Human gingival fibroblasts function is stimulated on machined hydrided titanium zirconium dental implants

Objectives

The aim of this study was to evaluate the influence of different titanium zirconium (TiZr) alloy surfaces on primary human gingival fibroblasts (HGF) for improved soft tissue integration of dental implants.

Methods

TiZr polished, machined and machined + HCl/H₂SO₄ acid-etched surfaces were modified by cathodic polarization and/or HNO₃/HF acid etching. Contact angle of surfaces was measured. The influence of modified TiZr surfaces on HGF was evaluated through the analysis of cell number, morphology, recovery after a wound (wound healing assay) and the expression of several genes, including matrix metalloproteinase-1 (MMP1) and metallopeptidase inhibitor-1 (TIMP1).

Results

Modification of TiZr surfaces decreased its hydrophilicity. Hydride implementation on TiZr surfaces via cathodic polarization increased TIMP1 expression and decreased MMP1/TIMP1 mRNA ratio. Cathodic polarization of machined surfaces promoted cell attachment. Cells on machined and machined + cathodic polarization surfaces grew aligned to the microgrooves whereas on all polished surfaces they grew randomly. Acid etching of polished and machined surfaces did not improve HGF function.

Conclusions

Hydride implementation on TiZr machined surfaces may be used as new dental implant material for improved soft tissue integration.

Clinical significance

Enhancing dental implant surfaces’ bioactivity by hydride implementation may promote soft tissue attachment and sealing around the implant and reduce peri-implantitis related to ECM-destruction compared with conventional machined surfaces.     

多孔磷酸三钙-羟基磷灰石对人牙龈成纤维细胞黏附行为的影响

目的　研究多孔磷酸三钙 羟基磷灰石 (tricalcium phosphate hydroxyapatite ,TCP HA)复合材料对人牙龈成纤维细胞黏附行为的影响。方法　应用离子束辅助沉积法在纯钛试件表面制备多孔TCP HA复合涂层材料和羟基磷灰石 (hydroxyapatite,HA)涂层材料 ,定量对比人牙龈成纤维细胞在涂层和未涂层材料表面初期黏附、增殖、细胞铺展面积、细胞外基质和黏着斑形成的情况。结果　TCP HA和HA涂层材料表面黏附的细胞数、细胞铺展面积高于纯钛未涂层组 ,差异有显著性(P <0 0 5 ) ,黏着斑的形成早于未涂层组 ;TCP HA表面黏附的细胞数和Ⅰ型胶原的形成都高于纯钛未涂层组和HA涂层组。在培养 2 4h后TCP HA组表面黏附细胞数为 198 1± 2 7 7,Ⅰ型胶原形成的荧光强度为 15 4 10± 31 5 6 ,同纯钛组表面的细胞数 ( 12 5 1± 2 9 9)和Ⅰ型胶原荧光强度( 132 6 3± 35 2 6 )相比 ,差异有显著性 (P <0 0 5 )。结论　与纯钛未涂层和HA涂层材料相比 ,多孔TCP HA复合涂层材料更有利于人牙龈成纤维细胞的初期黏附 ,具有更良好的生物相容性     

Plasminogen activator in human gingival tissue adjacent to dental implants

The installment of endosseous dental implants has become an accepted treatment procedure, and the long-term clinical results appear excellent. The composition of the soft tissue environment, however, is different from that around natural teeth. One characteristic of original junctional epithelium is its association with plasminogen activator (PA) activity. In 11 patients with a total of 30 ITI hollow-screw titanium dental implants, 16 biopsies were taken. Histologic cryostat sections were assayed for the presence of PA in the junctional epithelium. The results demonstrated that junctional epithelium around titanium implants yields PA activity in a manner very similar to that of natural teeth. The ability to produce this enzyme activity is not related to the developmental origin of the junctional cells, but to their position and function at the base of the gingival sulcus.     

钛表面微沟槽形貌对人牙龈纤维细胞黏着斑蛋白表达的影响

目的 比较不同尺寸微沟槽表面对人牙龈成纤维细胞（HGF）黏着斑蛋白vinculin表达的影响,作为选择种植体穿龈部分微沟槽尺寸的依据之一。方法针对HGF大小,设计不同沟槽尺寸,利用光刻技术制作微沟槽形貌,沟槽宽度和间隔分别为15 μm、30 μm和60 μm,沟槽深度为5 μm和10 μm,分组为T15/5、T15/10、T30/5、T30/10、T60/5和T60/10,光滑钛(T0)表面为对照组。通过免疫荧光、实时荧光定量PCR和蛋白免疫印迹比较vinculin基因和蛋白水平的表达差异。采用SPSS17.0软件包对数据进行统计学分析。结果免疫荧光显示,随着沟槽宽度增加,vinculin 的绿色荧光点增多,mRNA和蛋白水平表达T60最高,T15最低。相同沟槽宽度下,深度改变对该蛋白的表达无显著影响。结论微沟槽形貌有利于vinculin蛋白的表达,表达量随着沟槽的宽度增加而增加。就vinculin蛋白的表达而言,T60组沟槽更适合作为穿龈部分的沟槽尺寸。     

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目的    探讨精氨酸-甘氨酸-天冬氨酸（RGD）肽修饰纯钛表面对人牙龈成纤维细胞（human gingival fibroblasts,HGF）和上皮细胞（human gingival epithelial cells,HGE）初期黏附行为的影响。方法    应用羰基二咪唑（1,1′-carbonyldiimidazole,CDI）活化法将含RGD的短肽共价连接到纯钛表面,免疫荧光法检测钛表面RGD肽。评价RGD接枝与未接枝纯钛表面对HGF和HGE初期黏附的影响。结果    RGD肽可以通过CDI活化方法接枝到纯钛表面,HGF和HGE在RGD接枝钛表面黏附和增殖的细胞数量显著高于未接枝钛表面,差异有统计学意义（P < 0.01）。结论    生物活性肽RGD接枝纯钛表面可有效促进HGF和HGE在其表面的黏附。     

牙种植修复与骨密度的临床应用研究

目的：探讨颌骨骨密度在牙种植修复中的作用及意义，并分析种植体松动度与颌骨骨密度及牙龈指数的关系。方法：对49例患者，66颗缺牙进行牙体种植修复，修复前后分别进行临床及X线检查。结果：49例患者中有48例骨密度值在150～80范围内，占牙种植数的72％，松动度为0度者占95％．牙龈指数为0度者占93％；骨密度与松动度呈负相关，而牙龈指数与松动度呈正相关。结论：骨密度与种植修复体的成功与否密切相关，以X线定期检查是必要的。     

All-on-Four技术在口腔种植领域中的应用进展

种植修复是恢复无牙颌患者咀嚼功能和美观的有效治疗方法,但因可用骨量的不足、上颌窦和下牙槽神经血管束等解剖问题而面临巨大挑战。对该类患者行种植体植入术时,常需要进行相关的骨增量手术。All?on?Four技术是指在无牙颌前牙区植入两颗轴向种植体,在远中端植入两颗角度种植体,并即刻负重,且在4～6个月后完成最终修复的新种植修复技术。该技术避免了人工骨粉植入术及上颌窦提升术等骨增量过程,患者心理反应及术后反应较轻,同时节省了患者的时间和金钱成本。这种联合应用倾斜种植体和直种植体来共同完成无牙颌患者的固定修复治疗被认为是一种可行的治疗方式。本文将就All?on?Four概念、常规技术、评价研究以及近年来提出的一些新的观点进行阐述。     

Clinical study of patients whose dental implants were removed

Twenty-nine cases including 13 males and 16 females, aged 24 to 71 years (average age of 53.7±11.6), whose dental implants were removed at our deparments for past thirteen years from 1985 to 1998 have been retrospectively discussed. Implants were placed in 26 partial edentulous and 3 totally edentulous, 14 for maxilla, 13 for mandible, 2 for both jaws were removed. These implants included 14 blade, 6 endosseous, 14 subperiosteal, 3 endodontic, and 2 home-made implants. Durations from implant placement to removal were 10 days to 20 years (average of 78.3±83.7 months). Causes of removal were 12 local infections, 4 maxillary sinusitis, 2 nerve disturbances and 1 psycologic problem.

     

1144颗种植牙修复临床效果分析

目的评价北京口腔医院种植中心2000年1月至2005年4月所完成种植修复病例的临床效果。方法2000年1月至2005年4月共植人种植体2158颗,随访观察时间3-8年。依照珠海种植会议标准,采用寿命表法进行统计分析。结果2000年1月至2005年4月种植病例1125人,随访到577人,1144颗种植体。累计5年存留率91．37％。结论累计种植5年存留率达到91．37％。     

引导骨再生术对前牙区种植牙龈美学及牙槽骨吸收的影响

目的 了解前牙美学区种植位点存在骨缺损的患者行引导骨再生术（guided bone regeneration,GBR）在种植术后能否获得无明显骨缺损患者相近的牙龈美学效果,评价引导骨再生术对牙槽骨吸收的影响。方法 选取2017年8月—2018年6月间在中国科学技术大学附属第一医院（安徽省立医院）口腔医学中心行前牙种植术的患者31例,术前测量种植位点牙槽骨宽度,宽度小于6.8 mm的患者为GBR组,宽度大于6.8 mm患者为非GBR组,比较2组二期修复时牙龈美学评分、探诊深度及牙槽骨吸收的差异。采用SPSS 19.0软件包对数据进行两独立样本t检验。结果 GBR组牙龈美学评分显著高于非GBR组（P<0.01）,GBR组与非GBR组探诊深度无显著差异（P>0.05）,GBR组牙槽骨吸收显著小于非GBR组（P<0.01）。结论 使用GBR术可以减缓骨吸收速度,使存在局部牙槽骨缺损的患者达到无骨缺损患者牙种植术后的美学效果。     

即刻种植与种植体早期加载的临床研究

目的探讨即刻种植与种植体早期加载的临床效果。方法患者37例，拔牙后即刻植入64枚种植体。36枚为Ⅰ期完成手术，其中无牙颌患者覆盖义齿的种植体17枚均即刻加载；14枚种植体于术后1～2个月早期加载，22枚种植体于3～4个月加载。28枚3～6个月后行Ⅱ期手术，常规修复。结果全部种植体稳定无松动，种植体周围无炎症。X线片未见明显骨吸收，即刻加载和即刻修复的病例与常规方法修复的种植体周围龈袋深度差异无统计学意义。结论即刻种植与种植后早期加载缩短了种植修复疗程，其疗效与常规方法修复无差异。     

Effect of 3D microgroove surface topography on plasma and cellular fibronectin of human gingival fibroblasts

Objectives

Fibronectin (FN), an extracellular matrix (ECM) glycoprotein, is a key factor in the compatibility of dental implant materials. Our objective was to determine the optimal dimensions of microgrooves in the transmucosal part of a dental implant, for optimal absorption of plasma FN and expression of cellular FN by human gingival fibroblasts (HGFs).

Methods

Microgroove titanium surfaces were fabricated by photolithography with parallel grooves: 15 μm, 30 μm, or 60 μm in width and 5 μm or 10 μm in depth. Smooth titanium surfaces were used as controls. Surface hydrophilicity, plasma FN adsorption and cellular FN expression by HGFs were measured for both microgroove and control samples.

Results

We found that narrower and deeper microgrooves amplified surface hydrophobicity. A 15-μm wide microgroove was the most hydrophobic surface and a 60-μm wide microgroove was the most hydrophilic. The latter had more expression of cellular FN than any other surface, but less absorption of plasma FN than 15-μm wide microgrooves. Variation in microgroove depth did not appear to effect FN absorption or expression unless the groove was narrow (∼15 or 30 μm). In those instances, the shallower depths resulted in greater expression of cellular FN.

Conclusions

Our microgrooves improved expression of cellular FN, which functionally compensated for plasma FN. A microgroove width of 60 μm and depth of 5 or 10 μm appears to be optimal for the transmucosal part of the dental implant.     

牙种植体结合上皮形成中表皮生长因子受体表达

目的观察牙种植体结合上皮形成过程、增殖核抗原（proliferating cell nuclear antigen，PCNA）及表皮生长因子受体（epidermal growth factor receptor，EGFR）的表达，探讨EGFR与结合上皮形成的关系。方法建立Beagle狗牙种植体模型。分别于取材前1天、3天、6天、9天、12天、15天、20天、30天8个时间段各植入4颗种植体。取标本作HE染色及PCNA、EGFR免疫组化染色检测。结果种植术后12天结合上皮开始形成，PCNA、EGFR呈强阳性表达；15天上皮细胞增生趋于平稳，PCNA表达显著减弱；20天形成类似天然牙的上皮附着，EGFR表达显著减弱。结论纯钛牙种植体周能形成类似天然牙的上皮附着；EGFR表达与种植体周结合上皮的形成密切相关。     

螺旋型牙种植体下颌磨牙区种植的尝试

目的：针对下牙槽神经的特殊解剖特点探讨下颌磨区种植义齿方法。方法：根据缺牙后下颌磨牙区颌骨的不骨吸收程度,分别采取直接种植,跨越下颌管种植和解剖游离下牙槽神经血管束种植的3种方法,1992－1998年共完成22例,45颗种植体,平均随访时间为3．7年。结果：除2颗种植体分别于术后3个月和修复后1．5年脱落失败外,其余43颗种植体均呈骨结合,且骨吸收不明显、义齿功能良好,种植体5年累积成功率为96％,结论：3种种植方法基本解决了临床中下颌磨牙区种植的大部分问题,但应特别注意选择选择适应证。     

改良粘接固位后牙种植义齿修复对种植体周围组织的影响

目的:考察改良粘接固位后牙种植义齿修复对种植体周围组织的近期影响.方法:纳入后牙缺陷的患者182例,随机分为2组,对照组(n=89)接受传统粘接固位,观察组(n=93)接受改良粘接固位,考察治疗后1年的种植体周围骨吸收量、牙槽骨高度和厚度、粉红美观计分标准(pictorial view of pink esthetic score variables,PES)、改良菌斑指数(modified plaque index,mPLI)、改良出血指数(modified suleus bleeding index,mSBI)和患者对种植义齿的满意度.结果:与对照组比,观察组的近和远中边缘骨吸收量明显降低(P＜0.05),牙槽骨高度和厚度明显增高(P＜0.05),舒适程度、咀嚼功能、语言功能、固位功能、美观功能、PES、mPLI和mSBI均有不同程度的改善(P＜0.05).结论:改良粘接固位较传统粘接固位在稳定种植体的骨支持和降低细菌感染方面具有明显的优势.     

Immediate loading of dental implants

The purpose of this review is to explore the concept of immediate loading as it pertains to dental implants and the indications for clinical practice. The definition of immediate loading will be considered together with a review of the relevant literature in an attempt to provide evidence-based guidelines for successful implementation into practice.
A search of electronic databases including Medline, PubMed and the Cochrane Database of Systematic Reviews was undertaken using the terms ``immediate loading', ``dental implants', ``immediate function', ``early loading', ``oral implants', ``immediate restoration' and ``systematic review'. This was supplemented by handsearching in peer-reviewed journals and cross-referenced with the articles accessed. Emphasis was given to systematic reviews and controlled clinical trials.
A definition of immediate loading was suggested pertinent to the realities of logistics in clinical practice with respect to application and time frame. The literature was evaluated and shown to be limited with significant shortcomings. Guidelines and recommendations for clinical protocols were suggested and illustrated by examples of case types with a minimum of 1–3 years follow-up. A list of additional references for further reading was provided.
Within the limitations of this review, there is evidence to suggest that immediate loading protocols have demonstrated high implant survival rates and may be cautiously recommended for certain clinical situations. However, more high level evidence studies, preferably randomized controlled trials (RCTs), over a long time frame are required to show a clear benefit over more conventional loading protocols.     

The effect of low-intensity pulsed ultrasound on the osseointegration of titanium dental implants

Our aim was to record the effect of low-intensity pulsed ultrasound (LIPUS) on the osseointegration of endosseous dental implants in 10 New Zealand rabbits. One titanium implant with screw was inserted into the metaphyseal region of each femur and tibia in the knee joints of each rabbit, making a total of 40 implants. The area of one lateral knee joint, including implants, was irradiated with LIPUS for 10 min twice a day for 21 days. The other side acted as control, having been given "sham" irradiation. Two rabbits were killed at each of 0, 2, 4, 6, and 8 weeks after irradiation. A micro-computed tomogram (μCT), histological examination, and implant pull-out test were used to judge the reactions of the bone to the titanium implant. Histological and μCT examinations showed that osseointegration of the implants on the LIPUS-treated side happened earlier and more effectively than on the control side. The mechanical test showed that the maximal axial pull-out strength of the implants on the LIPUS-treated side was greater than that on the control side. We conclude that LIPUS has the potential to accelerate the osseointegration of dental implants.     

New technology for the removal of corundum residues on dental implants

Surface modification is an important measure to improve dental implants. Corundum residues, which are part of current dental implant blasting, on Straumann dental implants, were found to have disappeared in recent publications. We further evaluated this new cleaning technology by evaluating the surface of four different Straumann implants using scanning electron microscopy (SEM) and energy-dispersive radiographic spectroscopy (EDX). The involved technology fits to a Straumann patent involving a dextran coating allowing easy corundum particle removal by aqueous solution.     

种植体失败位点再种植的临床回顾分析

目的: 评估种植体失败位点再种植修复治疗的临床效果及其影响因素。方法: 选择2005年1月—2011年12月间就诊的失败位点再种植的患者共12例(15颗种植体), 统计再植入种植体的存留情况, 收集并分析影响再植入种植体存留相关危险因素的临床资料。采用SPSS13.0软件包对数据进行统计学分析。结果: 首次失败位点再植入的种植体存留率为100%。再种植时选择的平均种植体直径为(4.5±0.6) mm, 大于首次种植时的(4.1±0.7) mm(P<0.05)。首次植入种植体的平均存留时间为(12.9±15.9)个月, 从种植体脱落到再种植的平均间隔时间为(6.8±4.4)个月。患者自身因素、种植体因素以及手术、修复治疗因素并未对失败位点再植入种植体的存留产生影响。结论: 种植失败位点可考虑再种植治疗的修复方案, 种植医师对取得满意的种植体存留率应具有足够信心。     

Effect of hyaluronic acid on the osseointegration of dental implants

The mechanism of osseointegration is related to many factors, including the quality of the bone, the biocompatibility and surface characteristics of the implant material, the surgical technique, and functional loading. The purpose of this study was to investigate the effects of hyaluronic acid gel on the osseointegration of implants placed in defined areas of the mandible in rabbits. Hyaluronic acid is known to have an osteoinductive effect during regeneration of bony defects, and we thought that it might also have a favourable effect on osseointegration, a specialised mechanism to heal bone. Ten New Zealand rabbits aged 10 weeks and weighing 2.5–3.0 kg were used, and sites for implants that were far enough from the apices of the teeth in the mandibular molar area were chosen. Two cavities were prepared in each rabbit, one (anterior) for the control implant, and one (posterior) for the implant with hyaluronic acid gel (Medical Instinct GmbH, Bovenden). New bone and the osteoid matrix content around the dental implants were evaluated histologically and histomorphometrically two months after the operation, and no significant difference was found between the two groups.