Studies of the quality of the intraosseous dental implant bed and of thermal effects in implant pathology

Dental implants may offer solutions to problems of tooth loss and removable dentures, avoiding the blighting of sound teeth in conventional bridgework. However, there may be severe problems due to deficient and poor quality host bone, particularly in the maxillary sinus region. The success of particulate irradiated mineralised cancellous allograft (IMCA) in generating new bone in the sinus was analysed using the trephine bone cores removed to create an implant bed. Bone cores were embedded and examined using 3D fluorescence fight microscopy and scanning electron microscopy in the backscattered electron (BSE) mode to study the quantity and the quality [degree of mineralisation] of bone in implant sites. In all graft cases, new bone as immature (woven) or mature (lamellar) bone formed on the surfaces of the allograft. The bone volume fraction was found to be significantly greater within 5 mm height of the host sinus floor. In an extended study, control sinuses grafted with IMCA soaked in saline showed no significant difference to the test side treated with the patient's own serum. IMCA was shown to retain much of its original topographical and morphological characteristics. Biopsy core specimens from other (non-sinus) sites in both maxilla and mandible were treated similarly. The highest mineral density distributions were observed in the mandible, with the lowest in the residual posterior maxilla beneath the sinus floor. A novel quantitative bone quality scale is proposed to include three parameters of bone quality: mineralisation density, bone volume fraction and connectivity. Clinical use of Laser Doppler Flowmetry (LDF) confirmed positive blood flow in grafts, sinus membrane, and oral tissues. A model of heat conduction in dental implants, predicted oral heat to be a possible factor in implant pathology. The effect of temperature on avian osteoclastic resorption in vitro was studied using a volumetric pit assay. Osteoclastic function measured as volumes and depths of lacunae excavated was increased at 41 deg. and 43 deg. C. (author)