CLR 12022

409 Posters Material Research
evaluating the success of this novel dental implant approach is needed.
Designing a novel dental root analogue implant using cone beam computed tomography and CAD/CAM technology
David David Anssari Moin
ACTA, Amsterdam, The Netherlands Background: One of the new possibilities with innovative
A novel internal irrigation system is capable to decrease temperature rise caused by trephine osteotomies
Christoph Arnhart,1 Ewald Unger,2 Georg Watzek1
1
techniques is to produce a customized dental root analogue implant (RAI) as an alternative to the traditional threaded, straight or tapered implant systems intended to replace a missing tooth. This new implant would have similar dimensions to the original root and should be congruent with the root socket. Anticipated benets include uncomplicated immediate implant placement, decreased number of surgeries and increasing patient comfort. Moreover, mimicking root features might result in higher aesthetic outcome. Few studies describing techniques of creating and placing custom, root analogue implants have been noted in the literature. However, a signicant shortcoming with previously reported techniques is that the process entails laser scanning or machine copying of an extracted root with placement of the subsequently created RAI at a second surgery. Aim: The study aim is to introduce a novel preemptively constructed dental root analogue implant (RAI) based on threedimensional (3D) root surface models obtained from a cone beam computed tomography (CBCT) scan, computer aided designing and computer aided manufacturing technology. Methods: One partially edentulous mandibular human cadaver was scanned with the Accuitomo 170 CBCT system. The scan volumes and datasets were used to create 3D surface models of the tooth. A 3D surface mesh of the tooth was stored as a standard triangulation language (STL) le. A high-end selective laser melting technology was used to fabricate the RAI from the STL le. The RAI was produced in a biocompatible titanium alloy (Ti6Al4V). Optical scanning technology was used to measure the RAI, as well as the natural tooth that was extracted. To validate the accuracy of the CBCT 3D root surface and the manufactured Titanium RAI, both surfaces were superimposed on the optical scan of the tooth, which served as the gold reference standard. Results: The differences between the RAI and the optical scan of the original tooth are most noticeable at the level of the apex and the cementenamel junction areas on the buccal and lingual side (divergence of more than 0.15 mm). Surface area measurements show an overall decrease in surface area of 6.33% for the RAI in comparison with the original tooth and an increase of 0.27% when comparing the 3D surface model with optical scan of the original tooth. Conclusions and clinical implications: With the use of currently available technology it is very well feasible to preemptively create a custom RAI in titanium. However, clinical evidence
Oral Surgery, Bernhard Gottlieb University of Dentistry, Vienna,
Austria, 2Center of Biomedical Engineering and Physics, Medical University of Vienna, Vienna, Austria Background: Trephine osteotomies (TO) may cause extensive
rise in ambient bone temperature due to friction by drill geometry. Common irrigation systems failed to ensure proper temperature control at the cutting edge. A supplementary internal irrigation system within the cylindric wall of the drill body was developed in order to reduce the risk of thermal bone trauma. Aim: The present pilot study aimed at monitoring thermal changes caused by TO done by these prototypes and standard trephines. Methods: Trephine prototypes were constructed by direct metal laser sintering. Based on this technology the construction of irrigation channels within the wall of trephine drills became possible. Overall 100 TO (prototype vs. standard trephine) were realized to a depth of 6 mm in an organic bone analogon (bone sim) by a standardized procedure applying a constant force of 37 N and a rotation speed of 2000 rpm. Temperature was recorded on surface and in a depth of 2, 4 and 6 mm by a four-canal-thermocouple placed in a vertical canal drilled 1 mm adjacent to the drilling site. Additionally, the surfaces of the trephines were analysed by a thermographic camera. Results: Data acquisition is not completely nished yet but preliminary results show signicantly lower temperatures on the surface of the prototypes than on the standard trephines within the thermographic analysis. Furthermore, higher ambient temperatures were recognized for TO caused by standard trephines. Conclusions and clinical implications: The use of a supplementary internal irrigation system within the wall of cylindric trephine drills can signicantly reduce temperature rise caused by trephine osteotomies in an organic bone analogon. Further studies will be necessary to prove whether direct metal laser sintering is a safe and effective method for the production of drills to reduce thermal trauma in case of trephine osteotomies.
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treatment) are at least as effective and safe as conventional control implants.
Efcacy and safety of multi-phosphonate treated dental implants (randomised trial)

Marco Esposito, Ivan Dojcinovic, Laurence Germon,3 Richard Curno,3 Sabrina Buchini,3 Peter Pechy,3 Sven Lindskog,4 Bjorn-owe Aronssons3
1
Sisters chromatide exchange could be induced by synthetic bone grafts?!

,2 Mehmet Ali lu,1 Amila Brkic rkan Ko seog Banu Gu 1 3 Erdem, S u u kru Oztu rk, S kru Palanduz,3 Kivanc 3 C ee
1
University of Gothenburg, Gothenburg, Sweden, 2Private Dental

3
Clinic, Morges, Switzerland, Nano Bridging Molecules SA, Gland, Switzerland, 4Karolinska University Hospital, Stockholm, Sweden Background: Improving biocompatibility of an implant surface
Department of Oral and Maxillofacial Surgery, Faculty of
Dentistry, Istanbul University, Istanbul, Turkey, 2Department of Oral Surgery, Faculty of Dentistry, Sarajevo University, Sarajevo, Bosnia and Herzegovina, 3Division of Medical Genetics, Department of Internal Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey Background: Bone grafts present different spectrum of organic
is a long standing challenge. Several approaches have been developed over the years ranging from mechanical (e.g. blasting, machining) to chemical (e.g. anodisation and acid etching) treatments. SurfLink surface treatment by NBMolecules is made up of a monolayer of permanently bound multi-phosphonate groups mimicking the surface of hydroxyapatite. The SurfLink surface treatment is designed to improve osseointegration resulting in enhanced bone to implant xation. Aim: To evaluate safety and clinical efcacy of the SurfLink surface treatment. Methods: Twenty-three partially edentulous subjects requiring at least two single implant-supported crowns were randomised according to a split-mouth design to receive one test (SurfLink treated) implant and an identical non-treated control implant. Implants used were cylindrical titanium grade IV sand-blasted and acid etched implants with internal connection (SPI Element, Thommen Medical). If more implants were needed, test implants were placed. Mandibular implants were submerged for 3 months and maxillary for 6 months and then loaded with denitive single crowns. Outcome measures were implant success, marginal peri-implant bone level changes, complications and adverse events, and marginal bleeding. The study was designed as quadruple blinded. Paired t-tests were used to calculate the difference of continuous outcomes between the two groups. Results: Two patients did not return for denitive crown placement. Up to 3 months after loading, no deviation from the protocol, implant failures, complications and adverse events related to the implant occurred. No bleeding was observed when running a periodontal probe in the peri-implant soft tissues. Random codes were not yet broken so preliminary results of mean SD are given for the two types. For four patients X-ray measurements are not yet done. At implant placement marginal bone levels were comparable between groups (n = 17, Type 1: 0.67 0.67 mm and Type 2: 0.82 0.79 mm). No statistically signicant differences were observed between the two groups neither at implant loading (P = 0.409; n = 17; Type 1: 2.01 0.52 mm and Type 2: 1.98 0.59 mm) nor 3 months after loading (P = 0.416; Type 1 (n = 17): 1.87 0.61 mm and Type 2 (n = 16): 1.91 0.72 mm). Conclusions and clinical implications: These preliminary results show that the implants with a monolayer of permanently bound multi-phosphonate groups (SurfLink surface
and syntethic materials, necessary to provide structural stability and linkage by stimulating osteogenesis, which leads to biological repair of sceletal defects. In oral and maxillofacial surgery use of bone grafts is limited in reconstruction of bone defects after trauma, cyst or tumor removals, in implant and periodontal surgery. Due to limited sources of autologous bone, synthetic bone grafts are the most widely used bone substitutes. Aim: The aim of this study is to examine an inuence of three different synthetic bone grafts (Cerasorb, Fortoss and Perioglass) on sisters chromatide exchange (SCE) in peripheral lymphocytes. Methods: Peripheral blood samples taken from 68 patients (45 female and 23 male) subdivided into two groups, who underwent oral surgery procedures, such as apical resection, cyst enucleation and periodontal curretage, were obtained for SCE a day before and 2 months after the surgeries. Control group included 30 patients, while the other group was formed from the patients who underwent a bone grafting with Cerasorb (11 patients), FortossVITAL (10 patients) and Perioglass (17 patients). Results: Comparing the results of groups before and after the treatment, the results were statistically signicant (P = 0.001). In Perioglass subgroup a greater statistically signicance (P = 0.003) was noted, than it was in cases of Cerasorb( P = 0.620) and Fortoss( P = 0.210) subgroups, in which there were no statistically signicance. Conclusions and clinical implications: Although further investigations may be necessary, the results of the study suggest that some alloplasts, such as bioactive glass ceramics, might behave genotoxic having an inuence on SCE frequency in peripheral lymphocytes.
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Biofunctionalization of orthodontic miniscrews: torque and resonance frequency analyses

Adriano Crismani,1 Michael Bertl,2 Kloss Frank,3 Rasse Michael3
1
Development of implant/interconnected porous calcium hydroxyapatite complex as all-in-one implant

Kazuya Doi,1 Takayasu Kubo,1 Hiroshi Oue,1 Koji Morita,1 Shiho Kajihara,1 Vittoria Perrotti,2 Giovanna Iezzi,2 Adriano Piattelli,2 Yasumasa Akagawa1
Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan, 2University G. dAnnunzio Chieti-Pescara, Chieti, Italy Background: Dental implant therapy has been successfully
1
Department of Orthodontics, Medical University of Innsbruck,
Innsbruck, Austria, 2Division of Orthodontics, Medical University of Vienna, Vienna, Austria, 3Department of Maxillofacial Surgery, Medical University of Innsbruck, Innsbruck, Austria Background: In areas of insufcient alveolar bone and close
proximity to anatomical structures, the application of orthodontic miniscrews is limited. Small miniscrews often suffer high failure rates over the course of treatment. Since osseointegration is considered a factor in their stability, improvements to the osteogenic capabilities of the implant surface could greatly benet their applicability. The success of osteoconductivity of titanium implants is greatly inuenced by BMP-2 and its mode of delivery. The agent has to bind strongly yet reversibly to the surface in order to withstand mechanical strain but remain biologically active. A nanocrystalline diamond (NCD) surface was shown to immobilize BMP-2 without conformational changes to the protein, while providing a constant and physiological release of the agent. Aim: The aim of this pilot study was to investigate the inuence of a BMP-2 functionalized implant surface on the stability and osseointegration of orthodontic miniscrews. Methods: Seventy-two miniscrews were inserted in three domestic pigs. Half of the screws received a nano crystalline diamond (NCD) surface modication and were biofunctionalized with BMP-2. The other half remained untreated. Fortyeight miniscrews were immediately loaded with a force of 150 cN. Upon insertion, resonance frequency analysis (RFA; Osstell ISQ, Osstell Integration Diagnostics AB, Go teborg, Sweden) and insertion torque measurements were performed. One animal was each sacriced after 2, 4 and 12 weeks, RFA carried out and exertion torque was measured. Results: RFA showed increasing stability over the course of the experiment. For functionalized miniscrews this increase was statistically signicant at 4 and 12 weeks (P < 0.05). Both insertion (12.0 4.9 Ncm) and exertion torque (8.1 3.4 Ncm) were signicantly higher in the mandible than in the maxilla (8.6 1.6 Ncm; 2.9 4.0 Ncm). However results did not correlate with coating or loading properties. Conclusions and clinical implications: Within the limits of this pilot study, results suggest an increase in stability of miniscrews after biofunctionalization with BMP-2. Consequently biofunctionalized surfaces may allow the application of miniscrews of smaller dimensions.
used to replace missing teeth. However, there are some clinical situation in which implant placement may be difcult. Therefore, we developed a new concept implant surrounded by an interconnected porous calcium hydroxyapatite (IP-CHA). Aim: The purpose of this study was to assess the feasibility of Implant/IP-CHA complex in the treatment of such demanding clinical situations. Methods: The protocol was approved by the Research Facilities Committee for Laboratory Animal Science at Hiroshima University School of Medicine, Japan. Twelve hollow cylinder type of IP-CHA (outside diameter: 6 mm, inside diameter: 3 mm, height: 8.5 mm, NEOBONE, Covalent Materials, Co. Ltd., Japan) were used for this study. After tap and countersink preparations were done inside of the cylinder, implant (diame nemark System, Nobel ter: 3.75 mm, length: 8.5 mm, Bra Biocare, Sweden) was placed into the cylinder to fabricate Implant/IP-CHA complex ex vivo. This complex was then placed into the prepared bone socket (6 9 8.5 mm) in the femur of four Healthy Breeding Dogs (weight: 20 kg, age: 14 16 months) by a two stage procedure. As a control, implants placed in the femur without any bone substrate were used. Bone sockets were allowed to heal for 2, 3, and 6 months without loading and implant stability quotients (ISQ) were measured by resonance frequency analyzer (OsstellTM, Integration Diagnostics, Sweden). Then, the animals were sacriced and tissue blocks with Implant/IP-CHA were retrieved. Specimens were processed for histology and stained with toluidine blue. Results: The highest mean of ISQ value was 77.8 2.9 in the 6-month, 72.0 5.7 in the 3-month and 47.4 11.0 in the 2month groups. There was no signicant difference between 3, 6-month groups and control groups. In all the groups examined newly formed bone lling in some pores of the IP-CHA was detected. In the 2 and 3-month groups connective tissue, including capillary angiogenesis, was predominant around the implants, although newly formed bone could also be observed. While, in the 6-month group newly formed bone could be seen in contact to most of the implant surface. Conclusions and clinical implications: Implant/IP-CHA complex demonstrated to be a promising as an all-in-one implant system to achieve osseointegration.
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Three nite element analysis and fatigue load test between different internal conical type implant connections
Juwon Eom, Ho-beom Kwon, Young-jun Lim, Myung-joo Kim, Seong-joo Heo, Jai-young Koak, Seong-kyun Kim, Jung-suk Han, Jai-bong Lee, Sung-hun Kim, In-sung Yeo
Seoul National University Dental Hospital SNUDH, Seoul, Korea Background: Dental implants with an internal connection
Photodynamic therapy on osseointegration. A histometric study in dogs

Paulo Faria,1 Daniela Felipucci,2 Andreza Simioni,2 Antonio Tedesco,2 Luiz Salata2
1 2
University of the State of Sao Paulo, Aracatuba, Brazil, University of Sao Paulo, Ribeirao Preto, Brazil
Background: The combination between photosensitivity sub-
have better stress distribution, less bone loss and less screw loosening compared to dental implants with an external connection. But, there are some problems such as tearing of xture top wall of internal conical type implants. Aim: The purposes were to analyze on the stress distribution of internal conical implant-abutment connection based on the abutment connection depth and hexagonal internal key design under compressive forces which lead to the bending moment and to compare the fatigue limit of different implant connections. Methods: Three-dimensional nite element analysis was used to analyze equivalent stress distribution of the implant complex. The implant complex was embedded in the supporting bone and the abutment was bonded with crown prosthesis that has a at and rectangular top surface. Four models with various internal conical interface design including different implant abutment connection depth (3, 4 mm), and shape of internal conical surface (with hexagonal internal key, without hexagonal internal key) were constructed. To compare the fatigue limit of the different systems, two models with various internal conical interface design including different implant abutment connection depth (3, 4 mm) were used with an Instron universal machine. Results: In case of the 4 mm connection depth, von Mises stress of implant complex decreased compared to the case of 3 mm connection depth. When the internal hexagonal key did not exist at the internal conical surface, von Mises stress decreased compared to the case of the internal hexagonal key. When loading a compressive force with an Instron universal machine, the mean loads needed for a displacement of 1.5 mm of abutment were 1324 N and 1607 N, for the 3 mm (shallow) connection and the 4 mm (deep) connection implants respectively. The fatigue limit of the 3 mm (shallow) connection and and the 4 mm (deep) connection implants is 278 and 421 N respectively. Conclusions and clinical implications: The 4 mm connection depth has better stress distribution than the 3 mm connection depth. So, the former, deep (4 mm) connection implant system required signicantly greater loads than the latter, shallow (3 mm) connection implant system for displacements of 1.5 mm of abutment, and the fatigue limit of the deep connection system is higher than that of the shallow connection system.
stances with laser or LED (light emitting diode) form the photodynamic therapy (PDT) basis that consists of photosensitivity drug activated by low frequency light. This mechanism is used in soft tissue healing process to improve the oxygen tension leading to a fast revascularization. Aim: The objective of this study was to evaluate the effects of photosensitivity drugs activated through LED on osseointegration process. Methods: Eight mongrel dogs were underwent to four mandibular defects made by 5.0 mm trephine drill on each side of the mandible. The defects were randomly lled up with (1) nanoemulsion, (2) lipossome, (3) blood clot and (4) autogenous bone. LED with visible and infrared light were applied after 48/72 postoperative hours on four dogs and after 96/120 postoperative hours in the other four dogs. All the animals were euthanized at 15 days after surgery. Histological slides were prepared from each experimental site for histomorphometry and histological analysis. Results: No difference was detected in the follow parameters: bone implant contact, bone inside the defect and crest level on LED 48/72. Signicant difference was detected inside the defect when lled with autogenous bone (P = 0.0238) on LED 96/120. When LED 48/72 and LED 96/120 were compared, signicant higher bone formation was detect when used autogenous bone on bone implant contact (P = 0.0043) and bone inside the defect (P = 0.0008). Conclusions and clinical implications: The use of photosensitivity drugs activated by LED demonstrated a tendency to stimulate bone formation, similar to autogenous bone graft on later time point.
Control of calcium deposition and bone organization around the rough surface
Sergio Alexandre Gehrke1,2
1 2
Biotecnos Technology and Science, Santa Maria, Brazil, Catholic University of Uruguay, Montevideo, Uruguay
Background: Several studies show that levels of osseointegra-
tion are related to the degree of surface roughness this being attributed to factors such as physico-chemical properties that increase the wettability, adhesion and promoting cell proliferation, and increasing the contact area of bone/implant, improving biomechanical interaction with the bone implant.
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Aim: The aim of this study was the observation in vivo of cal-
cium deposition and bone organization around the rough surface implants obtained by sandblasted with particles of TiO and acid conditioning. Methods: The in vitro observation was made with imaging in SEM and evaluation of morphological characteristics. Six adult New Zealand rabbits with average weight of 3.5 kg obtained from the Federal University of Santa Maria were used for the evaluations. Were used 24 cylindrical implants with internal hex manufactured by the company Implacil Dental Material (Implants DeBortoli) sandblasted to TiO and acid conditioning. A marker of bone growth of uorescence, calcein was injected subcutaneously at two different time intervals to assess the calcium deposition in the bone in the period from second to fourth week, corresponding to the experimental group 1 (exp 1) with three animals, and from sixth to eighth week, corresponding to the experimental group 2 (exp 2) with three animals. The samples obtained were cut three slices of each implant using a histological technique for each: light microscopy, uorescence and scanning, which were analyzed and compared the contact areas between bone/implant times of 30 and 60 days. Results: The results demonstrate that the proposed surface promotes bone stimulation very effectively in the times studied. Implants of bone presented large areas corticalized and a feature of lamellar bone. Calcium deposition occurs with more intensity after 30 days of implantation. Conclusions and clinical implications: Thus we conclude that the implant surface by DeBortoli sandblasted with particles of TiO and acid conditioning have good bone-conductive capacity, promoting proper growth and bone corticalization.
adults in the proximal tibia bilaterally (two implants per tibia). After euthanasia, the tibiae were removed and for the removal torque test and histological processing. Statistical analysis was performed using t-test with a condence interval of 95%. Results: Results for the removal torque within 30 days were 9.3% and after 60 days, 21.2% higher for group 2. A statistically signicant difference between groups was found (P < 0.001) in samples with 60 days in group 2 (mean 95% condence interval). Histologically, both groups had adequate biocompatibility and osseoconduc a o with osteogenesis in cortical and medullary regions of the tibia. When analyzed by SEM, in two times, the implants in Group 1 had a lower retention of bone tissue on the surface and little structural organization of bone, while implants in Group 2, there was a greater amount of bone integration and better organization that retained tissue. Conclusions and clinical implications: Based on the results obtained showed that the surface microstructure directly inuences bone stimulation, promoting an increased adhesion of bone tissue in quantity and a better structural organization during the periods studied compared with mashined implants.
Analysis of metallic properties and microstructure of titanium dental implants

Aikaterini Gkouzioti,1 Tim Hoesel,2 Simon Zabler,3 Thorsten Steinberg,1 Michael Swain,1 Rainer Schmelzeisen,1 Katja Nelson1
1
School of Dentistry, University Hospital Freiburg, Freiburg,
Germany, 2Department of Microsystems Eingineering, University
of Freiburg, Freiburg, Germany, 3Faculty of Physics and Astronomy, University of Wuerzburg, Wuerzburg, Germany Background: Titanium dental implants have been successfully
Real inuence of the roughness surface in the bone stimulation an experimental study in vivo
Sergio Alexandre Gehrke,1,2 Berenice Anina Dedavid,3 Miriam Souza Dos Santos Vianna,3 Giovanni Wiel Marin4
1 2 3
Biotecnos Technology and Science, Santa Maria, Brazil, Catholic University of Uruguay, Montevideo, Uruguay, lica do Rio Grande do Sul, Porto Ponticia Universidade Cato
Alegre, Brazil, 4Private Practice, Roma, Italy Background: Different surface treatments have been proposed
to improve and accelerate the osseointegration of implants through the development of roughness on the surface, creating changes in the microtexture. Aim: The objective of this study was to evaluate the inuence of surface treatment of implants in cellular stimulation during ossoeintegration at different times in the tibiae of rabbits. Methods: Were used 24 cylindrical implants (Implancil DeBortoli, Sa o Paulo, Brazil), with 12 smooth implants without surface treatment (Group 1), and 12 other surface treated with blasting microparticles of titanium oxide and acid etching (Group 2). These were inserted in six New Zealand rabbits,
used for more than three decades. However, despite the large number of implantations that take place every year, an extensive long term study of the mechanical performance and failure of dental implants is still missing. Aim: In order to minimize technical complications of dental titanium implants as well as to achieve a downsizing of their diameter without compromising their clinical performance, further study and exploration of their mechanical and, respectively their metallic properties, is needed. Methods: In this study nine different commercially available titanium implants (Straumann BoneLevel, Straumann BoneLevel Roxolid, Camlog Rootline, Nobel Replace, Astra, Ankylos, SPI-Thommen, Blue-Sky) were examined using a standard metallographic preparation method, including grinding, polishing and etching. Light microscopic analysis and X-ray diffractometry for characterization of their metallic microstructure and Vickers microhardness tests were applied. Results: Differences among the examined implants occur in all the examined parameters. The microhardness varies between 332 HV0.1 to 299 HV0.1, as well as the grain size,
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suggesting a wide variation of metallic properties for Ti Grade 4 implants. Conclusions and clinical implications: Although, most of the examined implants are made of commercially pure Titanium Grade 4 (exception Roxolid), a difference exists in their metallic microstructure and their mechanical properties. There is no consensus on what constitutes an implant ideal. Thus, the evaluation of the implants structural qualities could help to interpret and enhance the clinical performance of titanium dental implants.
References:
1. Tamimia, F., Torresb, J., Lopez-Cabarcosc, E., Bassetta, D. C., Habibovica, P., Luceronb, E., Barraleta, J.E. (2009) Minimally invasive maxillofacial vertical bone augmentation using brushite based cements. Biomaterials 30: 208216. 2. Cama, G., Barberis, F., Capurro, M., Di Silvio, L., Deb, S. (2011) Tailoring brushite for in situ setting bone cements. Materials Chemistry and Physics 130: 11391145.
Quantitative and qualitative characterization of various dental implant surfaces

Prabhu Gubbi, Ross Towse
BIOMET 3i, Palm Beach Gardens, USA Background: An endosseous implants surface characteristics
A novel synthetic bone graft material

Clare Gleeson, Guiseppe Cama, Tara Renton, Mark Mc Gurk, Sanjukta Deb
Kings College London, London, United Kingdom Background: Bone augmentation procedures experience high
failure rate with main causes related to infection, exposure and or instability of the graft and formation of brous tissue. Calcium phosphate based materials have been shown to exhibit resorbability, biocompatibility and osseoconductivity. Typically calcium phosphate cements either form hydroxyapatite or brushite. However, the former leads to poor resorbability and the latter yields a metastable cement and the initial pH is low and thus would briey expose tissues to acidic conditions. In order to overcome this, excess amounts of b-TCP have been used in previous studies [1] and typically they are b-TCP granules in brushite cements. In this study we report the development of an injectable brushite cement with a bioactive glass additive with excellent clinical handling properties and the potential as an applictaion in minimally invasive oral surgery. Aim: The present study aims to develop a self-setting bone substitute based on a brushite with a bioactive bioglass additive. Furthermore the effect of the addition of glycerol on injectability was studied. Methods: b-TCP, Monocalcium Phosphate Monohydrate and Monosodium Citrate solution were used to prepare brushite cements according to a protocol developed earlier [2] and optimised in terms of handling and physical properties with the addition of a bioactive glass with alteration in particle size, percentage by weight and powder liquid ratio. Glycerol was added in one group of cements. Results: The addition of the bioactive glass was seen to decrease the setting time to approximately half, alter consistency of the cement to putty which improved handling and an increase in pH was observed. Compressive strength remained comparable to that of cancellous bone 815 MPa. Conclusions and clinical implications: The results indicated that the addition of bioactive glass to brushite cements has the potential to improve biocompatibility whilst having minimal deleterious effects on strength. The putty like consistency improves the clinical handling properties and therefore ease of use.
play a substantial role in the mechanism of osseointegration. In particular, surface topographies of specic scale and geometry have been shown to inuence the pre-cursors to de-novo bone formation, thereby impacting the extent and rate of formation as well as provide surface features for inter-locking of the de-novo bone throughout the peri-implant healing phase. Aim: The current study is intended to characterize the scales and geometries of the leading dental implant companies surface topographies. Methods: Osseotite(BIOMET 3i) with hybrid surface of both turned coronal and remaining dual acid-etch, MTXTM implant (Zimmer Dental) with blasted surface, Replace implant (Nobel Biocare) with anodic oxidation TiUnite surface, OsseoSpeedTM implant (AstraTech) with blasted and uoride etched surface, Bone Level implant (Straumann) with blasted and etched SLActive surface, and a new implant design (BIOMET 3i) with blasted, dual acid etched, and discrete HA crystal deposition surface. In order to adequately assess the scale and geometries of the various surface topographies, multiple evaluation methodologies are employed namely Field Emission Scanning Electron Microscopy (FE SEM) analysis for sub-micron features (<1.0 m), Scanning Electron Microscopy (SEM) for micron features (110 m), and Light Interferometry for coarse micron features (>10 m, commonly quantied with output measures such as Sa Absolute Mean Height Deviation). Results: Table 1 provides a brief summary of the ndings.
Methodology Descriptor FESEM (30,0009) Actual Features (nm) SEM (20009) Actual Features (lm) Interferometer (3129) Quantitative Proxy: Sa (lm)
3i
Osseotite(turned area)
Minimal features noted
0.18 3i Osseotite(dual acid-etched area) Minimal features noted Homogenous coverage of 1 3 lm pits 0.48
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Table (continued)
Methodology FESEM (30,0009) SEM (20009) Interferometer (3129)
Methods: Three Ti surfaces were characterised and S. epide-
Zimmer MTXTM
Irregular blasted facets, 510 lm range Homogenous coverage of spaced, 5 10 lm tubular structures
0.79
Nobel Replace TiUnite
1.06
AstraTech OsseospeedTM Straumann SLActive
Minimal features noted Homogenous coverage of 10 20 lm rod shaped oxide features
Irregular, angular facets, 10 lm range Homogenous coverage of 1 3 lm pits Homogenous coverage of 1 3 lm pits
1.50
1.60
3i New Implant Design
Homogenous coverage of 20 100 nm irregularly shaped HA crystals
1.39
rmidis were inoculated on these surfaces. NaCl (0.9 vol.%), EDTA (12 vol.%), H2O2 (3 vol.%) or H2O2 + TiO2 nanoparticles (Degussa Aeroxide P25, Hanau-Wolfgang, Germany) served as chemical debridement agents, while Ti BrushTM (Straumann, Basel, Switzerland) was used as mechanical debridement tools. Biomass still attached to surfaces after cleaning was measured by safranin staining while re-incubating the samples after debridement assessed its viability. SEM analysis was performed before and after cleaning process. Results: Surface average roughness (Sa) of the samples were measured at 2.22 0.19 lm for group A, 0.19 0.02 lm for group B, and 1.99 0.10 lm for group C. When chemical debridement agents were used alone, H2O2-containing products were the most efcient in reducing biomass from the three surfaces as well as viability. When combining chemical and mechanical debridement, further reduction of biomass and viability was observed with higher effects surface with low Sa value (group B). Conclusions and clinical implications: Combining H2O2-containing chemical agents with mechanical debridement (Ti BrushTM) provided best biomass removal and lowest bacterial re-growth.
Conclusions and clinical implications: The current evaluation
demonstrated that these modern implant surfaces are highly complex comprising multiple scales of topographies and differentiated geometries.
A nano-thickness coating of single hydroxyapatite crystals on titanium implant xture improves osseointegration
Kyung-won Ha,1 Hyun-man Kim2
Osstem Implant, Institute of Bone Science, Seoul, Korea, 2School of Dentistry, Seoul National University, Seoul, Korea Background: To
1
Low bacterial re-growth on rough titanium surfaces when combining chemical and mechanical debridement techniques in vitro
Eva Eva Gustumhaugen, Jessica Lnn-stensrud, Anne Aamdahl Scheie, Karl Ekstrand, Spetter Lyngstadaas, Anders Ekfeldt, Sebastien Taxt-lamolle
University of Oslo, Oslo, Norway Background: The success of an implanted titanium (Ti) dental
implant is measured by its stability over time. However, implant failure have been reported to be due to bacteria infection and biolm establishment in the peri-implant area affecting soft and hard tissue1. A wide range of decontamination techniques have been suggested, both chemical and mechanical, but few scientic reports exist on the topic. The aim of this in vitro study was to quantify the efciency of combining chemical and mechanical debridement methods on three different Ti surfaces inoculated with Staphylococcus epidermidis (S. epidermidis), contra chemical debridement alone. Aim: The aim of this in vitro study was to quantify the efciency of combining chemical and mechanical debridement methods on three different Ti surfaces inoculated with Staphylococcus epidermidis (S. epidermidis), contra chemical debridement alone.
improve the osseointegration of dental implants, coating hydroxyapatite (HA) on titanium surface has been developed for a long time. However, widely used plasma sprayed HA coatings produce a thick layer with layer-by-layer structure of which structural weakness could affect to longterm stability of implants in clinical uses. Thus there is a need for developing a HA coating method which improves osseointegration with free of interface separation. Aim: A method partially covering the titanium surface with single-crystal HA of which thickness is nano-dimension was developed to expose both HA and titanium simultaneously. This method was supposed to prevent separation of interface between newly forming bone and implant surface and improve the osseointegration. Methods: Activated titanium xture was coated with a low saturated ion solution with calcium and phosphate ions. Titanium xture (Bio-HA) coated with this method was examined by scanning electron microscopy or transmission electron microscopy. Stability in vitro and resorbability in vivo of the coating were examined. The percentage of bone to implant contact (BIC) was compared between Osstem SA (Group 1), Bio-HAprepared on OsstemSA (Group 2), and Straumann SLActive implants (Group 3) after implanting them in canine
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mandible for 2 or 4 weeks. Statistical analyses were performed with Students t-test. Results: Bio-HA surface was coated with a layer of HA single crystals of which thickness was below 20 nm. Thin wide single HA crystals were deposited tightly contacting with the titanium surface. Titanium surface was partially covered with HA crystals. Coverage percentage was 44.8 3.7%. The HA crystals of Bio-HA were not dissolved in PBS or in rat subcutaneous tissue up to 7 days. However, HA crystals of Bio-HA were completely disappeared from the titanium surface which was implanted in rabbit tibia for 6 weeks. BIC percentage of group 2 was signicantly improved compared with group 1 (Table 1). BIC percentage of group 2 was similar to those of group 3. Table 1. BIC percentage (mean SD) Group 1
2 weeks 4 weeks 51.80 11.25 59.29 6.09
Group 2
68.55 8.77 85.27 5.27
Group 3
70.20 13.01 83.69 6.83
Conclusions and clinical implications: HA coating of Bio-HA
composed of a layer of single HA crystals improved osseointegration signicantly compared to the control titanium surface up to the BIC percentage of Straumann SLActive. Furthermore, HA crystals of Bio-HA seems to be resorbed by osteoclasts during bone remodeling to secure a direct bonding between bone and titanium to get rid of fear of interface separation between them.
Aim: The aim of this in vitro study was to investigate the inuence of surface roughness and cyclic loading on the fatigue resistance of Y-TZP fabricated by a HIP processing for evaluating the durability in oral environment. Methods: Disk-shaped specimens of size, 10 mm in diameter/ 0.5 mm in thickness were prepared by cutting and grinding with a diamond wheel. These specimens were randomly divided into four groups 1) mirror-polished (MS), 2) gridblasted with 50-lm alumina (SB50), 3) grid-blasted with 150lm alumina (SB150), and 4) grid-blasted with 150-lm alumina and acid-etched (SB150E). The static loading test was calculated using the equation listed in ISO 6872 for both materials. In the cyclic fatigue test, cyclic load was applied in the bending mode at a frequency of 10 Hz, for 106 cycles in distilled water at 37C. Results: The fracture strength under the static loading test were 1819 77 MPa (MS), 1761 55 MPa (SB50), 1526 85 MPa (SB150) and 1410 78 MPa (SB150E). The fracture strength under the cyclic fatigue test were 1134 63 MPa (MS), 950 85 MPa (SB50), 854 53 MPa (SB150) and 888 42 MPa (SB150E). Conclusions and clinical implications: Cyclic fatigue strength of HIP Y-TZP treated by grit-blasting and etching was much higher than 320 MPa, the required fatigue strength of Y-TZP in surgical implants specied in ISO 13356. Theresults indicate that the greater cyclic fatigue strength of HIP Y-TZP make it a promising material for application to dental implants.
Inuence of surface treatment on strength of hot isostatic pressing (HIP) yttria-stabilized tetragonal zirconia polycrystal (Y-TZP)
Toshihiko Iijima,1 Shinya Homma,1 Masao Yoshinari,1 Yasutomo Yajima2
Division of Oral Implants Research, Oral Health Science Center, Tokyo Dental College, Chiba, Japan, 2Department of Oral & Maxillofaicial Implantology, Tokyo Dental College, Chiba, Japan Background: Zirconia implants have excellent resistance to
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Application of a novel GBR membrane made from DNA-polycation complexes

Akihito Irie
Fukuoka Dental College, Fukuoka, Japan Background: DNA-polycation complexes have almost no cyto-
corrosion and wear, good biocompatibility and high bending strength and fracture toughness. In general, xed prostheses of TZP were fabricated by a half-sintered compact and subsequent air sintering at around 1350C. Hot isostatic press (HIP) processing under the high pressure in inert atmosphere is considered to be suitable to apply the implant body, because dental implants are not fabricated for individual patient, thus, high mechanical performance can be ensured by HIP processing without complicated fabricating procedure. This processing has been introduced to achieve very high density to enhance the reliability of the ceramic components. Hot isostatic press (HIP) processing to zirconia (Y-TZP) has a potential for application to the oral implants due to their high mechanical performance.
toxicty and have good biocompatibility. However, the complexes form a cross-linked structure resulting in difculty of its processability. Thus, we used hydrothermal hot-pressing, a processing method of inorganic substances, to synthesize the complexes and produced a transparent lm of complexes. We report here the processing method and the application of this lm to a GBR barrier membrane. Aim: DNAand polycations were used to synthesize complexes for the development of a novel GBR barrier membrane. The polycations were chitosan and polyamino acids (polylysine and polyarginine). Methods: Cell adhesion to the lm was examined (adhesion of normal human synovial stromal cells, human dermal broblasts, and human keratinocytes). The following properties were measured: surface zeta potential, contact angle of water on a surface, and amount of bronectin adsorption. In addition, an examination was performed on the in vivo degradation in the subcutaneous dorsal region in rats.
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Results: The lm had almost no cell adhesion. DNA-polyami-
no acid complexes had faster in vivo degradation than DNAchitosan complexes. Conclusions and clinical implications: It is speculated that the rate of degradation can be controlled with the addition of DNA-polyamino acid complexes to DNA-chitosan complexes. Thus, the transparent lm of complexes is expected to be applied to a barrier membrane for oral use.
implants with RBM surface and sand-blasting treatment on injection molded Zr implant was not critical on removal torque. In the limitation of this study, injection molded Zr implant shows similar removal torque to RBM Ti implant. Conclusions and clinical implications: With previous studies of biocompatibility and mechanical properties, the result of this study suggests that injection molded Zr implant could be an alternative to RBM Ti implant from the perspective of on removal torque. Further studies include histomorphometry and micro CT analysis are needed for in vivo application.
Removal torque analysis of injection molded zirconia implants

Woonchul Shin,1 Mongsook Vang,1 Hongso Yang,1 Sangwon Park,1 Hyunpil Lim,1 Kwi-dug Yun,1 Kwangmin Lee,2 Seongsoo Kang,3 Gyejeong Oh,1 Hansung Joo1
Department of Prosthodontics, School of Dentistry, Chonnam National University, Gwangju, Korea, 2Department of Materials Science and Engineering, Research Institute for Functional Surface Engineering, Chonnam National University, Gwangju, Korea, 3College of Veterinary Medicine, Chonnam National University, Gwangju, Korea Background: The current zirconia (Zr) implants are produced
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Inuence of implant abutment screw coating materials on joint stability

Woonchul Shin, Young-sun Park, Mongsook Vang, Hongso Yang, Sangwon Park, Hyunpil Lim, Kwi-dug Yun, Hansung Joo
Department of Prosthodontics, School of Dentistry, Chonnam National University, Gwangju, Korea Background: The osseointegration implant has been developed
by rst making rod using hot extrusion method then machining such as milling process. In this way, it has not only difculties on mass production but also technique sensitivities for its size uniformity. In previous study, using injection molding instead of mechanical process has been developed to reduce the risk of crack formation and already got satised results from previous in vitro study on mechanical properties and biocompatibility. Aim: The aim of this study was to compare the removal torque between injection molded Zr implants and titanium (Ti) implant (ExFeel, Megagen, Daegu, Korea) with resorbable blast media (RBM) surface in beagle humerus. Methods: Manufacturing process of injection molded Zr implant went following order: computer aided design (CAD) system, metallic mold design and fabrication, powder mixing, debinding, sintering, and hot isostatic pressure (HIP). Total 15 implants were placed in the right and left humeri of three beagles. Three implants groups are classied and these are introduced as follows: Ti implant with RBM surface (Group RT), injection molded Zr implant (Group Zr) and injection molded Zr implant with sand-blasted surface (Group ZrS) (n = 5). After post-surgical period of 12 weeks, removal torque was measured. All data were analyzed using one-way analysis of variance plus post hoc Tukeys multiple comparison test (P < 0.05) with SPSS 19 software (SPSS Inc., Chicago, IL, USA). Results: The mean removal torque value (SD) were 57.9 (17.3) Ncm (Group RT), 60.1 (33.8) Ncm (Group Zr), and 58.3 (16.5) Ncm (Group ZrS), respectively. There were no signicant differences among groups, which means removal torque of injection molded Zr implant was similar to that of Ti
nemark introduced the implant system. Recently, the since Bra success rate of the osseointegration implant is statistically over 90%. During the period of using implants, loosening is one of drawbacks of abutment screws and several methods have been attempted to prevent this problem. There are various methods using abutment screw coating are reported including not only minimize the frictional resistance but also increase the strength. TiN, TiCN and TiC have been considered as a coating material for abutment screws of implant because of their properties, but there are only few studies for applying these materials to dental eld. Aim: The aim of this study was to evaluate the mechanical properties of implant abutment screw coating treatment and the effect of this coating treatment on joint stability. Methods: ExFeel external hexed implant system and 15 9 1 mm disc were used for this study. TiN, TiCN and TiC coated abutment screws and discs were used as experimental group and non-coated specimens were used as control group. We measured the removal torque and rotation angle after tightening up the abutment screws with 32 Ncm. The change of the removal torque was also evaluated after fatigue test. All data was analyzed using KruskalWallis test and MannWhitney U test with SPSS 12.0 software (P < 0.05). Results: Rotation angle of coated screws was greater than that of non-coated screws. Especially TiC coated screw group had the largest value (P < 0.05). In contrast, the removal torque of experimental group was lesser than that of control group (P < 0.05). Torque loss after fatigue test in coated screws was higher than non-coated screws (P < 0.05) and there were no statistically signicant difference between dry and wet condition. Conclusions and clinical implications: TiC coated abutment screws have low torque-consuming and high rotation angle because of its low friction coefcient. For this reason, TiC
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coating treatment will be considered as an efcient method to effect on joint stability of implant abutment screw.
Biocompatibility and corrosion performance of nanostructured titanium-bioceramic composite scaffolds

Karolina Jurczyk,1 Mieczyslawa U. Jurczyk2
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Bone healing response to the various surfaces of the implant

Woonchul Shin, Yong-hak Kim, Mongsook Vang, Hongso Yang, Sangwon Park, Hyunpil Lim, Kwi-dug Yun, Hansung Joo
Department of Prosthodontics, School of Dentistry, Chonnam National University, Gwangju, Korea Background: Recently, the implants with nano-surface and
Department of Conservative Dentistry and Periodontology, Division of Mothers and Childs Health, Poznan University of
Poznan University of Medical Sciences, Poznan, Poland,

2
Medical Sciences, Poznan, Poland Background: Application of new biomaterials increases stea-
micro-surface treatment have been introduced for successful implant procedure and there are many reports that these implant surface treatments may affect the cellular reaction on implant surface. Aim: The aim of this study was to evaluate the effect of implant surface treatment on bone healing and periodical bone healing appearance by histological and histomorphometric analysis with an experiment installing eight different types of implant with various surface treatment, used or developed, on the mandible of the mature dogs. Methods: Seventy-two implants consisted of eight different implant surface treatments were installed on the mandibles of nine mature dogs and three dogs were evaluated every 2, 4, 8 weeks. After preparing specimens with making bone fragments by cutting and managing, the specimens were analyzed histologically and comparatively evaluated the bone to implant contact (BIC) for histomorphometric analysis. All data were analyzed using one-way analysis of variance plus post hoc Tukeys multiple comparison test and Duncans test (P < 0.05) with SPSS 12.0 software (SPSS Inc., Chicago, IL, USA). Results: There was a large amount of bone formation in good state on the adjacent area of implant at 2 weeks in histological analysis. At 4 weeks, the new bone was separated with basal bone, although general bone formation was observed. In contrast, the new bone became matured and tightly connected with basal bone at 8 weeks. There were no signicant differences in eight different methods of implant surface treatment. In histomorphometric analysis, the value of 2 weeks group was considerably lower than that of 4 and 8 weeks group and there was no signicant difference between both groups. Furthermore, there was no difference in the each surface treatment method of implant. Conclusions and clinical implications: The mandible differences among the osseo-integration of eight different implant surface treatments used in this study because of the sufcient healing time. From these results, none of the implant surface treatments could be considered the best treatment for implant surface in this study. Further studies include histological analysis of the implant surface within 2 weeks and evaluation on the implant placed in poor bone condition may need for in-vivo application.
dily. However replacement systems do not provide trouble-free service. In dental implants the rate of success is 9698%, which by millions of implants gives a signicant number of patients in trouble. An appropriate modication of implant bulk structure and properties is one of the main aims of current research projects. Aim: Aim of our studies is to develop nanostructured titanium-bioceramic scaffolds by producing porous structures with a strictly specied porosity and such that will good adhere to the substrate, show high hardness, high resistance to biological corrosion and good biocompatibility. In this work, in vitro biocompatibility and corrosion performance of titanium-20 wt% 45S5 Bioglass bioceramic scaffolds were studied. Methods: Mechanical alloying for the fabrication of titaniumbioceramic nanopowders is developed. Porous scaffolds (typical dimensions of the pellets were: 10 mm in diameter and 3 mm in height) are successfully fabricated with porosities ranging from 50% to 70% using NH4HCO3 and powder sintering technique. Results: Corrosion resistance potentiodynamic test in Ringer solution at 37C shows no negative effect of porosity on Ti-10 wt.% nanocomposite scaffolds in comparison to microcrystalline titanium. Titanium composites with 20 wt.% of 45S5 Bioglass have better corrosion resistance (iC = 1.15 9 107 A/ cm2, EC = 0.41) than microcrystalline titanium (iC = 2.27 9 106 A/cm2). Scanning electron microscopy was carried out to evaluate the interaction between Ti-20 wt.% 45S5 Bioglass nanocomposite scaffolds and cells on the 1- and 5-day cultures. After 1-day cell culture, cells grow into the structure of the surface instead of forming lapodia. After 5-day cell culture on the Ti-20 wt.% 45S5 Bioglass nanocomposite scaffold with 67% porosity, spindle-like shape cells were observed to be spreading well, both on the surface of the porous scaffold and inside the pores. Based on the SEM observations, the culture evolves in the following stages: cell colonization and multilayering. Conclusions and clinical implications: The investigated scaffolds have porous architecture, with 400800 lm macropores and some tens of micrometers micropores. Scaffolds are more corrosion resistant than microcrystalline titanium, moreover in vitro biocompatibility test suggest that scaffolds display good biocompatibility compared to that of microcrystalline titanium. Very important in hard tissue implant is surface
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roughness, responsible for cell attachment. Not only micro-, but also nanotopography can support different cells-type proliferation. New generation porous Ti-based nanocomposite scaffolds can promote bone or tissue ingrowth into pores and provide biological anchorage, therefore being a promising material in biomedical applications.
UV on machined surface. In WST-1 assay, cell kinetics on EDSurface were better than machined surface. Conclusions and clinical implications: It was found that there were major effects by radiation of EX-UV to machined surface. EDSurface showed high biocompatibility both before and after radiation of UV. We will attempt analysis of surface chemical constitution change before and after the UV radiation, especially paying attention to oxide layer, and continue in vivo and in vitro study successively.
Effect of excimer ultraviolet to titanium modied by Wire-type EDM

Yu Kataoka, Yuichi Takiguchi, Shigeru Ikeda, Kazutaka Sugiyama, Takashi Miyazaki
Showa University School of Dentistry, Tokyo, Japan Background: Titanium is major used for materials in dental
Accelerated osteogenesis in extraction sockets using a novel calcium sulfate-PRF combination: a clinico-histological study
Supriya Kheur,1 Mohit Kheur2
1
implants because of high biocompatibility by the stable oxide layer. Some methods for surface treatment to get early osseointegration are reported and there are applied a clinic. The authors have demonstrated that wire-type electric discharge machining of titanium allowed a microstructured surface with an irregular morphology as well as thicker oxide layer. In addition, those surface characteristics have favorable scaffold properties for cell kinetics in vivo and bone formation by contactosteogenesis in vivo. Recently photocatalysis by radiation of ultraviolet lamp to improve titanium surface characteristic becomes the topic. Aim: This study aimed to investigate the surface characteristics at before and after radiation of ultraviolet lamps, excimer UV lamp (EX-UV) and the low-pressure Hg-UV lamp (Hg-UV), to titanium modied by wire-type electric discharge machining. Methods: Two kinds of UV lamps, EX-UV and Hg-UV, were prepared and analyzed by measuring device of wavelength dispersion. Titanium plates (10 9 10 9 1.0 mm) have surface modied by wire-type electric discharge machining (EDSurface) and machined surface were prepared at before and after radiation of UV. The surface of each specimen was characterized by measuring angle of contact of water, scanning electron microscopy (SEM), X-ray diffraction spectroscopy (XRD) and X-ray photoelectron spectroscopy (XPS). Each specimen was incubated in alfa-MEM containing 10%FBS with and without osteoblastic cells (MC3T3-E1). Adsorption of cell-binding proteins by each specimen was examined by XPS. Initial cell adhesion, proliferation and differentiation were measured by using WST-1. Results: The peak of spectral distribution properties of EX-UV was observed at 175 nm. Whereas, the maim peak of Hg-UV was at 250 nm, and some small peaks were at other wavelength. An XPS and XRD survey indicated that the composition of the titanium oxide layer on EDSurface was consistent with machined surface. The adsorption of serum proteins on EDSurface was signicantly higher than that with the another specimen. Both before and after radiation of each UV lamp, EDSurface showed super hydrophilia. The radiation of EX-UV lamp was able to increase contact angle as compared with Hg-
Department of Oral Pathology, Dy Patil Dental College and
Research Centre, Pimpri, Pune, India, 2Department of Prosthodontics and Implantology, M A Rangoonwala College of Dental Sciences and Research Centre, Pune, India Background: A pre requisite for placement of dental implants
is availability of sufcient vital bone. Literature reports vertical and horizontal ridge reduction following extraction, primarily in the initial 3 months. Post extraction socket grafting is performed to avoid future complex bone augmentations. The search for an ideal socket graft material is ongoing. Calcium sulphate is a biocompatible, easily available material reported to be osteogenic in presence of periosteum and/or bone. It resorbs completely, rapidly leaving behind a calcium phosphate based osteoconductive scaffold that guides bone regeneration. Platelet rich brin is a second generation platelet concentrate which physiologically polymerises releasing growth factors. (PDGF, TGF-1, VEGF and IGF-1). Combining it with Calcium sulphate could result in activation of platelets and delivery of calcium, growth factors over time, sustaining nourishment of the bone defect. Although Calcium sulphate and PRF have been successfully individually used, no human clinical study using their combination in extraction sockets has been reported. Aim: To evaluate and compare (Clinically, Radiographically, Histologically) the quantity of newly formed bone in naturally healing human extraction sockets to sockets grafted with a combination of Medical-Grade Calcium Sulphate Hemihydrate (MGCSH) and Platelet Rich Fibrin (PRF). Methods: Twenty-ve patients (both male and females) in the age group of 2045, who require to undergo multiple extractions in the mandible were selected based on strict inclusion and exclusion criteria. For each patient, one socket received a combination of MGCSH and PRF combination. The other socket was left to heal naturally. Radiographic analysis of the extraction sites were performed pre and post extraction and after 8 weeks, using a standardized radiographic technique. Bone cores were trephined out of the socket after 810 weeks. They were decalcied and the amount of new osteoid deposi-
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tion and trabaculae formation was evaluated under an Image analyser for determining percentage of vital bone formation. Results: Thirty-six per cent new bone formation (mostly lamellar) was seen in the grafted sites and 22% in the control sites. Comparisons between the test and control group was performed using un-paired Student t-test. Conclusions and clinical implications: A combination of calcium sulphate and PRF is highly osteogenic resulting in faster bone formation in extraction sockets. This can be used as a simple, inexpensive, uncomplicated yet effective socket graft material. Its use can yield tooth extraction healing sites ready to receive dental implants at an earlier stage than conventionally healing sockets.
Biologic response of MG63 osteoblast-like cells in uoride-modied titanium surfaces

Myung-joo Kim, Seong-joo Heo, Jung-suk Han, Jai-young Koak, Young-jun Lim, Seong-kyun Kim, Seong-hun Kim, In-seong Yeo
Seoul National University, Seoul, Korea Background: Fluoride is an element with specic attraction for
Effect of nitric oxide and N-methyl-D-aspartic acid receptor antagonist on human periodontal ligament broblast cell apoptosis
Dae-hyun Kim, Tae-il Kim
Seoul National University Dental Hospital, Seoul, Korea Background: Nitric oxide (NO) has been known as an impor-
tant regulator of osteoblasts and periodontal ligament cell activity. Aim: This study was performed to investigate the relationship between NO-mediated cell death of human periodontal ligament broblasts (PDLFs) and N-methyl-D-aspartic acid (NMDA) receptor antagonist (+)-5-methyl-10, 11-dihydro-5Hdibenzo[a,d]cyclohepten-5, 10-imine hydrogen maleate (MK801). Methods: Human PDLFs were treated with various concentrations (04 mM) of sodium nitroprusside (SNP) with or without 200 lM MK801 in culture media for 16 h and the cell medium was then removed and replaced by fresh medium containing MTS reagent for cell proliferation assay. Western blot analysis was performed to investigate the effects of SNP on the expression of Bax, cytochrome c, and caspase-3 proteins. The differences for each value among the sample groups were compared using analysis of variance with 95% condence intervals. Results: In the case of SNP treatment, as a NO donor, cell viability was signicantly decreased in a concentration-dependent manner. In addition, a synergistic effect was shown when both SNP and NMDA receptor antagonist was added to the medium. SNP treated PDLFs exhibited a round shape in culture conditions and were dramatically reduced in cell number. SNP treatment also increased levels of apoptotic marker protein, such as Bax and cytochrome c, and reduced caspase-3 in PDLFs. Mitogen-activated protein kinase signaling was activated by treatment of SNP and NMDA receptor antagonist. Conclusions and clinical implications: These results suggest that excessive production of NO may induce apoptosis and that NMDA receptor may modulate NO-induced apoptosis in PDLFs.
calcium. On the cellular level, it is assumed that uoride has effects on the differentiation pathway of undifferentiated mesenchymal cells or preosteoblasts to osteoblasts. By a surface modication of TiO2 with uoride, the uoride probably replaces the titanium-bound oxygen and forms a titanium uoride compound, and this surface is thought to be benecial for bone healing after implant placement. Aim: The aim of the present study were to examine the surface characteristics of various uoride-modied titanium surfaces, to evaluate the cell responses such as morphology, proliferation, the gene expression level of Cbfa1 (Runx2) and also cytoskeletal organization, osteogenic protein expression at the early stage in MG63 premature osteoblast-like cells compared with the uoride concentration percentage of each surface. Methods: In this study, titanium disks were sandblasted with TiO2 particles and modied with dilute HF under different conditions. The surface characteristics such as surface chemical composition, surface roughness and surface wettability were investigated. To examine the MG63 premature osteoblast-like cell responses of early stage to uoride-modied titanium surfaces as compared to those of non-modied surfaces, the cell morphology was examined using SEM for 12 h, 1 and 3 day. A cell proliferation assay was performed by WST8 assay and the gene expression level of Runx2 was evaluated using real time PCR. The cytoskeletal organization and expression of type I collagen, osteocalcin, and osteonectin as osteogenic differentiation marker by immunouorescence analysis. Results: The uoride-modied titanium surface resulted in a surface slightly reduced in roughness yet with hydrophilic properties. The relative atomic concentration percentage of uoride are 0.7%, 1.5%, and 2.8%. As the uoride concentration increased, the surface wettability increased and the cell proliferation began earlier. However, the gene expression level of Runx2 increased earlier and more on the surfaces with 1.5% uoride (P < 0.05). The immunoreactions of Type I collagen and osteonectin were more intense and diffuse to the cytoplasm and nucleus on uoride modied surfaces. Osteocalcin in the uoride modied surfaces were observed mainly in the cytoplasm but rarely in the nucleus and showed more intense compared to grit blasted titanium surfaces. Conclusions and clinical implications: Surface parameters by uoride concentration seem to be important factors in the enhancement of osteoblast differentiation, proliferation and activity. In addition, there seems to be an optimal uoride
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concentration percentage when the gene expression level of Cbfa1 (Runx2) was taken into consideration.
The quest for optimal implant drill design: what is the optimal number of utes?
Ki-tae Koo,1 Hyun-jun Oh,1 Ulf Wikesjo,2 Ji-hoon Yoon3
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Mechanical study on bar-type substructure made from CAD/CAM system

Toru Kimura, Masahiro Wada, Tomoya Gonda, Yoshinobu Maeda
Department of Prosthodontics and Oral Rehabilitation, Osaka University Graduate School of Dentistry, Osaka, Japan Background: The treatment of implant-supported overdenture
Seoul National University, Seoul, Korea, 2Georgia Health and
Sciences University, Augusta, USA, 3Osstem R&D Center, Busan, Korea Background: The utes of a drill are designed to remove debris
(IOD) is one of the valuable options in dentistry. However, a survival rate is somewhat lower on maxilla because of its bone density. Therefore, for resistant to reducing a survival rate of IOD, bar-type substructure using that connects rigidly among each implants is indispensable and recently CAD/ CAM system is helpful to fabricating this. However, there is no mechanical study on design criteria of bar dimensions and cross sectional shapes. Aim: To evaluate the effects of different dimensions and cross sectional shapes of the bar-type substructure made from CAD/ CAM system on the rigidity and deformation of bar, implant and peri-implant bone. Methods: Master model was fabricated from acrylic resin (Palapress Vario Kulzer Co.) and two implants (NobelBiocare Co. Regular type 3.75 9 10 mm) were inserted on. Intervals of implants were 20 mm and each implant was connected with bar attachment made from CAD/CAM system. The bar attachment shapes were square (Length 40 mm, Sectional area 6.25 mm2, Cantilever part length 10 mm). The strain gauges (KFG-03-120-C1-11, Kyowa Electric) were attached on each part of two implants and the bar attachment. Vertical Loads were applied on the center of the bar attachment, and strains were measured. A same experiment was performed by changing sectional area (9, 16, and 25 mm2). Measuring the strain was performed by ve times for each bar attachment. By three-dimensional nite element, the same experiment was performed by changing cross sectional shape of the bar attachment (T-bar and Hollow-bar). The data was statistically analyzed using single-factor ANOVA test. Results: In this experiment model, when bar dimension was getting larger, the strain of bar and implant was getting smaller. In three-dimensional nite element experiment, there were no signicant differences of peri-implant bone stress between each cross sectional shapes. Conclusions and clinical implications: Larger dimension and square cross sectional shape are more advantage in terms of the inuence on bar attachment and implant. However, in terms of the denture structure (for example, articial tooth), square cross sectional shape is not always optimal. Therefore, we will study how much stress range is acceptable for bar, implant and peri-implant bone in terms of the rigidity and deformation. In addition, we will research stress of each component when the bone density is changed.
from the drill tip as it cuts and ideally allow the debris to exit through thechannels. The Advantage of having an extra ute in the drill design may be the enhanced cutting efciency that reduces drilling time which in turn also reduces heat generation. On the other hand, more utes may narrow the channels of the utes that function as a path for bone chip removal resulting in impaired cutting efciency and elevated frictional heat. Aim: The purpose of the present study was to compare heat generation and cutting efciency associated with 2-, 3-, and 4uted implant drills that were specially fabricated in search for optimal number of utes. Material and methods: Two-, 3-, and 4-uted implant drills were designed and manufactured. Real-time temperature changes during drilling were measured in articial bone with irrigation using an infrared thermal imager. Cutting efciency was assessed as drilling time to the 15 mm depth under constant load with a specially fabricated measurement system. Each drilling procedure for each drill was performed up to 20 times. A one-way ANOVA was used for statistical analysis. Results: Mean temperature changes were 8.30, 10.76, and 15.13C for the 2-, 3-, and 4-uted drills, respectively. As the number of utes increased, mean temperature changes also increased (P < 0.001). The mean drilling time for cutting efciency measurement were 2.58, 2.46, and 2.53 seconds for the 2-, 3-, and 4-uted drills, respectively. A tendency for the cutting efciency to increase or decrease by the number of the utes was not observed. However, cutting efciency between the three drills was statistically signicant (P = 0.015). Cutting efciency of the 3-uted drill was superior to the 2-uted (twist) drill (P = 0.016). Conclusions and clinical implications: As the number of utes increased, frontal contact area between the drill and bone increased and consequently the mean temperature changes also increased. As the effective elimination of the bone chips were hampered in the narrowed path of the drills with more utes, bone chips accumulated in the channels eventually resulting in elevated frictional heat. As for cutting efciency, it turned out to be more related to the inherent stability and self-centering nature of the tripod rather than number of utes. Therefore, within the limits of this study, the optimal drill in terms of heat generation was the two-uted drill and the optimal drill in terms of cutting efciency was the threeuted drill.
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Inuence of microthread conguration on periimplant tissue dimension after functional loading in dogs
Joo Hyun Kwon, Sunjai Kim, Chong Hyun Han
Gangnam Severance Dental Hospital, College of Dentistry, Yonsei University, Seoul, Korea Background: The scalloped implant is designed to maintain
Enhanced wettability and cellular response on hydrothermally treated hydroxyapatite coatedtitanium surface
Mi-kyung Kwon, Hye-ri Shin, Ju-suk Kim, Yu-bok Choi, Gi-bong Sim
Dentis Co., Ltd, R&D Center, Deagu, Korea Background: Hydroxyapatite [HA; Ca10(PO4)6(OH)2] has been
the marginal bone height and preserve interdental papilla in the esthetic zone. According to recent studies, however, bone loss around the scalloped implants was greater than traditional at top implant. Therefore it is necessary to modify the design of the scalloped implant for more desirable esthetic outcomes. Aim: The aim of this study was to evaluate which the new scalloped implant design could maintain the interproximal bone level and the overlaying soft tissue dimension, compared with the clinically-proven at top implant. Methods: All implant group have internal conical interface, rough surface, diameter of 4.3 mm, length of 10 mm. I group (control) are 400 lm pitched, triangle-sectional microthreaded at top implant. Sh group are scalloped implant having the same horizontal microthread with I group. Ss group are scalloped implant which have 300 lm picthed, circle-sectional, scalloped loop microthread following the outline of scalloped xture top. Six implants in groups were placed in three Beagle dogs with one-staged protocol. After 2 months cementretained 3-unit metal bridge was fabricated and ve periapical radiographs was taken during 6 month functional loading. The marginal bone loss was measured and analyzed using 1-way ANOVA and Tukey test at 5% signicance. The histomorphologic analysis was performed after sacrice. Results: After 9 months marginal bone level change was 0.12 mm in I group, 0.15 mm in Ss group, and 0.32 mm in Sh group. The bone loss of Sh group were signicantly higher than I and Ss group (P = 0.00). Ss group had no signicant difference with I group (P = 0.66). The marginal bone resorption in rst experimental period (02 months) were signicantly higher than other periods (P < 0.05). Clinically the growth of rm and keratinized interdental papilla was shown in all the cases. In histomorphologic analysis, the growth of crestal bone over the xture top was observed in Ss group. Conclusions and clinical implications: The scalloped implant with scalloped loop microthread is advantageous design in the esthetic zone because of the minimal marginal bone resorption and maintenance of interdental papilla after functional loading.
used for orthopedic/dental implants because it has a similar chemical composition and structure to the mineral phase of human bone. But HA coatings reportedly exhibit reduced wettability, which could potentially negatively affect tissue adhesion and long-term clinical outcome. Wettability may be one of the surface factors to be considered when selecting dental implant biomaterials. Contact angles of dental implant surface preparations inuence wettability and tissue adhesion. Aim: The purpose of this study was to evaluate the effect of hydrothermal treatment in HA coated-titanium surface. Methods: In this study, Titanium (Grade 4) discs were HAcoated by low temperature high speed collision (LTHSC) and divided into the following groups: Group 1, HA coated (control), and Group 2, HA coated and hydrothermal treated for 4 h. The surface characteristics including contact angle, roughness, phase of HA layer, and chemical elemental composition were inspected. MC3T3-E1 mouse osteoblast-like cells were cultured on control and test group discs. Initial cellular attachment, CCK-8 cell proliferation assay were compared between the two groups for the evaluation of cellular response. Results: After hydrothermal treatment to HA-coated disc, the contact angle decrease signicantly. The content of crystalline HA increased and carbon showed a considerable decreased. The surface morphology and roughness did not show denite changes. Initial cell attachment and cell proliferation were increased in test group. Conclusions and clinical implications: The hydrothermal treatment in HA coated titanium induced enhanced wettability, and increased initial cellular responses of MC3T3-E1 cells in HA coated titanium surface. These ndings suggest that hydrothermal treated HA-coated implant would be favorable for more earlier osseointegration.
Mechanical properties and biocompatibility of implant material titaniumzirconium alloy

Tsung-lin James Lee, Takeshi Ueno, Ryota Kondo, Satoshi Migita, Suya Latu, Naoyuki Nomura, Noriyuki Wakabayashi, Yoshimasa Igarashi, Takao Hanawa
Tokyo Medical and Dental University, Tokyo, Japan Background: In the development of smaller-diameter implant,
the mechanical strength relies upon the proof stress/hardness of the xture. Harder material sustains higher external force
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even with reduced diameter. Titaniumzirconium (TiZr) alloy could be potential material for smaller-diameter implant due to its superior properties by forming of solid solution. Despite the similar chemical properties of Ti and Zr, it is still unknown whether the biocompatibility pertains while the mechanical property increases to crucial threshold. A fullspectrum compositional investigation is still absent and would be essential for further studies. Aim: This study aimed to provide a comparative analysis of compositional change of TiZr alloys on their mechanical properties and biocompatibility. Methods: TiZr alloy ingots were prepared by arc-melting in an argon atmosphere, with Zr concentration from 10 to 90 molar percentages, and casted in the same condition into specimen rods with gauge of 3, 5 and 10 mm, followed by sectioning and polishing. The hardness was measured by Vickers indentation with a load of 1.961 N for 15 s. Tensile test was applied with Instron universal testing machine, and tensile strength was evaluated by the stress-strain curve. Biocompatibility was tested with assays of MCT3T-E1 mouse osteoblast cell cultivated for 3 and 24 h. Viability was examined with staining of 2 lM calcein-acetoxymethylester and 100 nM rhodamine phalloidin. The cell morphology images were recorded under laser confocal scanning microscope prior to analyzing mean cell size. Results: Vickers hardness increased up to 301 3 kg/mm2 (Ti30Zr) compared to the lowest as 128 2 kg/mm2 (Ti). Oneway ANOVA shows the difference is signicant, [F(10, 154) = 3.299, P < 0.05]. Ti30Zr presents with highest ultimate tensile strength (UTS) as 980 MPa compared to 345 MPa for Ti. For biocompatibility, one-way ANOVA shows no signicant difference on mean cell size, [F(5, 64) = 1.832, P = 0.119]. Largest cell size, however, was detected on Ti10Zr instead of Ti. Vickers hardness increased up to 301 3 kg/mm2 (Ti30Zr) compared to the lowest as 128 2 kg/mm2 (Ti). One-way ANOVA shows the difference is signicant, [F(10, 154) = 3.299, P < 0.05]. Ti30Zr presents with highest ultimate tensile strength (UTS) as 980 MPa compared to 345 MPa for Ti. For biocompatibility, one-way ANOVA shows no signicant difference on mean cell size, [F(5, 64) = 1.832, P = 0.119]. Largest mean cell size, however, was detected on Ti10Zr instead of Ti. Conclusions and clinical implications: It is concluded TiZr alloys provide higher mechanical properties and equivalent biocompatibility to Ti, which suggests TiZr may be a potential material for clinical smaller-diameter implants.
a belief that the fracture mode is caused by lower bending strength of zirconia vs. titanium. Titanium has high strength, however, is notaesthetic. Recently, the hybrid-type abutment has emerged as an alternative to resolve this issue. A hybridtype abutment consists of a titanium-connector and zirconiahead, and is said to have both strength and aesthetic. Aim: The aim of this research is to evaluate strength and aesthetic of a hybrid-type abutment Methods: First, to evaluate the structure of a hybrid-type abutment, we made three kinds of connector for the hybrid-type abutment. These connectors have post-structure with lengths of 2.7, 5.3 and 8.0 mm from the platform level of the implant xture and are bonded to the zirconia-head with resin-cement (G-CEMTM Automix, GC). Finally the height of these abutments is 8 mm from the platform level of implant xture. Second, to evaluate the inuence of materials, we made three kinds of abutments (AadvaTM Blend abutment [hybrid-type abutment], AadvaTM Ti abutment and AadvaTM Zr Abutment) that are 8 mm height from the platform level of the implant xture. The test was conducted with abutment for xture, Aadva Implant, GC. After these abutments were set on xture at 30-degree angle with the loading direction, abutments were retained with each abutment screw tightened to 20 N/cm with an electronic torque controller. Static loading was performed according to ISO14801 until failure. The bending strength were compared to each condition and subjected to statistical analysis (one-way ANOVA). Third, to evaluate the aesthetic of abutment, we compared the color of three kinds of materials through gum-silicon (Softissue Moulage, Kerr).
Results:
The bending strength in N (n = 5)

AVE SD
Structures (post length)
Materials
2.7 mm
516.1 17.0
5.3 mm
439.3 24.7
8.0 mm
411.9 8.5
Hybridtype
498.0 73.7
Ti
462.5 4.6
Zr
276.4 0.7
Evaluation of strength and aesthetic of hybridtype abutment

Go Mashio, Yuuki Sakamoto, Masayuki Takayama, Tetsuro Sakuma
GC Corporation, Tokyo, Japan Background: There are many reported cases of fracturing of zir-
In evaluation of the structure of hybrid-type abutment, the post length of connector inuenced strength (between 2.7 and 5.3 mm, 8.0 mm). In evaluation of the inuence of materials, the strength of hybrid-type abutment was similar to that of Ti abutment, and stronger than that of Zr abutment (between hybrid-type abutment, Ti abutment and Zr abutment). (P < 0.01) In evaluation of the aesthetic, the aesthetic of hybrid-type abutment was similar to that of Zr abutment. Conclusions and clinical implications: In this research, we showed that hybrid-type abutment has both strength and aesthetic. Therefore hybrid-type abutment is safe and effective in clinical situations.
conia abutments compared with titanium abutments. There is
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Clinical evaluation of demineralized dentin matrix for bone graft material

Tokutaro Minamizato,1 I Takashi,1 Mayumi Umebayashi,1 Yoshinori Sumita,1 Seigo Ohba,1 Masaru Murata,2 Izumi Asahina1
1
Division of Reconstructive Oral Surgery, Graduate School of
Biomedical Sciences, Nagasaki University, Nagasaki, Japan, 2Oral and Maxillofacial Surgery, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido, Japan Background: Although autogenous bone graft is still gold stan-
dard for alveolar bone regeneration, it has impediments such as a limited availability and donor site morbidity. Allogenic or xenogenic bone is clinically utilized as a substitute for autogenous bone, but it cannot be ruled out the possibility that they cause transmitting diseases. Hence, we think of the utilization of autogenous teeth that cannot be preserved. Aim: The purpose of this study is to evaluate the efcacy of autogenous demineralized dentin matrix (ADDM) as a bone substitute on alveolar bone regeneration. Methods: This clinical study was approved by the ethic committee of Nagasaki University Hospital. After getting the informed consent, the affected tooth was extracted and processed for the preparation of ADDM. The extracted tooth was crushed, washed with 1.0 M NaCl, and demineralized with 2%HNO3. ADDM particles, ranging from 0.4 to 0.8 mm, were extensively rinsed, and were grafted immediately after the preparation for which it takes about 1 h. ADDM was applied to socket preservation, sinus lift, and alveolar bone augmentation with simultaneous implant placement. Bone formation was assessed by dental radiography and bone biopsy if possible. Dental implant stability was evaluated with ISQ in the cases with simultaneous implant placement. Results: Any adverse effects were observed during the course of the study. The radiography showed the increasing radio-opaque area in time-dependent manner. The new bone was histologically identied among the ADDM particles at 3 or 6 months after the graft. The sufcient implant stability was conrmed with ISQ in the cases with simultaneous implant placement. Conclusions and clinical implications: ADDM could be a safe and efcient bone grafting material for alveolar bone regeneration
especially in terms of esthetics, quality of life and patient satisfaction, depends on the prosthetic elements. In particular, the implant-abutment connection is of great importance when it comes to long-term stability and a successful prosthetic restoration. Dental implants are particularly sensitive to lateral forces. Therefore the design of an internal connection system that neutralizes and distributes all forces equally on the entire implant is crucial. Aim: The purpose of this study was to compare the stress distribution characteristics of different abutment connections under occlusal loading, using three-dimensional (FEM) Finite Element Method. Methods: In this study ve different implant brands were investigated. The strain distiribution of different implant-abutment connection systems having same material properties were evaluated under same loading conditions, the advantages and disadvantages of each system were assessed. The investigations were performed using FEM (Finite Element Analysis Software) methods in a software based system. Results: Regardless of abutment types and loading conditions, higher stress concentration was observed at the cortical bone. In cancellous bone, the highest stress was observed at apical portion and the maximum stress occurred at the implant neck. The higher internal stress was observed in the xtures than in the bone. No differences were found between different implant brands. Conclusions and clinical implications: Since the highest stress was observed at implant neck, the design of an internal connection, that distributes the forces hemogeneously around the implant coller, is essential.
Osseointegration of nonthermal atmospheric pressure plasma-treated zirconia implants with different surface roughness in rabbit tibiae
Young-seok Park
Seoul National Universtiy, Seoul, Korea Background: Until now, the materials of choice for endosseous
Comparative measurement of fracture resistance of various kind internal connection systems

Cem Tanyel, Mustafa Ramazanoglu, Merve Ozgul, Ahmet Bulent Katiboglu
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Istanbul, Turkey Background: The prosthetic elements have an important effect
on the degree of implant the osseointergration of the success,
dental implants have traditionally been Ti and Ti alloys. Therefore, research on bioactive surface modication has been focused mainly on the surface of Ti and Ti alloys. Recently, several zirconia ceramics have received considerable attention as an alternative, and their successful osseointegration has been reported Among the surface properties of dental implants, hydrophilicity is gaining interest because it has been demonstrated to provide a great advantage during the early phase of wound healing that facilitates osseointegration. Efforts to increase surface hydrophilicity have been made in the form of physicochemical modications and results show that osseointegration in the early healing phase was superior for hydrophilic surface implants compared with hydrophobic surface implants not only in animal studies, but also in a recent human study. One popular method to improve surface hydrophilicity is the use of gas plasma.
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Aim: The aim of this study was to evaluate and compare the
Aim: The purpose of this study was to compare the stability
osseointegration of powder injection molded (PIM) zirconia implants in rabbit tibiae with or without He plasma treatment. Methods: Twenty-ve rabbits received four types of external hex implants with identical geometry on the tibiae: PIM zirconia implants, roughened PIM zirconia implants, plasma-treated PIM zirconia implants, and plasma-treated roughened PIM zirconia implants. The contact angles of the four types of implants were evaluated. Removal torque testsand histomorphometric analyses were performed. Results: The plasma treatment markedly enhanced the hydrophilicity, but did not seem to change the surface topography and chemical composition of the PIM zirconia implants. There were statistically signicant differences in the bone to implant contact (BIC) ratios and removal torque values (RTQ) among the tested implant types (P < 0.001). The plasma-treated implants exhibited signicantly higher BIC and RTQ values than the uncoated implants. Conclusions and clinical implications: The plasma treatments on PIM zirconia implants made the surface more hydrophilic and enhanced the osseointegration of the implants without changing the micro-topography.
of SLA and SLActive implants by resonance frequency analysis. Methods: Twenty-ve SLA implants and 25 SLActive implants were placed in bilaterally partial edentulous patients. Implant stability quotient (ISQ) values were determined with Osstell at baseline, 1, 2, 3, 4, 8, 12 weeks. Data were analyzed by repeated measures analysis of variances. Results: After installation of implants, ISQ values increased by 78 values (P < 0.05) and decreased at 3 weeks for both surfaces (P < 0.05). The ISQ values increased gradually for SLA implants up to 12 weeks. The mean of ISQ values of the SLActive implants decreased after 2 and 4 weeks (P < 0.05). No signicant differences were observed between surfaces at 8 and 12 weeks (P > 0.05). In both groups an increase were observed by time but the difference between two groups were not signicant. Conclusions and clinical implications: With the limitations of this study, it could be said that where bone quality is good like in mandible, SL Active surface has not any advantages when compared with SLA surface.
Appreciation of stability in implants with two different surfaces

Gulsum Sayin,1 Gamze Alniacik,2 Asli Secilmis Acar,3 Ozgur Inan,1 Dogan Dolanmaz,4 Gulsun Yildirim4
1
Impact of abutment material and dis-/ reconnection on soft and hard tissue changes at platform switched implants
Kathrin Becker, Ilja Mihatovic, Vladimir Golubovic, Frank Schwarz
Heinrich Heine University, Du sseldorf, Germany Background: Platform-switching was proven to limit the apical
Department of Prosthodontics, Selcuk University, Konya,
Turkey, 2Department of Prosthodontics, Kocaeli University, Kocaeli, Turkey, 3Department of Prosthodontics, Gaziantep University, Gaziantep, Turkey, 4Department of Oral Maxillofacial Surgery, Selcuk University, Konya, Turkey Background: Implant surface micro-roughness and hydrophilic-
ity are known to improve the osteogenic differentiation potential of osteoprogenitor cells. A recently introduced hydrophilic dental implant surface with a sandblasted and acid-etched topography (SLActive, Institute Sraumann AG, Basel, CH), has been shown to enhance osteogenic cell response, bone apposition, stability, strength and subepithelial connective tissue attachment during the initial healing stage, when compared with a conventional implant of the same surface topography (SLA, Institute Straumann AG). According to the manufacturer, these implants are produced from the same cpTi alloy and subjected to the same roughening treatment with large grit size (250500 lm) corundum sandblasting plus acid etching (H2SO4/HCl). The sole parameter which differentiates the new product from its predecessor is that the hydrophilic implant is purged and directly sealed under N2 in vials containing isotonic NaCl, to protect the chemical activity of the clean TiO2 passivation layer.
downgrowth of the junctional epithelium (JE) when compared with matching implant-abutment congurations. The inuence of abutment material and a repeated dis-/reconnection, as routinely applied for conditioning of soft tissues, on dimensional changes of the peri-implant complex is currently rather unknown. Aim: To assess the impact of abutment material and dis-/ reconnection on soft and hard tissue changes at platformswitched implants. Methods: Titanium implants, placed epicrestally in the upper jaws of three dogs, were connected with titanium (Ti) and zirconium dioxide (ZrO2) abutments (horizontal mismatch of 0.4 mm) and randomly allocated either to repeated (29) dis-/ reconnection at 4 and 6 weeks (test), respectively, or left undisturbed (control). At 8 weeks, histomorphometrical measurements were made between the implant shoulder (IS) and: (1) the apical extension of the long junctional epithelium (aJE), (2) the most coronal level of bone in contact with the implant (CBI). Results: Repeated abutment manipulation was associated with increases in mean PM-aJE and IS-CBI values at both Ti (1.82 0.37 to 1.99 0.40 mm and 0.72 0.18 to 1.12 0.60 mm) and ZrO2 (1.90 0.28 to 2.67 0.67 mm and 0.22 0.10 to 2.15 0.77 mm) abutments at 8 weeks. These
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changes were comparable at both vestibular and oral aspects. Between group comparisons, however, failed to reveal a significant difference between test and control sites. Conclusions and clinical implications: Repeated manipulation may be associated with dimensional changes of peri-implant soft- and hard tissues formed at both non-matching Ti and ZrO2 abutments.
porosity volume, were of 143.62 2.60 mm3 for Group A and 152.79 2.47 mm3 for Group B (P = 0.0009); and nally, for cylinder porosity percentage, were of 74.08 1.27% for Group A and 79.46 1.18% for Group B (P = 0.0001). Conclusions and clinical implications: It was concluded that this methodology can produce standardized bone cylinders of high and low bone density, which could be used in future studies to comparatively evaluate the initial stability of different dental implants.
Development of standardized high and low density porcine bone models: an in vitro pilot study
Sergio ScombattiDe Souza, Carolina Dantas, Daniela Pizzo, Jessica Carvalho, Danilo Reino, a Reis, Arthur Novaes Jr, Valdir Muglia Andre
School of Dentistry of Ribeira o Preto, University of Sa o Paulo, Ribeira o Preto, Brazil Background: Bone quality can affect the primary stability of
Resorbable GBR membrane of hydrogel type based on polyethylene glycol (PEG)

Da-mi Choi,1 Young-il Chung,1 Min-kyoung Kim,1 Seung-hwa Shin,1 Su-kyoung Kim,1 Taw-gwan Eom,1 Kyoo-ok Choi,2 Ju-dong Song1
1 2
Implat R&D Center, Osstem Implant Co., Ltd., Busan, Korea, Osstem Implant Co., Ltd., Seoul, Korea
dental implants and it is one of the most important factors for treatment success. Considering that, many manufacturers have designed different implants for using in poor bone quality (low density bone). In this way, it is interesting to develop a standardized bone model for future use in the evaluation of implants primary stability. Aim: The purpose of this pilot study was to comparatively evaluate porcine bone cylinders, of high and low bone density, using three-dimensional (computerized micro-tomography) analysis. Methods: Using an especially designed trephine burr, osteotomy was conducted and 20 bone cylinders with 15 mm in diameter and 18 mm in length were prepared from porcine bone, removed from mandibular condyle or from femur head, and divided in two groups: Group A 10 bone cylinders removed from femur head (high-density bone); and Group B 10 bone cylinders removed from mandibular condyle (low-density bone). All bone cylinders were three-dimensionally evaluated using SkySkan 1172-160, a high resolution micro-CT, analyzing the following tomographic parameters: cylinder bone area (bone area of all CT slices), cylinder bone volume (volume occupied by bone trabeculae), three-dimensional bone density (cylinder bone volume/cylinder total volume), cylinder porosity volume, cylinder porosity percentage. Student t-test was used to verify the differences between groups A and B (previous analysis showed normal distribution of data); for all analysis, a signicance level of 5% was used. Results: The results showed that the differences between Groups A and B were statistically signicant for all the evaluated tomographic parameters. The averages standard-deviation for cylinder bone area were of 1775.55 89.85 mm2 for Group A, and 1469.77 111.62 for Group B (P = 0.002); for cylinder bone volume, were of 50.23 2.42 mm3 for Group A and 39.51 2.25 mm3 for Group B (P = 0.0001); for threedimensional bone density, were of 25.88 1.30 for Group A and, for Group B, of 20.54 1.18 (P = 0.0001); for cylinder
Background: Guided bone regeneration (GBR) is a surgical pro-
cedure in which periodontal regeneration membrane (called membrane hereafter) is used to protect in-growth of broblast from surrounding connective tissues and new bone is formed by induced impregnation of blood, and proliferation of bone cells. Such GBR membranes commonly require tissue afnity, biocompatibility and space maintenance. However, membranes that have been developed until now failed to satisfy all of these conditions. Aim: The aim of this study was to develop the membrane of hydrogel type for supplement limitations of existing resorbable membranes. Methods: In this study, a hydrogel membrane based on polyethylene glycol (PEG) was developed by photo-polymerization. PEG is a safe biodegradable polymer that received FDA approval. The following of items was measured for evaluation of physiochemical properties; strength, mass loss, pH and transmission of nutrient substance. For biological safety, transplant of membranes was performed on the mandible of a mini pig along with cytotoxicity. Results: As a result of experiment, hydrogel and collagen membrane showed equivalent results in terms of transmission of nutrient substance, change in pH and cytotoxicity. On the contrary, greater mass loss occurred in the collagen membrane because it is a natural biomolecule with weaker resistance to disintegrating enzymes than hydrogel membrane. Also in the evaluation of effectiveness, in-growth of soft tissues were proteced in all experimental groups as GBR membranes without particular inammatory responses, showing equivalent level of osteogenesis. Conclusions and clinical implications: In this study, physiochemical and biological safety evaluation were performed and verifying possibility of application as a resorbable membrane. The results show that the hydrogel membrane developed in this study is a clinically convenient membrane that can substitute existing resorbable membranes. Accordingly, hydrogel
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membrane is expected to be used in various indications of GBR procedure in the eld of dentistry.
Aim: We have obtained signicant results on simultaneous
Alterations of gene expression by beta-tricalcium phosphate in osteoblast-like MG63 cells

Chang-joo Park,1 Kyung-gyun Hwang,1 Tae-yun Im,1 Su-kyoung Kim2
1
Division of Oral and Maxillofacial Surgery, Department of
Dentistry, College of Medicine, Hanyang University, Seoul, Korea, 2Osstem Implant Co., Ltd. Implant R&D Center, Busan, Korea Background: Beta-tricalcium phosphate (b-TCP) is a synthetic
calcium phosphate ceramic that has widely been used as a bone material to repair bone defects. Aim: Despite many clinical studies, the molecular mechanism whereby this biomaterial alters gene expression in osteoblasts to promote bone formation is poorly understood. We, therefore, attempted to address this question by using microarray techniques to identify the genes that are differentially regulated in osteoblasts exposed to b-TCP. Methods: By using DNA microarrays, we identied several genes whose expression levels were signicantly up- or downregulated in osteoblast-like MG-63 cells cultured with b-TCP at a concentration of 100 mg/10 ml for 24 h. Results: The differentially expressed genes cover a broad range of functional activities: signal transduction, transcription, cell cycle regulation, vesicular transport, apoptosis, immunity, cytoskeletal elements, and cell proliferation and differentiation. Conclusions and clinical implications: The gene expression changes related to cell proliferation and differentiation, vesicle transport, immunity and defense could affect the osteogenic activities of osteoblasts for bone regeneration. However, further studies will be required to verify the relative importance of these genes in bone formation, their temporal and spacial expression patterns, and their interactions with each other.
sinus lift and implantation in 1 mm bone width. Recently, CAS-KIT has been developed and a further great result can be expected by using the PEP7 implant. Methods: SLA, HA, PEP7 have different surface properties and they are implanted in the frontal sinus of beagle dogs. RBM was used as a control. Simultaneous sinus lift and implantation was performed using autologous blood instead of saline. We name this technique as BLT (Blood lifting technique). Results: We only report the ISQ value of control group using histomorphometry, and CT image obtained three and 6 months after implantation. Conclusions and clinical implications: In this study, we can predict the results from our past outcome of an experiment showed excellent BIC in HA. In addition, PEP7 can be expected better results than HA and we will let you know the progress of this experiment in the future.
Design and development of osteogenic coatings for titanium dental implants

a MartinezJulio Suay,1 Maria Jesus Juan-Diaz,2 Mar ndez-Escolano,2 Vicente Ferrer,3 Iban ez,2 Miriam Herna ez,2 Jaime Franco,4 Antonio Coso,4 Irene Lara-Sa 2 2 Marilo Gurruchaga, Isabel Gon i
n, Spain, 2University of Basque Jaime I University, Castello n, Spain, 3Murcia University, Murcia, Country, San Sebastia rida, Spain Spain, 4Ilerimplant, Le Background: The main reason for failure of dental implants is
1
The use of autologous blood derived from frontal sinus membrane elevation using the B.L.T Method; an experimental study
Yoshikazu Yamazaki,1 Su-kyoung Kim2
1
Yamazaki Dental Ofce, Kanagawa, Japan, 2Implant R&D
Center, Osstem Implant Co., Ltd., Busan, Korea Background: We have done animal experiment without bone
graft in the frontal sinus of beagle dogs. The present animal experiment was designed to study maxillary sinus lift performed with autologous blood using CAS-KIT (Osstem CO. Ltd.) to insert the implant. We report the ongoing experiment that makes PEP7 a target.
the wrong anchor with the bone and the fact that osseointegration is a long process. One way to avoid these problems is the development of coatings to improve the bioactivity of metallic implant that allow creating direct and strong linkages with the bone. Aim: The development of hybrid coatings obtained via sol-gel, to increase the osteogenic capacity of titanium implants and improve the osseointegration. Biological responses of the coatings will be evaluated through in vitro and in vivo studies. Methods: The sol was prepared by acid catalysis method. Different types of alcoxysilanes were used. The coatings were physicochemically evaluated. In vitro tests of the proliferation of adipose mesenchymal stem cells were performed. The presence of calcium deposited by osteogenic cells was analyzed by Alizarin Red Test. Biological evaluation was carried out through the implantation of 20 Titanium implants in rabbit tibias during 1, 2, 4 and 8 weeks. Results: The chemical characterization conrms the formation of a well-structured Si-O-Si network. The weight loss of the coatings measured in the degradation assay is directly connected with the Si release. The in vitro results of proliferation of the adipose mesenchymal stem cells show better results that those found in the titanium control. The Alizarin Red test reveals that all the coatings form calcied extracellular matrix. In vitro assays were used to optimize the best coating
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because its biological response. The study in vivo of implanted samples indicates that the osseointegration response is signicantly improved in short times (1, 2 and 4 weeks) in the coated implants compared to Titanium controls. Histological analysis shows the formation of trabecular bone in only seven days in the case of using the optimal coated titanium implant. It is possible to design the degradation rate of the coating with chemical parameters. An osteoinductor coating that completely disappears after 8 weeks when in contact to trabecular bone zones is obtained. Conclusions and clinical implications: Bioactive sol-gel coatings with a well-structured Si-O-Si network were obtained. The in vitro studies showed that the materials provided the proliferation of the mesenchymal stem cells and the activity of the osteogenic cells and improve its behavior compared to titanium control. The in vivo studies indicated that the coating were able to improve the osteogenic capacity and are able toconstitute a future vehicle for bioactive molecules to develop implants to specic and particular clinical patients.
Results: All samples failed due to a pure breach at the IAJ,
meaning that no components yielded and/or fractured. The initial titanium screw produced seal strength values averaging 500 N, and the second screw provided no improvement in seal robustness. Use of the Gold-Tite screw increased the average seal strength to 780 N. Table 1. Breach load data (N): System
1 2 3 4 5 Average SD
Ti screw 1
450 500 600 500 450 500 61
Ti screw 2
450 500 600 500 450 500 61
Gold screw
750 800 850 750 750 780 45
Effect of abutment screw design on implant system seal performance

Zachary Suttin, Ross Towse
BIOMET 3i, Palm Beach Gardens, USA Background: Seal integrity of the implant-abutment-junction
Conclusions and clinical implications: A method has been developed to assess the seal robustness of implant systems subjected to clinically relevant loading conditions. The GoldTite screw demonstrated a signicant improvement over titanium, indicating that the additional preload generated is benecial to the seal integrity.
Initial biocompatibility of titanium nanostructure surface modied by new method

Yoichiro Taguchi, Satoshi Komasa, Hisataka Nishida, Tetsuji Kusumoto, Shoji Takeda, Kazuyo Yamamoto, Masahiro Tanaka, Joji Okazaki, Akio Tanaka, Makoto Umeda
Osaka Dental University, Osaka, Japan Background: Recently, researches for nding unusual new
(IAJ) has signicant clinical relevance due to the potential detriments associated with an inferior seal such as microleakage. Abutment screw design is a paramount factor as the screw generates the preload required to establish and maintain system stability. Aim: To characterize the IAJ seal robustness of implant systems subjected to dynamic loading with titanium and GoldTite abutment screws. Methods: The apex of the 4/3.4 mm Certain Prevail test implants (n = 5) was modied to have a barb tting and through hole. The implants were embedded in a phenolic block 3 mm supragingival, and the implant barb was connected to a 7 psi peristaltic pump containing red dye. A GingiHue abutment and titanium screw were assembled with the prescribed 20 N-cm of torque. The block was mounted at 20 off-axis in a clear water tank, and the IAJ was magnied 509 with a video camera. The system was cyclically loaded at 100 N for 100 k cycles at 30 Hz. Following this wear phase, the pump was activated and the frequency was reduced to 2 Hz for 1 k cycles to monitor the IAJ. The wear-monitor routines were incremented in 50 N load steps until a breach occurred, and the system components were then examined to detect yield and/or fracture damage. A new titanium screw was assembled, and the testing was reinitiated at the prior breach load. Upon breaching, the components were reexamined for damage and the testing was resumed at the prior breach load using a Gold-Tite screw.
function of material have been going on eagerly. A joint researcher found that titanium oxide generates the nanosheet structure by itself in room temperature and ordinary atmospheric pressure. The application to biocompatible materials is expected because of interaction between biological tissue and titanium nanosheet structure. Recently, researches for nding unusual new function of material have been going on eagerly. A joint researcher found that titanium oxide generates the nanosheet structure by itself in room temperature and ordinary atmospheric pressure. The application to biocompatible materials is expected because of interaction between biological tissue and titanium nanosheet structure. Aim: The aim of this study was to evaluate the inuence of titanium at nanosheet surface on initial attachment of bone marrow cells for application to biocompatible materials. Methods: In the test group, Ti discs which educed the nanosheet were used as an experimental material, and unprocessed Ti discs were also used in the control group. For educing nanosheet, Ti discs were dipped in 10 M Na(OH)2 solution (30C, 24 h), washed and dried. The titanium nanostructure surface was viewed by scanning electron microscopy. It was
207
measured adhesion behavior of cows serum albumin and bronectin according to previous method at 1, 3, 6, 24 h and new method by using QCM nano sensor which educed nanosheet. Cell culture experiments were performed with the SD rat bone marrow cells. Cells (4 9 104 cells/well) were plated into each well, and the number of cells were counted at 1, 3, 6, 24 h of culture by using CellTiter-BlueTM Cell Viabillity Assay Kit. And, focal adhesion contacts were monitored by uorescence actin staining. Results: SEM and SPM images show sheet structure with nano size on Ti surface in the test group. The adhesion number of both proteins on Ti surface in the test group was signicantly higher than that of the control group at both experiments. After 1 and 3 h of culture, the number of cells of the test group shows signicantly more than those of cells of the control group, but after 6 and 24 h of culture, no signicant difference was observed between the test and control group. And uorescence images revealed at cell adhesion in the control group and also revealed extended adhesion of cell excrescence in the test group. Conclusions and clinical implications: In conclusion, these data suggest that reforming of the new Ti nanostructure surface changed its molded surface with nano size and improved adhesion of protein and focal adhesion of cells. We conclude that further development of advanced implant materials using nanotechnology will improve earlier and stronger osseointegration.
XRD, FT-IR and SEM. Male Wister Rats (12-week-old) were used for investigate. All procedures were approved by the Animal Reserch Committee of Showa University. All rats were divided into ve groups; HAP treated group, b-TCP treated group, xenogeneic bone treated group, collagen treated group and control. The experimental rats were anesthetized with intraperitoneal sodium pentobarbital supplemented by ether inhalation. One trephine detect, 9 mm diameter which was critical size bone detect, was surgically created including the mid-sagittal suture. In the ve groups, the detect was treated differently. Then their bone formation modality were assessed by tissue section, bone formation volume by l-CT and new bone hardness by nano indentation tester. Results: By tissue section for 8 weeks, bone formation by using calcium phosphate and xenogeneic bone occurred from materials surfaces. Neonatal bone volume by using both materials were not difference. And, neonatal bone hardness by both group were not inferior to preexisting cranial bone. Conclusions and clinical implications: This study implies that calcium phosphate is not difference as compare to xenogeneic bone in the point of new bone formation. So, these ndings indicate that calcium phosphate materials are useful for bone regeneration.
Unconventional treatment of the aged single tooth implant in the molar region
Lutz Tischendorf
Praxis MKG Chirurgie, Halle, Germany Background: With longer implant survival disturbances did
Bone regeneration by bone grafting material in rat calvarial defect model

Yuichi Takiguchi, Yu Kataoka, Yo Shibata, Takashi Miyazaki
Showa University, Tokyo, Japan Background: Many kind of bone grafts are used to replace or
reconstruct skeletal critical sized defects resulting from periodental disease, cyst, tumor and trauma. In particulary autogenous bone has been most useful bone grafting materials because it is nonrejection, osteoinduction, bone conduction and osteogenic. The graft used autogenous bone has several disadvantages such as limitation of collection volume, operation is complicated and infection associated with harvesting bone. Many clinical researches of various bone grafting materials have reported. And, calcium phosphate (HAP, b-TCP) have researched by reason of these are similar to mineral of mammals tooth and bone. So these are considered desirable bone regenerative materials. Aim: A appropriate rules of select of bone grafting materials to bone preparation by reason of their uniform research have not been did yet. In this study, we investigated utility of calcium phosphate (HAP, b-TCP) in the point of their adsorptive, bone formation volume and new bone hardness. Methods: Bone grafting materials were prepared with three different types; calcium phosphate (HAP, b-TCP) and xenogeneic bone. Evaluation of their physical property were performed by
occur on implant of itself. They do not always lead to the removal of the perfectly osseointegrated implants. Aim: Based on case reports unconventional approaches are described. Methods: There are cases with single tooth repair in the molar region. Results: Case 1: Branemark implant. Fracture of the abutment screw. In the removal of the screw the internal thread is damaged. A permanent stable xation with conventional abutment screw is not be achieved. With the implant producer is individually produce an 0.5 mm longer version of the abutment screw. After recutting the threat by means of this abutment screw a stable xation of the abutment was now achieved. Case 2: Replace select implant. Fracture of the mesiale wall of the implant head between two grooves down to the rst thread. With the implant producer is individually produce a version of the Esthetic abutment. There was a shit cowering outside the implant head to the rst threat. To insert the abutment bone is removed to the shits level by means of a calibrated trephine drill with drill guide. Now a stable xation of the abutment is achieved. Conclusions and clinical implications: Out of more than 2000 implants two cases are presented with unusual late complica-
208
tions at the implants itself. Individual solutions lead to the further use of the osseointegrated implants.
Conclusions and clinical implications: Experiments have shown
Microbial contamination of impression materials in implants-prosthetic rehabilitation

Matei Traistaru,1 Ruxandra Sfeatcu,1 Simion Gheorghe Dumitru,2 Liliana Burlibasa,3 Corina Marilena Cristache,4 Mihai Burlibasa,1 Teodor Traistaru1
1
that tested materials inuence the rate of adhesion and development of microbial biolms and can cause illness, both among patients and medical staff. Also, the ability of adhesion and microbial biolm formation proved to be a strain characteristic.
Faculty of Dentistry, University of Medicine and Pharmacy
Early bone apposition to hydrophilic titanium implant surfaces: a histologic and histomorphometric study in minipig
Christoph Vasak,1 Uwe Yacine Schwarze,2 Stefan Tangl,1,2 Fernando Muzon Guzon,3 Georg Watzek,1 Thomas Hefti,4 Dieter Busenlechner,5 Falko Schlottig,4 Reinhard Gruber1,2,6
1
Carol Davila, Bucharest, Romania, 2U.M.01751, Bucharest, Romania, 3Faculty of Biology, University of Bucharest, Bucharest, Romania, 4S.C. Concordia Dent S.R.L., Bucharest, Romania Background: Microbial biolms have an important role in oral
Department of Oral Surgery, Bernhard Gottlieb University Austrian Cluster for Tissue Regeneration, Vienna, Austria, School of Veterinary of Lugo, University of Santiago de
pathology, in etiology of periodontitis, but also in contamination of materials commonly used in implants-prosthetic rehabilitation. Aim: This study aims to determine the ability of adhesion and formation of microbial biolm on the surface of common material used in implants-prosthetic rehabilitation: the impression materials are compared with other materials of wide interest in dentistry. Methods: During September 2011December 2011 was taken microbial dental plaque from a number of 43 patients rehabilitated with conjunct ceramic prostheses on nickel-chromium metal support. The materials selected in order to determinate the adhesion and microbial biolm formation, were inert substrates, represented by: impression materials (irreversible hydrocolloids, condensation silicones, polyethers) compared with diacrylic composite resins, zinc phosphate cement and selfcuring acrylic resins. They were pursued following: (1) Isolation of microbial strains taken from dental plaque. From initial sample, were seeded primary isolation media, represented by the agar-blood and medium YPG, which were incubated at a temperature of 3537C, for a period of 2448 h to allow the development of slow-growing germs. From 2448 h culture obtained, Gram smears were performed to detect morphological types. (2) Identication of microbial strains isolated from dental plaque was based on characters on agar-blood culture, YPG medium and morphotinctorial characteristics. (3) Quantitative assessment of the degree of biolm formation and microbial adhesion to inert surface layers mentioned above. Samples were viewed using an electron microscope type Leica CSLM TGS-SP featured with PL FLUOTAR and an Ar-Fe laser set at 488 nm. There was obtained a 200 nm lateral resolution. Results: There was a great diversity of aerob and anaerobe species. So, the microbial biolms formed on these inert substrates gradually increase after the rst 24 h, maximum development has 72 h, followed by a phase of sharp decline, without disappearing completely. The irreversible hydrocolloids proved to presents the greatest microbial load compared to other materials tested.
School of Dentistry, Medical University, Vienna, Austria,

2 3
Compostela, Santiago De Compostela, Spain, 4Thommen Medical AG, Waldenburg, Switzerland, 5Academy of Oral Implantology, Vienna, Austria, 6Laboratory of Oral Cell Biology, School of Dental Medicine, University of Bern, Bern, Switzerland Background: In-vitro and in-vivo studies showed enhanced tis-
sue reactions and bone apposition to hydrophilic surfaces compared to conventional hydrophobic microrough surfaces during the healing process. In addition surface conditioning might further stimulate especially early osseointegration. By now, investigations on initial and early bone formations to chemically modied hydrophilic surfaces are still limited. Aim: The aim of this study was to evaluate the osseointegration at two chemically modied microrough, hydrophilic surfaces (INICELL and SLActive) compared to a conventional microrough surface (Thommen SPIElement: sandblasted and hot-acid etched) during the early phases of healing. Methods: Nine minipigs received bilateral extraction of their maxillary and mandibular premolars. After a healing period of 12 weeks, all four quadrants received dental implants (Thommen Medical SPI Element; Straumann Bone Level Implant) alternating between sandblasted and hot acid etched, INICELL and SLActive. In total, 108 implants were placed. After 5, 10 and 15 days of submerged healing ground sections were prepared and subjected to histologic and histomorphometric analyses. Results: The histologic analyses revealed a similar healing pattern among the three implant surfaces with bone formation becoming visible at day 10. At day 15, the mean new boneto-implant contacts of the hydrophilic surface (INICELL: 55.8 14.4%) was slightly higher compared to the conventional microrough surface (40.6 20.2%) and SLActive (25.5 12.2%), but not reaching statistical signicance. The values for the new bone-volume-per-tissue-volume were rather similar between the INICELL, SLActive and conventional mi-
209
crorough surface (16 6.2; 11.2 5.4%; 14.3 8%, respectively). Conclusions and clinical implications: The data from the present study demonstrate a tendency towards an increased bone apposition to the hydrophilic surface INICELL after a short healing period.
Availability of secondary xation of implants pilot model study

Masahiro Wada, Toru Kimura, Tomoya Gonda, Yoshinobu Maeda
Department of Prosthodontics and Oral Rehabilitation, Graduate School of Dentistry, Osaka University, Suita, Japan Background: The treatment of removable overdentures which
In vitro behavior of osteoblasts on zirconia after Er, Cr:YSGG-laser irradiation

Ricardo Vecchiatti, Renan Soares, Fabiano Zanardo, Rodrigues, Jamil Shibli Odair Borghi, Jose
UNG, Guarulhos, Brazil Background: Can the ceramics materials be used instead tita-
nium in oral implants? They are more esthetics and with no allergy history. How it would be the behavior of the cells of the body in ceramics? Can we improve their incomes with some external stimulates? Aim: The aim of the study was to investigate the osteoblastic behavior to Ytrium-stabilizedtetragonal zirconia policristal (YTZP) surface after Er, Cr:YSGG laser irradiation treatment as an alternative to titanium for implant material. Methods: Twenty-four blocks of zirconia Y-TZP (Vita in Ceram YZ) were randomized in four groups to laser irradiation: G1-control (no laser irradiation); G2-1,5W; G3-3,0W; G45,0W. Each block was treated for 30s with Er, Cr:YSGG laser (Waterlase, Biolase Technologies Inc), in focused mode, repetition rate xed on 20 Hz, with air-water irrigation. These specimens were ultrasonically cleaned for 10 min in acetone, ethyl alcool and distilled water, and were sterilized in autoclave for 20 min at 121C under 2 ATM. Six blocks of each group were inserted in a 96-well plates. Osteoblast cells MC3T3-E1 Subclone 4 (ATCC, Manassa, VA, USA) were cultured in a-Modied Minimal Essencial medium, and when reached conuencethey were trypsinated and seeded onto the treated surfacesat a place density of 10,000 cells/ml. (3-[4,5-dimethylthiazolyl-2]-2,5-diphenyl tetrazolium bromide (MTT, SigmaAldrich, St Louis, MO, USA) colorimetric assay methods. Cells were xed with glutaraldehyde and prepared to scanning electron microscope (SEM) to observe adhesion and morphology of cells. Results: After 3 days of incubation the MTT assay showed that MC3T3-E1 cells attached and proliferated in all groups. Compared to G1 (control), the G2 group had a proliferation 1.4% higher (P < 0.05); the G3 group had a proliferation 3.1% higher (P > 0.05) and G4 group had a proliferation 6.64% higher (P > 0.01) (ANOVA, NewmanKeuls). SEM images demonstrated that MC3T3-E1 on all the plates appeared to attach and spread well. Conclusions and clinical implications: Er, Cr:YSGG laser irradiation may have contributed to the greater and earlier cell spreading that was observed with the Y-TZP surface.
are supported by implants (IOD) is very useful because of its maintenancy, economic efciency and others. In recent years, we can use the CAD/CAM system to manufacture the accurate and complicated bar type structures which can connect rigidly among each implant, and this treatment concept is very important in maxilla case because of its bone quality. However, these structures need considerable space to place into denture framework. One of the solutions of this problem is that each implant connects rigidly by denture stiffened structures secondary xation. Aim: The aim of this pilot study is to examine the mechanical stabilities between different connection types under varied loadings. Methods: Two implants (NobelBiocare Co. Regular type 3.75 mm0 mm) are inserted on in vitro jawbone model made of acrylic resin (Palapress vario Kulzer Co.) at intervals of 20 mm which simulate the two implants IOD in anterior region. The shape of bar attachment and denture stiffened structure are square as for a standard sectional area (Length 40 mm, Sectional area 16 mm2, Cantilever part length is 10 mm). The strain gauges (KFG-03-120-C1-11, Kyowa Electric) are attached on each part of two implants, bar attachment and denture stiffened structure. Loads are applied in the center of the bar and denture stiffened structure, and strains on two implants, bar attachment and structure are measured. Results: In this study, strains on implant surface were reduced by secondary xation of implants using denture stiffened structure. In addition, signicant differences were noted for the strain on implants and bar attachments between primary xation (bar attachment) and secondary xation (P < 0.05). The data was statistically analyzed using Welchs t-test. Conclusions and clinical implications: In maxillary IOD case, each implant should be rigidly connected for implant survival. On the other hand, indication of bar attachments is often difcult because of limited denture space, especially vertical dimension. In this limited study, we demonstrate that secondary xation of implants shows equal or more efcacy than bar attachments. Furthermore, we will research stress of each component under the various bone density situation.
210
Study of a new collagen membrane with extended resorption time

Bastian Wessing,1 Martin Emmerich,1 Bernd Sellhaus,2 Ahmet Bozkurt3
1 2
membrane exposure. Initial clinical results obtained with Remaix are very encouraging but need to be conrmed in further clinical studies.
Dental Practice Clinic at Luisen Hospital, Aachen, Germany, Institut for Neuropathology, University Clinic, RWTH, Aachen,
Effect of reinforcement for immediately loaded implants provisional prostheses

Kikue Yamaguchi,1 Yuichi Ishiura,2 Daisuke Sato,2 Masahiko Ozeki,2 Kazuyoshi Baba1
1
Germany, 3Clinic for Plastic Surgery, University Clinic, RWTH, Aachen, Germany Background: A relatively common, but minor complication
Department of Prosthodontics, School of Dentistry, Showa
after the use of barrier membranes in GTR/GBR procedures is premature exposure of the membrane due to soft tissue dehiscence. It is generally recognized that an accelerated degradation of the membrane after premature exposure has a negative effect on bone regeneration. Therefore, membranes with prolonged resorption times could provide clinical benets in these cases. Aim: The goal of the current study is the evaluation of a new commercially available barrier membrane with extended resorption time both preclinically (in vitro, animal studies) and clinically. Methods: Examined barrier membranes were commercially available; either from Matricel GmbH, Herzogenrath, Germany (Remaix) or Geistlich Pharma AG, Wolhusen, Switzerland (Bio-Gide). The in-vitro degradation assay examined two aspects. First, it was performed to study the bio-resorption of Remaix in comparison with Bio-Gide. Second, it was performed to study the effect of colonization by oral bacteria after incidental exposure of the membrane in the clinical setting on the bio-resorption rate of Remaix in comparison to Bio-Gide. Subcutaneous implantation of Remaix and Bio-Gide in rats was performed to study the in vivo degradation and tissue integration of both membranes. In the clinical part of the study, a total of 10 patients (6 male, 4 female; mean age of 61.7 years) underwent surgical treatment in a dental practice clinic between October and December 2010 for augmentation of the alveolar ridge or maxillary sinus. In these cases, only Remaix was used. Results: The in-vitro studies revealed a higher collagenase-stability of Remaix when compared to Bio-Gide. This nding was conrmed by a longer stability of Remaix when compared to Bio-Gide in the subcutaneous animal implantation studies. Excellent tissue integration was observed for both membranes. In the clinical part the prosthetic treatment of all patients with implants after bone augmentation was possible. In one documented case of a dehiscence, the exposed Remaix was very stable, did not become gel-like and the bone graft material remained covered until the epithelialization was complete. Conclusions and clinical implications: Besides advantages in terms of handling, the Remaix membrane provides a higher degree of resistance against biodegradation in vitro, in vivo and clinically than the Bio-Gide membrane used previously and thus enabled reliable GBR procedures even in case of a
University, Tokyo, Japan, 2Department of Implant Dentistry, School of Dentistry, Showa University, Tokyo, Japan Background: Provisional prostheses for full-arch immediately
loaded implants are generally made of acrylic resin and therefore are not rigid enough to distribute occlusal forces across the dental arch, which may cause force concentrations on the implant under load. In order to successfully obtain osseointegration of immediately loaded implants, micromovements of implant and stresses around implant xtures should be controlled to be minimum, which might be achieved by the reinforcement of provisional prostheses. Aim: The purpose of the present study was to evaluate reinforcement effects of provisional prostheses on micromovements of the implant and on stresses around immediately loaded implants using a 3D-FEA. Methods: A male patient with an edentulous maxilla, who had computerized tomography (CT) and received immediately loaded full-arch dental implants, was selected and 3D-FEA models were created using his CT-Digital Imaging and Communication in Medicine (DICOM) data (MECHANICAL FINDER, Research Center of Computational Mechanics, Inc). On this model four implants (13.0 mm length and diameter of 4.0 mm) were placed bilaterally, two at the incisor region and two at the second premolar region with inclination. Their surfaces made contact with alveolar bone but were not connected to the bone to simulate immediately loaded condition. The provisional prosthesis, which was made of acrylic resin, was designed between bilateral second premolars without cantilever. In addition the palatal surface of the provisional prosthesis was reinforced by cobalt-chromium alloy (1.0 mm thickness). Over all, the model consisted of approximately 400,000 nodes and 2,000,000 elements. A load of 40270 N was applied on lingual surfaces of right upper lateral incisor and canine and occlusal surfaces of rst and second premolars in order to simulate parafunctional tooth grinding toward the right side. The magnitude of displacements of the implant xture and von Mises stress on the bone were analyzed. Results: The magnitude of the maximum implant displacements was reduced from 130 to 110 lm by applying the reinforce material. The von Mises stress concentration was observed at the surrounding bone of the right premolar region for with/without reinforcement conditions and the magnitude of the stress was reduced from 2.24 9 102 to 1.94 9 102 MPa by the reinforcement.
211
Conclusions and clinical implications: This nite element study
on immediately loaded implants showed that the magnitude of micromovements of the implant and the bone stresses can be reduced by the reinforcement of provisional prostheses. It appears that provisional prostheses should be reinforced in order to successfully obtain osseointegration of immediately loaded implants.
Inuence of abutment material on peri-implant clinical parameter

Fabiano Zanardo, Ricardo Vecchiatti, Jose Rodrigues, Jamil Shibli, Jose Neto, Alessandra Cassoni
UNG, Guarulhos, Brazil Background: The facial esthetics and proper fonetic function
Bone regenerative effects of CHO cell expressed rhBMP-2 in rabbits

Yu-jin Kim
Department of Periodontology, Research Institute for Periodontal Regeneration, Seoul, Korea Background: Allogeneic demineralized bone matrix (DBM) has
been used extensively as a clinical graft material because of its inherent osteoinductive and osteoconductive properties. The coating of CHO-rhBMP-2 on DBM is expected to have a synergic effect on bone regeneration. Aim: The Aim of this study was to evaluate the bone regenerative effects of DBM coated by newly-developed Chinese hamster ovary (CHO) cell-expressed rhBMP-2 in rabbit cranial defect model. Methods: Two symmetric, 11-mm-diameter, critical-size osteotomy defects were created in seven New Zealand white rabbit craniums received DBM and rhBMP-2 coated DBM, respectively. The animals were allowed to heal for 8 weeks, after which they were sacriced for radiographic, histologic and histometric analyses. Mann-Whitney test method was used to evaluate the statistical signicance among the two groups. Results: Surgical implantation rhBMP-2 coated DBM resulted in enhanced local bone formation at 8 weeks. In the defect closure, rhBMP-2 coated DBM group was statistically signicant greater than DBM group (P < 0.05). Total augmented area was not signicant different between DBM group and rhBMP2 coated DBM group. However, The new bone area of rhBMP2 coated DBM group was a signicantly greater than those of DBM group (P < 0.05). Conclusions and clinical implications: This study showed that DBM coated by newly-developed CHO-rhBMP-2 produced signicant new bone and tissue formation in the rabbit cranial defect model. It suggested that DBM may be an available carrier for rhBMP-2.
have direct inuence on social and psychological human behavior. The premature upper anterior lost can negatively alters this aspect. The implant-supported restorations have been used as an alternative with high success rates. Some characteristics of these restorations such as extension and smile line, and gingival biotype have to be analysed to acheive optimal esthetics results. The peri-implant mucosa color biotype also inuences the implant esthetics. Aim: The aim of this clinical study was to evaluate periimplant clinical parameters of zirconia abutments vs. metallic for standardized custom-made implant-supported single-tooth restorations in esthetic region. Methods: Sixteen subjects received 35 implants on esthetic maxila region. Test group had 14 implant-supported singletooth restorations with ceramic abutment and control group had 16 restorations with metallic abutment. Peri-implants clinical parameters were recorded after 110 10 days in function at six sites by each implant, in each subject. The means of clinical measures: probing depth (PD) and clinical level of insertion (CAL); mean of percentages of sites with visible plaque (VP), bleeding on probing (BOP) and supuration (S) were recorded to each subject. MannWhitney U-test was selected to verify differences between groups (P < 0.05). Results: Four implants failed to osseointegration and one implant-supported single-tooth restoration fractured at insertion time. The mean of PD of the samples sites were lower values to test group (P < 0.05). The mean levels of CAL of the samples sites were lower values to test group (P < 0.05). The mean levels of VP were not different between groups (P > 0.05) and there was no suppuration. The mean levels of (BOP) of the samples sites were lower values to test group (P < 0.05). The mean of the proximal PD (PDp) of the samples sites had no signicant differences between groups, however the buccal PD (PDb) of the samples sites were lower to test group (P < 0.05). Conclusions and clinical implications: Clinical parameters around reconstructions implant supported were inuenced by abutment type with better results to zirconia on PD, CAL and BOP, however one single-tooth implant-supported restoration with zirconia abutment fractured at insertions.
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409 Posters Material Research

evaluating the success of this novel dental implant approach is needed.

410 Posters Material Research

Oral Surgery, Bernhard Gottlieb University of Dentistry, Vienna,

411 Posters Material Research

treatment) are at least as effective and safe as conventional control implants.

Efcacy and safety of multi-phosphonate treated dental implants (randomised trial)

412 Posters Material Research

Sisters chromatide exchange could be induced by synthetic bone grafts?!

University of Gothenburg, Gothenburg, Sweden, 2Private Dental

Department of Oral and Maxillofacial Surgery, Faculty of

413 Posters Material Research

414 Posters Material Research

Biofunctionalization of orthodontic miniscrews: torque and resonance frequency analyses

Development of implant/interconnected porous calcium hydroxyapatite complex as all-in-one implant

Department of Orthodontics, Medical University of Innsbruck,

415 Posters Material Research

416 Posters Material Research

Photodynamic therapy on osseointegration. A histometric study in dogs

Background: The combination between photosensitivity sub-

417 Posters Material Research

Background: Several studies show that levels of osseointegra-

419 Posters Material Research

Analysis of metallic properties and microstructure of titanium dental implants

School of Dentistry, University Hospital Freiburg, Freiburg,

Germany, 2Department of Microsystems Eingineering, University

418 Posters Material Research

421 Posters Material Research

420 Posters Material Research

Quantitative and qualitative characterization of various dental implant surfaces

A novel synthetic bone graft material

Minimal features noted

Minimal features noted

Methods: Three Ti surfaces were characterised and S. epide-

Minimal features noted

Nobel Replace TiUnite

Minimal features noted

AstraTech OsseospeedTM Straumann SLActive

Minimal features noted Homogenous coverage of 10 20 lm rod shaped oxide features

3i New Implant Design

Homogenous coverage of 20 100 nm irregularly shaped HA crystals

Conclusions and clinical implications: The current evaluation

423 Posters Material Research

422 Posters Material Research

Conclusions and clinical implications: HA coating of Bio-HA

424 Posters Material Research

425 Posters Material Research

Application of a novel GBR membrane made from DNA-polycation complexes

Results: The lm had almost no cell adhesion. DNA-polyami-

426 Posters Material Research

Removal torque analysis of injection molded zirconia implants

427 Posters Material Research

Inuence of implant abutment screw coating materials on joint stability

429 Posters Material Research

428 Posters Material Research

Biocompatibility and corrosion performance of nanostructured titanium-bioceramic composite scaffolds

Bone healing response to the various surfaces of the implant

Poznan University of Medical Sciences, Poznan, Poland,

430 Posters Material Research

Effect of excimer ultraviolet to titanium modied by Wire-type EDM

431 Posters Material Research

Department of Oral Pathology, Dy Patil Dental College and

433 Posters Material Research