Category Archives: Implants

Biological Drilling: Implant Site Preparation in a Conservative Manner and Obtaining Autogenous Bone Grafts

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Eduardo Anitua
Eduardo Anitua Foundation, Vitoria, Spain


Background/Aim: The drilling process for insertion of an implant should be as conservative as possible, as not to damage the future implant bed. If this drilling is conservative additional bone can be obtained to be used afterwards, during the same surgery, as bone graft particulate if needed. The objective of this study was to evaluate the efficiency of a biological low-speed drilling and to analyse the bone obtained in order to ascertain viability and vitality of the contained bone cells. Also, the bone obtained from the low-speed drilling was compared with bone obtained with high speed drilling and irrigation, collected through a filter in aspiration system.

Material and Methods: In this pilot study, samples of biological drilling (low speed without irrigation) were collected in five patients undergoing implant surgery. In the same patients a high speed drilling with irrigation was also used. Bone of the drilling was collected through a filter in the aspiration system. Subsequently the samples were analysed by conventional histology and cultivated in order to observe cell growth.

Results: The samples of bone obtained by biological drilling showed live cells in the conventional optical microscopy and cell growth after cultivation. The bone obtained with drilling at high revolutions showed no living cells and no cell growth after cultivation.

Conclusions: The biological drilling at low speed offered two advantages compared to drilling at high speed with irrigation. The first of these is the perfect control of the drilling depth as the marks of the burs are visible during drilling; the second is possibility of collection of a large number of viable particulate bone grafts without increasing time and complexity of the surgery, which allows immediate augmentation of bone if needed.

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Is Dental Implantation Indicated in Patients with Oral Mucosal Diseases

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Eleni-Marina Kalogirou / Alexandra Sklavounou

Department of Oral Medicine and Pathology, Faculty of Dentistry National and Kapodistrian, University of Athens, Athens, Greece


Background/Aim: Dental implants are a reliable treatment choice for rehabilitation of healthy patients as well as subjects with several systemic conditions. Patients with oral mucosal diseases often exhibit oral mucosal fragility and dryness, erosions, blisters, ulcers or microstomia that complicate the use of removable dentures and emphasize the need for dental implants. The aim of the current study is to review the pertinent literature regarding the dental implantation prospects for patients with oral mucosal diseases. Material and Method: The English literature was searched through PubMed and Google Scholar electronic databases with key words: dental implants, oral mucosal diseases, oral lichen planus (OLP), epidermolysis bullosa (EB), Sjögren’s syndrome (SS), cicatricial pemphigoid, bullous pemphigoid, pemphigus vulgaris, scleroderma/systemic sclerosis, lupus erythematosus, leukoplakia, oral potentially malignant disorders, oral premalignant lesions, oral cancer and oral squamous cell carcinoma (SCC). Results: Literature review revealed dental implantation in patients with OLP (14 articles), EB (11 articles), pemphigus vulgaris (1 article), SS (14 articles), systemic sclerosis (11 articles), systemic lupus erythematosus (3 articles) and oral SCC development associated with leukoplakia (5 articles). No articles regarding dental implants in patients with pemphigoid or leukoplakia without SCC development were identified. Most articles were case-reports, while only a few retrospective, prospective or observational studies were identified. Conclusions: Dental implants represent an acceptable treatment option with a high success rate in patients with chronic mucocutaneous and autoimmune diseases with oral manifestations, such as OLP, SS, EB and systemic sclerosis. Patients with oral possibly malignant disorders should be closely monitored to rule out the development of periimplant malignancy. Further studies with long follow-up, clinical and radiographic dental data are required to predict with accuracy the outcome of dental implants in patients with oral mucosal diseases.

Keywords: Dental Implants; Oral Lichen Planus; Epidermolysis Bullosa; Pemphigus Vulgaris; Sjögren’s Syndrome; Systemic Sclerosis; Leukoplakia;Oral Carcinoma


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Citation Information: Balkan Journal of Dental Medicine, ISSN (Online) 2335-0245, DOI: Export Citation

Biomechanical Outcomes of Tooth-Implant-Supported Fixed Partial Prostheses (FPPs) in Periodontally Healthy Patients using Root Shape Dental Implants

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1 / Argirios Pissiotis2

1Postgraduate student, Yerevan State Medical University after Mkhitar Heratsi (YSMU), Armenia
2School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece


Background: Connecting an osseointegrated implant and a natural tooth is a treatment alternative for partially edentulous patients in some clinical situations. The main issue of a connected tooth-implant system is derived from the dissimilar mobility patterns of the osseointegrated fixtures and natural abutments causing potential biomechanical problems within the entire system. Purpose: The aim of this review was to multilaterally analyze and discuss the main biomechanical factors that may question the reliability of splinted tooth-implant system and the long-term success of fixed partial prostheses (FPPs) supported by both teeth and implants with an emphasis on the disparity of mobility of these two different abutments.

Material and methods: An electronic MEDLINE (PubMed) search supplemented by manual searching was performed to retrieve relevant articles. An assessment of the identified studies was performed, the most valuable articles were selected and biomechanical outcomes of tooth-implant splinting system were analyzed.

Results: 3D FEM stress analyses and photoelastic studies show uneven load distribution between the tooth and the implant and stress concentration in the crestal bone around the implant neck when connected to a natural tooth by FPPs. However, clinical studies demonstrate good results for both the implants and FPPs supported by splinted implant-to-tooth abutments.

Conclusion: Connecting implants to natural teeth is not a preferable treatment option because of possible inherent biomechanical complications. Whenever possible, this treatment option should be avoided.

Keywords: Tooth-Implant Supported Prostheses; Natural Tooth; Osseointegrated Dental Implant; Occlusal Force; Finite Element Analysis; Rigid Connector; Non-Rigid Connector


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Citation Information: Balkan Journal of Dental Medicine. Volume 21, Issue 1, Pages 1–11, ISSN (Online) 2335-0245, DOI:, March 2017

High Crown to Implant Ratio as Stress Factor in Short Implants Therapy

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1 / R. Isufi1 / E. Petrela2 / L. Abazaj3 / K. Vera3

1University of Medicine Tirana, Faculty of Dental Medicine Oral and Maxillo-Facial Surgery Department
2University of Medicine Tirana, Faculty of Medicine Public Health Department
3University of Medicine Tirana, Faculty of Dental Medicine Tirana, Albania


Background/Aim: The purpose of this study was to report the outcomes of crown to implant ratio (C/IR) measurements of single-tooth short implants. The specific aim of this study was to evaluate the effect of C/ IR on crestal bone loss, assessing the success of short locking-taper implants treatment.

Materials and Methods: The cohort study was based on a sample of 33 patients, 14 males and 19 females. They were treated by at least one hydroxyapatite-coated Bicon implant, restored with Integrated Abutment Crown cementless technique and porcelain fused to metal crowns. The study was conducted between 2010 and 2015. Patients were recalled after 1-year and 2-year period time. Periapical, panoramic radiographs and clinical photos were obtained. The outcome measures were C/IR, crestal bone levels and the success of short implants therapy.

Results: After all the measurements were done on the first day of implant loading and at last visit, the mean C/IR was 1.85 (range, 0.95 to 3.20) and the mean change in the mesio-distal crestal bone levels was -0.73mm. No significant correlation was found between the C/IR and the risk for crestal bone loss nor the risk for implant failure.

Conclusions: A high C/IR has no significant effect on crestal bone levels (r= -0.151, p= 0.230) and on failure of implant treatment (p= 0.631) after the insertion of single-tooth locking-taper and implant restorations.

Keywords: crowntoimplant ratio; short implants; integrated abutment crowns


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Citation Information: Balkan Journal of Dental Medicine. Volume 20, Issue 2, Pages 94–98, ISSN (Online) 2335-0245, DOI:, July 2016

Implant Therapy In The Esthetic Zone-Surgical Considerations

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1 / T. Mišić2

1Clinic of Oral Surgery, School of Dentistry, University of Belgrade, Dr Subotica 4, 11 000 Belgrade, Serbia, Tel: +381 11 2685860, Fax: +381 11 2685268
2Oral Surgery Clinic, School of Dental Medicine, University of Belgrade


Implant placement in the esthetic zone is a complex procedure and requires a restoration-driven approach. Proper selection of patients and implant together with individual assessment of the risk of esthetic complications are very important. Correct 3D-implant positioning and sufficient bone volume should provide long-term esthetic and function. Esthetic region is a zone in which expectations and possibilities collide. Clinician should bring the important decision on the appropriate time of implant placement. Immediate implant placement is particularly challenging in the esthetic zone. Patient desire for reduced treatment time should be weighed against the possible risk factors. Protocol of immediate implant placement in conditions of unfavourable gingival biotypes, the lack of bone or soft tissue in patients with a high smile line lead to esthetic failure which is very important in the esthetic region.

Keywords: 3D-implant positioning; esthetic region; immediate implant placement


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Citation Information: Balkan Journal of Dental Medicine. Volume 20, Issue 2, Pages 83–88, ISSN (Online) 2335-0245, DOI:, July 2016