Effect of Compromised Cortical Bone on Implant Load Distribution

Purpose: To investigate photoelastically the difference in load distribution of dental implants with different implant neck designs in intact and compromised bone. Materials and Methods: Composite photoelastic models were fabricated using two different resins to simulate trabecular bone and a 1‐mm thick layer of cortical bone. The following parallel‐sided, threaded implants were centrally located in individual models representing intact and compromised cortical bone: Straumann (4.1‐mm diameter × 12‐mm length), AstraTech (4.0‐mm diameter × 13‐mm length), and 3i (3.75‐mm diameter × 13‐mm length). The compromised cortical bone condition was simulated by contaminating a 1‐mm neck portion with Vaseline to impair the implant–resin interface. Vertical and oblique static loads were applied on the abutments, and the resulting stresses were monitored photoelastically and recorded photograhphically. Results: For the fully intact condition, the highest stresses were observed around the crest and apical region for all implant designs under vertical and inclined loads. There were no appreciable differences in magnitude or distribution between implant types. With compromised cortical bone, for all designs and load directions, higher stresses in the supporting structures were observed. Increased stresses were noted especially at the cortical bone–trabecular bone interface. Somewhat lower stress levels were observed with the 3i implant. Conclusions: The condition of implant–cortical bone contact has considerable influence on stress distribution. A compromised cortical bone condition caused higher level stresses for all implant designs tested.     

Clinical evaluation of patients with temporomandibular joint implants

PURPOSE: An undetermined number of patients with temporomandibular joint (TMJ) symptoms have been treated with intra-articular disc implants composed of Teflon ethylene/propylene or Teflon polytetrafluoroethylene and aluminum oxide (Proplast-Teflon; Vitek, Houston, TX). These implants have shown the potential to fragment in situ resulting in nonbiodegradable particles that stimulate a giant cell reaction and lead to degeneration of local structures, pain, and limitation of mandibular opening. We examined the possible relationship between TMJ implants and persistent pain, responses to sensory stimuli, quality of life, and systemic immune dysfunction. PATIENTS AND METHODS: This case series (32 patients) were referred from university-based orofacial pain centers and private practices from across the United States. Laboratory and clinical assessments evaluated orofacial pain symptoms, neurologic function, clinical signs and symptoms of rheumatologic disease, physical function, systemic measures of immune function, and behavioral measures. RESULTS: We found that TMJ implant patients appeared to have altered sensitivity to sensory stimuli, a higher number of tender points with a diagnosis of fibromyalgia, increased self-report of chemical sensitivity, higher psychologic distress and significantly lower functional ability. Systemic illness or autoimmune disease was not evident in this series of TMJ implant patients. CONCLUSIONS: Significant problems were noted on clinical assessment of TMJ implant patients. This is a US government work. There are no restrictions on its use.