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Background : Osseointegration of standard and mini dental implants: a histomorphometric comparison [1]

Background : Osseointegration of standard and mini dental implants: a histomorphometric comparison [1]

author: Jagjit S Dhaliwal, Rubens F Albuquerque Jr, Monzur Murshed, Jocelyne S Feine | publisher: drg. Andreas Tjandra, Sp. Perio, FISID

The term “osseointegration” was first introduced to explain the phenomenon for stable fixation of titanium to bone by Brånemark et al. in the 1960s [1]. Osseointegrated implants were introduced, a new era in oral rehabilitation began, and many studies were conducted [2, 3]. A success rate of over 90% has been reported [4, 5]. Further, a success rate of 81% in the maxillary bone and 91% in the mandible can be accomplished [6]. Dental implants have been widely used for the stabilization of complete dentures and also help to maintain bone, function, esthetics, and phonetics and improve the oral health-related quality of life [7]. The dental implants are available with different surfaces and sizes. The size of the dental implants usually ranges in the diameter range of 3 mm (narrow diameter) to 7 mm (wide diameter). However, majority of the implants fall in the “standard diameter” range of 3.7 to 4.0 mm [8].

Mini dental implants or small size implants are also being widely used for stabilizing the complete dentures [9], for orthodontic anchorage [10–12], single tooth replacements [13, 14], fixing the surgical guides for definitive implant placement [15], and as transitional implants for the support of interim removable prosthesis during the healing phase of final fixtures [16, 17].

The single-piece mini dental implants (MDIs) are becoming increasingly popular for the purpose of denture stabilization. There are many advantages of the MDIs over the regular implants. The surgery is minimally invasive as compared with conventional implant surgery which helps in decreased morbidity for the patient. Transmucosal placement is possible using a single pilot drill, and these can often be loaded immediately [18]. Gingival healing is typically seen in 2 to 5 days, extended healing period with MDIs is usually not necessary [19]. The insertion of MDIs needs a minimal disturbance of the periosteum, thus osseointegration process is accelerated and time needed for MDIs tends to be considerably small than that of regular implants due to less injurious insertion procedure [9]. The need for sutures or long recovery periods is eliminated [3]. The patient can walk in to the office in the morning and is out the same day with a full set of teeth, the patient is allowed to eat the same day. These can work well for patients who have significant bone loss that restrict them from being a candidate for regular dental implants. MDIs are also a solution for patients that cannot have surgery for medical reasons. MDIs are also cost effective [20]. Considerable confusion exists in the literature regarding the best method to monitor the status of a dental implant. Various methods have been used to demonstrate the osseointegration of dental implants. A common and time-tested method to evaluate biological responses to an implant is to measure the extent of bone implant contact (BIC), referred to as histomorphometry at the light microscopic level. Bone implant contact (BIC) is one of the parameters which has been used extensively to study the amount of bone apposition next to the implants [21–27]. When an implant is placed in the jaw, it is in contact with compact bone as well as cancellous bone. The different structures of the two types of bone frequently result in variation of mineralized bone-to-implant contact length along the implant surface [28, 29]. Albrektsson et al. identified the key features affecting osseointegration about 4 decades ago, e.g., implant surface and topography, surface chemistry, charge, and wettability [30]. Roughness and enhanced surface area seems to be helpful for osseointegration. Carlsson et al. reported that screw-shaped implants with a rough surface had a stronger bonding than implants with a polished surface [31]. A coarse surface seems to be more appropriate for osseointegration of implants than a relatively smoother implant surface by representing a greater degree of implant integration [32–34]. The bone contact areas of 3MESPE MDIs are surface treated. The treatment process of these MDIs includes sandblasting with aluminum oxide particles followed by cleaning and passivation with an oxidizing acid [35].

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