• Advances in biomechanics and applications
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• 제1권2호
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• pp.95-109
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• 2014

Peri-acetabular bone ingrowth plays a crucial role in long-term stability of press-fit acetabular cups. A poor bone ingrowth often results in increased cup migration, leading to aseptic loosening of the implant. The rate of peri-prosthetic bone formation is also affected by the polar gap that may be introduced during implantation. Applying a mechano-regulatory tissue differentiation algorithm on a two-dimensional plane strain microscale model, representing implant-bone interface, the objectives of the study are to gain an insight into the process of peri-prosthetic tissue differentiation and to investigate its relationship with implant-bone relative displacement and size of the polar gap. Implant-bone relative displacement was found to have a considerable influence on bone healing and peri-acetabular bone ingrowth. An increase in implant-bone relative displacement from $20{\mu}m$ to $100{\mu}m$ resulted in an increase in fibrous tissue formation from 22% to 60% and reduction in bone formation from 70% to 38% within the polar gap. The increase in fibrous tissue formation and subsequent decrease in bone formation leads to weakening of the implant-bone interface strength. In comparison, the effect of polar gap on bone healing and peri-acetabular bone ingrowth was less pronounced. Polar gap up to 5 mm was found to be progressively filled with bone under favourable implant-bone relative displacements of $20{\mu}m$ along tangential and $20{\mu}m$ along normal directions. However, the average Young's modulus of the newly formed tissue layer reduced from 2200 MPa to 1200 MPa with an increase in polar gap from 0.5 mm to 5 mm, suggesting the formation of a low strength tissue for increased polar gap. Based on this study, it may be concluded that a polar gap less than 0.5 mm seems favourable for an increase in strength of the implant-bone interface.

• 대한치과의사협회지
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• 제52권7호
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• pp.396-401
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• 2014

Peri-implantitis is an inflammatory disease of the peri-implant tissue by bacterial infection or other factors, which results in peri-implant bone loss. Many nonsurgical treatments were tried on initial to moderate peri-implantitis lesion to reduce the inflammation. Some of these treatments made effective results, however, they were not definitively predictable. To prevent peri-implantitis and further peri-implant bone loss, early intervention is the most important. Early detection of peri-implant infection through the regular maintenance care can make it possible to do early nonsurgical intervention. Nonsurgical intervention is effective on peri-implant mucositis and can also be effective on initial peri-implantitis lesion. If the peri-implantitis is not resolves by nonsurgical treatment, surgical approach should be considered.

• 대한치과보철학회지
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• 제39권3호
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• pp.273-281
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• 2001

Digital subtraction radiography may be one of the most precise and noninvasive methods for assessing subtle density changes in peri-implant bone, providing additional diagnostic information on implant tissue integration in overall maintenance. The aims of this study were to evaluate density changes after first, second surgery of dental implant and to measure the amount of marginal bone loss 9 months after second surgery using digital subtraction radiography. Bone change around 30 screw-shaped implants in 16 patients were assessed on radiographs. 17 Branemark implants of 3.75mm in diameter(Nobel Biocare, Goteborg, Sweden), 2 Branemark implants of 5.0mm in diameter, 11 $Replace^{TM}$ implants of 4.3mm in diameter(Nobel Biocare, Goteborg, Sweden) were used. To standardize the projection geometry of serial radiographs of implants, customized bite block was fabricated using XCP film holder(Rinn Corporation, Elgin, IL.) with polyether impression material of Impregum(ESPE, Germany) and direct digital image was obtained. Qualitative and quantitative changes on radiographs were measured with Emago software(The Oral Diagnostic System, Amsterdam, Netherlands). The results were as follows: 1. The peri-implant bone density of 69.2% implants did not change and the peri-implant bone density of 30.8% implants decreased after 3 months following first surgery. 2. The crestal bone density of 53.9% implants decreased first 3 months after second surgery. The crestal bone density of 58.8% implants increased 9 months after second surgery. No density change was observed around the midportion of the implants after second surgery, 3. The amount of marginal bone loss between different kinds of implants showed no statistically significant differences (p>0.05). 4. More than 90% of total marginal bone loss recorded in a 9-month period occurred during the first 3 months.

• 대한치과의사협회지
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• 제58권6호
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• pp.336-345
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• 2020

Peri-apical implant lesion, also known as 'retrograde peri-implantitis' can occur with multifactorial etiological factors. The purpose of this case report is to demonstrate resolution of periapical implant lesion by removal of causative factors and saving implant by regenerative therapy. A 54-year old male patient with mild dull pain around implant on the right mandibular second premolar area due to persistent peri-apical infection of the adjacent first premolar was treated. Extraction of tooth with symptomatic apical periodontitis and regenerative therapy on the buccal fenestration area of the implant and extraction site were performed. After 6-month reentry, notable regenerated bone tissue around implant was found, and implant placement on the previous extraction site was performed. After 14-month follow-up from the regenerative therapy, neither biological nor mechanical complication could be found around the implant, evidenced by high implant stability, normal clinical probing depth, and absence of discomfort spontaneously and during masticatory function. In conclusion, surgical intervention including regenerative therapy using bone graft and barrier membrane on periapical implant lesion can be suggested as one of the treatment options considering the extent of periapical lesion.

• Journal of Periodontal and Implant Science
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• 제42권1호
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• pp.13-19
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• 2012

Purpose: The aim of this study was to examine whether a previous peri-implantitis site can affect osseointegration, by comparing implant placement at a site where peri-implantitis was present and at a normal bone site. A second aim of this study was to identify the tissue and bone reaction after treating the contaminated implant surface to determine the optimal treatment for peri-implant diseases. Methods: A peri-implant mucositis model for dogs was prepared to determine the optimal treatment option for peri-implant mucositis or peri-implantitis. The implants were inserted partially to a length of 6 mm. The upper 4 mm part of the dental implants was exposed to the oral environment. Simple exposure for 2 weeks contaminated the implant surface. After 2 weeks, the implants were divided into three groups: untreated, swabbed with saline, and swabbed with $H_2O_2$. Three implants from each group were placed to the full length in the same spot. The other three implants were placed fully into newly prepared bone. After eight weeks of healing, the animals were sacrificed. Ground sections, representing the mid-buccal-lingual plane, were prepared for histological analysis. The analysis was evaluated clinically and histometrically. Results: The untreated implants and $H_2O_2$-swabbed implants showed gingival inflammation. Only the saline-swabbed implant group showed re-osseointegration and no gingival inflammation. There was no difference in regeneration height or bone-to-implant contact between in situ implant placement and implant placement in the new bone site. Conclusions: It can be concluded that cleaning with saline may be effective in implant decontamination. After implant surface decontamination, implant installation in a previous peri-implant diseased site may not interfere with osseointegration.

• Journal of Periodontal and Implant Science
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• 제43권2호
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• pp.58-63
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• 2013

Purpose: The aim of this study was to measure the peri-implant bone length surrounding implants that penetrate the sinus membrane at the posterior maxilla and to evaluate the survival rate of these implants. Methods: Treatment records and orthopantomographs of 39 patients were reviewed and analyzed. The patients had partial edentulism at the posterior maxilla and limited vertical bone height below the maxillary sinus. Implants were inserted into the posterior maxilla, penetrating the sinus membrane. Four months after implant insertion, provisional resin restorations were temporarily cemented to the abutments and used for one month. Then, a final impression was taken at the abutment level, and final cement-retained restorations were delivered with mutually protected occlusion. The complications from the implant surgery were examined, the number of failed implants was counted, and the survival rate was calculated. The periimplant bone lengths were measured using radiographs. The changes in initial and final peri-implant bone lengths were statistically analyzed. Results: Nasal bleeding occurred after implant surgery in three patients. No other complications were found. There were no failures of the investigated implants, resulting in a survival rate of 100%. Significantly more bone gain around the implants (estimated difference=-0.6 mm, P=0.025) occurred when the initial residual bone height was less than 5 mm compared to the >5 mm groups. No significant change in peri-implant bone length was detected when the initial residual bone height was 5 mm or larger. Conclusions: This study suggests that implants penetrating the sinus membrane at the posterior maxilla in patients with limited vertical bone height may be safe and functional.

• Journal of Periodontal and Implant Science
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• 제31권1호
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• pp.57-74
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• 2001

The purpose of this study was to evaluate the adjunctive combined effect of demineralized freeze-dried bone allograft(DFDB) in guided bone regeneration on supra-alveo-lar peri-implant defect. Supra-alveolar perio-implant defects, 3mm in height, each including 4 IMZ titanium plasma-sprayed implants were surgically created in two mongrel dogs. Subsequently, the defects were treated with 1 of the following 3 modalities: Control) no membrane or graft application, Group1) DFDB application, Group2) guided bone regeneration using an expanded polytetra-fluoroethylene membrane, Group3) guided bone regeneration using membrane and DFDB. After a healing period of 12-week, the animals were sacrificed, tissue blocks were harvested and prepared for histological analysis. Histologic examination were as follows; 1. New bon formation was minimal in control and Group 1, but considerable new bone formation was observed in Group 2 and Group 3. 2. There was no osteointegration at the implant-bone interface in the high-polished area of group2 and Group 3. 3. In fluorescent microscopic examination, remodeling of new bone was most active during week 4 and week 8. There was no significant difference in remodeling rate between group 2 and group 3. 4. DFDB particles were observed, invested in a connective tissue matrix. Osteoblast activity in the area was minimal. The results suggest that guided bone regeneration shows promising results in supra-alveolar peri-implant defects during the 12 week healing period although it has a limited potential in promoting alveolar bone regeneration in the high-polished area. There seems to be no significant adjunctive effect when DFDB is combined with GBR.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제41권2호
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• pp.84-89
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• 2015

We report the eventually successful treatment of a huge bone defect and peri-implantitis following reconstruction of a previously failed intra-mobile cylinder implant system (IMZ) implant site using distraction osteogenesis (DO). In the anterior mandible, two IMZ implants failed and surgical debridement was performed in accordance to the patient's needs. Thereafter, mobility and suppuration were decreased and the patient visited the dental clinic on a regular basis for oral health maintenance. However, the inflammation did not resolve, and the bone destruction around the implants progressed for 4 years. Finally, the implants failed and a severe bone defect remained after implant removal. To reconstruct the bone defects, we attempted bone graft procedures. Titanium mesh was unsuccessfully used to obtain bone volume regeneration. However, DO subsequently was used to obtain sufficient bone volume for implant placement. The new implants were then installed, followed by prosthetic procedures. In conclusion, progression of peri-implantitis could not be arrested despite surgical intervention and repeated maintenance care for 3 years. Reconstruction of the peri-implantitis site was complicated due to its horizontal and vertical bone defects. Lesions caused by implant failure require an aggressive regenerative strategy, such as DO. DO was successful in reconstruction of a peri-implantitis site that was complicated due to horizontal and vertical bone defects.

• 대한치과의사협회지
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• 제51권12호
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• pp.650-657
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• 2013

The aim of this study was to achieve healing of Peri-implantitis defects and hard tissue augmentation using a bovine-derived bone mineral on the defect site. Two patients were treated with the surgical approach. With a full muco-periosteal flap elevation, the implant surfaces were exposed and granulation tissue removed around the implant and between the threads. Each surface of the contaminated implant was prepared with the air-abrasive device(PerioFlow$^{(R)}$) for decontamination. Bovine-derived bone mineral(Bio-Oss collagen$^{(R)}$) was then used to fill the defects and muco-periosteal flaps sutured to achieve transmucosal healing. Radiographs and clinical photographs were taken before and after 6 months of healing and an estimate of bone fill was assessed. Within the limits of the present case report, a surgical approach in treatment of peri-implantitis defects using a collagen form of bovine bone mineral was visited. Although limited, the two cases showed the stability and biocompatibility of a bovine-derived bone mineral and effectiveness of air-abrasive device(PerioFlow$^{(R)}$) as a decontamination method.

• Journal of Periodontal and Implant Science
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• 제38권4호
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• pp.723-728
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• 2008

Purpose: During guided bone regeneration procedures for the augmentation of deficient alveolar ridge, primary closure of flap is necessary. For primary flap closure, flap is repositioned coronally and the zone of attached keratinized mucosa may decreased. The need for attached keratinized mucosa around dental implants is still controversial, but sufficient peri-implant attached keratinized mucosa would be beneficial for functional and esthetic aspects. This case report presents three cases that demonstrated free gingival graft for increasing the zone of peri-implant attached keratinized mucosa which was decreased after guided bone regeneration. Materials and Methods: In first case, maxillary incisors were extracted and guided bone regeneration was performed simultaneously. Because the membrane was exposed at 3 weeks after operation, the membrane was removed and free gingival graft was performed for primary flap closure. Free gingival graft was performed again at implant placement for the increase of attached keratinized mucosa. In second case, guided bone regeneration was performed on lower right first molar area, and implant was placed with free gingival graft. In third case, lower right molar area showed insufficient attached keratinized mucosa after implant placement with guided bone regeneration. When abutments were connected, free gingival graft with apically positioned flap was performed. Result: In these three cases, the zone of attached keratinized mucosa around dental implants was decreased after guided bone regeneration. And the increase of peri-implant attached keratinized mucosa could be obtained effectively by free gingival graft. Conclusion: Free gingival graft could be a effective treatment method increasing the zone of attached keratinized mucosa which was decreased after guided bone regeneration procedures.