The dissolution of Ca ion from amorphous calcium phosphate of spherical 35 μm and 50 μm (35 AP and 50 AP) and high pH crystallized calcium phosphate of spherical 35 μm and 50 μm (35 BC and 50 BC), and pH changes in solutions in which both AP and BC were separately soaked, were continuously measured over time. ALPase activity of dissolved solutions from AP and BC, using osteoblast-like cells, was also investigated. The following conclusions were drawn.
1. Relationship between amount of Ca ion and pH value was not clear.
2. The amount of dissolved Ca from 35 AP and 35 BC was larger than that from 50 AP and 50 BC, because of the larger ratio of area to weight: 35 μm versus 50 μm. The amount of dissolved Ca from amorphous calcium phosphate was larger than that from crystallized calcium phosphate.
3. As to the ALPase activity, the culture solution of 35 BC was higher than the reference group after 3 hours, and the culture solution of 35 AP was higher than the reference group after 3, 6, and 48 hours.
The present study was designed to investigate the usefulness of a periodontal regeneration procedure with enamel matrix proteins for the coverage of experimentally induced localized gingival recession in dogs. Serial histopathologihcal and morphological changes in the root surface after application of the enamel matrix proteins were compared with the changes after conventional tooth coverage using a subepithelial connective tissue graft. The results revealed no serial changes in the amount of covering in exposed dental root surfaces in the enamel matrix proteins group or the subepithelial connective tissue graft group. Hardly any newly formed cementum or bone was observed at 2,6, and 12 weeks after subepithelial connective tissue grafting. Significant epithelial invasion and long epithelial attachment among the exposed root surfaces were observed in the subepithelial connective tissue graft group (p＜0.01). In the enamel matrix proteins group, however, significant newly formed cementum and bone were observed at 6 and 12 weeks, and it was associated with connective tissue attachment between the dental root surfaces (p＜0.01). Based on the above evidence, the application of enamel matrix proteins appears to be a highly effective, reliable procedure for covering exposed root surfaces associated with gingival recession defects.
In 14 cases of implants in fresh tooth extraction sites, we filled the gap with baked dental root tips between the site and the implant body.
The Clinical findings were as follows.
1. Intraoral finding is not a problem after operation.
2. Though the tips were large and these margins were sharp, they were small and round after some months, and they were enclosed by connective tissue in the upper part of the gap, and assimilated with bone tissue in the lower part of it.
3. In the X-ray findings, at surgery, though the radiopaque shadow was shown up to the top of the neck of the implant body, the border between the tips and the bone tissue was unclear. After 3～6 months, the radiolucent shadow was slightly shown around the neck of the implant body, but the border was more unclear. After 1～2 years, their shapes were unrecognizable, the top of alveolar bone was flat, and the radiolucent area was slightly shown at the part of implant neck.
4. These results suggest that it is possible to use baked dental root tips for bone replacement material in clinical treatment.
Creeping of grafted gingiva can occur after free gingival grafting to the region surrounding natural teeth. To our knowledge, however, creeping of grafted gingiva after placement of a free gingival graft around implants has not been reported previously. We describe creeping of a free gingival graft placed around implants. The creeping gingiva covered the gap between the superstructures and three implants. The histopathological findings of the these regions are also described.
In December 1993, three ITI-Bonefit implants were placed, using GTAM membrane with the GBR method, at a defect in the right mandibular molar region. Subsequently, a free gingival graft was placed around the three implants, to obtain cornified immobile mucosa. An operator-removable superstructure (ITI Octa-System) was used. Clinically, creeplng of the cornified gingiva surrounding the implants was gradually noted about 1 year after the surgery. After 4 years, the gingiva covered the gap at the junction between the implants and supersturucture. After 5 years, a specimen was taken from tissue surrounding the implants associated with gingival creeping for histopathological examination. The examination revealed normal epithelial tissue. Beneath the epithelium, there was fibrous connective tissue thickening. There was no inflammatory cell infiltration. At the region where the creeping gingival graft extended beyond the gap between implants and superstructure, there was no deep proliferation of epithelial tissue along the implant surface. Nearly normal gingiva covered the gap, and fibrous connective tissue thickening was seen beneath the epithelium. These findings suggest that a free gingival graft around impiants is very useful.
Orthodontic treatment of patients with periodontal disease has been difficult due to the lack of a source of anchorage to which orthodontic force can be applied．However，osseointegrated implants have become popular as a safe and reliable tool，not only for the treatment of a missing tooth but also for other purposes，including the use of osseointegrated implants to reposition natural teeth．We report here two patients in whom an osseointegrated implant was placed into the alveolar bone and used in orthodontic treatment．The oral implant was immobile by definition．Case 1 had maxillary and mandibular protrusion，a mandibular molar defect，and periodontal disease．After treatment of her periodontal disease，an osseointegrated implant was placed．Seven months later，the patient received orthodontic treatment using the implant as the source of anchorage．After 29 months of orthodontic treatment，the patient is satisfied with the improvements in her initial complaints of difficulty in mastication， dysfunction of the masticatory system， difficulty in closing the lips，and aesthetic dissatisfaction．Case 2 was a patient with anterior crossbite reversed occlusion，a molar defect，and periodontal disease．After treatment of the periodontal disease and bite-raising by temporary restoration for 2 months，an oral implant was placed．After the 6-month healing period，the patient received orthodontic treatment for 24 months．After the 6-month retention，the final prosthesis was placed using hybrid ceramics．The problem with difficulty of mastication has improved，and the patient is greatly satisfied with the treatment．In both patients who received orthodontic treatment using an oral implant as the source of anchorage，the oral implant did not move or looser． Oral implants may be useful in orthodontic treatment of patients who have no source of anchorage．
This report showed a case of implant treatment with tissue management for a severely atrophic mandible. The patient was a 67-year-old woman,who visited our clinic in December 1995. Her chief complaint was difficulty in masticating due to pain caused by peri-implantitis. She had been treated with an implant procedure in the mandible at another dental clinic in the beginning of 1995, but it had not worked well. When she came to our clinic, her mandibular alveolar bone was severely resorbed, and her lower full bridge, supported by several implants, was movable. Moreover, she had paralysis of her lower lip.
First, all implants were removed, and free gingival grafts were perfomed as tissue management in the mandible. Four month after the tissue management, 3 implants (ITI Bonefit®) were placed in the 3＋3 region. Then, an overdenture was fabricated and connected to those implants with a Dolder bar.
Dental Prescale was used to evaluate the function of the implants-supported overdenture. And, periodontal parameters were used to evaluate the implants. As a result, the function has been good, and the implants have been stable for more than 3 years.
We present a case in which a misplaced implant fixture in the maxillary sinus was removed by means of endoscopic sinus surgery.
A 57-year-old man was referred to Azabu Kitami Triology Hospital because of misplacement of his implant fixture. At the first visit, there was an oro-antral fistula in the right upper molar region,without surrounding inflammation. Radiographical examinations, including CT, revealed the misplaced fixture in the right maxillary sinus, and thickening of mucosa of the sinus.
Under general anesthesia, endoscopic sinus surgery was performed.
Endoscopic examination showed that the fixture was embedded in edematous mucosa. The fixture was successfully removed, along with the surrounding edematous mucosa, by means of endoscopic sinus surgery.
Operation time was only 20 minutes, and blood loss was little, and also there was no marked postoperative inflammatory reaction.
The healing was uneventful, and there was no evidence of sinuitis at 12 months after the surgery.
Endoscopic sinus surgery seems to be a very useful procedure for removal of a foreign body in the maxillary sinus.
Recently, the mainstream of implant therapy has shifted toward the use of endosseous impqlants, and the development of various techniques has broadened their indication range. However, we used subperiosteal implants to prosthetically repair unilateral defects involving the left side of the maxilla and mandible in a patient in whom the placement of endosseous implants was considered impractical in 1988. The use of endosseous implants was contraindicated due to a lack of adequate vertical bone from the alveolar crest to the floor of the maxillary sinus in the left maxillary molar region, as demonstrated on X-ray film. In addition, an osseous cavity was present at the site scheduled for implant placement in the mandible.
Subperiosteal implants were fitted with a super-structure in December 1988. Within 3 years after the operation, the frame of the subperiosteal implant in the left maxillary molar region was exposed two times. The exposed portion was cut off and removed.
In May 1989, the subperiosteal implant in the left maxillary molar region was fitted with a superstructure. Although more than 10 years have passed, radiographic examination has revealed no radiolucency between the frame and bone, and there have been no clinical signs of inflammation of the soft tissue surrounding the implant posts. Form 1994 onward, 6 years after the operation, the radiolucent area gradually became smaller. At present, the radiolucent area is distinctly smaller than that at presentation, and there is evidence of ossification.
Currently, about 10 years after implant placement,the patient has maintained adequate masticatory performance in response to treatment with subperiosteal implants and the patient is satisfied with the outcome.
Five Facilities at the Kanto-Koshinetsu Division, Japanese Society of Oral Implantology, have done 5,155 implantation procedures in 3,003 cases. We held up the analysis about health basic item of implant patient. We can mention sex, age, anamnesis life-style, state of deficit, state of opposite teeth, and implantation time after extraction.
1. Reference based on age: Fifties 971 cases (32.7%) were most, and then forties, sixties.
2. Reference based on sex: Males, 1,245 cases (41.9%); females, 1,724 cases (58.1%).
3. Reference based on life-style: We sent questionnaires about smoking, drinking, and habitual drug use. Smoking 998 cases (33.6%), no smoking 1,886 cases (63.5%). Drinking 1,279 cases (43.1%), not drinking 1,602 cases (54.0%). Habitual drug use 255 cases (8.6%), no habitual drug use 2,553 cases (86.0%).
4. Reference based on anammesis: No anamnesis, 2,592 cases (87.3%); anamnesis exist 362 cases (12.2%).
5. Reference based on the state of a deficit: Mandibular was many. Free end deficit was most, and only molar part was most.
6. Reference based on the state of opposite teeth: Natural teeth, 2,373 cases (79.9%) was most.
7. Reference based on implantation time after extraction: More than one year was most 2,063 cases (69.5%), and then from six months to one year, 403 cases (13.6%).
These data show the clinical progress of endosseous implants. In conclusion, we present imagination of patients for implant treatment.