Early loading of hydrophilic titanium implants inserted in low-mineralized (D3 and D4) bone: one year results of a prospective clinical trial

Abstract

IntroductionPure titanium is the material of choice for contemporary dental implants. However, superficial reaction of the moderately rough titanium surface with atmospheric components decreases its hydrophilicity. INICELL® represents a chemical alteration and hydrophilization of a moderately rough i. e. sand-blasted and acid-etched titanium surface. The hydrophilicity leads to a more homogenous adsorption of proteins on the implant surface in-vitro, supporting the activation of a higher number of platelets and the generation of a homogenous, complete fibrin matrix in the early phases of osseointegration. This in turn helps to reduce the healing time and enhances the predictability of osseointegration in compromised bony situations.The objective of this case series trial was therefore to investigate if early loading (after 8 weeks) of hydrophilic INICELL implants is feasible in patients with reduced bone quality.MethodsIn 10 patients, 35 hydrophilic implants were placed in sites revealing bone quality class 3 and 4, and uncovered after 4 weeks. Eight weeks later implants were released for loading if the tactile resistance was ≥35 Ncm. Lower resistances resulted in 12 weeks initial healing period. Insertion torque, ISQ, tactile resistance and vertical bone level were evaluated at implant installation, after 4 weeks (uncovering), 8 or 12 weeks (loading), and 12 weeks and one year after loading.ResultsMean implant insertion torque was 21 Ncm. 31 (88.6%) showed a tactile resistance of >35 Ncm after eight weeks and were released for prosthetic loading. Eight weeks after insertion, one implant (2.9%) had to be removed following a soft tissue complication. One implant had to be removed after 4 weeks due to a technical complication (fractured Osstell-abutment), it was therefore excluded from the analysis.33 of 34 implants (97%) were loaded to occlusion and were in situ/functional one year after implantation. ISQs increased from 43 at baseline to 63 at eight weeks, and 72 at three months after loading. Then, ISQ remained constant until one year after loading.ConclusionsWithin the limitations of this prospective case series, hydrophilic implants may allow for shortening of the initial healing period even in bone with compromised density.

Follow‐Up of the Sinus Membrane Elevation Technique for Maxillary Sinus Implants without the Use of Graft Material

“…10 In soft bone (Lekholm and Zarb class 3 and 4) of the maxilla, Held and colleagues measured the course of ISQs over time, from installation to one year, in 10 patients and 33 loaded implants (moderately rough surface implants). 18 They found an increase of mean values of ISQ from 43 at baseline, 63 at eight weeks, and 72 at three months of loading. ISQ thereafter remained constant until 1 year after loading.…”

“…Lower baseline ISQ values were seen in the implants that later failed compared with the successful ones, and these subjects also displayed lower ISQ average for all their implants with decreasing values at the second registration at 3 months . In soft bone (Lekholm and Zarb class 3 and 4) of the maxilla, Held and colleagues measured the course of ISQs over time, from installation to one year, in 10 patients and 33 loaded implants (moderately rough surface implants) . They found an increase of mean values of ISQ from 43 at baseline, 63 at eight weeks, and 72 at three months of loading.…”

Evaluation of local cancellous bone amelioration by poly‐l‐dl‐lactide copolymers to improve primary stability of dental implants: a biomechanical study in sheep

“…; Held et al. ), initial implant stability depends on macro‐design, surgical technique, and above all bone quality. Implants placed in bone of poor quality have disclosed higher failure rates (Herrmann et al.…”

A review on the wettability of dental implant surfaces II: Biological and clinical aspects

“…Finally, the alkali-treatment used to hydrophilize hydrophobic BAE surfaces has also been tested in a clinical case series [131]. For this study, 35 implants were placed in 10 patients with compromised bone density (class 3 and 4).…”