerido por el fabricante, para cada uno de los pilares. Se registran los valores de torque requeridos para apretar y aflojar el sistema pilar / implante después de apriete único y 10 aprietes múltiples. En seguida las muestras son sujetas a proba de fatiga con una carga de 50 kg durante 1000 ciclos y una vez más se registran los valores de torque de remoción. En una fase siguiente se analiza una muestra de cada sistema pilar/implante por SEM en busca de posibles daños en la estructura y superficie de los componentes (implante-pilar). Los

El tratamiento con implantes dentales ha demostrado tener unas tasas de supervivencia y de éxito muy altas en estudios controlados con criterios de inclusión y exclusión muy bien definidos, sin embargo, son muy pocos los estudios que evalúan el resultado del tratamiento en condiciones no controladas las cuales representan la mayoría de los implantes colocados en las clínicas dentales. Por lo tanto, son necesarios estudios no intervencionistas en los que en la población de estudio no se incluyan criterios de inclusión ni de exclusión, sino que la participación en el estudio vendría determinada por la necesidad del tratamiento con implante/s establecido por el criterio clínico del profesional dentro de su ambiente laboral habitual en el consultorio dental. En el presente estudio los implantes se colocarán en las diferentes situaciones clínicas bajo diferentes protocolos de tratamiento determinados libremente por cada profesional en cada momento particular. La intención es que este trabajo nos permita determinar la efectividad de los implantes en el mundo real frente a la eficacia ya demostrada en estudios controlados. El objetivo de este estudio es evaluar el uso de implantes Tissue Level Klockner Essential Cone en situaciones que intentan representar el mundo real del tratamiento con implantes (efectividad). Para conseguir nuestro objetivo se realiza un estudio observacional multicéntrico de casos consecutivos.

The purpose of this research is to study the biomechanical response of dental implants in bone-level type locations, 0.5 mm above and below the bone level. In addition, the influence of the thickness of the cortical bone on osseointegration is determined due to the mechanical loads transfer from the dental implant to the cortical and trabecular bone. The thicknesses studied were 1.5 mm and 2.5 mm. Numerical simulations were performed using a finite element method (FEM)- based model. In order to verify the FEM model, the in silico results were compared with the results obtained from a histological analysis performed in an in vivo study with 30 New Zealand rabbits. FEM was performed using a computerized 3D model of bone-level dental implants inserted in the lower jawbone with an applied axial load of 100 N. The analysis was performed using different distances from the bone level and different thicknesses of cortical bone. The interface area of bone growth was evaluated by analyzing the bone–implant contact (BIC), region of interest (ROI) and total bone area (BAT) parameters obtained through an in vivo histological process and analyzed by scanning electron microscopy (SEM). Bone-level implants were inserted in the rabbit tibiae, with two implants placed per tibia. These parameters were evaluated after three or six weeks of implantation. FEM studies showed that placements 0.5 mm below the bone level presented lower values of stress distribution compared to the other studied placements. The lower levels of mechanical stress were then correlated with the in vivo studies, showing that this position presented the highest BIC value after three or six weeks of implantation. In this placement, vertical bone growth could be observed up the bone level. The smallest thickness of the study showed a better transfer of mechanical loads, which leads to a better osseointegration. In silico and in vivo results both concluded that the implants placed 0.5 mm below the cortical bone and w

The procedure generally used to remove bacterial biofilm adhering to the surface of titanium on dental implants is implantoplasty. This treatment is based on the machining of the titanium surface to remove bacterial plaque. In this study, we used 60 grade 4 titanium implants and performed the implantoplasty protocol. Using X-ray diffraction, we determined the stresses accumulated in each of the as-received, machined and debris implants. The resistance to corrosion in open circuit and potentiodynamically in physiological medium has been determined, and the corrosion potentials and intensities have been determined. Tests have been carried out to determine ion release by ICP-MS at different immersion times. The results show that the corrosion resistance and the release of titanium ions into the medium are related to the accumulated energy or the degree of deformation. The titanium debris exhibit compressive residual stresses of −202 MPa, the implant treated with implantoplasty −120 MPa, and as-received −77 MPa, with their corrosion behavior resulting in corrosion rates of 0.501, 0.77, and 0.444 mm/year, respectively. Debris is the material with the worst corrosion resistance and the one that releases the most titanium ions to the physiological medium (15.3 ppb after 21 days vs. 7 ppb for as-received samples). Pitting has been observed on the surface of the debris released into the physiological environment. This behavior should be taken into account by clinicians for the good long-term behavior of implants with implantoplasty.

The stability and integrity of the abutment-implant connection, by means of a screw, is fallible from the moment the prosthetic elements are joined and is dependent on the applied preload, wear of the components and function. One of the main causes of screw loosening is the loss of preload. The loosening of the screw-abutment can cause complications such as screw fracture, marginal gap, peri-implantitis, bacterial microleakage, loosening of the crown and discomfort of the patient. It is also reported that loosening of the screw/abutment may lead to a failure of osseointegration. It is necessary to evaluate and quantify, with in vitro studies, the torque loss before and after loading in the different connections. Aim: evaluate the influence of implant- abutment connection design in torque maintenance after single tightening, multiple tightening and multiple tightening followed by mechanical cycling. Materials and Methods: 180 Klockner implants divided in 4 groups: 15 SK2 external connection, 25 Ncm tightening torque; 15 KL external connection, 30 Ncm tightening torque; 15 Vega internal connection, 25 Ncm tightening torque; 15 Essential internal connection, 30 Ncm tightening torque. In each group removal torque values (RTV) were evaluated with a digital torque meter, in 3 distinct phases: after one single tightening, 10 multiple tightenings and 10 multiple tightenings and cyclic loading (500 N × 1000 cycles). Results: After one single tightening, and for all connections, RTV were lower than those of insertion, but only for Essential and Vega internal connections this result was statistically significant. After multiple tightening, RTV were significantly lower in all connections. After repeated tightening followed by cyclic loading, mean RTV were significantly lower, when compared to insertion torque. The multiple tightening technique resulted in higher RTV than the single tightening technique, except for Vega implant. The multiple tightening followed by cyclic load, c

Este estudio tiene como objetivo principal, describir las complicaciones tardías asociadas a la utilización del injerto gingival libre desepitelizado (IGLD) en comparación con el injerto de tejido conectivo (ITC). Aportando un porcentaje de incidencia. Como objetivo secundario, proponer una clasificación de las complicaciones. Nuestro protocolo de estudio y plan de trabajo de investigación fue aprobado por el Comité de Ética e Investigación de la Junta de Andalucía, mediante un informe dictamen favorable (Código estudio 1259-N-19). Para el cálculo del tamaño muestral necesario, se diseñó un estudio piloto para determinar la incidencia de complicaciones.

Articles on the prevalence of peri-implant diseases showed that 90% of peri-implant tissues had some form of inflammatory response and a prevalence of peri-implantitis from 28% to 51% according to various publications. Objective: To provide an overview of how risk factors can be related with peri-implantitis. Methods: A retrospective longitudinal study including 555 implants placed in 132 patients was evaluated based on the presence of peri-implantitis following the criteria of Renvert et al. 2018. Results: In total, 21 patients (15.9%) suffered peri-implantitis (PPG) and 111 patients (84.1%) did not suffer peri-implantitis (NPG). The results reveal that smokers have a high incidence of peri-implantitis (72.7%) compared to non-smokers (27.3%) (p < 0.0005). Another variable with significant results (p < 0.01) was periodontitis: 50% PPG and 23.9% NPG suffered advanced periodontitis. Systemic diseases such as arterial hypertension, diabetes mellitus, osteoporosis, and cardiovascular diseases do not show a statistically significant influence on the incidence of peri-implantitis. Patients who did not attend their maintenance therapy appointment had an incidence of peri-implantitis of 61.4%, compared to 27.3% in those who attend (p < 0.0001). From the results obtained, we can conclude that relevant factors affect peri-implantitis, such as tobacco habits, moderate and severe periodontitis, and attendance in maintenance therapy.

La enfermedad periodontal ha sido ampliamente estudiada como factor de riesgo frente a la pérdida de piezas dentales. Se busca medir la influencia de esta enfermedad en el éxito/fracaso de los implantes. A pesar de la repercusión de la enfermedad periodontal como factor de riesgo, este estudio concluye afirmando que es lícito colocar implantes en pacientes periodontales. Sin embargo, existen evidencias respaldadas por numerosos autores que señalan un aumento en la incidencia en la aparición de complicaciones tras el tratamiento implantológico en pacientes con enfermedad periodontal o antecedentes de la misma. No obstante, se hace evidente la necesidad de estudios de mayor calidad metodológica para poder elaborar conclusiones de confianza. Esto es debido a la presencia de factores confundentes, así como la presencia de múltiples factores de riesgo que dificultan analizar los antecedentes de enfermedad periodontal como factor aislado. Así mismo, se reflejan resultados estadísticamente significativos sobre la importancia de una terapia de mantenimiento periodontal, como factor clave para el éxito de implantes tanto en pacientes con enfermedad periodontal como en pacientes sanos., Periodontal disease has been extensively studied as a risk factor for tooth loss. The influence of periodontal disease on implant success/failure is being measured. Despite the impact of periodontal disease as a risk factor, this study concludes that it is permissible to place implants in periodontal patients. However, there is evidence supported by numerous authors,that show an increased incidence of complications after implant treatment in patients with periodontal disease or a history of periodontal disease. Nevertheless, we need studies of higher methodological quality in order to have reliable conclusions. This is due to the presence of confounding factors, as well as the presence of multiple risk factors that make it difficult to analyse a history of periodontal disease as an isolated factor. Statistically significant results show the importance of periodontal maintenance therapy as a key factor for the success of implants in both patients, with periodontal disease and healthy patients.

Objetivo: evaluar las diferencias en la pérdida ósea crestal periimplantaria entre Grupo Test, cuyo pilar fue colocado el día de la cirugía, el cual nunca más fue retirado frente al Grupo Control, en el que se retiró el pilar de cicatrización 3 veces durante el proceso de realización de la prótesis. Se analizaron dos subgrupos: Pilar 1mm (altura) y Pilar 2 mm (altura). Material y método: 147 pacientes con una edad de 54,82±11,92 años, que fueron distribuidos aleatoriamente tras la colocación de implante/s en grupo Test y Control. Se valoró mediante radiografías periapicales individualizadas el nivel óseo el día de la cirugía tras la colocación de los implantes, a los 6 y 12 meses. Además se registraron valores AFR tanto el día de la cirugía, como a los 6 y 12 meses; y valores de salud de los tejidos periimplantarios. Resultados: Tras 1 año la pérdida ósea acumulada fue de 0.48±0.71mm para el grupo Control y 0.36±0.79mm para el grupo Test, sin DES. Se encontraron DES entre 0 y 6 meses (Test: 0.40±0.66mm; Control: 0.46±0.66mm) y entre 0 y 12 meses (Test: 0.36±0.79mm; Control: 0.48±0.71mm), con independencia del grupo. La pérdida ósea acumulada (1 año) fue de 0.45±0.78mm para grupo Pilar 1mm y 0.41±0.70mm para grupo Pilar 2mm (DES). No se observaron diferencias estadísticas en la estabilidad implantaría ni en salud de los tejidos periimplantarios entre los grupos. Conclusiones: El concepto “One Abutment - One Time” no reduce la pérdida ósea periimplantaria frente a conexión-desconexión. La altura del pilar sí influye en la pérdida ósea: cuanto mayor altura del pilar, menor es la pérdida ósea.

Antecedentes y justificación: En la actualidad la rehabilitación mediante implantes dentales constituye un procedimiento más que aceptado por parte de los clínicos. La consolidación de la osteointegración y su funcionalidad, ha dado paso a una nueva etapa donde los pacientes requieren para el éxito del tratamiento una gran estética. El sector anterior maxilar representa una de la zona más compleja en cuanto a colocación de implantes, pues se deben tener en consideración además de los aspectos óseos, las condiciones gingivales que favorezcan un resultado estéticamente armonioso. Para ello se tiene en cuenta diversos factores quirúrgicos y protésicos los cuales se detallarán en la presente revisión con el fin de prevenir dichas complicaciones. Objetivo: Realizar una revisión sistemática para la determinación de los factores estéticos, quirúrgicos y protésicos que influyen en la prevención de complicaciones alrededor de los implantes de la zona estética del paciente. Método: La recuperación de los estudios se realizó a través de la siguiente base de datos principal, MEDLINE, a través de PubMed. Únicamente se incluyeron estudios publicados en inglés, francés y español, en un intervalo de 10 años, sobre implantes unitarios y que hablarán directa o indirectamente sobre la prevención de las complicaciones de los tejidos blandos periimplantarios. Resultados: De los 1551 artículos inicialmente recuperados, no todos concordaban con los criterios de elegibilidad, por lo que se fueron descartando hasta obtener un total de once artículos, que fueron los incluidos en la revisión. Todos los estudios tienen en común que analizan un factor que condiciona la estética en la zona anterior. Conclusiones: Varios parámetros y diversas técnicas quirúrgicas, se han desarrollado para manipular los contornos de los tejidos duros y blandos para poder controlar el resultado estético del contorno gingival. Se han encontrado recomendaciones y beneficios en la presencia de encía queratinizada e in, Background and justification: Nowadays, rehabilitation through dental implants is a procedure accepted by the clinicians. The consolidation of osseointegration and its functionality leads to a new stage where patients require great aesthetics for the success of the treatment. The anterior maxillary sector is one of the most complex areas in terms of placement of implants, considering bone aspects and the gingival conditions who favor aesthetically harmonious result. It's important to consider about several surgical and prosthetic factors, which will be detailed in this review in order to prevent such complications. Objective: Carry out an exhaustive search to determine the aesthetic, surgical and prosthetic factors that influence the prevention of peri-implant complications of the aesthetic area of the patient. Methods: Studies were retrieved from the following database, MEDLINE through PubMed. Only studies written in English, French and Spanish, published in a 10-year interval, about single-tooth implants, and who directly spoke about preventive care of peri-implant soft tissue, were included. Results: Of 1551 articles, not all of them met the eligibility criteria, so we follow a discarding process until a total of eleven articles were included in this review. All the studies have in common that they analyze the factor that determines aesthetics in anterior maxilla. Conclusions: Se han encontrado recomendaciones y beneficios en la presencia de encía queratinizada e indicaciones de injertos autógenos en biotipo fino. Recommendations and benefits have been found in the presence of keratinized gingiva and indications for autogenous grafts in fine biotype. When interpreting the results of the present review, one must consider the heterogeneity in terms of the techniques applied in the different trials, the scarcity of eligible articles and the lack of long-term data, so it could not be provided a definitive answer.

La hiperneumatización del seno y reabsorción de la cresta alveolar en maxilar posterior tras la pérdida dentaria; hace necesario la necesidad de usar técnicas de regeneración para la colocación de implantes dentales en estas áreas, debido a la baja disponibilidad ósea. La técnica más usada y documentada hasta hace unos años era la técnica de elevación de suelo de seno de Tatum mediante ventana lateral. En 1994, Summers propuso una técnica menos invasiva a través de un acceso transcrestal usando un instrumento denominado osteotomo, seguido de la colocación del implante en la misma cirugía. El objetivo de este estudio es analizar la técnica de Summer y los beneficios e inconvenientes encontrados con el uso de material de injerto en dicha técnica., Sinus hyperpneumatization and resorption of the alveolar crest in the posterior maxilla after tooth loss, it makes necessary the need to use regeneration techniques for the placement of dental implants in these areas, due to the low bone availability. The most widely used and documented technique until a few years ago was the Tatum sinus floor elevation technique using a side window. In 1994, Summers proposed a less invasive technique through a transcrestal approach using an instrument called an osteotome, followed by implant placement in the same surgery. The objective of this study is to analyze the Summer technique and the benefits and drawbacks found with the use of graft material in this technique.

Purpose: The aim of this retrospective study was to compare the influence of removing or not removing a prosthesis after regenerative surgery on peri-implant defects. Methods: Two different groups were compared (Group 1: removing the prosthesis; Group 2: maintaining the prosthesis), analyzing radiographic bone filling (n = 32 implants) after regenerative treatment in periapical radiographs. The peri-implant defects were measured before and after regenerative treatment using Bio-Oss® (Geistlich Pharma, Wohhusen, Switzerland) and a reabsorbable collagen membrane (Jason®, Botis, Berlin, Germany), the healing period was two years after peri-implant regenerative surgery. Statistical analysis was performed, and a Chi square test was carried out. To determine the groups that made the difference, corrected standardized Haberman residuals were used, and previously a normality test had been applied; therefore, an ANOVA or Mann–Whitney U test was used for the crossover with the non-normal variables in Group 1 and Group 2. Results: The results obtained suggest that a regenerative procedure with xenograft, resorbable membrane, and detoxifying the implant surface with hydrogen peroxide form a reliable technique to achieve medium-term results, obtaining an average bone gain at a radiographic level of 2.84 mm (±1.78 mm) in patients whose prosthesis was not removed after peri-implant bone regenerative therapy and 2.18 mm (±1.41 mm) in patients whose prosthesis was removed during the healing period. Conclusions: There are no statistically significant differences in the response to treatment when removing or keeping the prosthesis after regenerative surgery in peri-implant defects.

Background: Implant dentistry has evolved over time, resulting in better treatment outcomes for both patients and clinicians. The aim of this trial was to test whether the immediate loading of implants with a platform-switching design influences the marginal bone level, compared to four-week loading, after one year of follow-up. Moreover, a comparison of clinical data regarding implant survival, implant stability, and patient-reported outcome measures (PROMs) was conducted. Methods: Klockner® VEGA® implants with a ContacTi® surface were placed in partially edentulous patients in the posterior areas. Group A received an immediately loaded prosthesis (one week) and Group B received an early-loaded prosthesis (four weeks). All abutments were placed at the time of surgery. Radiographic and clinical data were recorded. Results: Twenty-one patients were treated (35 implants). No implants were lost during the study. The final marginal bone level did not show differences between groups. The bone loss at 12 months at the implant level was 0.00 mm for both groups (median). The final implant quotient stability (ISQ) values did not differ between groups (median 73 and 70.25), nor did the other clinical parameters or PROMs. Conclusions: The results suggest that neither of the loading protocols with the implants used influenced the marginal bone level—not the osseointegration rate, clinical conditions, or PROMs.

Introduction. Digital impressions in implant dentistry rely on many variables, and their accuracy, particularly in complete edentulous patients, is not well understood. Aim. The purpose of this literature review was to determine which factors may influence the accuracy of digital impressions in implant dentistry. Emphasized attention was given to the design of the intra-oral scan body (ISB) and scanning techniques. Materials and methods. A Medline, PubMed and EBSCO Host databases search, complemented by a hand search, was performed in order to select relevant reports regarding the appliance of digital impressions in implant dentistry. The search subject included but was not limited to accuracy of digital impressions in implant dentistry, digital scanning techniques, the design and material of the ISBs, and the depth and angulation of the implant. The related titles and abstracts were screened, and the remaining articles that fulfilled the inclusion criteria were selected for full-text readings. Results. The literature search conducted for this review initially resulted in 108 articles, among which only 21 articles fulfilled the criteria for inclusion. Studies were evaluated according to five subjects: accuracy of digital impressions in implant dentistry; the design and material of the intra-oral scan bodies; scanning technique; the influence of implants depth/angulations on the digital impression and accuracy of different intra-oral scanner devices. Conclusions. The accuracy of digital impressions in implant dentistry depends on several aspects. The depth/angulation of the implant, the experience of the operator, the intra-oral scanner used, and environmental conditions may influence the accuracy of digital impressions in implant dentistry. However, it seems that ISBs’ design and material, as well as scanning technique, have a major impact on the trueness and precision of digital impressions in implant dentistry. Future research is suggested for the better understan

El presente trabajo se trata de un estudio transversal in vitro, realizado en dos tipos diferentes de hueso bovino. El hueso utilizado fue de origen bovino, hueso fresco obtenido en el comercio. Tomando la clasificación de Lekholm y Zarb como modelo, 1985 las dos densidades se dividieron en: o Tipo II: costilla bovina, hueso cortical más grueso y hueso trabecular denso. o Tipo III: parte interna de la rótula, hueso cortical muy fino y hueso trabecular poco denso. En el presente trabajo, los implantes utilizados son del Klockner Implant System, SOADCO S.L. Se utilizaron implantes Klockner VEGA como control y diferentes Prototipos, evolución de los implantes Klockner VEGA y desarrollados en colaboración con el departamento de I + D de la empresa SOADCO. Los Prototipos se desarrollaron en base a propuestas surgidas tras una revisión de la literatura del estado actual del arte, en lo que ha diseño de implantes se refiere, y elaboradas por los integrantes del grupo de trabajo. Los implantes empleados en el estudio son implantes que trabajan a nivel de hueso, tipo bone level, con concepto de cambio de plataforma o platform switching. Son implantes para colocarse idealmente entre 1 y 2 mm infracrestales. La microestructura o superficie de los implantes empleados no se alteró en ninguno de los implantes, manteniendo la superficie original proporcionada por la compañía, superficie ShotBlasting.

According to classic Hirschfeld studies, the first teeth to be lost are the first and second maxillary molars. After the teeth are extracted and the alveolar process is developed, the maxillary sinus is reabsorbed and pneumatized with a decrease in bone availability in the posterior sector of the maxilla. This process often creates the need to perform regeneration techniques for the placement of implants in this area due to the low availability of bone. The most frequently used and documented technique for the elevation of the sinus maxillary floor is elevation by the side window, as proposed by Tatum. In 1994, Summers proposed a technique that allowed the elevation of the sinus floor from a crestal access using an instrument called an osteotome, as well as the placement of the implant in the same surgical act. The aimed of the study was to evaluate the survival of 32 implants placed in posterior maxilla with bone availability less than 5 mm performing a sinus lift augmentation technique with osteotome without biomaterials. The results of this study show a survival rate of 100% for 32 implants placed in situations with an initial bone availability of 2 to 5 mm without the use of graft material. The infra-drilling technique used offers an increase in the primary stability of implants that allows adequate osteointegration Implants placed were charged at 12 weeks. In all cases, spontaneous bone formation was observed, even in cases where a positive Valsalva maneuver was observed. This proposed technique reduces treatment time and the need for more invasive maxillary sinus augmentation techniques.

Purpose: The aim of this retrospective study was to compare the influence of removing or not removing a prosthesis after regenerative surgery on peri-implant defects. Methods: Two different groups were compared (Group 1: removing the prosthesis; Group 2: maintaining the prosthesis), analyzing radiographic bone filling (n = 32 implants) after regenerative treatment in periapical radiographs. The peri-implant defects were measured before and after regenerative treatment using Bio-Oss® (Geistlich Pharma, Wohhusen, Switzerland) and a reabsorbable collagen membrane (Jason®, Botis, Berlin, Germany), the healing period was two years after peri-implant regenerative surgery. Statistical analysis was performed, and a Chi square test was carried out. To determine the groups that made the difference, corrected standardized Haberman residuals were used, and previously a normality test had been applied; therefore, an ANOVA or Mann–Whitney U test was used for the crossover with the non-normal variables in Group 1 and Group 2. Results: The results obtained suggest that a regenerative procedure with xenograft, resorbable membrane, and detoxifying the implant surface with hydrogen peroxide form a reliable technique to achieve medium-term results, obtaining an average bone gain at a radiographic level of 2.84 mm (±1.78 mm) in patients whose prosthesis was not removed after peri-implant bone regenerative therapy and 2.18 mm (±1.41 mm) in patients whose prosthesis was removed during the healing period. Conclusions: There are no statistically significant differences in the response to treatment when removing or keeping the prosthesis after regenerative surgery in peri-implant defects.

Previous studies have shown that the most reliable way to evaluate the success of an implant is by bone-to-implant contact (BIC). Recent techniques allow modifications to the implant surface that improve mechanical and biological characteristics, and also upgrade osseointegration. Objective: The aim was to evaluate the osseointegration in rabbit tibia of two different titanium dental implant surfaces: shot-blasted with Al2O3 (SB) and the same treatment with an acid-etching by immersion for 15 s in HCl/H2SO4 (SB + AE). Material and methods: Roughness parameters (Ra, Rt, and Rz) were determined by white light interferometer microscopy. Surface wettability was evaluated with a contact angle video-based system using water, di-iodomethane, and formamide. Surface free energy was determined by means of Owens and Wendt equations. Scanning electron microscopy equipped with X-ray microanalysis was used to study the morphology and determine the chemical composition of the surfaces. Twenty-four grade 4 titanium dental implants (Essential Klockner®) were implanted in the rabbit’s tibia, 12 for each surface treatment, using six rabbits. Six weeks later the rabbits were sacrificed and the implants were sent for histologic analysis. Resonance frequency analysis (RFA) was recorded both at the time of surgery and the end of the research with each device (Osstell Mentor and Osstell ISQ). Results: The roughness measurements between the two treatments did not show statistically significant differences. However, the effect of the acid etching made the surface slightly more hydrophilic (decreasing contact angle from 74.7 for SB to 64.3 for SB + AE) and it presented a higher surface energy. The bone-to-implant contact ratio (BIC %) showed a similar tendency, with 55.18 ± 15.67 and 59.9 ± 13.15 for SB and SB + AE implants, respectively. After 6 weeks of healing, the SB + AE showed an implant stability quotient (ISQ) value of 76 ± 4.47 and the shot-blasted one an ISQ value of 75.83 ± 8.44 (n

Background: The objective of this study was to measure two parameters involved in tri-dimensional implant plan‑ ning: the position of the buccal and palatal bone wall and the palatal thickness. Methods: Cone beam computed tomography (CBCT) images (Planmeca ProMax 3D) of 403 teeth (208 upper teeth and 195 lower teeth) were obtained from 49 patients referred to the Dental School of Seville from January to Decem‑ ber 2014. The height diference between the palatal and buccal walls was measured on the most coronal point of both walls. The thickness of the palatal wall was measured 2 mm from the most coronal point of the palatal wall. Results: The mean values in the maxilla were 1.7±0.9 mm for central and lateral incisors, 2.2±1.7 mm for canines, 1.6±0.9 mm for premolars and 1.9±1.5 mm for molars. In the lower jaw, the mean values were 1.3±0.8 mm for inci‑ sors, 1.7±1.2 mm for canines, 2.3±1.3 mm for premolars, and 2.6±1.7 mm for molars. In the upper jaw, more than 55% of maxillary teeth (excluding second premolars and molars) presented mean height diferences greater than 1 mm. In the mandible, more than 60% of incisors showed a buccal bone thickness of 1 mm from the apical to lingual aspect. All teeth except the second premolar presented a buccal wall located more than 1 mm more apically than the lingual bone wall. Conclusions: The buccal bone wall is located more apically (greater than 1 mm) than the palatal or lingual table in most of the cases assessed. The thickness of the palatal or lingual table is also less than 2 mm in the maxilla and man‑ dible, except in the upper canines and premolars and the lower molars.

Actualmente, se realizan numerosas cirugías en el área mandibular, realizandose la mayor parte de estas, en pacientes con sectores posteriores atróficos. Esto complica gravemente la cirugía, debido a las importantes estructuras anatómicas mandibulares. En este estudio nos centraremos en el daño del nervio dentario inferior, así como la incidencia de esta lesión, los tipos de lesiones y su posterior tratamiento. Así pues, tras el estudio de la literatura científica, proponemos un protocolo de actuación en base a diferentes artículos examinados., Nowadays, numerous surgeries are performed in the mandibular area, most of which are performed in patients with atrophic posterior sectors. This severely complicates the surgery, due to the important anatomical mandibular structures. In this study, we will focus on the damage of the lower dental nerve, as well as the incidence of this injury, the types of injuries and their subsequent treatment. Thus, after studying the scientific literature, we propose an action protocol based on different articles examined.

El principal objetivo a la hora de fabricar una prótesis implantosoportada es conseguir un buen ajuste pasivo que evite complicaciones biomecánicas, y esta pasividad de ajuste depende en primer lugar de la exactitud de la técnica de impresión. El desarrollo de la tecnología ha hecho que aparezcan nuevos protocolos implanto-protésicos que nos abren otras posibilidades a la hora de enfocar el tratamiento. Es por ello que esta revisión de la bibliografía pretende determinar la existencia de suficiente evidencia científica que muestre si la odontología digital alcanza tal desarrollo como para poder tomar impresiones sobre implantes de forma tan o más precisa que con la toma de impresión convencional. Tras examinar los artículos que mostraban relación con el tema y cumplían los criterios de inclusión y exclusión, se llegó a la conclusión de que las impresiones digitales parecen ser un procedimiento preciso como alternativa a las impresiones convencionales. A pesar de ello, son necesarios más estudios que tengan en cuenta todos los factores que pueden alterar esta precisión, así como que combinen las técnicas de impresión convencionales y digitales para generar unas conclusiones y directrices decisivas., The main objective when fabricating an implant-supported prosthesis is to achieve a good passive fit that avoids biomechanical complications, and it depends mainly on the accuracy of the impression technique. The technology development has led to the emergence of new implant-prosthetic protocols that open up other possibilities when it comes to approaching treatment. This is why this review of the literature aims to determine the existence of sufficient scientific evidence to show whether digital dentistry has developed to the point where impressions can be taken on implants as accurately or more accurately than with conventional impression techniques. After examining the articles that were relevant to the topic and met the inclusion and exclusion criteria, we concluded that digital impressions seem to be an accurate procedure as an alternative to conventional impressions. Nevertheless, more studies are needed which take into account all factors that may alter this accuracy, as well as combine conventional and digital impression techniques to generate decisive conclusions and guidelines.

La evolución sufrida en los últimos años en Odontología tanto de instrumentos, nuevas tecnologías e incluso técnicas nos obliga a realizar estudios constantes poniendo en duda tela de juicio las técnicas convencionales usadas habitualmente, más aún en ramas de la Odontología como Implantología en las que resulta fundamental una planificación previa de las actuaciones, teniendo en cuenta las ventajas e inconvenientes de cada una de ellas. Debido a esto, el objetivo de nuestro estudio es valorar la altura residual inicial óptima para realizar una técnica de elevación de seno u otra, teniendo en cuenta las connotaciones económicas y complicaciones intra y postoperatorias. Como resultado de nuestra búsqueda hemos obtenido un total de 5 artículos válidos que se centran en el tema de nuestra revisión, por los cuales podemos predecir que no hay un consenso en cuanto a la cifra exacta de mm que delimiten la realización de una técnica u otra, sino que depende de la experiencia del operador y habría que sopesar otros factores tales como las complicaciones asumidas al realizar la técnica de ventana lateral y el mayor nivel de complejidad quirúrgica de esta. Cabe destacar también que no hay una relación significativa entre la altura ósea residual inicial y la supervivencia del implante., The evolution in last years in Dentistry of both instruments, new technologies and even techniques obliges us to carry out constant studies calling into question the conventional techniques commonly used, especially in branches of Dentistry as Implantology in which it is essential a prior planning of the actions, taking into account the advantages and disadvantages of each one of them. Due to this, the objective of our study is to assess the optimal initial residual bone height to perform a breast lift technique or another, taking into account the economic connotations and intra and postoperative complications. As a result of our search we have obtained a total of 5 valid articles that focus on the subject of our review, by which we can predict that there is no consensus as to the exact number of mm that delimit the performance of one technique or another, but it depends on the experience of the operator and we would have to weigh other factor such as the complications assumed when performing the side window technique and the higher level of surgical complexity. It should also be noted that there is no significant relationship between initial residual bone height and implant survival.

Introduction: Different implant–abutment connections have been developed to reduce mechanical and biological failure. The most frequent complications are loss of preload, screw loosening, abutment or implant fracture, deformations at the different interfaces, and bacterial microleakage. Aim: To review the evidence indicating whether the implant–abutment connection type is significant regarding the following issues: (1) maintenance of the preload in static and dynamic in vitro studies; (2) assessment of possible deformations at the implant–abutment interfaces, after repeated application of the tightening torque; (3) evaluation of the sealing capability of different implant connections against microleakage. Materials and Methods: In June 2020, an electronic literature search was performed in Medline, EBSCO host, and PubMed databases. The search was focused on the ability of different implant connections to maintain preload, resist deformation after tightening and retightening, and prevent microleakage. The related titles and abstracts available in English were screened, and the articles that fulfilled the inclusion criteria were selected for full-text reading. Results: The literature search conducted for this review initially resulted in 68 articles, among which 19 articles and 1 systematic review fulfilled the criteria for inclusion. The studies were divided according to the three proposed objectives, with some studies falling into more than one category (maintenance of preload, surface abutment–implant deformation, and resistance to microleakage). Conclusions: Conical abutment appears to result in fewer mechanical complications, such as screw loosening or fractures, and higher torque preservation. After SEM evaluation, damage was observed in the threads of the abutment screws, before and after loading in internal and external connections. Internal hexagon implants and predominantly internal conical (Morse taper) implants showed less microleakage in dynamic loading c

Desde los inicios de la cirugía implantológica, se ha recomendado excluir a ciertos pacientes con problemas de salud, lo cual viene a ser un inconveniente al encontrarnos ante una sociedad cada vez más envejecida y con un aumento de enfermedades que, gracias a los avances de la medicina, se cronifican en el tiempo. Es por ello que esta revisión de la bibliografía pretende determinar la existencia de suficiente evidencia científica que muestre el comportamiento de los implantes dentales colocados en pacientes diabéticos, al ser esta una de las enfermedades crónicas de mayor prevalencia en nuestra sociedad, y al ser conscientes de su estrecha relación con numerosas manifestaciones y complicaciones orales. Tras examinar los artículos que mostraban relación con el tema y cumplían los criterios de inclusión y exclusión, se llegó a la conclusión de que el tratamiento con implantes en pacientes diabéticos parece ser predecible, con altas tasas de supervivencia en pacientes con diabetes bien controlada. A pesar de ello, para establecer una relación más clara entre la diabetes mellitus y el comportamiento de los implantes dentales colocados en estos pacientes, se necesita un mayor número de estudios clínicos a largo plazo., Since the beginning of implant surgery, it has been recommended to exclude patients with bad health, which becomes a problem as we find an aging society with an increase in chronic diseases. This is why this review of the literature aims to determine the existence of sufficient scientific evidence to show the behaviour of dental implants placed in diabetic patients, as this is one of the most prevalent chronic diseases in our society, and to be aware of its close relationship with numerous oral manifestations and complications. After analyzing the articles that were relevant to the topic and met the inclusion and exclusion criteria, we concluded that implant treatment in diabetic patients seems to be predictable, with high survival rates in patients with well-controlled diabetes. However, to establish a clearer relationship between diabetes mellitus and the behaviour of dental implants placed in these patients, a larger number of longer-term clinical studies are needed.

Los implantes dentales han supuesto una revolución a la hora de enfocar las diferentes alternativas de tratamiento de nuestros pacientes. Su uso ha permitido mejorar la calidad de vida de muchas personas, sin embargo, al aumentar el número de implantes, también lo han hecho el número de casos de complicaciones; pudiendo clasificarse estas como complicaciones biológicas y complicaciones relacionadas con el material. En este estudio nos centraremos en una de las complicaciones relacionadas con el material más grave en la actualidad: las fractura de los implante en relación a sus componentes, con el objetivo de establecer unos criterios clínicos para su prevención, diagnóstico y manejo, así como mejorar la capacidad terapéutica en la toma de decisiones para decantarse por un tipo u otro de implante en base a sus características., Dental implants have been a revolution when it comes to focusing on the different treatment alternatives of our patients. Its use has improved the quality of life of many people, however, by increasing the number of implants, so have the number of cases of complications; These can be classified as biological complications and complications related to the material. In this study we will focus on one of the complications related to the most serious material at present: fractures of the implant in relation to its components, with the aim of establishing clinical criteria for prevention, diagnosis and management, as well as improving The therapeutic capacity in decision making to opt for one type or another of implant based on its characteristics

Hoy día, la creciente demanda de rehabilitación de perdidas dentarias mediante implantes, ha supuesto el desarrollo de técnicas que permiten su colocación en pacientes que, por pérdida del volumen óseo alveolar, no se consideraban candidatos aptos para dicho tratamiento. La finalidad de esta revisión bibliográfica es la comparación hasta la fecha entre los tiempos de regeneración ósea previa y simultánea a la colocación de implantes, para comprobar si existe evidencia científica que demuestre si hay diferencias en los resultados de ambas técnicas, además de las ventajas, inconvenientes e indicaciones de cada una. Para la elaboración de este trabajo se han tenido en cuenta estudios publicados en los últimos 10 años, incluyendo exclusivamente estudios de metaanálisis, ensayos clínicos aleatorizados y revisiones sistemáticas; filtrando las búsquedas, limitándolas a aquellos estudios realizados en humanos y descartando aquellos basados en animales., Nowadays, the growing demand for rehabilitation of lost teeth by dental implants has led us to develop techniques to allow implant placement in patients who were not considered suitable candidates for such treatment, due to the deficit of bone volume for their placement. The aim of this bibliographic review is to compare the bone regeneration timing in order to test whether there is scientific evidence to prove if there are differences between bone regeneration prior and simultaneous to implant placement. Also, the advantages, disadvantages and the indications of each technique. For the elaboration of this review, we have considered exclusively meta-analysis studies, randomized clinical trials and systematic reviews published in the last 10 years. Only human studies were contemplated, excluding those carried out in animals.

Los implantes colocados en el maxilar posterior con frecuencia necesitan alguna cirugía adicional de ganancia ósea para poder ser ejecutada con éxito. Uno de los procedimientos más comunes es la elevación sinusal transcrestal, sin embargo, existen diferentes protocolos a la hora de llevarla a cabo y genera controversia o no el uso de materiales de injerto simultáneos a la elevación. En este estudio clínico prospectivo aleatorizado en humanos, se realizan un total de 49 elevaciones transcrestales en 49 pacientes diferentes, quedando repartidos en grupo control (sin injerto, 25 pacientes) y grupo test (con injerto, 24 pacientes). Las variables analizadas fueron obtenidas a través de ortopantomografías digitales desde el día 0 (día de la cirugía) hasta 18 meses tras la cirugía. Estas mediciones muestran cierta tendencia a una mayor ganancia ósea vertical en el grupo test, sin embargo, no existen diferencias estadísticamente significativas entre ambos grupos. Por lo tanto, teniendo en cuenta que la elevación sin injerto es un tratamiento exitoso y con menos complicaciones, es necesario una valoración critica en cuanto a la necesidad del uso de estos biomateriales., Implants inserted in the posterior maxilla frequently need additional surgery for successful bone augmentation. One of the most common procedures for this is transalveolar sinus floor elevation. There are different protocols for this procedure, and there is controversy over the simultaneous application of grafting material upon elevating. In this prospective randomized clinical study in humans, a total of 49 transalveolar sinus floor elevations were performed in 49 different patients, divided into a control group (without graft, 25 patients) and a test group (with graft, 24 patients). The analysed variables were obtained through digital orthopantomography on day 0 (day of surgery) and 18 months after surgery. These measurements showed a tendency towards greater vertical bone gain in the test group, but this was not statistically significant. Therefore, considering that sinus elevation and implant placement without the application of grafts is a successful treatment with fewer complications, a critical assessment of the need for these biomaterials is necessary.

Se realiza un estudio prospectivo en modelo animal para analizar y evaluar la osteointegración ósea de 4 prototipos de implantes dentales (Klockner VEGA) con diferentes diseños de cuello colocados a nivel óseo, con el propósito de determinar la geometría más adecuada que asegure un mejor mantenimiento del hueso crestal. Dicha evaluación se realizará mediante un doble procedimiento: análisis histomorfométrico (a las 3 y 6 semanas) valorando el porcentaje de contacto hueso-implante que ocurre en cada uno de los diferentes diseños de los prototipos de implante,s con el fin de determinar el diseño de cuello de implante ideal. Igualmente, se analizó la estabilidad de los implantes mediante análisis de frecuencia de resonancia (AFR- Osstell), en el momento de la colocación, a las tres y a las seis semanas, intentando correlacionar los valores AFR con el porcentaje de contacto hueso-implante obtenidos. Se obtuvieron las siguientes conclusiones: El tiempo transcurrido tras la implantación es determinante en la respuesta ósea circundante, encontrándose mayores niveles de BIC a las seis que a las tres semanas (en todos los diseños de cuello). La misma tendencia se detectó en AFR. El diseño de tres espiras y el liso son los que obtienen niveles más elevados de BIC a las seis semanas. En un estudio paralelo y complementario a nuestro trabajo, basado en elementos finitos, muestran que el prototipo de tres espiras proporciona menores valores de tensión, pudiendo reducir la reabsorción ósea del tejido circundante y por lo tanto le otorga un mejor comportamiento en la osteointegración. Considerando el criterio histomorfométrico de nuestro estudio, junto con el comportamiento mecánico descrito en la conclusión anterior, consideramos el diseño del implante con tres espiras en el cuello la mejor opción al obtener el mayor compromiso entre niveles altos de BIC y el soporte de esfuerzos tensionales. OBJETIVO PRINCIPAL: - Valorar mediante estudio histomorfométrico (a las tres y seis se

Post-extractional implants and immediate loading protocols are becoming much more frequent in everyday clinical practice. Given the existing literature about tapered implants, the objective of this paper was to understand whether implant shape had a direct influence on the results of the insertion torque (IT) and implant stability quotient (ISQ). Seven tapered implant prototypes were developed and distributed into three groups and compared with a control cylindrical implant—VEGA by Klockner Implant System. The implants were inserted into bovine bone type III according to Lekholm and Zarb Classification. The sample size was n = 30 for the three groups. Final IT was measured with a torquemeter, and the ISQ was measured with Penguin Resonance Frequency Analysis (RFA). Modifications done to the Prototype I did not reveal higher values of the ISQ and IT when compared to VEGA. In the second group, when comparing the five prototypes (II–VI) with VEGA, it was seen that the values of the ISQ and IT were not always higher, but there were two values of the ISQ that were statistically significantly higher with the 4.0 mm diameter Prototypes II (76.3 ± 6.1) and IV (78 ± 3.7). Prototype VII was the one with higher and significant values of the ISQ and IT. In both diameters and in both variables, all differences were statistically significant enough to achieve the higher values of primary stability values (IT and ISQ). Given the limitations of this study, it can be concluded that when there is an increase of the diameter of the implant and body taper, there is an increase of the ISQ and IT, showing that the diameter of the implant is an important criteria to obtain higher values of primary stability.

Implants inserted in the posterior maxilla frequently need additional surgery for successful bone augmentation. One of the most common procedures for this is transalveolar sinus floor elevation. There are di erent protocols for this procedure, and there is controversy over the simultaneous application of grafting material upon elevating. In this prospective randomized clinical study in humans, a total of 49 transalveolar sinus floor elevations were performed in 49 di erent patients, divided into a control group (without graft, 25 patients) and a test group (with graft, 24 patients). The analyzed variables were obtained through digital orthopantomography on day 0 (day of surgery) and 18 months after surgery. These measurements showed a tendency towards greater vertical bone gain in the test group, but this was not statistically significant. Therefore, considering that sinus elevation and implant placement without the application of grafts is a successful treatment with fewer complications, a critical assessment of the need for these biomaterials is necessary.

The aim of this study was to evaluate the effects of different implant sites an under-preparation sequence associated with two different implant designs on implant primary stability measured by two parameters: insertion torque (IT) and implant stability quotient (ISQ). It used two different implants: one cylindrical as a control and another one with a tapered design. The implants were inserted in type III fresh humid bovine bone and four drilling sequences were used: one control, the one proposed by the implant company (P1), and three different undersized (P2, P3 and P4). P2 was the same as P1 without the cortical drill, P3 was without the last pilot drill and P4 was without both of them. The sample size was n = 40 for each of the eight groups. Final IT was measured with a torquemeter and the ISQ was measured with Penguin resonance frequency analysis. Results showed that both ISQ and IT have a tendency to increase as the preparation technique reduces the implant site diameter when compared with the standard preparation, P1. The preparations without cortical drill, P2 and P4, showed the best results when compared with the ones with a cortical drill. Tapered implants always showed higher or the same ISQ and IT values when compared with the cylindrical implants. Giving the limitations of this study, it can be concluded that reducing implant preparation can increase IT and ISQ values. Removing the cortical drill and the use of a tapered design implant are also effective methods of increasing primary implant stability.

The aim of this study was to evaluate the changes in periodontal parameters solely using free gingival grafts during orthodontic treatment without any oral hygiene re-enforcement. Methods: A total of 19 patients underwent periodontal examination before orthodontic treatment. Patients received oral hygiene instruction and professional hygiene therapy. Where needed; full periodontal treatment was completed. Only periodontally stable patients were included in the study. Periodontal indices and keratinized tissue were recorded at time 0 (T0) (delivery of orthodontic appliances), and at three months (T1) during orthodontic therapy; when surgery was performed. At T1; orthodontically treated sites with minimum keratinized tissue (≤1 mm) received a free gingival graft to enhance the band of keratinized tissue. At three months after surgery (T2), new measurements were recorded. The orthodontics-treated sites after three months (T1) were used as control. The same sites were used as a test three months after mucogingival correction (T2). Between T1 and T2; orthodontics was suspended; no professional oral hygiene was performed; and no additional oral hygiene instructions were given to the patient. No oral hygiene procedures were administered for 15 months (T3), when the final recordings were taken. Results: The results showed that there was a worsening of gingival index (GI) and plaque index (PI) of the treated sites between T0 and T1 during initial orthodontics treatment; whereas there was an improvement of the gingival inflammation at T2 when compared with T1. At T2; there was also a statistically significant improvement in GI and PI compared with T0. A T3 improvement in periodontal parameters was sustained. A non-parametric test (Wilcoxon signed-rank test) was used for statistical analysis. Conclusions: Augmentation of the width of keratinized gingiva; as the sole treatment; favors the improvement of GI and PI during orthodontic therapy

Aim: (PRIMARY) Assess the changes in bone level (6 and 12 months after implant placement) between the test (definitive abutment (DEF)) and control (healing abutment (HEA)) groups. (SECONDARY) Assess the changes in bone level (6 and 12 months after implant placement) between the 1 mm high abutment group and 2 mm abutment group. Evaluate changes in implant stability recorded with analysis of the resonance frequency (RFA) Osstell system, at 6 and 12 months after implant placement, between the control group (HEA) and test (DEF). For the DEF group, the abutment was placed at the time of the surgery and was never removed. For the HEA group, the abutment was removed three times during the manufacture of the crowns. The abutments used were 1 mm high (Subgroup A) and 2 mm high (Subgroup B). Materials and methods: A total of 147 patients were selected between 54.82 ± 11.92 years old. After implant placement, patients were randomly distributed in the DEF and HEA group. After the implant placement, a periapical radiograph was taken to assess the peri-implant bone level; the same procedure was carried out 6 and 12 months post-placement. To compare the qualitative variables between the groups (HEA/DEF), the Chi-square test was used; for quantitative (MANOVA). Results: After a year, the accumulated bone loss was 0.48 ± 0.71 mm for the HEA group and 0.36 ± 0.79 mm for the DEF group, without statistical significance. Differences were only found due to timing (time) between 0 and 6 months (=0.001) and 0 and 12 months (0.001), with no differences attributable to the study groups (DEF and HEA). The accumulated bone loss (1 year) was 0.45 ± 0.78 mm for the 1 mm abutment group and 0.41 ± 0.70 mm for the 2 mm abutment group (p = 0.02). No differences were observed in implant stability between groups. Conclusions: The “One Abutment—One Time” concept does not reduce peri-implant bone loss compared to the connection–disconnection technique. The height of the abutment does influence bone loss

Resonance frequency analysis (RFA) requires abutment disconnection to monitor implant stability. To overcome this limitation, an experimental transepithelial abutment was designed to allow a SmartPeg to be screwed onto it, in order to determine the prototype abutments repeatability and reproducibility using Osstell ISQ and to assess whether implant length and diameter have an influence on the reliability of these measurements. RFA was conducted with a SmartPeg screwed directly into the implant and onto experimental abutments of different heights of 2, 3.5 and 5 mm. A total of 32 patients (116 implants) were tested. RFA measurements were taken twice for each group from mesial, distal, buccal and palatal/lingual surfaces. Mean values and SD were calculated and Intraclass Correlation Coefficients (ICC) (p < 0.05, IC 95%). The implant stability quotient (ISQ) mean values were 72.581 measured directly to implant and 72.899 (2 mm), 72.391 (3.5 mm) and 71.458 (5 mm) measured from the prototypes. ICC between measurements made directly to implant and through 2-, 3.5- and 5-mm abutments were 0.908, 0.919 and 0.939, respectively. RFA values registered through the experimental transepithelial abutments achieved a high reliability. Neither the implant length nor the diameter had any influence on the measurements’ reliability.

The aim of this study was to compare the quality of different computer-assisted-design and computer assisted manufacturing systems (CAD-CAM) generated by only one scanner, focusing on vertical fit discrepancies and the mechanical properties. A master model was obtained from a real clinical situation: the replacement of an absent (pontic) tooth, with the construction of a fixed partial denture on natural abutments with three elements. Nine scans were performed by each tested and 36 copies were designed using a dental CAD-CAM software (Exocad). The frameworks were manufactured using three-axis and five-axis, with the same batch of the chrome-cobalt (CrCo) alloy. The frameworks were not cemented. A focus ion beam-high resolution scanning electron microscope (FIB-HRSEM) allowed us to obtain the vertical gap measurements in five points for each specimen. Roughness parameters were measured using white light interferometry (WLI). The samples were mechanically characterized by means of flexural tests. A servo-hydraulic testing machine was used with a cross-head rate of 1 mm/min. One-way ANOVA statistical analysis was performed to determine whether the vertical discrepancies and mechanical properties were significantly different between each group (significance level p < 0.05). The overall mean marginal gap values ranged: from 92.38 ± 19.24 µm to 19.46 ± 10.20 µm, for the samples produced by three-axis and five-axis machines, respectively. Roughness was lower in the five-axis machine than the three-axis one, and as a consequence, the surface quality was better when the five-axis machine was used. These results revealed a statistically significant difference (p < 0.005) in the mean marginal gap between the CAD-CAM systems studied. The flexural strength for these restorations range from 6500 to 7000 N, and does not present any statistical differences’ significance between two CAD-CAM systems studied. This contribution suggests that the number of axes improves vertical fit and

Numerous randomised controlled multicentric studies have investigated various responses to different treatment modalities with dental implants. These studies do not always show the results of daily practice as they are performed under controlled and strict clinical conditions. This multicentric, non-interventionist trial aimed to document the behaviour of implants when used in daily dental practice, without inclusion or exclusion criteria. One hundred and ninety-six screw-shaped, tissue-level implants were placed, and each clinician decided which implant, surgical loading and prosthetic protocol to use. At surgery, data related to the implants were recorded. Additionally, the crestal bone level changes were evaluated for up to two years of follow-up. Two implants were lost before they were loaded. The success rate was 98.31%, and the survival rate was 98.79%. The implant stability quotient (ISQ) at surgery was 68.61 ± 10.35 and at 2 years was 74.39 ± 9.64. The crestal–shoulder distances were 1.25 ± 1.09 mm and 1.68 ± 1.07 mm in the mesial and distal aspects on the day of surgery, respectively, and 2.04 ± 0.91 and 2.16 ± 0.99 mm at 2 years, respectively. At 2 years, 69.3% of the patients were highly satisfied. The use of implants under standard conditions seemed to have success rates similar to their placement in controlled studies.

Actualmente, un acto muy común en nuestra práctica odontológica es monitorizar la estabilidad implantaria tanto en el momento de colocación del implante, como posteriormente, durante el período de cicatrización y con la prótesis en función. El Análisis de Frecuencia de Resonancia (AFR) es un método no invasivo, sencillo y clínicamente aplicable que nos permite evaluar la rigidez de la interfase implante-hueso. El AFR lo podemos medir directamente en la plataforma del implante o a través de unos nuevos pilares customizados que permiten valorarlo de forma indirecta, simplificando el procedimiento clínico y ayudando a preservar los tejidos blandos y duros al evitar la continua desconexión-conexión del pilar de cicatrización. En este trabajo el objetivo es revisar la literatura publicada hasta la fecha para demostrar si son comparables los valores ISQ obtenidos al medir el AFR de forma directa en la plataforma del implante versus el AFR medido con los pilares de cicatrización. Se concluye que no existe suficiente evidencia científica que demuestre este hecho. Los resultados de esta revisión deben ser interpretados con cautela debido a la alta heterogeneidad de los mismos, siendo necesarios más estudios que nos permitan obtener resultados concluyentes., Nowadays it is a very common act in our dental practice to monitor implant stability when placing the implant, but also later, during the healing period and with the prosthesis functioning. Resonance Frequency Analysis (RFA) is a non-invasive, simple and clinically applicable method that allows us to evaluate the rigidity of the implantbone interface. RFA can be measured directly on the implant platform or through new customized abutments that allow to assess it indirectly, simplifying this way the clinical procedure and helping to preserve soft and hard tissues by avoiding the continuous disconnection-connection of the healing abutment. In this work, the objective is to review the literature that has been published so far in order to demonstrate if the ISQ values obtained by measuring the RFA directly on the implant platform are comparable versus the RFA measured with the healing abutments. It is concluded that there is not enough scientific evidence to demonstrate this fact. The results of this review should be interpreted with caution due to their high heterogeneity, and further studies to obtain conclusive results are necessary

El incesante crecimiento de la población portadora de prótesis completa, así como la demanda por una mejor retención, estabilidad y menor molestias de la prótesis ante la continua reabsorción de la cresta alveolar residual, conduce a buscar alternativas de tratamiento más viables para pacientes edéntulos. Esto sería el uso de sobredentaduras mandibulares retenidas por implantes de diámetro estrecho. Es por ello que nos disponemos a valorar la evidencia científica del uso de implantes de diámetro reducido sometidos a protocolos de carga inmediata en sobredentadura mandibular. Tras la búsqueda realizada, se localizaron artículos que aceptaban la evidencia científica de carga inmediata en mini implantes dentales, aportando una supervivencia por encima del 90%. En cambio, también constan datos de complicaciones biológicas que figuraban en torno a un 6%, mientras que las complicaciones biomecánicas aparecían en un 13% aproximadamente. Existe evidencia científica que justifica el uso de protocolos de carga inmediata en sobredentadura mandibular retenida por implantes de diámetro reducido., The unceasing growth of the population carrying a complete prosthesis, as well as the demand for better retention, stability and minor discomfort of the prosthesis facing the continuous resorption of the alveolar residual crest, leads to a more viable search of treatment alternatives for edentulous patients. This would be the use of mandibular overdentures retained by narrow diameter implants. That is why we are up to assess the scientific evidence of the use of narrow diameter implants placed with immediate loading protocols in mandibular overdentures. After the search made, articles that accepted the scientific evidence of immediate loading in mini dental implants were found, providing a survival rate above 90%. On the other hand, there is also data on biological complications that were around 6%, while biomechanical complications appeared in a 13% approximately. There is scientific evidence that justifies the use of immediate loading protocols in mandibular overdentures retained by narrow dental implants.

Actualmente, la implantología se ha convertido en un tratamiento con una alta demanda en las clínicas dentales. Además, con el avance de la tecnología, las nuevas técnicas de imagen y la fabricación de prótesis asistida por ordenador, la implantología ha evolucionado mucho en los últimos años. De ésta manera ha surgido la implantología guiada asistida por ordenador, con la que se puede planificar la colocación de implantes de manera virtual. El objetivo de la presente revisión bibliográfica es analizar la efectividad y aplicaciones de la técnica, así como sus ventajas e inconvenientes. La técnica de implantología guiada proporciona un postoperatorio con menos molestias para el paciente, además, las mejoras que ha experimentado en los últimos años, han conseguido un alto grado de precisión. No obstante, sigue presentando errores derivados de la planificación y la propia técnica quirúrgica, por lo que habrá que respetar un margen de seguridad., Nowadays, implantology has become a treatment with a high demand in dental clinics. In addition, with the advance of technology, new imaging techniques and computer-assisted prosthetic manufacturing, implantology has evolved a lot in recent years. This has led to the emergence of computer-guided implantology, with which implant placement can be planned virtually. The objective of this literature review is to analyze the effectiveness and applications of the technique, as well as its advantages and disadvantages. The guided implantology technique provides a postoperative period with less discomfort for the patient, and the improvements it has experienced in recent years have achieved a high degree of precision. Nevertheless, it still presents errors derived from the planning and the surgical technique itself, so a margin of safety must be respected.

As immediate loading protocols are becoming more frequent, the primary stability of implants has become an essential criterion for the osseointegration of dental implants. Based on this, the objective of this study was to understand the influence of different undersized surgical preparation sites on the insertion torque (IT) and implant stability quotient (ISQ). Four different site-preparation protocols were performed on fresh humid type III bovine bone: one control, the standard protocol recommended by the manufacturer (P1), and three variations of undersized techniques (P2, P3 and P4). The implant used was VEGA by Klockner Implant System. The sample size was n = 40 for each of the four groups. A torquemeter was used to measure the IT, and the ISQ was measured with a Penguin RFA. Both variables showed a tendency to increase as the preparation technique was reduced, although not all the values were statistically significant (p < 0.05) when comparing with the standard preparation. The preparations without a cortical drill, P2 and P4, showed better results than those with a cortical drill. Given the limitations of this study, it can be concluded that reducing the implant preparation can increase both the IT and ISQ. Removing the cortical drill is an effective method for increasing implant stability, although it should be used carefully.

Implant design evolved alongside the development of implant therapy. The purpose of this finite element analysis (FEA) study was to analyze the influence of different implant designs on the stress and strain distribution to the implants and surrounding bone. Three implant designs with the same length and diameter were used. The three-dimensional geometry of the bone was simulated with a cortical bone of three different thicknesses and two medullar bone densities: low density (150 Hounsfield units) and high density (850 Hounsfield units). A 30° oblique load of 150 N was applied to the implant restoration. Displacement and stress (von Mises) results were obtained for bone and dental implants. The strain and stress distributions to the bone were higher for the tissue-level implant for all types of bone. The maximum principal strain and stress decreased with an increase in cortical bone thickness for both cancellous bone densities. The distribution of the load was concentrated at the coronal portion of the bone and implants. All implants showed a good distribution of forces for non-axial loads, with higher forces concentrated at the crestal region of the bone–implant interface. Decrease in medullar bone density negatively affects the strain and stress produced by the implants.

Background: Assess the reliability (by means of reproducibility and repeatability) of the PenguinRFA system, analyse the ISQ values of different implant types and correlate the ISQ with the insertion torque during the place ment of the implant. Material and Methods: 120 rough surface implants were placed in bovine bone (type II and III). The implants were divided into groups, according to its design. Once the implants were in place, the exact insertion torque was regis tered. Then, primary stability was measured by means of the resonance frequency analysis with the PenguinRFA and the Osstell ISQ devices. In each implant two transducers of each device were used. Three measurements were obtained with each transducer. Results: The mean ISQ (implant stability quotient) of the whole sample is 67,70 ± 5,51. The Intraclass Correlation Coefficient (ICC) is 0,933 and 0,944 for transducers 1 and 2 respectively. The reproducibility is 0,906. The mean insertion torque is 24,54 ± 8,96N. The correlation between the ISQ and the insertion torque is 0,507 p<0,000 (MultiPeg 1) and 0,468 p<0,000 (MultiPeg 2) for bone type II and 0,533 p<0,801 (MultiPeg 1) and 0,193 p<0,140 (MultiPeg 2) for bone type III. Conclusions: The results of the present trial suggest that the PenguinRFA presents excellent reproducibility and re peatability, so it could be very useful in the monitoring of the stability of implants over time. Additionally, according to the results, the correlation between the IT and the RFA is low and there are no statistically significant differences in between implant types.