Characterization of the surface properties of commercially available dental implants using scanning electron microscopy, focused ion beam, and high-resolution transmission electron microscopy

Background: Since osseointegration of the respective implant is claimed by all manufacturing companies, it is obvious that not just one specific surface profile including the chemistry controls bone apposition. Purpose: The purpose was to identify and separate out a particular set of surface features of the implant surfaces that can contribute as factors in the osseointegration process. Material and Methods: The surface properties of several commercially available dental implants were extensively studied using profilometry, scanning electron microscopy, and transmission electron microscopy. Ultrathin sections prepared with focused ion beam microscopy (FIB) provided microstructural and chemical data which have not previously been communicated. The implants were the Nobel Biocare TiUnite® (Nobel Biocare AB, Göteborg, Sweden), Nobel Biocare Steri‐Oss HA‐coated (Nobel Biocare AB, Yorba Linda, CA, USA), Astra‐Tech OsseoSpeed? (Astra Tech AB, Mölndal, Sweden), Straumann SLA® (Straumann AG, Waldenburg, Switzerland), and the Brånemark Integration Original Fixture implant (Brånemark Integration, Göteborg, Sweden). Results: It was found that their surface properties had differences. The surfaces were covered with crystalline TiO₂ (both anatase and rutile), amorphous titanium oxide, phosphorus doped amorphous titanium oxide, fluorine, titanium hydride, and hydroxyapatite, respectively. Conclusion: This indicates that the provision of osseointegration is not exclusively linked to a particular set of surface features if the implant surface character is a major factor in that process. The studied methodology provides an effective tool to also analyze the interface between implant and surrounding bone. This would be a natural next step in understanding the ultrastructure of the interface between bone and implants.     

Oxidized titanium implants (Nobel Biocare TiUnite) compared with turned titanium implants (Nobel Biocare mark III) with respect to implant failure in a group of consecutive patients treated with early functional loading and two-stage protocol

OBJECTIVES: The purpose of this study was to compare two implant types of similar shape but with different surfaces with respect to implant failure. MATERIAL AND METHODS: A total of 136 patients were treated with Nobel Biocare Implants between January 2001 and December 2002. Totally 394 implants were placed, of which 199 were oxidized titanium implants (Nobel Biocare TiUnite and 195 with turned titanium surface (Nobel Biocare Mark III. Sixty-three patients underwent a one-stage surgical protocol, of which 24 were objected to early functional loading. The remaining 73 patients were treated with a traditional two-stage surgical protocol. All patients were followed for a minimum of 5 months after loading of the implants. Implants were classified as survivals when clinically stable and fulfilling purported function without any discomfort to the patient, with no signs of infection or ongoing pathologic process. RESULTS: Seven implants were lost in five patients (two males and three females), six in the maxilla and one in the mandible. All failed implants were Mark III implants, inserted following the traditional two-stage protocol. The implant success rate was 98.2% for the whole-patient group, divided as a 100% success rate following the implants with oxidized surface (Nobel Biocare TiUnite compared with a success rate of 96.4% with implants with turned surface (Nobel Biocare Mark III).     

Measurements comparing the initial stability of five designs of dental implants: a human cadaver study

Background: A number of different dental implant designs are currently in clinical use. A successful outcome of implant placement is thought, at least in part, to be due to the primary stability of an implant after placement. Few data are available for comparing the primary stability characteristics of different implant designs. Purpose: This investigation compared the primary stability of five types of endosseous dental implant of varying geometry and surface topography. Materials and Methods: Comparison was made between a standard threaded commercially pure titanium implant (Nobel Biocare AB, Göteborg, Sweden), the Mark II self‐tapping implant (Nobel Biocare AB, Göteborg, Sweden), the Mark IV tapered self‐tapping implant (Nobel Biocare AB, Göteborg, Sweden), the Astra Tioblast (AstraTech AB, Mölndahl, Sweden), and the 3i Osseotite (3I [Implant Innovations Incorporated], Palm Beach, Florida, USA). Fifty‐two fixtures were placed in the maxillary bone of nine unembalmed human cadavers. Implant stability as a function of peak insertion torque and resonance frequency values was recorded for each fixture site after placement. Removal torque was also measured 1‐hour postinsertion. Assessment of bone quality at each site was made. Results: All of the implants tested demonstrated good primary stability in type 2 and 3 bone. The Standard, Mark II, Osseotite, and Tioblast were less stable when placed into bone type 4. The Mark IV implants appeared to maintain a high primary stability even in Type 4 bone. Conclusion: When looking across all bone qualities, the Mark IV implant develops a significantly higher insertion torque than the Standard, Mark II, and Osseotite implant types, and a significantly higher resonance frequency value than the Standard implant, indicating a higher interfacial stiffness at the implant–bone interface.     

Digitally planned, immediately loaded dental implants with prefabricated prostheses in the reconstruction of edentulous maxillae: a 1-year prospective, multicenter study

Background: The introduction of digital planning programs has made it possible to place dental implants in preplanned positions and being immediately functionally loaded by using prefabricated prostheses.
Purpose: The aim of this multicenter study was to describe the 1-year results of digitally planned, immediately loaded edentulous maxillae.
Materials and Methods: A total of 312 implants (Brånemark System®, TiUnite RP, Nobel Biocare, Göteborg, Sweden) in 52 patients from eight Scandinavian clinics were digitally planned, surgically as well as prosthetically, by using the NobelGuide® (Nobel Biocare AB, Göteborg, Sweden) and received prefabricated, immediately loaded fixed prosthetic constructions in the maxillae. Individual implant stability was manually tested at 1-year follow-up.
Results: All patients received a Procera Implant Bridge® (Nobel Biocare AB); however, in two cases, the bridges were reconstructed due to misfit. In five patients, difficulties in getting the surgical guide completely in position, and in five patients, getting the prostheses completely seated, were noted.
All but four patients fulfilled the 1-year follow-up. Two implants were lost during the study period, resulting in a cumulative survival rate of 99.4%. The mean marginal bone resorption from implant placement to the 1-year follow-up was 1.3 mm (SD 1.28). More than 2 mm of marginal resorption was noted in 19% of the implants at this instant. The most frequently reported complications during the first year were gingival hyperplasia and prosthesis-related problems (prosthesis screw loosening, occlusal fractures, and occlusal adjustments).
Conclusion: The 1-year results in this multicenter are promising regarding implant and bridge stability; however, the study is planned to be running for at least 3 years.     

Effect of a cordless retraction paste material on implant surfaces: an in vitro study

Cordless retraction paste material for gingival retraction in implant dentistry has recently become of interest to the clinician. However, few studies have been conducted on the use of retraction pastes and their possible interaction with implant surfaces. This in vitro study evaluated the effect of a cordless retraction paste material, Expasyl? (Acteon), on TiUnite? (Nobel Biocare) implant surfaces. Three areas of the fixtures were evaluated before and after contact with the retraction paste using scanning electron microscopy to evaluate changes in surface topography and energy-dispersive spectroscopy to identify any surface chemistry modifications. Alteration of the initial surface after exposure to Expasyl? was identified, with the implant collar showing the most changes.     

A 4-year prospective clinical and radiological study of maxillary dental implants supporting single-tooth crowns using early and delayed loading protocols

Background: Recent studies have showed that immediate/early loading of dental implants is a clinically feasible concept with results similar to those for standard two‐stage procedures, especially in the mandible. However, there are only a few studies regarding the immediate/early loading of maxillary implants supporting single‐tooth crowns. Purpose: The aim of this study was to compare the clinical and radiological outcomes of early‐ and delayed‐loaded dental implants supporting single‐tooth crowns in the maxilla. Materials and Methods: Twenty‐nine patients were consecutively treated between 2000 and 2002 with 59 Brånemark System MK III TiUnite implants (Nobel Biocare AB, Göteborg, Sweden) in the maxilla. Two groups were formed according to the loading protocols. In the test group, definitive implant‐supported single crowns were delivered to 19 patients 6 weeks after the implant placement. In the control group, definitive implant‐supported single crowns were delivered to 10 patients 6 months after the implant placement. Clinical and radiographic parameters were recorded at baseline, 1 to 4 years. Implant stability measurements have only been performed at 4‐year follow‐up recall. Results: Overall, three implants were lost during the study period. Two implants were lost in the test group including 36 implants, which indicated a survival rate of 94.4%. One of the lost implants was replaced and then osseointegrated successfully. One implant was lost in the control group during the healing period, which indicated a survival rate of 95.7%. The average marginal bone loss was 1.11 mm for 56 implants after 4 years. There were no significant differences in marginal bone levels, insertion torque, and resonance frequency values between the two groups. Conclusion: The results of this study indicate that 6 weeks of early loading period for TiUnite‐surface titanium implants in the maxilla is reliable and predictable for this patient population and may offer an alternative to the standard loading protocol.     

Implant Osseointegration in Circumferential Bone Defects Treated with Latex‐Derived Proteins or Autogenous Bone in Dog's Mandible

Background: In sites with diminished bone volume, the osseointegration of dental implants can be compromised. Innovative biomaterials have been developed to aid successful osseointegration outcomes. Purpose: The aim of this study was to evaluate the osteogenic potential of angiogenic latex proteins for improved bone formation and osseointegration of dental implants. Materials and Methods: Ten dogs were submitted to bilateral circumferential defects (5.0 × 6.3 mm) in the mandible. Dental implant (3.3 × 10.0 mm, TiUnite MK3?, Nobel Biocare AB, Göteborg, Sweden) was installed in the center of the defects. The gap was filled either with coagulum (Cg), autogenous bone graft (BG), or latex angiogenic proteins pool (LPP). Five animals were sacrificed after 4 weeks and 12 weeks, respectively. Implant stability was evaluated using resonance frequency analysis (Osstell Mentor?, Osstell AB, Göteborg, Sweden), and bone formation was analyzed by histological and histometric analysis. Results: LPP showed bone regeneration similar to BG and Cg at 4 weeks and 12 weeks, respectively (p ≥ .05). Bone formation, osseointegration, and implant stability improved significantly from 4 to 12 weeks (p ≤ .05). Conclusion: Based on methodological limitations of this study, Cg alone delivers higher bone formation in the defect as compared with BG at 12 weeks; compared with Cg and BG, the treatment with LPP exhibits no advantage in terms of osteogenic potential in this experimental model, although overall osseointegration was not affected by the treatments employed in this study.     

Biological adaptation to misfits of immediately loaded fixed prostheses following computer-guided surgery

In this clinical report, following computer‐guided (3D Procera Software Planning Program, Nobel Biocare, Yorba Linda, CA) placement and immediate provisionalization of 12 dental implants (NobelSpeedy? Replace, Nobel Biocare), misfits of the prefabricated screw‐retained interim prostheses were noted at several implant‐abutment junctions. Nevertheless, adaptation of the misfits was observed 10 days later, after the loosened screws were tightened. While a high mean marginal bone loss of 2.1 mm (range: 1.4 to 3.5 mm) was noted, all implants remained osseointegrated at 3‐year follow‐up.     

Maxillary sinus augmentation using sinus membrane elevation and peripheral venous blood for implant-supported rehabilitation of the atrophic posterior maxilla: case series

Background Dental implants need appropriate bone volume for adequate stability in the rehabilitation after tooth loss. In the severely atrophic posterior maxilla, the clinical success of implant treatment sometimes requires a vertical ridge augmentation in the maxillary sinus floor. Purpose The purpose of this investigation was to evaluate a maxillary sinus floor augmentation technique using a replaceable bone window, elevation of the membrane, placement of implants, and injection of the patient’s own venous blood to fill the voids. Materials and Methods Six patients with need of maxillary sinus floor augmentation participated in the study. After preparation of a replaceable bone window in the lateral aspect of the sinus and careful elevation of the Schneiderian membrane, a total of 14 Brånemark implants (TiUnite, MK III, Nobel Biocare AB, Göteborg, Sweden) were installed in the residual bone penetrating into the sinus cavity. The sinus cavity was then filled with peripheral venous blood and the bone window replaced and stabilized with a medical tissue glue (Aron Alpha A, Sankyo, Inc., Tokyo, Japan) to prevent blood leakage from the created compartment in the maxillary sinus. Results After a healing period of a minimum of 6 months, new bone was successfully generated in all 14 implant sites as judged from radiographs. One of the 14 implants failed, corresponding to a survival rate of 92.9% after a follow‐up period ranging 12 to 34 months. Conclusions The present case series demonstrate that the creation of a secluded space in the maxillary sinus and filling with venous blood results in bone formation at simultaneously installed dental implants over a 6‐month period.     

BMP与骨融合式种植体复合的实验研究

ＢＭＰ与微孔钛种植体、生物陶瓷涂层微孔钛种植体复合后，具有新骨形成早、骨早成熟的特点，加速了种植体－骨融合，缩短了种植周期，值得临床推广应用。     

Immediate Occlusal Loading of Single Lower Molars Using Brånemark System® Wide Platform TiUnite™ Implants: A 5‐Year Follow‐Up Report of a Prospective Clinical Multicenter Study

Introduction: Although not essential, molars hold their importance in terms of functional jaw stability, antagonist opposition, and support of facial height. Therefore, implant therapy is an attractive concept in molar areas. However, especially in the posterior mandible, the conventional two‐stage surgical approach to implant therapy was reported to cause higher bone loss and/or higher implant failures with machined implants because of the peculiar anatomic and physiologic conditions of this area. As the TiUnite? (Nobel Biocare AB, Göteborg, Sweden) surface results in faster bone healing than with machined‐surface implants, it was hypothesized that this surface would also improve the performance of wide implants in posterior mandibles. Based on these assumptions, a protocol for immediately loaded implants for single molar replacement was developed. Purpose: This paper aimed to report on the clinical and radiological performance of Brånemark System® TiUnite Wide Platform implants supporting single molars in the lower jaw, loaded immediately and followed for up to 5 years, and to assess if the benefit delivered by oxidized surfaces in the short run is also present after 5 years. Materials and Methods: The study includes 33 consecutive patients treated between March 2001 and September 2003 and monitored until September 2008 in two private dental offices. A total of 40 Brånemark System TiUnite Wide Platform MK III implants were placed. All implants were provided with provisional crowns in full centric occlusion at the time of surgery. Patients were clinically and radiologically followed up for up to 5 years. Results: Two implant failed so that the cumulative success rate at 5 years was 95.0%. The mean marginal bone remodeling (n = 38) expressed as mesial plus distal value averages was ?1.17 mm (SD ± 0.90) at the 5‐year time point. Conclusion: Although limited by the number of patients treated in accordance with the protocol described, 5‐year results encourage the use of immediately loaded single lower molars supported by Brånemark System Wide Platform TiUnite implants and further document the clinical advantages of titanium oxidized surfaces.     

TiUnite表面种植体的临床研究进展

TiUnite是一种在种植体表面进行阳极氧化的处理技术。因其独特的微观结构和组成,TiUnite表面种植体具有良好的骨结合能力。大量的临床追踪报道表明,TiUnite表面种植体在即刻/早期功能负重时可以取得很好的长期疗效,而且TiUnite表面种植体在软质骨和后牙区应用时较机加工的表面种植体具有更高的成功率。此外,TiUnite表面种植体在骨量不足和骨重建的患者中也可以取得很高的成功率。本文就其最新的研究进展作一综述。     

Histomorphometric analysis of the osseointegration of four different implant surfaces in the femoral epiphyses of rabbits

Objectives: The surface properties of titanium dental implants are key parameters for rapid and intimate bone–implant contact. The osseointegration of four implant surfaces was studied in the femoral epiphyses of rabbits. Material and methods: Titanium implants were either grit‐blasted with alumina or biphasic calcium phosphate (BCP) ceramic particles, coated with a thin octacalcium phosphate (OCP) layer, or prepared by large‐grit sand blasting and acid‐etched (SLA). After 2 and 8 weeks of implantation, the bone‐implant contact and bone growth inside the chambers were compared. Scanning electron microscopy (SEM) and profilometry showed distinct microtopographies. Results: The alumina‐Ti, BCP‐Ti and OCP‐Ti groups had similar average surface roughness in the 1–2 μm range whereas the SLA surface was significantly higher with a roughness averaging 4.5 μm. Concerning the osseointegration, the study demonstrated a significantly greater bone‐to‐implant contact for both the SLA and OCP‐Ti surfaces as compared with the grit‐blasted surfaces, alumina‐ and BCP‐Ti at both 2 and 8 weeks of healing. Conclusion: In this animal model, a biomimetic calcium phosphate coating gave similar osseointegration to the SLA surface. This biomimetic coating method may enhance the apposition of bone onto titanium dental implants.     

Implant-abutment screw joint preload of 7 hex-top abutment systems.

This study measured the screw joint preload of the implant-abutment interface for 7 common hex-top abutment systems. Increasingly, prosthetic designs are utilizing a direct prosthetic connection to the implant, placing the implant-abutment screw joint under direct functional loads and moments. Sufficiently high screw joint preloads are required to maintain screw joint integrity and confer clinical longevity to implant prosthetic components to prevent such complications as abutment screw loosening and screw fracture. Strain-gauged abutment load cells were calibrated to measure screw joint pre-load at the implant-abutment interface. Torque delivery by electronic torque controller was varied at low- and high-speed settings. At manufacturer's recommended torques, the overall mean preload measured was 181.6 +/- 60.0 N for the Nobel Biocare Standard abutment, 291.3 +/- 41.2 N for the Nobel Biocare EsthetiCone abutment, 456.5 +/- 44.0 N for the Nobel Biocare MirusCone abutment, 369.7 +/- 32.9 N for the 3i Titanium Abutment post, 643.4 +/- 143.1 N for the Nobel Biocare CeraOne abutment, 536.3 +/- 68.6 N for the Nobel Biocare "Gold Cylinder to Fixture" abutment, and 556.9 +/- 145.6 N for the Nobel Biocare TiAdapt abutment. Analysis of variance revealed significant differences between abutment systems (P < .001) and between torque driver speed settings (P < .001). Implant-abutment screw joint preload of external-hex implants is dependent on abutment design, screw diameter, material, tightening torque, and torque controller speed.     

Rehabilitation of edentulous mandibles by means of five TiUnite implants after one-stage surgery: a 1-year retrospective study of 90 patients

Background: Recently, the present team reported the 1‐year data of one‐stage surgery and mainly early loading performed in edentulous mandibles using 750 turned Brånemark System® implants in 152 patients. Purpose: The aim of the present investigation was to retrospectively evaluate the 1‐year results of the same treatment technique, using Brånemark System implants with an oxidized surface (TiUnite?, Nobel Biocare AB, Göteborg, Sweden). The outcome was compared with that of the former study (control) on turned implants. Materials and Methods: The present study involved 90 individuals with 450 TiUnite implants of mainly the Brånemark System Mark III design, placed in edentulous mandibles and using one‐stage surgery. The prosthetic procedure was commenced as a mean 8 days after the surgical intervention. Intraoral radiographs were obtained at prosthesis insertion and at the 1‐year annual checkup. Failure rates of test and control groups were compared by means of the chi‐square test. Results: No implants were found to be mobile up to and including the first annual checkup, resulting in an implant cumulative survival rate (CSR) of 100%. The corresponding CSR for the control group was 97.5%, and this difference in implant survival was statistically significant when analyzed with the chi‐square test (p < .001). A statistically significant difference was also demonstrated (p < .01) when conducting the same statistical analysis on the patient level. The mean marginal bone resorption during the first year of function was 0.49 mm (SD 0.56), and the corresponding figures for the control study were 0.39 mm (SD 0.46). The central TiUnite implant, that is, the one placed in or in close relation to the symphyseal region showed significantly more bone loss (p < .05) than the corresponding central turned implant of the control study. Distally positioned test implants demonstrated less marginal bone loss than the corresponding central one. Conclusions: The outcome of 450 TiUnite implants placed in 90 patients with edentulous mandibles, of which 380 implants in 76 patients were followed for 1 year, showed an implant CSR of 100%. The figure was significantly different from the control study result of 97.5% on turned surface implants. The levels of marginal bone were close to identical for test and control implants at the 1‐year checkup.     

A Retrospective Comparison of Oxidized and Turned Implants with Respect to Implant Survival,Marginal Bone Level and Peri‐Implant Soft Tissue Conditions after at Least 5 Years in Function

Background: Long‐term clinical follow‐up studies comparing different implant surfaces with regard to survival and marginal conditions are rare. Objectives: The objective of this study was to compare the clinical performance of turned and oxidized implants after more than 5 years of loading Material and Methods: One hundred three patients (43 men, 60 women; mean age 67.4 years, range 32–90) previously treated with 287 implants (Nobel Biocare AB, Gothenburg, Sweden), 133 with turned surface (MKIII, Nobel Biocare AB) and 154 with an oxidized surface (MKIII, TiUnite, Nobel Biocare AB) were examined after at least 5 years of loading (mean 82 months, range 60–93 months). The implants had been used for support of single crowns (33 patients/36 implants), partial bridges (39 patients/103 implants), or full bridges (31 patients/148 implants) following an early loading protocol (14 patients /54 implants), a one‐stage protocol (32 patients/59 implants) or a two‐stage protocol (57 patients/174 implants). Clinical examinations of bleeding on probing (BoP) and pocket depth (PD) were performed. Intraoral radiographs were used for assessments of marginal bone levels (MBLs). Results: Seven turned implants and one oxidized implant failed, giving overall cumulative survival rates of 94.7 and 99.4%, respectively. There were no differences for BoP scores (0.5 ± 0.7 vs 0.4 ± 0.6) and PD measurements (1.7 ± 0.8 mm vs 1.8 ± 1.0 mm) parameters when comparing turned and oxidized implants, respectively. The mean MBL was 1.8 ± 0.8 mm and 2.0 ± 0.9 mm for turned and oxidized implants, respectively, after more than 5 years in function (NS). Frequency distribution of MBL loss showed no statistically significant differences between the two surfaces. A total of four implants (1.4%) (three oxidized and one turned) showed a PD > 3 mm, MBL > 4 mm, and BoP. However, none of these were associated with suppuration on examination. Conclusion: The present study does not state any differences in implant failure, MBL, presence of bleeding or PD around implants when comparing turned and oxidized titanium implants after at least 5 years of function.     

Comparison of Implant Stability Before Prosthetic Loading of Two Dental Implant Systems

Dental implantology is the state of the art technique to replace missing teeth. Implant stability of implant jeopardizes its longevity and success of treatment. This study evaluates the implant stability of implant before and after 4 months of the implant placement, but before prosthetically loading it. Ten two-stage implants of Life care and Nobel Biocare dental implants were placed in 20 patients. Digital OPG was taken on the day of implant placement. After 4 months, at the time of second stage surgery, the implant stability was evaluated by the Periotest instrument. Four months after the implant placement, Periotest evaluation showed a mean of 1.9, which indicated that implants were well osseointegrated and stable. Even before prosthetically loading the two-stage implant, crestal bone loss of 0.6–0.9 mm occurred around the implant. The smooth polished collar design of the implant may have contributed to crestal bone loss.     

Stability of dental implants in grafted bone in the anterior maxilla: longitudinal study

We aimed to assess the stability over time of dental implants placed in grafted bone in the maxilla using resonance frequency analysis, and to compare the stability of implants placed in grafted and non-grafted bone. Data were collected from 23 patients (15 test and 8 controls) in whom 64 implants (Brånemark system, Nobel Biocare, Göteborg, Sweden) were placed in accordance with the two-stage surgical protocol. In the test group 36 fixtures were placed in grafted bone, and in the control group 28 fixtures were placed in non-grafted bone. Resonance frequency analysis was used to assess the test sites at implant placement and abutment connection. The mean (SD) implant stability quotient (ISQ) for test sites at the time of implant placement was 61.91 (6.68), indicating excellent primary stability, and was 63.53 (5.76) at abutment connection. ISQ values at abutment connection were similar for test and control sites. Implants placed in grafted bone compared favourably with those in non-grafted bone, and showed excellent stability.     

Correlation of insertion torques with bone mineral density from dental quantitative CT in the mandible

Abstract: Objective: The aim of this study was to establish a correlation between bone mineral density measured preoperatively with dental computed tomography (CT), and insertion torque of screw‐shaped dental implants. Material and methods: In eight human mandibles obtained postmortem, bone mineral density (BMD) was measured with dental quantitative CT (DQCT) and correlated with insertion torque values at 45 implant sites during insertion of screw‐shaped dental implants (Brånemark System MKIII, Nobel Biocare, AB, Göteborg, Sweden). Results: A significant correlation (r=0.86, P<0.001) between BMD and torque values was observed, indicating that local BMD at a specific implant position is related to the supportive capacity of the jawbone. BMD exhibited no correlation with bone height or position. Conclusion: The noninvasive assessment of BMD using a DQCT scan employing a low‐dose protocol may be used to estimate expected primary stability depending on BMD, implant type and preparation procedure. These data may therefore help the surgeon to select the optimum implant position, implant type and operation technique.     

Facial and oral reconstruction following trauma and failed chin implant: a case report

Functional and esthetic reconstruction of a patient with microgenia who sustained traumatic injury was successfully accomplished using Br?nemark System osseointegrated implants (Nobel Biocare USA, Inc., Yorba Linda, CA) to support a permanent dental prosthesis following mechanical and biologic reconstruction of the anterior mandible and chin. A 25-year-old glycine chin implant previously used for facial esthetic enhancement had eroded the anterior cortical plate and migrated through the medullary bone, compressing the periosteum into the apex of the anterior tooth roots. Further destruction of the lingual cortex with risk of fracture was imminent. After removal of the chin implant, a cancellous bone graft was held in place with a titanium mesh frame. The prosthetic rehabilitation consisted of two phases of mandibular implant placement followed by the construction of a porcelain-fused-to-gold implant-supported fixed prosthesis, restoring the occlusal vertical dimension as well as appropriate lip support. Restoration of function was superior to the pretreatment condition.