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one day implants. โดย นทพ.พีระยุทธ อัสโม 4309050. Osteointegration . Integrate between living bone and surface of an implants It is for directly structure and function Not to have over loading force or shearing force Waiting in mand 3 months and 6 months max. Fibrous tissue formation.
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one day implants โดย นทพ.พีระยุทธ อัสโม 4309050
Osteointegration • Integrate between living bone and surface of an implants • It is for directly structure and function • Not to have over loading force or shearing force • Waiting in mand 3 months and 6 months max. • Fibrous tissue formation
Paper 1 • Immediate Loading of Titanium Plasma-Sprayed Screw-Shaped implants in man: A clinical and histological report of two cases • A.Piattelli, M. Paolantonio, M. Corigliano, and A. Scarano • Journal of periodontal 1997;68:591-597
Material and method • Ten patients----4 males , 6 females • Age from 48 to 72 (mean 59) • Restoration in edentulous posterior max. and mand. Arches • Three implants were inserted in each of these patients, for a total of 30. • 10 ---- immediately load • 20 ---- were allowed to heal in a submerged location
Material and method • Same day ---- a fixed transitional acrylic prosthetics was put on the implant • Immediated implants were inserted in max. or mand. Premolar region • And submerged were locate posteriorly to it.
Material and method • Started in November 1994,and checked at 3-month intervals to evaluation… • 1. Peri-implant tissues • 2. mobility • 3. periapical radiographs • Result in first 3 months • …no mobility, healthy condition at periapical tissue, no inflammation
Material and method • It was necessary to retrieve 2 of the loaded implant • 1. max.---8 months , fracture of abutment , (case 1) • 2. mand.---9 months , psychological reason , (case 2)
Histology method • Implants and surrounding tissues were washed in saline solution and immedately fixed in 4 % para-formaldehyde and 0.1 % glutaradehyde in 0.15 M cacodylate buffer at 4 oC and pH 7.4 • The specimens…dehydrate with alc. And embeded in a glyclmethacrylate resin • After polymerized specimens…section it in longitudinal axis about 100 um,30 um
Histology method • The slides were stained with acid fuchsin and toluidine blue • Normal transmitted light microsope • Von Kossa staining…done to visualized the calcified structures and their relationship with titanium • Von Kossa… double staining 1. Von Kossa 2. basic fuchsin
Von Kossa • After polishing, the slides were immersed in AgNO3 for 30 min. and exposed to sunlight • The slides were then washed under tap water,dried,and immersed in basic fuchsin for 5 min. ,and then washed and mouthed.
Histology method • Morphometry of percentage of bone contact was done by an optical system connected to an computer • The qualitative analysis of the peri-implant bone was done according to the parameter set in Table.1
Results • Case 1 max. implant • Mature,compat,cortial bone was present around the implant • No resorption,bone necrosis • The morphometrial analysis showed…the percentage of bone-implant contact was 72%(+/- 5) • The qualitve analysis was ++++(mature compat bone is present)
Results • Case 1 histological • Highly mineralized present at peri-implant • Basic fusin positive • At the higher magnification no gaps were visible in the surface
Results • Case 2 • Mature, compact bone with small osteocytic lacunae was present in peri-implant location (fig.13) • No gaps were present at the bone-implant interface
Results • Case 2 • no inflamatory cells at interface • Histomorphometrical analysis showed…the percentage of bone-implant contact was 61% (+/- 4) • The qualitve analysis was ++++(mature compat bone is present)
Discussion • Immediate loading implants can be success if primary stability is good with no mobility of implants • Good primary stability come from a precise fit of the implant or a friction related to implants design • Most of the case of immediately loading…were located in mandible
Paper 2 • Ultrastructural characterization of the implant/bone interface of immediately loaded dental implants • U. meyer,U.Joos,J.Mythili,T.Stamn ,department of cranio-maxillofacial surgery,university of munster,Germany • Biomaterials 25(2004) 1959-1967 • www.elsevier.com/locate/biomaterials
Introduction • Clinic and examination demonstrate that osseointegration can be achieved when healing under load is allowed • Szmukler-Moncler et al. show the relative the timing of loading and effect of micromotion on the bone-implant interface • Micromotion…during the healing process lead to a disruption of the bone-cell-implant contact and lead to deformation of osteoblast that fixed at surface in a strain-related manner
Introduction • The physiological bone loading(500-3000 microstrains)lead to mature bone formation but higher strains make a immature bone formation and fibroblastic cell • The aims of this study … to investigate the features of osteoblast behavior and matrix mineralization during the early bone/biomaterial interaction that depend on implant loading • We have 2 different immediate loading implants on newly titanium implants design
Material and method • Newly developed….. • Conical screw-shaped implants • A length… 10 mm. • A diameter… 4.1 mm. • Made from pure Titanium • Thread design… the curvature is well calculated to exhibit a homogenous and physiological strain distribution(1500-3000 microstrains) with in normal under mastigation and loading conditions
Experimental animals • 6 male minipigs • Minipigs were selected to adequate alveolar ridge size and hight for implant placement • The pigs were sedated with IM injection of… 1. ketamine 10 mg/kg 2. atropine 0.06 mg/kg 3. stresnil 0.03 mg/kg • extraction on mand. Second premolar bilaterally
Experimental animals • Two groups • 2 immediately loaded with in occlusal contact and 2 implants placed in a non-occlusal region
Surgical procedure • The implants inserted by manual tapping of the screw-shaped implants until the bodies were fully embedded in bone • Single crowns were prepared at the day of surgery • Dissected a block specimens on days 1,3,14 of implants loading and embedded it in Tehnovit and subsequent undecalcified histological section • The other block…with implants use SEM to investigation and immunostaining • Section without implants…TEM and diffracton analysis
Transmission electron microscopy • Tissue samples were fixed in 100mM phosphate buffer containing 2.5% glutaraldehyde (pH 7.4) • Specimens were dehydrated in a graded series of alcohol and embedded in Araldite resin • Ultrathin sections were stained for 1 h with 2% uranyl acetate followed by incubation in Reynold’s lead citrat. • Sections were examined under a Philips CM10 electron microscope. • Electron diffraction analysis was carried out on ultrathin sections with a Philips CM10 TEM. Three positions from each implant were usedto investigate the mineral formation.
Transmission electron microscopy x20 x40
Scanning electron microscopy • glutaraldehyde fixed specimens were critical-point dried • Additionally, samples were fixed in liquid nitrogen-cooled propane and cryodriedat 80C. • Samples were sputter-coated with gold for histological analysis (immunogold labeling for the localization of fibronectin,fibronectin receptor, and osteonectin on the surface) • Specimens were examined under a field emission scanning electron microscope (LEO 1530 VP,Oberkochem, Germany).
Immunolabeling • Cells were incubated with primary antibodies,anti-fibronectin, anti-.bronectin receptor, and antiosteonectin(Takara Chemicals, Japan), at a dilution of 1:200. • This was followed by secondary 20 nm gold conjugated antibody incubation (British Bio-Cell International). • After washing a silver enhancement was done for the gold particles using a Silver Enhancement kit(British Bio-Cell International). • The samples were then dehydrated, critical point dried, carbon coated and viewed also through the LEO 1530 VP scanning electron microscope. • Samples without first antibodies were used as controls.
Discussion • A long term success require rigid fixation between implants and host bone site • Axial symmetry is possible • Screw-shaped implants effective for achieving secure implant fixation • fibronectin,fibronectin receptor, and osteonectin on the surface
reference 1. www.pubmed.com 2. www.google.com 3. Piattelli A, Paoloantonio M, CoriglianoM Scarano A. Immediate loading of titanium plasma-sprayed screw-shaped implants in man: a clinical andhistologica l report of 2 cases. J Periodontol 1997;68:591–7.
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