MIS Implants Technologies Ltd. har donerat medel till stöd för ett stipendieprogram för parodontologi och implantat vid Harvard School of Medicine, Boston, USA. Dr. Rita K. Han mottog universitets första tvååriga stipendium.
Läs hela texten här: Periodontology Student Receives MIS Fellowship (pdf-fil)
By: Ivan Herrera Ustariz
Abstract
Osseointegrated implants are the best alternative for the restoration of partially or totally edentulous jaws, but in many cases there is not enough bone to place implants, that is why bone substitutes are required to regenerate this tissue. Now a days there are different kinds of regeneration materials such as: calcium sulfate (biomaterial that has been used for many years), and the platelet-rich plasma (used to potentiate the healing).
This article presents a case report, where bone regeneration is performed in an area of bone loss caused by a mandibular implant blade, using biphasic calcium sulfate, platelet-rich plasma and immediate implant placement.
Introduction
Calcium sulfate is an important material used to achieve bone regeneration, its excellent biocompatibility allows it to be an optimal biomaterial for this purpose, it can be applied alone or combined with other bone substitutes. Calcium sulfate comes in several formulas, the two main forms are hemihydrate and dihydrate, when they are put together in a single compound, they produce a synergistic effect, increasing the main advantages of both. The platelet – rich plasma is a rich source of growth factors with angiogenic and mitogenic properties that accelerates healing of soft and hard tissues.
Case Report
59 year old female patient with no systemic commitment who referred pain and swelling in right jaw area; approximately 20 years ago, blade implants were placed in this area. She referred mobility and discomfort of the prosthetic structure when chewing.
Radiographic examination showed a fixed prosthesis supported on tooth 43 (misfit and periapical lesion), pontics 44 – 45 and support on implant 46 and 47. On the left side the patient has an asymptomatic blade implant, that has been covered with soft tissue for a long period of time, (Figure 1). The patient is ordered antibiotic therapy etidoxina® Euroetika – Colombia every 24 hours for 10 days.
Surgical Procedure
After nerve block anesthesia, the fixed prosthesis was removed showing corrosion as well as the blade implants (Figure 2), also food remains were present. (Figure 3). The blade implant was removed, then a bone curettage was practiced in this area and a gauze impregnated with ambramicina hydrochloride Sanofi -Aventis of Colombia was placed in for 20 minutes, subsequently the site was washed with plenty of saline solution. Immediately 2 Implants (Seven® MIS® Implants Technologies) were placed in areas of tooth 43 (4.20x10mm) and 46 (6x8mm), this last implant was placed impregnated with a mixture of PRP and biphasic calcium sulfate BONDBONE® (calcium sulfate hemihydrate CaSO40. 5H2O calcium sulphate dihydrate CaSO42H2O MIS® Implants Technologies) (Figure 4). After the insertion of the implants, implant in 46 had a large space around it (Figure 5) so a graft of BONDBONE® mixed with platelet-rich plasma was inserted (Figure 6). The implants had primary fixation and the area was closed leaving the implants submerged. On the left side of the jaw, 2 Implants (Seven® MIS® Technologies) were placed in tooth areas of 33 (3.75x13mm) and 36 (6x8mm). The patient was formulated etoricoxib 120 mg, Arcoxia® Merck Sharp & Dohme Mexico, every 24 hours for 7 days and rinse with a Chlorhexidine digluconate 0.2mg mouth wash, (Clorhexol® Farpag Laboratory – Colombia) every 12 hours for 7 days. 15 days later a bilateral sinus lift procedure was performed using BONDBONE® and hydroxyapatite (biphasic calcium phosphate HA \ TCP 60:40 4BONE MIS® Implants Technologies) as a filler, mixed with PRP and 2 implants Seven® were placed in tooth area of 18 and 28. 6 months later, a CT was taken to evaluate the grafted area. The CT showed bone formation around Implant 46 with normal radiopacity (Figure 7). The Implants were uncovered in the lower jaw, final abutments were placed and a fixed prosthesis was processed (Figure 8). In the maxilla, 2 implants (Seven® MIS® Technologies) were placed in area 16 (4.20x13mm) and 26 (4.20×11.5) and 2 mini implants in area 12 and 22. After four weeks, a transitional total denture was fabricated.
Discussion
The immediate placement of implants with bone regeneration procedure, has a good clinical predictability if the principles of mechanical stability and good blood supply is taken in account. By impregnating the surface of the implant with PRP, this stimulates migration, proliferation and differentiation of osteoprogenitor cells and their adherence to the titanium surface, creating a dynamic surface that can accelerate bone healing and potentiate the osseointegration.
Combining calcium sulfate with PRP forms a solid biomaterial that can be shaped and stable in the grafted site, increases the amount of calcium and the activation of the platelets that releases growth factors increasing the concentration of adhesive proteins, vascularization and inducing cell differentiation.
Calcium ions that are released during the dissolution of calcium sulfate increases its concentration, stimulating the mitogenesis of stem cells and osteoblast differentiation, also this high concentration of calcium inhibits osteoclast mediated resorption and promoting bone remodeling. Biphasic calcium sulfate as a mixed compound has better properties than the individual forms, specially the hemihydrate form which increases the setting time significantly in the presence of fluids, when adding the dihydrate molecule a mixture of fast setting is formed, great mechanical stability and better hardness, that will not be altered when contact with blood and saliva occurs. Bone regeneration has been reported of not finding any residues of this material, making it optimal when compared with bovine bone, which studies of similar application have encountered remanent of graft material between 25 and 35%.
Conclusion
The Osteoconductive properties of biphasic calcium sulfate added to the potential of cell differentiation and angiogenic growth factors present in the Platelet Rich Plasma have a beneficial role in grafted sites.
References
1. Glowacki J. Angiogenesis in fracture repair. Clin Orthop 1998; 355(suppl):S82-9.
2. Anitua E. Enhancement of osseointegration by generating a dynamic implant surface. J Oral Implant 2006;32:72-76.
3. Anitua E, Orive G, Plá R, Román P, Serrano V, Andía I. The effects of PRGF on bone regeneration and on titanium osseointegration in goats: a histologic and histomorphometric 3 study. (Submitted 2007).
4. Bateman J, Intini G, Margarone J, Goodloe S, Bush P, Lynch SE, Dziak R. Platelet-Derived Growth Factor
Enhancement of Two Alloplastic Bone Matrices. J Periodontol. 2005;76:1833–1841. doi: 10.1902/jop.2005.76.11.1833.
5. Park EK, Lee YE, Choi JY, Oh SH, Shin HI, Kim KH, Kim SY, Kim S. Cellular biocompatibility and stimulatory effects
of calcium metaphosphate on osteoblastic differentiation of human bone marrow-derived stromal cells. Biomaterials 2004;25:3403–3411.
6. Ziv Mazor, DMD ; Michael D. Rohrer, DDS, MS ; Hari S. Prasad, BS,; Nick Tovar, PhD4; Robert A. Horowitz, DDS5. BondBoneTM a Biphasic Calcium Sulfate: A preliminary in socket therapy News No.24 July 201.
7. Givol N, Rohrer MD, Nemcovsky CE, Prasad HS, Tal H. Qualitative and quantitative expression of bovine bone mineral in experimental bone defects. Part 2: Morphometric analysis. J Periodontol 2003;74(8):1153-1160.
Dental implant maker MIS Implants Technologies has created a product called the PerioPatch that the company claims can help wounds in the oral cavity heal more quickly.
The PerioPatch, a hydrogel barrier, is the first nonimplant product launched by PeriZone, MIS Implants Technologies’ new oral care products division.
One part barrier, one part exudate absorber, the PerioPatch sticks to the inside of a patient’s mouth to protect an injury and help it heal, according to the manufacturer. All images courtesy of MIS Implants Technologies. ”The patch works in two ways: as a physical barrier by covering the wounded area, and it absorbs excess wound exudates,” said Noel Wilford, RDH, director of the oral health division at MIS Implants Technologies. ”Whenever there is a wound, whether it is from scaling and root planning or a burn from a hot piece of pizza, this enables the doctor to give their patient a localized way to deal with discomfort, particularly after a dental procedure.”
The patch sticks to the inside of the patient’s mouth with a gum acacia-based adhesive. When the gum comes into contact with the moist oral mucosa, it securely sticks to affected area, the company explained.
”The backing falls off one to two hours after you apply it, and then you’re left with the gel layer underneath,” Wilford said. ”So it still acts as a physical barrier, and that’s when it’s absorbing the excess exudates as well.” That layer provides protection from further irritation that may occur while eating and drinking, she added.
“It’s a relatively new concept in dentistry.”
— Noel Wilford, RDH The patch was developed by three periodontists in Israel who were looking for a combination of ingredients that would relieve inflammatory symptoms, according to Wilford.
”Although the concept of absorbing wound exudates has been used in medicine, it’s a relatively new concept in dentistry,” she said. ”One of the problems of using a product like this in the mouth has been the fact that it’s difficult to get something to stick to moist tissue. In the PerioPatch, there are three herbal ingredients that in combination really help with the adhesive ability of this product.”
The active ingredients in the PerioPatch are ethylcellulose, polyacrylic acid, Sambucus nigra, castor oil, acacia gum, methyl hydroxylpropyl cellulose, glycerol, strawberry flavor, Centella asiatica, titanium dioxide, Echinacea purpurea, polysorbate 80, CI 77491.
While presenting the product during the ADA’s annual session last week in Las Vegas, Wilford was pleased with the feedback she got.
PerioPatch indications:
MIS Implants recommends the PerioPatch for the following conditions:
”It’s funny, the comments that we got at our booth, because when you touch the film with your hand it’s not sticky at all,” she noted. ”A couple of people came by who either had braces or had some sort of ulceration in their mouth, and when they tried it they were surprised at how well it stuck to the moist tissue.”
Small in size with a strawberry flavor, the patch is designed to be user-friendly enough to be applied by patients after they have left the office of their care provider. They are instructed to swallow and apply the lighter side of the patch to the affected area. Multiple patches can be applied at once. However, patients should not eat or drink for one hour after placing the patch, nor should they apply it before sleeping.
Each pack contains six patches, and patients are instructed to use three of them within 24 hours. The additional three patches can be used as needed, depending on how traumatic their injury is, according to Wilford.
”If it’s a surgical procedure, they would benefit from using it for multiple days,” she said. ”For a simple cheek bite, they can be treated with one to three patches on a single day.”
Studies by the company have shown that the product is the most efficacious after three applications on the first day, Wilford noted.
Cheek bite images from an internal study show the injury’s progression with the aid of the patch.
”We see it as something that can be accepted by the periodontal community and by the general practitioner community,” Wilford said. ”There’s a tremendous usage potential for the orthodontic community also; kids and adults who have brackets and bands that are always beating up part of their cheek, there’s been a very good response to that sort of injury.”
By Rob Goszkowski, Assistant Editor
Full article: http://www.drbicuspid.com/index.aspx?sec=sup&sub=bai&pag=dis&ItemID=308903
21
OKT
F.n. har vi inga mässerbjudanden men återkommer när det blivit aktuellt
11
AUG
MIS Implants Technologies Ltd, en ledande tillverkare av dentala implantat och bensubstitut, lanserar nu en helt ny serie av mun
vårdsprodukter, som heter PeriZone™, tillsammans med den första produkten, kallad PerioPatch®, som är ett helt unikt plåster skapat för att absorbera sårexsudat.
PeriZone™ PerioPatch ® är ett unikt plåster som absorberar sårexsudat och främjar naturlig läkning genom att bilda en skyddande försegling över det inflammerade tandköttet och munnens slemhinnor. Det appliceras direkt på det påverkade området. PeriZone ™ PerioPatch ® fäster vid kontakt och ger smärtlindring och naturlig läkning med bibehållen skydd mot ytterligare irritation, som kan orsakas av att mat och dryck.
Plåstret innehåller gummi arabicum, en ingrediens som i kontakt med munnens slemhinnor håller plåstret säkert kvar på plats, vid det drabbade området. PeriZone ™ PerioPatch ® absorberar sårexsudat och stänger effektivt ute andra irriterande ämnen, som kan förvärra såret, så att patienten kan fungera med större komfort. Den fysiska barriär som skapas av PeriZone ™ PerioPatch ® skyddar också munnens slemhinnor från skador orsakade av tandställningar tandproteser eller andra intraorala apparater.
Patienter med följande förutsättningar har nytta av det skydd PeriZone™ PerioPatch® ger.
Fler än ett PeriZone™ PerioPatch® kan användas parallellt, för att skydda flera områden samtidigt.
I klinisk verksamhet har det visat sig att det normalt är mest effektivt att använda 3 plåster under det första dygnet, följt av ytterligare 2 dagar för att ge underhåll till effekten.
Patienten kan räkna med en lindring av de symptom som uppstår i munhålan vid:
Under 2012 kommer PeriZone™ PerioPatch® att finnas tillgängligt för den nordiska marknaden.
Limited bone height restricts the use of standard length implants. Short implants may be used in these cases as an alternative for lengthy and expensive augmentation procedures. Recent clinical studies indicate that short implants may support prosthetic restorations quite adequately, but still clinical documentation is sparse. The purpose of this study was to evaluate the clinical behavior of short implants in reduced bone conditions. The hypothesis was: “Short implants in atrophied jaws are able to result in similar long-term survival rates compared with standard implants.
Within the limitations of this preliminary study, it can be concluded that short implants are a viable treatment option when splinted, at least for 6 months after loading. Short implants seem to be the optimal option as supplementary implants in free end situations, especially in the rear mandible areas, when combined with standard implants. Although there are several studies which suggest that short implants are a viable solution for the use as stand-alone implants, there are sufficient arguments in favor of implant mechanical overload. Further investigation is needed in order to come up with more clear statements. At this point in time and although the clinical results of these short implants were favorable, it is recommended that short implants are used in combination with longer implants, especially when used in type III or IV bone that is often found in the maxilla. Bone remodeling may be due to a higher insertion torque caused by the large diameter of the implant and higher surface contact between implant and cortical bone.
Abstract
One piece implants were introduced many years ago, however in the last years they were
accepted as a treatment option for specific clinical cases.
Aim:
The aim of the study was to evaluate the probing depth values around one piece screw implants
with a rough surface neck two years after loading
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Ridge augmentation technics are a matter of choice after tooth extraction in order to prevent the loss of bone as a result of atrophic changes that may occur in time. We can say that for the current widely used alloplastic materials based on betatricalcium phosphate and hidroxylapatite the resorbtion time is 6 – 9 – 12 months. This fact needs to be taken in consideration, when placing an implant in an area with guided bone regeneration. The need of using a membrane to immobilize the bone graft and covering it with flap additionally increases the complexity of the procedure.
In this case study we are going to demonstrate the capabilities of biphasic calcium sulphate (Bond Bone) as a bone graft material that provides predictable results and bone regeneration on the 4th month after the usage.
This technique of extraction and simultaneous graft and barrier placement is predictable for restoring the alveolar ridge volume. BondBone™ can be safely left partially exposed to the oral environment. In this 4-month prospective study, the predictable formation of vital bone in treated extraction sockets has led to 100% success rate in implant placement and loading. Additionally, the bone has maintained its integrity radiographically and enabled support of keratinized tissue with no dimensional alterations over the experimental period. BondBone™ is simple and effective to use in treating extraction defects before dental implant placement. Within the limits of the presented case, it is suggested that BondBone™ is bio-compatible and osteoconductive and allows for newlyformed bone. Although the data are base on a single case, BondBone™ appears to be an accepted material in socket therapy.