A clinical, histological, and radiographic examination was performed on 77 permucosal dental implants, made of dense sintered hydroxylapatite: 34 solid cylinders and 43 hollow cylinders. The hollow cylinders were pre-compressed between two titanium caps. The implants were placed in partly edentulous mandibles of dogs, and were physiologically loaded. Healing was clinically and radiographically evaluated during a six-month to five-year period.
At various times, implants with their surrounding tissues were removed and prepared for light and electron microscopy. All implants showed a good initial fit and were maintained in place without undercut or mechanical stabilization. After 18 months, 76% of the solid cylinders had fractured at the implant/bone junction due to fatigue. However, the submerged portions of the solid cylinders were preserved without clinical problems, and became entirely embedded in bone. The pre-stressed implants did not fracture, and 91% were functioning 24 months after placement. The average scores of pocket depths and gingival bleeding showed no significant differences between implants and surrounding natural teeth.
Bone deposition occurred on the entire surface of the implant below the crest of the alveolar bone, and intimate bone contact was confirmed by electron microscopy. It was also observed that a layer of bone tissue was deposited on the implant surface in the permucosal area just above the alveolar bone level. Embedding of gingival fibers in this layer resulted in gingival attachment to the implant, comparable with that of natural teeth.
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References
1.
Adell, R.; Lekholm, U.; Rockler, B.; and Brånemark, P.I. (1981): A 15-year Study of Osscointegrated Implants in the Treatment of the Edentulous Jaw, Int J Oral Surg10:387-416.
2.
Atwood, D.A. (1963): Postextraction Changes in the Adult Mandible as Illustrated by Microradiographs of Midsagittal Sections and Serial Cephalometric Röntgenogram, J Prosthet Dent13:810-824.
3.
Atwood, D.A. (1979): Bone Loss of Edentulous Alveolar Ridges, J Periodont (Sp Iss), "Oral Perspective on Bone Biology": 11-21.
4.
Bell, D.H. (1972): Prosthodontic Failures Related to Improper Patient Education and Lack of Patient Acceptance, Dent Clin North Am16:109-118.
5.
Bergman, B. and Carlsson, G.E. (1972): Review of 54 Complete Denture Wearers, Patients' Opinion 1 Year after Treatment, Acta Odontol Scand30:399-414.
6.
Block, M.S. and Kent, J.N. (1985): Heating of Mandibular Ridge Augmentation Using Hydroxytapatite with and without Autogenous Bone in Dogs, J Oral Maxillofac Surg43:3-7.
7.
Bom-Van Noorloos, A.A.; Schipper, C.A.; Van Steen-Bergen, T.J.M.; De Graaff, J.; and Burger, E.H. (1986); Bacteroides gingivalis Activates Mouse Spleen Cells to Produce a Factor that Stimulates Resorptive Activity of Osteoctasts in vitro, J Periodont Res21:440-444.
8.
Buys, R. and Dogterom, A.A. (1983): An Improved Method for Embedding Hard Tissue in Polymethacrylate, Stain Techn58:135-141.
9.
De Groot, K. (1981): Degradable Ceramics. In: Biocompatibility of Clinical Implant Materials, Vol. 1, D. F. Williams, Ed., Boca Raton, Florida: CRC Press, pp. 199-222.
10.
De Groot, K. (1982): Implant Materials in Dentistry, Med Progr Technot9:129-136.
11.
De Groot, K. (1983): Ceramics Based on Calcium Phosphates. In: Ceramics in Surgery, P. Vincenzini , Ed., Amsterdam: Elsevier, pp. 79-90.
12.
De Lange, G.L.; De Putter, C.; and De Groot, K. (1984a): Histology of the Attachment of Gingival Fibers to Dental Root Implants of Ca-Hydroxylapatite. In: Biomaterials and Biomechanics 1983, P. Ducheyne, G. van der Perre, and A.E. Aubert, Eds., Amsterdam: Elsevier , pp. 451-456.
13.
De Lange, G.L.; De Putter, C.; and De Groot, K. (1986a): Permucosal Oral Implants: the Relationship between Scaling and Fixation. In: Tissue Integration in Oral and Maxillo-facial Reconstruction, D. van Steenberghe, Ed., Amsterdam: Elsevier, pp. 278-283.
14.
De Lange, G.L.; De Putter, C.; Kurashina, K.; and De Groot, K. (1985b): A Clinical and Histological Evaluation of 3 Types of Ceramic Permucosal Dental Implants, Trans 11th Ann Meeting Am Soc Biomat, Abst: No. 9.
15.
De Lange, G.L.; De Putter, C.; and De Groot, K. (1985b): Gingival Attachment at Dental Implants of Dense Hydroxylapatite, J Dent Res No. 64:711, Abst. No. 68 (Div.).
16.
De Lange, G.L.; De Putter, C.; De Vos, R.; De Laat. R.; and De Groot, K. (1986b): Permucosal Dental Implants. The Relationship between Bone Anchorage and the Quality of Surrounding Gingival Tissues. In: Biological and Biochemical Performances of Biomaterials, P. Christel, A. Mcunicr, and A.J.C. Lee, Eds., Amsterdam : Elsevier, pp. 519-524.
17.
De Putter, C. (1984a): Permucosal Dental Implants of Dense Hydroxylapatite , Amsterdam: Free University Press .
18.
De Putter, G.; De Groot, K.; and Sillevis Smitt, P.A.E. (1983a): Transmucosal Implants of Dense Hydroxylapatite, J Prosther Dent49:87-95.
19.
De Putter, C.; De Groot, K.; Sillevis Smitt, P.A.E.; and Van Der Zel, J.M. (1983b): In vivo Fatigue Behavior of Permucosal Dental Implants of Calciumhydroxylapatite. Comparing Non-prestressed with Prestressed Implants, Trans 9th Ann Meeting Am Soc Biomat, Prog & Abst: No. 27.
20.
De Putter, C.; De Lange, G.L.; and De Groot, K. (1986): Permucosal Dental Implants of Dense Hydroxylapatite, Evaluation and Prognosis of their Retention in Alveolar Bone. In: Biological and Biochemical Performance of Biomaterials. P. Christel, A. Meunier, and A.J.C. Lee, Eds., Amsterdam : Elsevier, pp. 111-115.
21.
De Putter, C.; De Lange, G.L.; De Groot, K.; and Sillevis Smitt, P.A.E. (1984b): Prestressed Permucosal Dental Implants of Dense Hydroxylapatite. In: Biomaterials and Bio-mechanics, P. Ducheyne, G. van der Perre, and A.E. Aubert, Eds., Amsterdam: Elsevier , pp. 439-444.
22.
De Wijs, F.L.J.A.; De Lange, G.L.; De Putter, C.; and De Groot, K. (1985): Kortektur von Resorptionsdefekten im Oberkieferfrontgebiet mit Calciumhydroxylapatite-Implantaten, Die Quintessenz4:647-656.
23.
De Wijs, F.L.J.A.; De Lange, G.L.; De Putter, C.; and De Groot, K. (1986): Correction of Resorption Defects in the Anterior Maxillary Region with Hydroxylapatite. In: Biological and Biomechanical Performance of Biomateirials, P. Christel , A. Meunier, and A.J.C. Lee, Eds., Amsterdam: Elsevier, pp. 117-222.
24.
Denissen, H.W. and De Groot, K. (1979): Immediate Dental Implants from Synthetic Dense Calcium Hydroxylapatite, J Prosthet Dent42:551-556.
25.
Denissen, H.W.; Veldhuis, H.A.; and Van Faasen, F. (1984a): Implant Placement in the Atrophic Mandible: An Anatomic Study, J Prosthet Dent52:260-263.
26.
Denissen, H.W.; Veldhuis, H.A.; and Rejda, B.V. (1984b): Dense Apatite Ceramic (DAC) Implant System: A Preliminary Report, J Prosthet Dent52:229-233.
27.
Donath, K.; Kirsch, A.; and Osborn, J.F. (1984): Zelluläre Dynamik um Enossale Titanimplantate , Fortschr Zahnärztl Implantol1:55-58.
28.
Frost, H.M. (1969): Tetracycline-based Histological Analysis of Bone Remodeling, Calcif Tissue Res3:211-237.
29.
Groeneveld, A. (1974): Dental Caries. Some Aspects of Artificial Caries Lesions Examined by Contact Microradiography. PhD Thesis, Utrecht.
30.
Helfrick, J.F.; Topf, J.S.; and Kaufman, M. (1982): Mandibular Staple Bone Plate: Long-term Evaluation of 250 Cases, J Am Dent Assoc104:318-320.
31.
Hench, L.L. and Ethridge, E.G. (1982): Biomaterials: An Interfacial Approach, New York: Academic Press.
32.
Hobkirk, J.A. (1983): Progress in Implant Research, Int Dent J33:341-349.
33.
Kawahara, H. (1983): Cellular Responses to Implant Materials: Biological, Physical and Chemical Factors, Int Dent J33 :350-375.
34.
Kirsch, A. (1985): IMZ-ein perio-implantologisch-prothetisches Behandlungskonzept . In: Parodontologie, Implantologie und Prothetik im Brennpunkt von Praxis und Wissenschaft, D.E. Lange , Ed., Berlin: Quintessenz.
35.
Klein, C.P.A.T.; Van Knaap, K.; De Groot, K.; and Vermeiden, J.W.P. (1980): Possible Involvement of the Immune System in the Degradation of Hydroxylapatite Implants. In: Dental Implants, G. Heimke, Ed., Miinchen : Carl Hanser Verlag, pp. 41-46.
36.
Kurashina, K.; De Lange, G.L.; De Putter, C.; and De Groot, K. (1984): Reaction of Surrounding Gingiva to Permucosal Implants of Dense Hydroxylapatite in Dogs, Biomaterials5:215-220.
37.
Lavelle, C. and Wedgwood, D. (1980): Effect of Internal Irrigation on Frictional Heat Generated from Bone Drilling, J Oral Surg38:499-503.
38.
Linkow, L.I. (1977): Maxillary Implants, North Haven, CT: Glarus Publishing.
39.
Linkow, L.I. (1978): Mandibular Implants, North Haven, CT: Glarus Publishing.
40.
Löe, H. and Silness, J. (1963): Periodontal Disease in Pregnancy. I. Prevalence and Severity, Acta Odontol Scand21 :533-551.
41.
Löe, H.; Theilade, E.; and Jensen, B.S. (1965): Experimental Gingivitis in Man, J Periodontol36:177-187.
Mervin, G.; Rodgers, L.; Martin, R.; and Wilson, J. (1985): Facial Bone Augmentation Using Bioglass in Dogs: Preclinical and X-Ray Studies, Trans 5th Europ Conf on Biomaterials, Prog & Abst: p. 105.
44.
Moskow, B.S. and Lubarr, A. (1983): Histological Assessment of Human Periodontal Defects after Durapatite Ceramic Implant, J Periodontol54:455-462.
45.
Ogilvie, A.; Frank, R.M.; Beneque, E.P.; Gineste, M.; Heughebaert, M.; and Hemmerle, J. (1987): The Biocompatibility of Hydroxylapatite Implanted in the Human Periodontium, J Periodont Res22:270-283.
46.
Osborn, J.F. and Newesely, H. (1980): Dynamic Aspects of the Implant-Bone Interface . In: Dental Implants, G. Heimke, Ed., Miinchen: Carl Hanser Verlag, pp. 111-123.
Page, R.C. (1977): Etiology of Periodontal Disease. In: Periodontal Disease, S. Schluger , R. Yuodelis, and R.C. Page, Eds., Philadelphia : Lea and Febiger, pp. 83-106.
49.
Page, R.C. and Schroeder, H.E. (1981a): Spontaneous Chronic Periodontitis in Adult Dogs , J Periodontol52:60-73.
50.
Page, R.C. and Schroeder, H.E. (1981b): Current Status of the Host Response in Chronic Marginal Periodontitis, J Periodontol52:477-491.
51.
Peelen, J.G.J.; Rejda, B.V.; and De Groot, K. (1978): Preparation and Properties of Sintered Hydroxylapatite , Ceramurgia Int4:71-74.
52.
Peelen, J.G.J.; Rejda, B.V.; Vermeiden, J.P.W.; and De Groot, K. (1977): Sintered Tricalcium Phosphate as Bioceramic, Sci Ceram9:266.
53.
Pietrokovski, J. (1975): The Bony Residual Ridge in Man, J Prosthet Dent34:456-462.
54.
Rejda, B.V.; Peelen, J.G.J.; and De Groot, K. (1977): Tricalciumphosphate as a Bone Substitute, J Bioeng1:93-97.
55.
Roberts, W.E.; Smith, R.K.; Zilberman, Y.; Mozsary, P.G.; and Smith, R.S. (1984): Osseous Adaptation to Continuous Loading of Rigid Endosseous Implants, Am J Orthod86 :95-111.
56.
Schepers, E.; De Clercq, M.; and Ducheyne, P. (1986): Histological Evaluation of Bulk and Fibre Reinforced Bioglass Submerged Dental Root Implants in Dogs. In: Tissue Integration in Oral and Maxillofacial Reconstruction, D. van Steenberghe, Ed., Amsterdam: Elsevier, pp. 144-149.
57.
Schnitman, P.A. and Schulman, L.B. (1979): Recommendations of the Consensus Development Conference on Dental Implants, J Am Dent Assoc98:373-377.
58.
Schnitman, P.A.; Woolfson, M.W.; Feingold, R.M.; Gettleman, L.; Freedman, H.M.; Kalis, P.J.; Buch-Anan, W.; and Schulman, L.B. (1980): Vitreous Carbon Implants: A Five-year Study in Baboons, J Prosthet Dent44 :190-200.
59.
Schroeder, A.; Suiter, R.; Ledermann, P.D.; and Stich, H. (1984): Bisherige Erfahrungen mit den ITI-Doppelhohlzylinderimplantat Typ K, Schweiz Mschr Zahnmed94:503-510.
60.
Schulte, W. (1981a): Das Tübinger Implantat aus Frialit. 5-Jahrige Erfahrungen, Dtsch Zahnärztl Z36:544-550.
61.
Schulte, W. (1981b): Das Enossale Tübinger Implantat aus Al2O3 (Frialit R). Der Entwicklungsstand nach 6 Jahren, Zahnärztl Mitt71:2-20.
62.
Silness, J. and Löe, H. (1964): Periodontal Disease in Pregnancy. II. Correlation between Oral Hygiene and Periodontal Condition, Acta Odontol Scand22:121-135.
63.
Small, LA (1978): Survey of Experiences with the Mandibular Staple-Bone Plate, J Oral Surg36:604-606.
64.
Sorensen, W.P.; Löe, H.; and Ramfjord, S. (1980): Periodontal Disease in the Beagle Dog. A Cross-sectional Clinical Study, J Periodont Res15:380-389.
65.
Strub, J.R.; Gysi, B.E.; and Scharer, P. (1983): Schwerpunkte in der Oralen Implantologie und Rekonstruktion , Berlin : Quintessenz.
66.
Takahashi, H.; Norimatsu, H.; Watanabe, G.; Konno, T.; Indue, J.; and Fukuda, M. (1980): The Remodelling Period (Sigma) in Canine and Human Trabecular Bone. In: Calcium Endocrinology, A. Yoshitoshi and T. Fujita , Eds., Tokyo: Igaku Co., pp. 13-31.
67.
Ten Cate, J.M. and Duysters, P.P.E. (1983): Influence of Fluoride in Solutions on Tooth Demineralization. II. Microradiographic Data, Caries Res17:513-519.
68.
Tracy, B.M. and Doremus, R.H. (1984): Direct Electron Microscopy Studies of the Bone-Hydroxylapatite Interface, J Biomed Mater Res18:719-726.
69.
Van Der Kuij, P. (1981): Reducing Residual Ridge Reduction, Thesis, Vrije Universiteit, Amsterdam.
70.
Van Der Velden, U. (1979): Probing Force and the Relationship of the Probe Tip to the Periodontal Tissues, J Clin Periodontol6:106-114.
71.
Vaughan, J.M. (1970): The Physiology of Bone, Oxford : Clarendon Press.
72.
Winter, C.M.; Woelfel, J.B.; and Igarashi, T. (1974): Five-year Changes in the Edentulous Mandible as Determined on Oblique Cephalometric Radiographs, J Dent Res53:1455-1467.
73.
Wilson, J.; Mervin, G.; Rodgers, L.; Martin, R.; and Spilman, D. (1986): Facial Bone Augmentation Using Bioglass in Dogs. In: Biological and Biomechanical Performance of Biomaterials, P. Christel, A. Meunier, and A.J.C. Lee, Eds., Amsterdam : Elsevier.
74.
Yukna, R.A.; Harrison, G.; Caudill, R.F.; Evans, G.H.; Mayer, E.T.; and Miller, S. (1985): Evaluation of Durapatite Ceramics as an Alloplastic Implant in Periodontal Osseous Defects. II. Twelve-month Re-entry Results . J Periodontol56 :540-547.
