Peri Implant Aesthetics - An Integrated Review

BACKGROUND Aesthetic dentistry is making its own new position in current scenario. The aesthetic desire of patient has become need of an hour and it is essential for dental practitioner to understand the aesthetics of implants. For planning of implants in anterior region, overall general health of patient should be considered including systemic health, good oral hygiene practice and good compliance of patients. The peri-implant aesthetics is determined by two components - soft tissue and hard tissue, which includes bone and gingiva. Modifications refining the tissues around implant can enhance the aesthetics. Treatment protocol should include pre-planning of all functional and aesthetic considerations which should be discussed to patients as well prior to preceding treatment of implant. Judicious understanding of these factors can not only provide physical integrity of tissue but also prevent future aesthetics and implant failure. Implants in anterior region become challenging for clinicians to emulate what nature has provided. The harmonious relationship between functional stability and peri-implant soft tissue becomes an essential requisite for successful endosseous implant so as to attain proper facial aesthetics. Visualization of aesthetics related to implants is a complex phenomenon which requires utilization of multidisciplinary approach including prosthetic and periodontal consideration as the implant position as well implant abutment junction if placed at improper position can cause bone resorption. Compiling this, comprehensive knowledge regarding soft and hard tissue can help dentists to integrate a balance between the smile and face of an individual. This review article is a detailed endeavour to explore peri-implant aesthetics. KEY WORDS Crestal Bone, Dental Aesthetics, Gingiva, Peri-Implant Aesthetics

Evaluation of hybrid implant in posterior edentulous maxilla with inadequate bone

Aim of this study is to investigate.Hybrid implant has got satisfactory results in our previous study in various edentulous areas with inadequate bone for endosseous implant placement .The credibility of the implant in the areas of posterior maxilla needed to be evaluated.Objectives• To evaluate the hybrid implant postoperatively 18 months for gingival status, pain, peri-implantitis and mobility, so that it can be applied in posterior maxillary edentulous spaces with inadequate bone as an alternative to conventional implant.Materials and methods15 patients were rehabilitated in the posterior edentulous areas with hybrid implant. we intended to study the rehabilitation of posterior maxillary edentulous space i.e. Maxillary- premolar, 1st molar and 2nd molar area with hybrid implant and evaluate the hybrid implant post operatively for 18months (1stmonth, 3rd month, 6th month ,12 th month,18thmonth).Results• During the study period the implant system presented with no gingivitis, peri-implantitis, and pain.• The periotest test values show the implant system to be very much stable.• Also proves to be safe, economical and clinician and patient friendly compared to other implant systems.Conclusion• Hybrid implant system proves to be very effective in rehabilitating the posterior maxillary regions with inadequate bone.• Also proves to be safe, economical and clinician and patient friendly compared to other implant systems.

Fatigue Evaluation of a New Two-Piece Dental Implant, Having a Replaceable Titanium Sleeve

A new two-piece dental implant, having a replaceable thin titanium sleeve in its 5mm crestal part was designed. The use of a sleeve of near 0.2mm thickness reduces implant diameter by 0.4mm. Narrower diameter implants may increase the likelihood of component fracture in dental implant systems. 14 two-piece dental implants, with 25° abutment angle were subjected to a dynamic fatigue test according to DIN EN ISO 14801. The highest load at which a runout (non-failure) occurred at 5x106 cycles, amounted to 575 N. According to DIN EN ISO 14801, this load level was confirmed with n=3 samples. The Wöhler curve was determined. Accordingly, the runout at 106 cycles can be anticipated as 625N. The new two-piece Implant B™ design using a 0.2 mm sleeve is compatible with the DIN EN ISO 14801 standard for dimensions of 4.2mm diameter and 13mm length. It withstands dynamic fatigue test at least as good as any other standard endosseous implant.

Evaluation of Stress Transfer at Bone Implant Interface in Emulate Implant and Conventional Endosseous Implant: A Comparative 3-D Finite Element Analysis Study

Aim: Aim of this study was to evaluate and compare stress transfer at bone implant interface in customized root form implant and conventional endosseous implant. Materials and methodology: A three-dimensional finite element model of Emulate implant and conventional endosseous implant (nobel active 4.2X11.5mm) was generated. The implants were restored with metal ceramic crown and subjected to 20 Mpa of axial applied stress. Resolved stresses were examined at four heights along the implant bone interface. Results: In conventional endosseous implant with 100 % osseointegration higher stresses (1.01-0.12 MPa) were concentrated on the facial surface of crest of implant. The stresses decreased from junction of cortical bone and trabecular bone to the apex of implant (0.36 – 0.12 MPa). The maximum stresses on emulate implant with 100 % osseointegration were at the facial surface of the crest of implant (0.05 MPa) which were comparatively lesser than conventional endosseous implant (1.01 MPa). Conclusion: The degree of osseointegration affected the stress levels or distributions around both implants. Crestal stresses were always higher than apical stress. When the implants were 100% osseointegrated, then stresses were higher on conventional endosseous implant while in case of 50% osseointegration, stresses were higher on emulate implant.

Surface characteristics of titanium dental implants with improved microdesigns: An in vivo study of their osseointegration performance in goat mandible

Current trends in endosseous implant research are focused on the modification of microdesign of implants to achieve early and strong osseointegration. This study compares the influence of zinc doped hydroxyapatite (ZnHAp) coated, hydrothermally treated (HT) and machined Ti6Al4V (control) implants on osseointegration. The surface characterisation and microbial affinity test for implants were performed. Twenty seven (27) cylinders (3 types in each animal) were placed in the mandible of 9 black Bengal goats. Bone-implant interface was examined with histological, radiological parameters and scanning electron microscopy at 6, 12, and 24 weeks post-implantation. Surface roughness alterations of bone-separated implants were analysed by non-contact profilometer with time. The ZnHAp coated implants revealed direct and early bone-implant contact but high bacterial adherence and coating cracks. Low bacterial affinity and early strong bony integration was observed with HT implants. Poor bacterial affinity and delayed but strong fixation was evident with control implants. Based on the results of laboratory and animal experiments, we conclude that the hydrothermal modification of titanium implant is the more suitable way to achieve safe and effective osseointegration than the other two implant types for endosseous application.

Calcium Phosphate-Coated Titanium Implants in the Mandible: Limitations of the in vivo Minipig Model

Introduction: We aimed to compare implant osseointegration with calcium phosphate (CaP) surfaces and rough subtractive-treated sandblasted/acid etched surfaces (SA) in an in vivo minipig mandible model. Materials and Methods: A total of 36 cylindrical press-fit implants with two different surfaces (CaP, n = 18; SA, n = 18) were inserted bilaterally into the mandible of 9 adult female minipigs. After 2, 4, and 8 weeks, we analyzed the cortical bone-to-implant contact (cBIC; %) and area coverage of bone-to-implant contact within representative bone chambers (aBIC; %). Results: After 2 weeks, CaP implants showed no significant increase in cBIC and aBIC compared to SA (cBIC: mean 38 ± 5 vs. 16 ± 11%; aBIC: mean 21 ± 1 vs. 6 ± 9%). Two CaP implants failed to achieve osseointegration. After 4 weeks, no statistical difference between CaP and SA was seen for cBIC (mean 54 ± 15 vs. 43 ± 16%) and aBIC (mean 43 ± 28 vs. 32 ± 6). However, we excluded two implants in each group due to failure of osseointegration. After 8 weeks, we observed no significant intergroup differences (cBIC: 18 ± 9 vs. 18 ± 20%; aBIC: 13 ± 8 vs. 16 ± 9%). Again, three CaP implants and two SA implants had to be excluded due to failure of osseointegration. Conclusion: Due to multiple implant losses, we cannot recommend the oral mandibular minipig in vivo model for future endosseous implant research. Considering the higher rate of osseointegration failure, CaP coatings may provide an alternative to common subtractive implant surface modifications in the early phase post-insertion.

Accentuated osseointegration in osteogenic nanofibrous coated titanium implants

Anchoring of endosseous implant through osseointegration continues to be an important clinical need. Here, we describe the development of superior endosseous implant demonstrating enhance osseointegration, achieved through surface modification via coating of osteogenic nanofibres. The randomized bio-composite osteogenic nanofibres incorporating polycaprolactone, gelatin, hydroxyapatite, dexamethasone, beta-glycerophosphate and ascorbic acid were electrospun on titanium implants mimicking bone extracellular matrix and subsequently induced osteogenesis by targeting undifferentiated mesenchymal stem cells present in the peri-implant niche to regenerate osseous tissue. In proof-of-concept experiment on rabbit study models (n = 6), micro-computed tomography (Micro-CT), histomorphometric analysis and biomechanical testing in relation to our novel osteogenic nanofibrous coated implants showed improved results when compared to uncoated controls. Further, no pathological changes were detected during gross examination and necropsy on peri-implant osseous tissues regenerated in response to such coated implants. The findings of the present study confirm that osteogenic nanofibrous coating significantly increases the magnitude of osteogenesis in the peri-implant zone and favours the dynamics of osseointegration.