The prosthetic value of the available teeth and the planned MDIs and SDIs. The recommendations are on the quadrant level.
\r\n\t
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For the past few decades, the main research tendency in solar cells has been to develop cells which are both highly efficient and also cost‐effective. Because of the abundance and nontoxicity of silicon, the fabrication simplicity, and the vast amount of accumulated knowledge in processing developed in the integrated circuit industry, silicon wafer‐based solar cells dominate the very dynamic photovoltaic market. Silicon solar cells generate electricity via absorbing photons and generating electron–hole pairs, which are separated by a
Schematic structure of a screen‐printed front junction
Figure 1 shows a schematic of the basic structure for a typical screen‐printed front junction
Figure 2 shows the schematic energy‐band diagram for the fundamental operating principles of a screen‐printed front junction
Schematic energy‐band diagram of a screen‐printed front junction
The
When the cell is illuminated, photons with energy greater than the silicon band gap energy are absorbed to excite electrons from the valence band to the conduction band, which generates an electron–hole pair (a hole refers to the missing electron in the valence band), as shown in Figure 3. The generated electrons and holes can diffuse within the solar cell until they reach the SCR, if they do not recombine. Then, the electric field at the
Schematic energy‐band diagram of a screen‐printed front junction
The
where
where
When the cell is illuminated, it is ideally modelled as
\nwhere
For an actual solar cell, Eq. (3) becomes
\nwhere
The resulting dark and illuminated
Dark and illuminated
In Figure 4b, the maximum power point (
where
Finally, the cell energy‐conversion efficiency is defined as
\nwhere
Actual silicon solar cells generally have a parasitic series resistance (
Schematic structure of major components of series resistance (
The
where
The generated electron–hole pair can recombine if they are not efficiently separated and collected. There are typically three recombination mechanisms that can occur in parallel in silicon solar cells. First, radiative recombination is the process that electron makes a band‐to‐band transition while emitting a photon as light. Hence, it is the reverse of the light absorption. But it is often neglected for silicon solar cell, because silicon is an indirect‐band‐gap material and a phonon is required for this type of recombination. Second, Auger recombination refers to electrons and holes that recombine and use the excess energy to excite a free carrier. Then, this excited free carrier relaxes back to its original energy status by emitting phonons. This type of recombination is particularly effective in the heavily doped regions with doping concentration over 1017 cm-3, for instance, the
The carrier lifetime is typically used to define the time for recombination to occur after the electron–hole generation. Because the three recombination mechanisms occur in parallel, the silicon material bulk lifetime (
where
In addition, for crystalline silicon wafers, dangling bonds are present on the front and back surfaces, and introduce defect levels throughout the energy‐band gap. Surface recombination velocity (
where
For silicon solar cells, recombination after carrier generation not only reduces
In order to conduct a detailed analysis about the recombination contribution from each part of a finished screen‐printed
where
where
Schematic of a test sample symmetrical structure with screen‐printed contact on one side for extracting
where
In Eq. (12),
where the intrinsic carrier concentration
Similar to
where
Schematic of a test sample symmetrical structure screen‐printed contact on one side for extracting
where
So, in order to obtain a low
Apart from the recombination that contributes to the
Schematic structure of optical loss mechanisms in a screen‐printed front junction
So, to reduce the optical loss in a finished cell, front gridline should be as narrow as possible to reduce metal shading while not sacrificing conductivity. Currently, the screen‐printed gridline in mass production typically demonstrates ∼60 μm width. The size of pyramids also needs to be as small as possible to reduce reflection at the front surface, and currently, typical size is in the range of 3–6 μm. Low doping levels in the diffused regions (
In this section, the typical processes of fabricating screen‐printed front junction
After the silicon ingot is grown, wire sawing is typically used to slice silicon ingots into wafers with a resulting thickness of around 200 µm, and often in pseudo‐square shape (∼156 × 156 mm2) with total area of about 239–242 cm2 depending on the diameter of the original ingot. During this process, the sawing damages the entire surface of both sides of the silicon wafers, with the damage depth of approximately 10 µm. This saw‐induced damage has a very bad effect on the electronic quality of the wafer as they dramatically increase the surface recombination velocity, and hence have to be removed together with other contaminants prior to the next high‐temperature diffusion step. This etching of the saw damage normally occurs in heated potassium hydroxide (KOH) solution at ∼80°C for few minutes. This etching reaction takes place in three steps, including oxidation of silicon, formation of a solvable salt and dissolving of the salt in water, which is summarized in [15, 16]
\nIn addition, this is a selective etching process as different crystallographic orientations have different etch rates, with the lowest etch rate for the <111> plane. In order to effectively reduce the reflection at the front surface, isopropyl alcohol (IPA) is normally added into KOH solution to form small pyramids with a square base randomly distributed over the <100> oriented silicon surface, as shown in Figure 9.
\nAppearance of a textured silicon surface for
After texturing, the wafers are processed by a thorough cleaning to remove impurities present on the wafer surface that could diffuse into the wafer and cause carrier recombination. This cleaning typically consists of a rinsing in deionized (DI) wafer, a thorough etching in hydrochloric acid (HCl) to remove metal impurities from wafer surfaces, then another DI water rinsing, a short etching in hydrofluoric acid (HF) to etch off the native silicon dioxide (SiO2) and to form a hydrophobic surface feature, and a final DI water rinsing and then air drying [17]. The more aggressive and more expensive ‘RCA’ clean (‘SC‐1’ and ‘SC‐2’) is another standard set of wafer cleaning steps typically used in R&D labs [18].
\nTo form the
This reaction is often referred to as the deposition stage, as a very high concentration of boron forms in the very thin layer on the silicon surface. Next, the formed B2O3 reacts with the silicon atoms which can diffuse boron atoms into the silicon bulk to form the
which is often referred to as the diffusion stage. The formed SiO2/B2O3 stack on the silicon surface is the so‐called borosilicate glass (BSG) that needs to be removed to improve surface passivation quality. The resulting boron‐doped
Due to BBr3 diffusion being a double‐sided coating process, a mask on the rear side is needed to protect the rear surface where the
The most commonly used technique to form phosphorus‐doped
where the formed P2O5 acts as a phosphorus dopant source. This is often referred to a deposition stage, as a very high concentration of phosphorus forms in the very thin layer (only tens of nanometres) on the silicon surface. Then, in the same process, the furnace temperature is often slightly increased for the next drive‐in stage: in which the phosphorus atoms diffuse deeper into the silicon. Phosphorus atoms diffuse into the silicon substrate to create an
where the formed SiO2/P2O5 stack is the so‐called phospho‐silicate glass (PSG). The resulting doping profile depends on diffusion temperature, diffusion time and gas flow rates [25, 26].
\nBecause the POCl3 diffusion is also a double‐sided coating process, a mask on the front side is needed to protect the
To obtain high cell performance, surface passivation plays an important role in reducing recombination in the finished cell. There are two fundamental mechanisms for surface passivation: (1) chemical passivation that the surface defect states are removed or reduced; (2) field‐effect passivation that a fixed‐charge dielectric is deposited on the surface to create an internal electrical field that repels or screens minority carriers inside the wafer from the defective surfaces. For field‐effect passivation, the positive‐fixed‐charge dielectrics (i.e., SiNx and SiO2) repel the positively charged holes inside the silicon wafer from the surfaces and are ideally suitable to passivate
In order to further reduce reflection losses at the textured front side, a layer of hydrogen‐rich silicon nitride (SiNx:H) is normally deposited by PECVD on top of the passivation layer (Al2O3 or SiO2) as an ARC. Since there is significant amount of H in this ARC layer, it can be released during the metal contact firing step at high temperature (∼800°C) and diffuse into the silicon wafer bulk region to passivate bulk defects, which reduces bulk recombination. The thickness of this ARC can be calculated by the quarter wavelength law [31]
\nwhere
where
Screen‐printed metallization is very robust, simple and widely used for PV applications since its introduction about four decades ago [32]. Figure 10 shows the schematic of a screen‐printing process. The squeegee is moved with a proper pressure over the screen that consists of emulsion and mesh wires, which presses down the screen locally against the wafer surface and pushes the paste on the wafer surface through the well‐defined opened region (typically 40–60 µm wide openings). During the printing, wafer stays on the stage under vacuum condition. The printer settings, i.e., snap‐off distance, print pressure and print speed, are very critical parameters to obtain a good aspect ratio (height to width ratio) of screen‐printed gridlines.
\nSchematic of a screen‐printing contact process for front junction
The paste ingredients are also crucial to obtain a high aspect ratio, good conductivity and low contact resistance. For front junction
Figure 11 shows an example of firing‐temperature profile, including the firing‐temperature ramp up and ramp down. During this firing step in a conveyor belt furnace at a peak temperature of over 700°C, the metal contact is formed on both sides (
A typical firing‐temperature profile for front junction
Optical microscope false colour height image of a screen‐printed gridline (a); a large‐area (∼239 cm2) front junction
During the firing process, organic binders are burned out below 600°C, which typically occurs during the plateau stage as shown in Figure 11. In the higher‐temperature zones of the furnace, including the peak firing temperature, both the front and rear contacts are simultaneously formed by etching through the ARC and passivation layers, Ag particle sintering, and forming the ohmic contact [35]. In the meantime, the hydrogen of the SiNx:H ARC layer is released into the wafer to passivate electrical defects at interfaces and in the wafer bulk regions. The duration of the peak temperature often only lasts for a few seconds. Figure 12b shows the physical appearance of a finished cell with screen‐printed contacts, featuring 5 bus‐bars on both front and rear sides. The final gridline on the cell is typically ∼60 µm wide, and ∼20 µm high, as shown in optical microscope image of Figure 12a.
\nAfter cell fabrication, the illuminated current density–voltage (
To obtain a better understanding of the loss mechanisms in a finished cell, detailed analysis is typically needed. For instance, a cell\'s internal and external quantum efficiency (
Typical internal and external quantum efficiency (
Due to the recent improvements in material quality and surface passivation, current high‐efficiency silicon solar cells are often limited by the recombination at the metal/semiconductor contacts. A feasible solution to minimize contact recombination is a selectively doped structure, which allows decoupling of the metallized and non‐metallized areas of the doped regions. Figure 14 shows an example of a selective doping structure on the front emitter (
Schematic of selective doping for a screen‐printed front junction
There are several selective doping technologies that have been developed over years in the field of photovoltaics. One of these promising technologies is based on ion implantation through a mask which only increases the dopant dose on the regions underneath the screen‐printed contacts. The advantages of this technology are eliminating the formation of PSG and/or BSG, and fewer process steps. Other selective doping technologies, such as the etch‐back process, laser‐doping, oxide mask process, etc., have been addressed by Hahn, et al. [37]. As a rule of thumb, in order to implement these selective doping technologies to an industrial production line, every extra process step should provide the enhancement in cell efficiency of 0.2–0.3% absolute considering the related extra manufacturing costs.
\nAnother feasible solution to minimize contact recombination is to put a passivating material with offset bands between the metal and silicon, also known as a passivated contact. Introduction of a thin passivating interlayer between the high recombination regions and the silicon absorber mitigates their negative impact because they are not in direct contact with the absorber. This reduces total recombination or saturation current density (
A promising approach to achieving a carrier selective passivated contact involves an ultra‐thin (∼15 Å, see the TEM image in Figure 15b) tunnel oxide capped with phosphorus doped
Schematic structure of a front junction
The annual shipment and installation of PV cells and modules up to date are still dominated by the standard industrial solar cell fabrication process on
Although it is hard to exactly predict which process approach and cell architecture will be the most cost‐effective in the future, selective doping and tunnel oxide passivated contacts have become active areas of investigation for silicon solar cells, because they can produce higher cell efficiency due to reduced minority carrier recombination. Combining these two promising technologies into a screen‐printed front junction
Schematic structure of a front junction
The author would like to thank Professor Ajeet Rohatgi for his kind support at University Center of Excellence for Photovoltaics (UCEP) at the Georgia Institute of Technology. The author also thanks Dr. Adam Payne of Suniva Inc. for proof‐reading.
\nDental implant service is a life-changing treatment modality for many patients. Giving our patients a fixed restoration is a very rewarding procedure, especially if the patients have difficulties: gage reflex, bulky prostheses, lack in retention, stability, or support. Unfortunately, this is not applicable for all patients, especially patients who cannot afford multiple implants or bone grafting. By considering the strategic implants under the existing removable partial denture (RPD), we make implant treatment simple and affordable for more patients.
The removable partial denture (RPD) is the dental prostheses that the patient, who suffers the absence of some but not all the natural teeth, can readily insert and remove from his/her mouth. The prostheses restore the missing teeth as well as the gingiva and the missing bone if needed. Removable partial dentures (RPDs) are indicated for patients with a long edentulous span, too long for a fixed prosthesis. The RPD is indicated for a patient with no posterior abutment to support a fixed prosthesis, and the cantilever bridge is contraindicated. Also, it is preferred if excessive alveolar bone loss is encountered, especially in the esthetic zone. Those patients who are not indicated for bone grafting or unable to afford the costly treatment are good candidates for the removable denture (RD). The acrylic flang is a good approach to compensate for the bone and soft tissue deficiency within a short fabrication time and a less aggressive approach. Moreover, this treatment option allows the patient to remove his prostheses for easier intraoral access, subsequently, better oral hygiene. The RD enables the dentist to repair or adjust the prostheses easily.
On the other hand, RD is less secure with limited retention and stability than fixed prostheses. RD metal clasp may compromise the final esthetic result. It may act as a gum stripper and accelerate alveolar bone resorption. These drawbacks in the RD can be managed by upgrading the RD using strategic implants, which are “the implants that change the prosthetic support type to a more favorable configuration” [1].
In this chapter the folllowing points is going to be discussed:
Classification as a systematic approach for communication and planning:
Kennedy classification system
Steffel classification and modified Steffel classification
Implant-Corrected Kennedy (ICK) Classification System for Partially Edentulous Arches
Strategic mini dental implants (MDI) and standard dental implant (SDI) under existing RPD, how many implant?
The abutment prosthetic value
Immediate and delayed restoration/loading, what is the difference?
Why strategic implant?
Mini-implant-assisted removable partial denture
Conclusion
A classification is a systematic approach in which the items or units are categories in groups or subgroups according to specific criteria. This approach facilitates the discussion regarding the most suitable treatment options, eases the communication between the dentist and the technician. The classification also allows for visualization and differentiation between the RPD support types: tooth-supported, tooth tissue-supported, tissue-supported, implant-supported, implant tissue-supported, and implant tooth-supported.
In 1925 Dr. Edward Kennedy introduced his approach of categorizing partially edentulous arches into four classes. He categorized the partially edentulous arches in a way that considered the edentulous area position in the arch and if it was surrounded with teeth or not. This approach was beneficial in visualizing the cases and reaching the decisions regarding the RPD designs.
The following is the Kennedy classification:
Class I: Edentulous free-end areas located on both sides (bilateral), posterior to the remaining teeth (Figure 1).
Class I maxillary arch.
Class II: Edentulous free-end area located on one side (unilateral), posterior to the remaining teeth (Figure 2).
Class II maxillary arch.
Class III: Edentulous bounded area with natural teeth remaining both anterior and posterior to it (Figure 3). The area is located on one side (unilateral).
Class III maxillary arch.
Class IV: Edentulous bounded area with natural teeth remaining posterior to it. The area is located anteriorly and crossing the mid-line (Figure 4).
Class IV maxillary arch.
In 1965 Applegate’s added eight rules to the classification. The rules can be summarized by the following: The categorization (classification) is always determined by the most posterior edentulous region (or regions). Any additional edentulous area (other than those that define the categorization) is considered a modification (Figures 6 and 7). If the teeth posterior to the edentulous area are not used to support the RPD, the edentulous area is classified as a free end (Figures 5 and 7), and vice versa (Figures 6 and 7). If the posterior free end edentulous region is not going to receive artificial teeth, it will not be considered in the classification (Figures 6–8), and vice versa. Putting the design and the structure of the RPD into consideration is a cornerstone in giving the correct RPD classification. Subsequently, the classification will be the start point making the best clinical decision regarding the number and the position of strategic implants under the RPD.
No rest is going to be costructed on # 38 or 37 ➔ the arch has two free end areas ➔ Class I mandibular arch.
Direct retainer is going to be constructed on 37. No artificial teeth is going to replace 46, 47 or 48 ➔ no free end ➔ Class III mod 1 mandibular arch.
No artificial teeth is going to replace, 48. Direct retainer is going to be constructed on 37 but not on 47 ➔ one free end ➔ Class II mod 3 mandibular arch.
No artificial teeth is going to replace, 38, 37, 36, 47 or 48. Class IV mandibular arch.
In 1962 Steffel described six support possibilities that can be encountered in RPD.[2] He labeled the classification categories from A to F based on the fulcrum, and the number and distribution of the abutments, Figure 9. The fulcrum line is a hypothetical line formed between abutments, teeth or implants. The RPD may rotate somewhat around the fulcrum during function.
Steffel classification.
ICK I (# 25).
In this chapter, we suggest a modification to this classification to simplify the communication and decision-making regarding the strategic implant under the existing RPD. In the modification, B, C, and D will be labeled together.
The following is the
Punctual-support, only one abutment.
Linear-support, two abutments; separated with edentulous area or at least one tooth.
Triangular-support, three well-distributed abutments; separated with edentulous area or at least one tooth. One of the abutments should be on the opposite quadrant.
Quadrangular-support, two well-distributed abutments on every quadrant.
Providing the patient with a stable prosthesis is a crucial target for the dentist. However, the RPD is not rigidly attached to the intraoral hard (teeth) and soft (mucosa) tissues, which have different levels of compressibility and mobility. Subsequently, the chewing and occlusal forces may generate different levels of tissue stress and prosthesis mobility. Both (stress and mobility) should be within the physiological level and cause no harm or trauma. Achieving this critical goal depends on the clinician’s understanding of the biomechanics and the different design solutions. The RPD design should consider the unique nature of each clinical case and counter the expected RPD movement in response to loading. The design also should minimize the potentially destructive forces that may affect the supporting tissues; teeth, mucosa, and bone. That can be achieved by avoiding a long lever system, good selection for the RPD supporting elements, and wide symmetrical distribution of the functional forces [3, 4]. Many of the previous points (if not all) can be achieved (fully or partially) by delivering an RPD with quadrangular-support type.
According to the modified Steffel classification, there are four types of prosthetic support: punctual, linear, triangular, and quadrangular. The RPD support improves gradually as the classification change from I to IV. Classification IV provides the best support to the RPD with the highest resistance of rotation. The strategic implant aims to change the prosthetic support type to a more favorable configuration.
One of the simple classification systems for RPD supported with implants or implants and natural teeth is Implant-Corrected Kennedy (ICK) classification system for partially edentulous arches by Al-Johany et al.[5] The ICK is based on the Kennedy classification system and the Applegate eight rules (Applegate–Kennedy system).[6] According to the ICK classification system coding guidelines, the Kennedy classification comes first, followed by the number of modification spaces (Applegate rules). Finally, round brackets enclose # followed by the implant’s or implants’ position will be added, Figures 10–18.
ICK II mod 2 (# 33, 36). Direct retainer is going to be constructed on 28.
ICK II mod 3 (# 13, 23). Direct retainer is going to be constructed on 28.
Meeting our patient’s expectations is a priority. That cannot be reached if the dentist did not provide the patient with a full straightforward clarification for the treatment plan. The clarification should cover the advantages, disadvantages, risks, time, cost, and alternatives. The explanation should be done in a way that helps both the patient first and the dentist second to reach the decision that best matches the patients’ needs, health status, and financial ability, as well as respect the patient’s chief complaint and consideration. Generally speaking, teeth-implant- or implant-supported removable dentures reduce (and in many cases eliminate) traditional denture problems.[1, 7, 8, 9] It helps the dentist widen his options to meet the patient’s needs and expectations by inserting one or few implants in strategic positions, but how many implants?
The needed number of mini dental implants (MDIs) or standard dental implants (SDIs) under existing RPD is a multifactorial process (see paragraph 2.5) and taken on the quadrant level. To give the patient an RPD with acceptable retention, stability, and support, the abutments should be well distributed. Two abutments on every quadrant in symmetrical position as possible are needed. On every quadrant, the sum of the abutments prosthetic value should be ≥2, Table 1 and Figure 19.
ICK II mod 1 (# 16, 13, 23).
The abutments prosthetic value | ||
---|---|---|
Teeth | Upper or lower incisor or lateral incisor | 0–0.5* |
Upper or lower canine | 1.3** | |
Upper or lower premolar or molar | 1*** | |
MDI | Upper MDI | 0.5–0.7**** |
lower MDI | 1 | |
SDI | Upper Standard Implant | 1 |
Lower Standard Implant | 1 |
The prosthetic value of the available teeth and the planned MDIs and SDIs. The recommendations are on the quadrant level.
The numbers represent the prosthetic value if abutment rest is planned; if not, the value will be 0.
If the four natural anterior abutment teeth are missing (11, 12, 13, 14), strategic implant/s is recommended even if all posterior teeth are available, and vice versa.
If there is no space ( edentulous area or at least one natural tooth) between the abutment teeth, the prosthetic value will decrease to 0.5 for each abutment.
Bone quality impacts the MDI prosthetic value.
ICK II (# 35, 33, 43).
For partially edentulous patients, the abutments can be implants or natural teeth and should be well-distributed with a sum of the prosthetic value ≥2 on quadrant level.
ICK III mod 3 (# 41).
In the course of formulating the prosthodontic plan, not all teeth or abutments have the same prosthetic value. The prosthetic value stands for the importance of the tooth or implant from a specific prosthodontic point of view. The last first molar (#36) in Figure 20 has a very high prosthetic value than the lateral incisor #32. Extracting #36 shifts the treatment modality (if an implant is not feasible) from fixed partial denture to removable partial denture. Suppose the dentist changes his prosthodontic point of view by selecting RPD as a treatment modality. In that case, the prosthetic value of #36 will be reduced a little for this specific treatment modality. However, the prosthetic value for the same tooth (#36, Figure 20) and the same treatment modality (RPD) will be very high if the patient has a knife-edge thin, sensitive mucosa. Usually, this type of patient can tolerate tooth-tooth-supported RPD better than tooth tissue-supported RPD. Therefore, it can be concluded that:
ICK III mod 1 (# 34, 42).
ICK III mod 1 (# 13, 23).
ICK IV (# 33, 43). Direct retainers are going to be constructed on 36 and 47. No artificial teeth are going to replace 37 or 38.
(A1 upper jaw and A2 lower jaw to G1 upper jaw): The recommended number of strategic standard implants (SDIs) or mini dental implants (MDIs) under existing RPD.
The #36 has a very high prosthetic value because the extracting change the treatment modality (if implant is not feasible) from fixed partial denture to removable partial denture.
The SDI #23 and MDI #33 have very high esthetic value as they help the dentist avoiding anterior metal clasps. #27 and MDI 35 have relatively high prosthetic value as they shift the RPD from tooth tissue supported to more implant tooth-supprted or implat implant-supported RPD.
Upgrading the existing clasp retained lower RPD by inserting strategic mini-implants, immediate restoration with immediate loading/soft material. A- Intraoral image with lower RPD before implantation. B- Partial edentulous lower jaw before implantation. C- Tissue surface of the RPD before implantation. D- Four strategic mini-implants in the interforaminal region, tooth 32 was extracted. E- Tissue surface of the RPD after implantation, soft relining in the areas opposing the implants’ head. F- Tissue surface of the RPD after 4 months, the matrix pick-up (housings). G- Intraoral image with lower RPD after the housing, clasps in esthetic zone were removed.
Narrow bone can be treated with bone grafting. Unfortunately, this is not always feasible. A- Biomechanically, the narrow implant is not always the best approach, see paragraph 5. B- Osteoplasty is used to insert a wider implant by increasing the bone width, which will impact the crown-implant ratio negatively and may place the implant near vital anatomical structure. C- One-piece mini-implant with ball attachment and preferable crown-implant ratio can be used to stabilize a complete removable denture or partial removable denture.
Upgrading the existing double crown retained upper RPD by inserting strategic mini-implants, immediate restoration, and delayed loading. A- Partial edentulous upper jaw before implantation. B- Tissue surface of the RPD before implantation. C- Five strategic mini-implants. D- Tissue surface of the RPD after implantation, recesses (empty notches) against the mini-implants. E- Tissue surface of the RPD after 4 months, the matrix pick-up (housings). The palate coverage was reduced. F- Intraoral image with the RPD after the housing.
Upgrading the existing double crown retained lower RPD by inserting strategic mini-implants, immediate restoration and immediate loading. A- Partial edentulous lower jaw before implantation. B- Tissue surface of the RPD before implantation. C- Two strategic mini-implants. D- Tissue surface of the RPD after implantation, the matrix pick-up (housings) inserted in the same implantation session. E- Intraoral image with the RPD in place after implantation.
The hidden #23 MDI under the saddle (Figure 21) has a very high esthetic value as it helps the dentist avoid metal clasp in the esthetic zone. In some cases, strategic implants enable the dentist to reduce or remove the flange to achieve a better esthetic result by reducing lip protrusion. In other cases, it gives the dentist the ability to minimize the RPD size (palate, Figure 24) and increase patient acceptance.
The prosthetic value (importance) for each abutment is estimated according to Table 1 and mainly the following points: [11, 12, 17, 18].
Periodontal status, mobility, and bone level around the abutment.
Crown-root ratio.
Tooth vitality, size of the defect (caries), size, and type of the restoration.
The shape and number of the abutment roots.
Occlusion, parafunctional activity and opposite jaw status: natural teeth, implant, fixed partial denture, complete denture, or partial denture.
In 1981 Albrektsson et al. suggested a protocol in which the implants are left to heal in situ for at least 3 to 4 months without loading.[19] He considered the non-loading phase a crucial period to achieve successful osseointegration and avoid fibrous tissue formation between the implant surface and the bone. On the other hand, many clinical studies proved that immediate restoration, immediate loading, or early loading are acceptable treatment modalities.[20, 21] These studies were in response to the social and psychological needs of many patients. The immediate or early treatment modalities aim to reduce the overall recovery time between the surgical intervention and the insertion of the final restoration. These approaches are known as immediate restoration protocol, immediate loading protocol, and early loading protocol.
Patients typically are uncomfortable and, in many cases, refuse to stay without their RPD for a long time, especially if it restores a lot of missing teeth or teeth in the esthetic zone. The immediate protocols can reduce the patient concerns related to the final restoration by reducing the waiting period. In some cases, a temporary restoration is immediately delivered to give the patient a hint on the form, size, and position (in some cases, the shade) of the final restoration. Moreover, the second surgical intervention can be averted through immediate protocols. To achieve a good success rate in this treatment modality, a good understanding of the topic, terminology, limitation, and biology is essential. These topics will be discussed in other chapters, but it is crucial to clarify a few terms.
The loading can be classified into four categories:
Conventional loading: The implants are left without loading for around two to three months.
Delayed loading: If the loading on the implant is applied after the conventional loading time, it is classified as delayed. That can be indicated if the tissue needs more healing time, such as external sinus lift with bone grafting. In such cases, the final restoration and implant loading may be applied after six to nine months.
Early loading: The implant is loaded by placing dental restoration in contact with opposing dentition at any time after one week but within two months after implant insertion.
Immediate loading: The dental restoration is inserted intraorally and placed in contact with opposing dentition within one week after the surgical intervention.
The timing of dental restoration can also be categorized to:
Conventional restoration in which the implant is left without temporary or final restoration for around two to three months.
Immediate restoration: The temporary or final restoration is placed within one week after surgical intervention.
Early restoration: The temporary or final restoration is placed any time after one week but within two months after implant insertion.
Delayed restoration: If the dental restoration is placed intraorally after the conventional loading time, the restoration is classified as delayed restoration.
According to the previous classifications, the dentist has different types of intervention. For example, he can go for immediate restoration with conventional loading or implement early restoration with delayed loading.
In the case of the strategic implant under existing RPD, there are seven scenarios: immediate restoration with one of the four loading types, or early restoration with early, conventional, or delayed loading. The decision regarding the best approach is multifactorial: age, esthetic expectations, oral hygiene level, bone quality and quantity, and treatment expenses. According to the 2018 census supported by the International Team for Implantology (ITI), the most critical factors that may impact the loading protocol selection are patient-related factors, especially patient’s general health, implant primary stability (ISQ), bone grafting, the size and shape of the implant, and the doctor skills and experience.[22] Moreover, the ITI tried to unify the two classifications (loading and restoration timing) to make it less complicated for the clinician and easier for the researchers to perform clinical studies and compare their results. They described four protocols:
Immediate loading: Within one week after implant placement, dental implants are linked to a prosthesis in occlusion with the opposing arch.
Immediate restoration: Within one week after implant placement, dental implants are linked to the dental restoration and are kept out of occlusion.
Early loading: Between one week and two months following implant placement, dental implants are linked to the prosthesis.
Conventional loading: dental implants are linked to the prosthesis after two months of implantation.
Improving dental treatment output by using implants to enhance the functional performance of the complete denture is a well-known approach in prosthodontics. The McGill Consensus Statement stated that the first option in treating the lower jaw edentulous patient should be two implants retained overdenture and not lower jaw conventional complete denture (CD).[23] Overwhelming scientific evidence supports the statement.[23] The evidence emphasized the superiority of two implants retained overdenture treatment modality on the conventional CD in many aspects, such as patients’ chewing efficiency, positive modification in patients’ diet, patients’ satisfaction with the CD stability, retention, and comfort as well as quality of life.[23] Although a lot of scientific evidence highlighted the positive impact of inserting implants under existing RPD, no similar Consensus Statement is available regarding implant-retained or implant-assisted removable partial denture. [24, 25, 26].
Not all patients are suitable for implant-supported fixed dental prostheses. For example, many patients are unwilling to have an extra surgical intervention (bone grafting, sinus lifting, bone splitting, or expansion). Other patients are not suitable for such intervention because they are medically compromised or do not have adequate financial flexibility. As an alternative to inserting multiple implants, the dentist can improve the quality of the prosthodontic treatment by changing the support type of the RPD to the quadrangular-support type. The improvement can be achieved by inserting one/two standard implants or one/two/three mini-implants per quadrant to reach a symmetrical quadrangular-support type. The prostheses will be tooth implant-supported RPD instead of tooth tissue-supported RPD. This prosthodontic approach is affordable to many patients.
The strategic implant is “the implant that can change the prosthetic support type to a more favorable configuration”.[1] It is a reliable way of treatment with an implant survival rate of 91.7–100%.[4] Also, it can support both the RPD and the other abutments effectively. In two clinical studies with 2 and 3 years follow-up, the survival rate of the natural teeth abutments was 100%.[9, 24].
Moreover, it can improve the survival rate of the RPD. The 10-year survival rate of RPDs; clasp-retained removable partial dentures, conical crown-retained dentures, or a combination of conical crown and clasp-retained dentures is 71.3%.[27] On the other hand, clinical studies with observation periods between 1 and 12.2 years reported survival rates of 90–100% for the implant-assisted removable partial denture prostheses.[7, 28, 29, 30, 31] This remarked difference in the survival rate plays an essential role in formulating the prosthodontic plan.
Many clinical studies have shown that implant placement in strategic locations under an existing RPD can enhance chewing efficiency, dental health-related quality of life, and patient satisfaction with speaking and eating, as well as RPD retention, stability, and support.[1, 8, 32] Above that, it gives the dentist the ability to reduce the tissue coverage and reduce the size of the RPD, which can positively impact the patient’s acceptance of the RPD, especially if he suffers hyperactive gag reflex, Figure 24. Also, it can improve the final esthetic result by avoiding the traditional metal clasp, Figures 19 and 22.
Unfortunately, inserting a standard implant under the existing RPD is not always feasible. The patient may have a very narrow bone that prevents inserting a standard implant without bone grafting. A procedure that is not suitable or acceptable by some patients. In this case, mini-implants can be considered a good alternative, Figures 22 and 25 [1, 8, 16].
In 1976, the U.S. Food and Drug Administration (FDA) approved the 3 mm root-form dental implant. With time, dental implants proved to be a predictable and reliable prosthodontic treatment modality with a high success rate.[33, 34, 35] After 21 years, the approval was cleared for implants less than 3 mm. The approval widens the spectrum of the patients treated with dental implants, particularly the cases with reduced bone width.
In literature, there is no standardization regarding the terminology of dental implant diameter.[36] For example, some authors considered the implants with diameters from 1.8 to 2.9 mm as small implants; others call them mini-implants.[37] Some authors defined the mini-implant as the implant with 2.2 mm.[38] Al-Johany et al. proposed a classification scheme and used four terms: Extra-narrow <3.0 mm, Narrow ≥3.0 mm to <3.75 mm, Standard 3.75 mm to <5 mm, and Wide ≥5 mm.[36] In this text, we will follow the lead of Resnik et al. and Schiegnitz et al. by considering the mini-implant as the implant with a diameter < 3.0 and the narrow-diameter implant as the implant with a diameter ≤ 3.5.[25, 37] This implant type is mainly used in heavily atrophic jaws but with sufficient bone height. The mini-implant gives the dentist the ability to avoid bone augmentation procedure, which is considered a time and cost-consuming surgical intervention. Avoiding additional surgical procedures can reduce morbidity and possible complications such as nerve trauma, hemorrhage, postoperative pain, or infection.[25] The infection may lead to the failure of bone grafting.[25] Above that, it is less invasive than the standard implant as it requires a smaller implant bed and no flap in a considerable number of cases.[26] Therefore, it is more appropriate for the compromised or elderly patients. Moreover, it is cost-effective and affordable. On the other hand, the small diameter of the implant may create a shear load to the crestal bone. That may increase the risk of bone resorption.[37, 39] Narrow -implant has been linked to biomechanical risk factors as implant fatigue or fracture, particularly when used in the canine area where high occlusal loads are applied or in parafunctional habits patients.[40].
A systematic review and meta-analysis reported that mini-implants (diameter < 3.0 mm) performed substantially worse than standard diameter implants with survival rates of 94.7 ± 5%.[25] However, narrow implants with a diameter (3–3.5 mm) have a better survival rate of 97.7 ± 2.3%.[25] Therefore, some researchers believe the best approach for a thin bone is bone augmentation.[37] If this is not feasible, narrow implant, osteoplasty and standard implant, or one-piece mini-implant with ball attachment and removable denture can be considered, Figure 23.
The small diameter implant is used to replace missing individual teeth in the anterior region, lower and upper jaw [41, 42]. Mini-implant is used as an orthodontic implant or transitional or provisional implant to support interim prostheses during the healing period after extensive implantations or augmentations and bone grafting.[43] The one-piece mini-implant with ball attachment is used as assisting / anchoring element under the removable denture.[1] Strategic min-implant under existing RPD and CD proved to be a reliable and straightforward approach.[1, 8, 44] New studies reported that the one-piece mini-implant with ball attachment has a significant advantage on the final prosthodontic treatment.[1, 8].
The one-piece implant mimics nature by having a solid unibody structure with no microgaps between the implant and the abutment. As a result, the possible biological complication (bone resorption) and structural flaw are reduced. Also, the flap or flapless single-stage surgery allows the dentist to implement immediate loading or immediate restoration.[42] Moreover, delayed loading is possible by preparing a recess against the mini-implant in the RPD’s tissue surface. The treatment protocol can be conventional or delayed loading. However, the recess (cavity) distorts the fit of the RPD’s, Figure 24.
On the other hand, if the mini-implants are inserted in a healthy, not compromised patent with insertion torque ≥35 Ncm, immediate loading can be considered. The immediate restoration with immediate loading can be implemented through one of two forms:
immediate loading using soft relining material, Figure 22.
immediate loading using the matrix pick-up (housings), Figure 25.
After implantation, soft relining material can restore the fit of the RPD, ease tissue pressure, and give the patient a secure feeling because the relining material encircles the implant head and minimizes RPD rocking. If all mini-implants have a high insertion torque, the patient can receive the final restoration with matrix pick-up (housings). Subsequently, no additional session for adjusting the RPD is needed. In this approach, the patient can directly feel and recognize the significant improvement in the RPD in many domains especially, retention, support stability, and chewing.[1, 8].
Studies proved that inserting strategic implants under existing RPD improves patient satisfaction on short- and medium-term follow-up (3-years).[1, 43] The improvement can be explained by the symmetrical distribution of the abutments and the increased number of the rests/abutments.[1, 17] Gorai S, et al. study reported a correlation between the rests number and denture usage.[17].
To sum it up, using strategic implants under existing RPD upgrade the design to more favorable support type and improve patient satisfaction with the RPD on several domains like speaking, chewing, retention, stability, and support of the RPD. This improvement could be reached earlier if the patient received immediate loading.[1].
In many cases, after putting into consideration the patient’s main complaint, expectation, desire, general health, intraoral/extraoral findings, evaluating the risks (do no harm) and the benefits of bone grafting and several implants, the dentist is able to provide his patient with one or few strategic standard or mini-implants that can satisfy the patients’ needs
Strategic implants can also improve chewing ability, stabilize the occlusion, increase bite force and improve patient oral health-related quality of life. Moreover, better distribution of occlusal forces that may reduce bone resorption may be gained. Furthermore, strategic implants can improve comfort, confidence, and esthetics by reducing the RPD size and removing metal clasps from the esthetic zone.
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His studies in robotics lead him not only to a PhD degree but also inspired him to co-found and build the International Journal of Advanced Robotic Systems - world's first Open Access journal in the field of robotics.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"441",title:"Ph.D.",name:"Jaekyu",middleName:null,surname:"Park",slug:"jaekyu-park",fullName:"Jaekyu Park",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/441/images/1881_n.jpg",biography:null,institutionString:null,institution:{name:"LG Corporation (South Korea)",country:{name:"Korea, South"}}},{id:"465",title:"Dr",name:"Christian",middleName:null,surname:"Martens",slug:"christian-martens",fullName:"Christian Martens",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"479",title:"Dr.",name:"Valentina",middleName:null,surname:"Colla",slug:"valentina-colla",fullName:"Valentina Colla",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/479/images/358_n.jpg",biography:null,institutionString:null,institution:{name:"Sant'Anna School of Advanced Studies",country:{name:"Italy"}}},{id:"494",title:"PhD",name:"Loris",middleName:null,surname:"Nanni",slug:"loris-nanni",fullName:"Loris Nanni",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/494/images/system/494.jpg",biography:"Loris Nanni received his Master Degree cum laude on June-2002 from the University of Bologna, and the April 26th 2006 he received his Ph.D. in Computer Engineering at DEIS, University of Bologna. On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. His research interests include pattern recognition, bioinformatics, and biometric systems (fingerprint classification and recognition, signature verification, face recognition).",institutionString:null,institution:null},{id:"496",title:"Dr.",name:"Carlos",middleName:null,surname:"Leon",slug:"carlos-leon",fullName:"Carlos Leon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Seville",country:{name:"Spain"}}},{id:"512",title:"Dr.",name:"Dayang",middleName:null,surname:"Jawawi",slug:"dayang-jawawi",fullName:"Dayang Jawawi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Technology Malaysia",country:{name:"Malaysia"}}},{id:"528",title:"Dr.",name:"Kresimir",middleName:null,surname:"Delac",slug:"kresimir-delac",fullName:"Kresimir Delac",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/528/images/system/528.jpg",biography:"K. Delac received his B.Sc.E.E. degree in 2003 and is currentlypursuing a Ph.D. degree at the University of Zagreb, Faculty of Electrical Engineering andComputing. His current research interests are digital image analysis, pattern recognition andbiometrics.",institutionString:null,institution:{name:"University of Zagreb",country:{name:"Croatia"}}},{id:"557",title:"Dr.",name:"Andon",middleName:"Venelinov",surname:"Topalov",slug:"andon-topalov",fullName:"Andon Topalov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/557/images/1927_n.jpg",biography:"Dr. Andon V. Topalov received the MSc degree in Control Engineering from the Faculty of Information Systems, Technologies, and Automation at Moscow State University of Civil Engineering (MGGU) in 1979. He then received his PhD degree in Control Engineering from the Department of Automation and Remote Control at Moscow State Mining University (MGSU), Moscow, in 1984. From 1985 to 1986, he was a Research Fellow in the Research Institute for Electronic Equipment, ZZU AD, Plovdiv, Bulgaria. In 1986, he joined the Department of Control Systems, Technical University of Sofia at the Plovdiv campus, where he is presently a Full Professor. He has held long-term visiting Professor/Scholar positions at various institutions in South Korea, Turkey, Mexico, Greece, Belgium, UK, and Germany. And he has coauthored one book and authored or coauthored more than 80 research papers in conference proceedings and journals. His current research interests are in the fields of intelligent control and robotics.",institutionString:null,institution:{name:"Technical University of Sofia",country:{name:"Bulgaria"}}},{id:"585",title:"Prof.",name:"Munir",middleName:null,surname:"Merdan",slug:"munir-merdan",fullName:"Munir Merdan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/585/images/system/585.jpg",biography:"Munir Merdan received the M.Sc. degree in mechanical engineering from the Technical University of Sarajevo, Bosnia and Herzegovina, in 2001, and the Ph.D. degree in electrical engineering from the Vienna University of Technology, Vienna, Austria, in 2009.Since 2005, he has been at the Automation and Control Institute, Vienna University of Technology, where he is currently a Senior Researcher. 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Aalborg University has Two Satellite Campuses, one in Copenhagen (Aalborg University Copenhagen) and the other in Esbjerg (Aalborg University Esbjerg).\n· He is a member of prestigious IEEE (Institute of Electrical and Electronics Engineers), and IAENG (International Association of Engineers) organizations. \n· He is the chief Editor of the Journal of Software Engineering.\n· He is the member of the Editorial Board of International Journal of Computer Science and Software Technology (IJCSST) and International Journal of Computer Engineering and Information Technology. \n· He is also the Editor of Communication in Computer and Information Science CCIS-20 by Springer.\n· Reviewer For Many Conferences\nHe is the lead person in making collaboration agreements between Aalborg University and many universities of Pakistan, for which the MOU’s (Memorandum of Understanding) have been signed.\nProfessor Akbar is working in Academia since 1990, he started his career as a Lab demonstrator/TA at the University of Sussex. After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. 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She obtained a BSc from the University of Derby, England, a master’s degree from Technische Universität München, Germany, and a Ph.D. from the University of Nottingham. She undertook a post-doctoral research fellowship in the School of Medicine before accepting tenure in Veterinary Medicine and Science. Dr. Rutland also obtained an MMedSci (Medical Education) and a Postgraduate Certificate in Higher Education (PGCHE). She is the author of more than sixty peer-reviewed journal articles, twelve books/book chapters, and more than 100 research abstracts in cardiovascular biology and oncology. She is a board member of the European Association of Veterinary Anatomists, Fellow of the Anatomical Society, and Senior Fellow of the Higher Education Academy. 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He studied \r\nchemistry at the Universidad Nacional de La Plata, Argentina, where received aPh.D. degree in chemistry (Biological Branch) in 1965. From\r\n1964 to 1974, he worked as Assistant in Biochemistry at the School of MedicineUniversidad Nacional de La Plata, Argentina. From 1974 to 1976, he was a Fellowof the National Institutes of Health (NIH) at the University of Connecticut, Health Center, USA. From 1985 to 2004, he served as a Full Professor oBiochemistry at the Universidad Nacional de La Plata, Argentina. He is Member ofthe National Research Council (CONICET), Argentina, and Argentine Society foBiochemistry and Molecular Biology (SAIB). His laboratory has been interested for manyears in the lipid peroxidation of biological membranes from various tissues and different species. Professor Catalá has directed twelve doctoral theses, publishedover 100 papers in peer reviewed journals, several chapters in books andtwelve edited books. Angel Catalá received awards at the 40th InternationaConference Biochemistry of Lipids 1999: Dijon (France). W inner of the Bimbo PanAmerican Nutrition, Food Science and Technology Award 2006 and 2012, South AmericaHuman Nutrition, Professional Category. 2006 award in pharmacology, Bernardo\r\nHoussay, in recognition of his meritorious works of research. Angel Catalá belongto the Editorial Board of Journal of lipids, International Review of Biophysical ChemistryFrontiers in Membrane Physiology and Biophysics, World Journal oExperimental Medicine and Biochemistry Research International, W orld Journal oBiological Chemistry, Oxidative Medicine and Cellular Longevity, Diabetes and thePancreas, International Journal of Chronic Diseases & Therapy, International Journal oNutrition, Co-Editor of The Open Biology Journal.",institutionString:null,institution:{name:"National University of La Plata",institutionURL:null,country:{name:"Argentina"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"186048",title:"Prof.",name:"Ines",middleName:null,surname:"Drenjančević",slug:"ines-drenjancevic",fullName:"Ines Drenjančević",profilePictureURL:"https://mts.intechopen.com/storage/users/186048/images/5818_n.jpg",institutionString:null,institution:{name:"University of Osijek",institutionURL:null,country:{name:"Croatia"}}},{id:"187859",title:"Prof.",name:"Kusal",middleName:"K.",surname:"Das",slug:"kusal-das",fullName:"Kusal Das",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSBDeQAO/Profile_Picture_1623411145568",institutionString:"BLDE (Deemed to be University), India",institution:null},{id:"79615",title:"Dr.",name:"Robson",middleName:null,surname:"Faria",slug:"robson-faria",fullName:"Robson Faria",profilePictureURL:"https://mts.intechopen.com/storage/users/79615/images/system/79615.png",institutionString:null,institution:{name:"Oswaldo Cruz Foundation",institutionURL:null,country:{name:"Brazil"}}},{id:"84459",title:"Prof.",name:"Valerie",middleName:null,surname:"Chappe",slug:"valerie-chappe",fullName:"Valerie Chappe",profilePictureURL:"https://mts.intechopen.com/storage/users/84459/images/system/84459.jpg",institutionString:null,institution:{name:"Dalhousie University",institutionURL:null,country:{name:"Canada"}}}]},{id:"12",title:"Human Physiology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/12.jpg",editor:{id:"195829",title:"Prof.",name:"Kunihiro",middleName:null,surname:"Sakuma",slug:"kunihiro-sakuma",fullName:"Kunihiro Sakuma",profilePictureURL:"https://mts.intechopen.com/storage/users/195829/images/system/195829.jpg",biography:"Professor Kunihiro Sakuma, Ph.D., currently works in the Institute for Liberal Arts at the Tokyo Institute of Technology. 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His research interest focuses on computational chemistry and molecular modeling of diverse systems of pharmacological, food, and alternative energy interests by resorting to DFT and Conceptual DFT. He has authored a coauthored more than 255 peer-reviewed papers, 32 book chapters, and 2 edited books. He has delivered speeches at many international and domestic conferences. He serves as a reviewer for more than eighty international journals, books, and research proposals as well as an editor for special issues of renowned scientific journals.",institutionString:"Centro de Investigación en Materiales Avanzados",institution:{name:"Centro de Investigación en Materiales Avanzados",country:{name:"Mexico"}}},{id:"76477",title:"Prof.",name:"Mirza",middleName:null,surname:"Hasanuzzaman",slug:"mirza-hasanuzzaman",fullName:"Mirza Hasanuzzaman",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/76477/images/system/76477.png",biography:"Dr. Mirza Hasanuzzaman is a Professor of Agronomy at Sher-e-Bangla Agricultural University, Bangladesh. He received his Ph.D. in Plant Stress Physiology and Antioxidant Metabolism from Ehime University, Japan, with a scholarship from the Japanese Government (MEXT). Later, he completed his postdoctoral research at the Center of Molecular Biosciences, University of the Ryukyus, Japan, as a recipient of the Japan Society for the Promotion of Science (JSPS) postdoctoral fellowship. He was also the recipient of the Australian Government Endeavour Research Fellowship for postdoctoral research as an adjunct senior researcher at the University of Tasmania, Australia. Dr. Hasanuzzaman’s current work is focused on the physiological and molecular mechanisms of environmental stress tolerance. Dr. Hasanuzzaman has published more than 150 articles in peer-reviewed journals. He has edited ten books and written more than forty book chapters on important aspects of plant physiology, plant stress tolerance, and crop production. According to Scopus, Dr. Hasanuzzaman’s publications have received more than 10,500 citations with an h-index of 53. He has been named a Highly Cited Researcher by Clarivate. He is an editor and reviewer for more than fifty peer-reviewed international journals and was a recipient of the “Publons Peer Review Award” in 2017, 2018, and 2019. He has been honored by different authorities for his outstanding performance in various fields like research and education, and he has received the World Academy of Science Young Scientist Award (2014) and the University Grants Commission (UGC) Award 2018. He is a fellow of the Bangladesh Academy of Sciences (BAS) and the Royal Society of Biology.",institutionString:"Sher-e-Bangla Agricultural University",institution:{name:"Sher-e-Bangla Agricultural University",country:{name:"Bangladesh"}}},{id:"187859",title:"Prof.",name:"Kusal",middleName:"K.",surname:"Das",slug:"kusal-das",fullName:"Kusal Das",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSBDeQAO/Profile_Picture_1623411145568",biography:"Kusal K. Das is a Distinguished Chair Professor of Physiology, Shri B. M. Patil Medical College and Director, Centre for Advanced Medical Research (CAMR), BLDE (Deemed to be University), Vijayapur, Karnataka, India. Dr. Das did his M.S. and Ph.D. in Human Physiology from the University of Calcutta, Kolkata. His area of research is focused on understanding of molecular mechanisms of heavy metal activated low oxygen sensing pathways in vascular pathophysiology. He has invented a new method of estimation of serum vitamin E. His expertise in critical experimental protocols on vascular functions in experimental animals was well documented by his quality of publications. He was a Visiting Professor of Medicine at University of Leeds, United Kingdom (2014-2016) and Tulane University, New Orleans, USA (2017). For his immense contribution in medical research Ministry of Science and Technology, Government of India conferred him 'G.P. Chatterjee Memorial Research Prize-2019” and he is also the recipient of 'Dr.Raja Ramanna State Scientist Award 2015” by Government of Karnataka. He is a Fellow of the Royal Society of Biology (FRSB), London and Honorary Fellow of Karnataka Science and Technology Academy, Department of Science and Technology, Government of Karnataka.",institutionString:"BLDE (Deemed to be University), India",institution:null},{id:"243660",title:"Dr.",name:"Mallanagouda Shivanagouda",middleName:null,surname:"Biradar",slug:"mallanagouda-shivanagouda-biradar",fullName:"Mallanagouda Shivanagouda Biradar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/243660/images/system/243660.jpeg",biography:"M. S. Biradar is Vice Chancellor and Professor of Medicine of\nBLDE (Deemed to be University), Vijayapura, Karnataka, India.\nHe obtained his MD with a gold medal in General Medicine and\nhas devoted himself to medical teaching, research, and administrations. He has also immensely contributed to medical research\non vascular medicine, which is reflected by his numerous publications including books and book chapters. Professor Biradar was\nalso Visiting Professor at Tulane University School of Medicine, New Orleans, USA.",institutionString:"BLDE (Deemed to be University)",institution:{name:"BLDE University",country:{name:"India"}}},{id:"289796",title:"Dr.",name:"Swastika",middleName:null,surname:"Das",slug:"swastika-das",fullName:"Swastika Das",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/289796/images/system/289796.jpeg",biography:"Swastika N. Das is Professor of Chemistry at the V. P. Dr. P. G.\nHalakatti College of Engineering and Technology, BLDE (Deemed\nto be University), Vijayapura, Karnataka, India. She obtained an\nMSc, MPhil, and PhD in Chemistry from Sambalpur University,\nOdisha, India. Her areas of research interest are medicinal chemistry, chemical kinetics, and free radical chemistry. She is a member\nof the investigators who invented a new modified method of estimation of serum vitamin E. She has authored numerous publications including book\nchapters and is a mentor of doctoral curriculum at her university.",institutionString:"BLDEA’s V.P.Dr.P.G.Halakatti College of Engineering & Technology",institution:{name:"BLDE University",country:{name:"India"}}},{id:"248459",title:"Dr.",name:"Akikazu",middleName:null,surname:"Takada",slug:"akikazu-takada",fullName:"Akikazu Takada",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/248459/images/system/248459.png",biography:"Akikazu Takada was born in Japan, 1935. After graduation from\nKeio University School of Medicine and finishing his post-graduate studies, he worked at Roswell Park Memorial Institute NY,\nUSA. He then took a professorship at Hamamatsu University\nSchool of Medicine. In thrombosis studies, he found the SK\npotentiator that enhances plasminogen activation by streptokinase. He is very much interested in simultaneous measurements\nof fatty acids, amino acids, and tryptophan degradation products. By using fatty\nacid analyses, he indicated that plasma levels of trans-fatty acids of old men were\nfar higher in the US than Japanese men. . He also showed that eicosapentaenoic acid\n(EPA) and docosahexaenoic acid (DHA) levels are higher, and arachidonic acid\nlevels are lower in Japanese than US people. By using simultaneous LC/MS analyses\nof plasma levels of tryptophan metabolites, he recently found that plasma levels of\nserotonin, kynurenine, or 5-HIAA were higher in patients of mono- and bipolar\ndepression, which are significantly different from observations reported before. In\nview of recent reports that plasma tryptophan metabolites are mainly produced by\nmicrobiota. He is now working on the relationships between microbiota and depression or autism.",institutionString:"Hamamatsu University School of Medicine",institution:{name:"Hamamatsu University School of Medicine",country:{name:"Japan"}}},{id:"137240",title:"Prof.",name:"Mohammed",middleName:null,surname:"Khalid",slug:"mohammed-khalid",fullName:"Mohammed Khalid",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/137240/images/system/137240.png",biography:"Mohammed Khalid received his B.S. degree in chemistry in 2000 and Ph.D. degree in physical chemistry in 2007 from the University of Khartoum, Sudan. He moved to School of Chemistry, Faculty of Science, University of Sydney, Australia in 2009 and joined Dr. Ron Clarke as a postdoctoral fellow where he worked on the interaction of ATP with the phosphoenzyme of the Na+/K+-ATPase and dual mechanisms of allosteric acceleration of the Na+/K+-ATPase by ATP; then he went back to Department of Chemistry, University of Khartoum as an assistant professor, and in 2014 he was promoted as an associate professor. In 2011, he joined the staff of Department of Chemistry at Taif University, Saudi Arabia, where he is currently an assistant professor. His research interests include the following: P-Type ATPase enzyme kinetics and mechanisms, kinetics and mechanisms of redox reactions, autocatalytic reactions, computational enzyme kinetics, allosteric acceleration of P-type ATPases by ATP, exploring of allosteric sites of ATPases, and interaction of ATP with ATPases located in cell membranes.",institutionString:"Taif University",institution:{name:"Taif University",country:{name:"Saudi Arabia"}}},{id:"63810",title:"Prof.",name:"Jorge",middleName:null,surname:"Morales-Montor",slug:"jorge-morales-montor",fullName:"Jorge Morales-Montor",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/63810/images/system/63810.png",biography:"Dr. Jorge Morales-Montor was recognized with the Lola and Igo Flisser PUIS Award for best graduate thesis at the national level in the field of parasitology. He received a fellowship from the Fogarty Foundation to perform postdoctoral research stay at the University of Georgia. He has 153 journal articles to his credit. He has also edited several books and published more than fifty-five book chapters. He is a member of the Mexican Academy of Sciences, Latin American Academy of Sciences, and the National Academy of Medicine. He has received more than thirty-five awards and has supervised numerous bachelor’s, master’s, and Ph.D. students. Dr. Morales-Montor is the past president of the Mexican Society of Parasitology.",institutionString:"National Autonomous University of Mexico",institution:{name:"National Autonomous University of Mexico",country:{name:"Mexico"}}},{id:"217215",title:"Dr.",name:"Palash",middleName:null,surname:"Mandal",slug:"palash-mandal",fullName:"Palash Mandal",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/217215/images/system/217215.jpeg",biography:null,institutionString:"Charusat University",institution:null},{id:"49739",title:"Dr.",name:"Leszek",middleName:null,surname:"Szablewski",slug:"leszek-szablewski",fullName:"Leszek Szablewski",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49739/images/system/49739.jpg",biography:"Leszek Szablewski is a professor of medical sciences. He received his M.S. in the Faculty of Biology from the University of Warsaw and his PhD degree from the Institute of Experimental Biology Polish Academy of Sciences. He habilitated in the Medical University of Warsaw, and he obtained his degree of Professor from the President of Poland. Professor Szablewski is the Head of Chair and Department of General Biology and Parasitology, Medical University of Warsaw. Professor Szablewski has published over 80 peer-reviewed papers in journals such as Journal of Alzheimer’s Disease, Biochim. Biophys. Acta Reviews of Cancer, Biol. Chem., J. Biomed. Sci., and Diabetes/Metabol. Res. Rev, Endocrine. He is the author of two books and four book chapters. He has edited four books, written 15 scripts for students, is the ad hoc reviewer of over 30 peer-reviewed journals, and editorial member of peer-reviewed journals. Prof. Szablewski’s research focuses on cell physiology, genetics, and pathophysiology. He works on the damage caused by lack of glucose homeostasis and changes in the expression and/or function of glucose transporters due to various diseases. He has given lectures, seminars, and exercises for students at the Medical University.",institutionString:"Medical University of Warsaw",institution:{name:"Medical University of Warsaw",country:{name:"Poland"}}},{id:"173123",title:"Dr.",name:"Maitham",middleName:null,surname:"Khajah",slug:"maitham-khajah",fullName:"Maitham Khajah",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/173123/images/system/173123.jpeg",biography:"Dr. Maitham A. Khajah received his degree in Pharmacy from Faculty of Pharmacy, Kuwait University, in 2003 and obtained his PhD degree in December 2009 from the University of Calgary, Canada (Gastrointestinal Science and Immunology). Since January 2010 he has been assistant professor in Kuwait University, Faculty of Pharmacy, Department of Pharmacology and Therapeutics. His research interest are molecular targets for the treatment of inflammatory bowel disease (IBD) and the mechanisms responsible for immune cell chemotaxis. He cosupervised many students for the MSc Molecular Biology Program, College of Graduate Studies, Kuwait University. Ever since joining Kuwait University in 2010, he got various grants as PI and Co-I. He was awarded the Best Young Researcher Award by Kuwait University, Research Sector, for the Year 2013–2014. He was a member in the organizing committee for three conferences organized by Kuwait University, Faculty of Pharmacy, as cochair and a member in the scientific committee (the 3rd, 4th, and 5th Kuwait International Pharmacy Conference).",institutionString:"Kuwait University",institution:{name:"Kuwait University",country:{name:"Kuwait"}}},{id:"195136",title:"Dr.",name:"Aya",middleName:null,surname:"Adel",slug:"aya-adel",fullName:"Aya Adel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/195136/images/system/195136.jpg",biography:"Dr. Adel works as an Assistant Lecturer in the unit of Phoniatrics, Department of Otolaryngology, Ain Shams University in Cairo, Egypt. Dr. Adel is especially interested in joint attention and its impairment in autism spectrum disorder",institutionString:"Ain Shams University",institution:{name:"Ain Shams University",country:{name:"Egypt"}}},{id:"94911",title:"Dr.",name:"Boulenouar",middleName:null,surname:"Mesraoua",slug:"boulenouar-mesraoua",fullName:"Boulenouar Mesraoua",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94911/images/system/94911.png",biography:"Dr Boulenouar Mesraoua is the Associate Professor of Clinical Neurology at Weill Cornell Medical College-Qatar and a Consultant Neurologist at Hamad Medical Corporation at the Neuroscience Department; He graduated as a Medical Doctor from the University of Oran, Algeria; he then moved to Belgium, the City of Liege, for a Residency in Internal Medicine and Neurology at Liege University; after getting the Belgian Board of Neurology (with high marks), he went to the National Hospital for Nervous Diseases, Queen Square, London, United Kingdom for a fellowship in Clinical Neurophysiology, under Pr Willison ; Dr Mesraoua had also further training in Epilepsy and Continuous EEG Monitoring for two years (from 2001-2003) in the Neurophysiology department of Zurich University, Switzerland, under late Pr Hans Gregor Wieser ,an internationally known epileptologist expert. \n\nDr B. Mesraoua is the Director of the Neurology Fellowship Program at the Neurology Section and an active member of the newly created Comprehensive Epilepsy Program at Hamad General Hospital, Doha, Qatar; he is also Assistant Director of the Residency Program at the Qatar Medical School. \nDr B. Mesraoua's main interests are Epilepsy, Multiple Sclerosis, and Clinical Neurology; He is the Chairman and the Organizer of the well known Qatar Epilepsy Symposium, he is running yearly for the past 14 years and which is considered a landmark in the Gulf region; He has also started last year , together with other epileptologists from Qatar, the region and elsewhere, a yearly International Epilepsy School Course, which was attended by many neurologists from