Part of the book: Computed Tomography
The prevalence of tooth loss and edentulism is among the most ubiquitous diseases of human history. Dental implants have been widely used for the treatment of any type of edentulism. However, the absence of sufficient bone volume usually limits the placement of implants. Many techniques and materials have been developed to restore an adequate volume of bone for future implant placement, but the process of biodegradation and replacement with new bone tissue is still under debate for all grafting materials. Among the available biomaterials, calcium phosphates (CaP) have been under the spot light for their advantages such as the ease of production and lack of disease transfer. The preparation of the material in two phases allowed self-hardening and subsequent space maintenance where it applied. This was of critical importance in load-bearing implants and joint prosthesis where rapid and strong healing is required. The injectability also allowed a better handling and manipulation in compromised areas such as the oral cavity. A novel form of injectable calcium phosphate cement (iCaP) with two distinct formulations was tested on dog tibiae. Healing and ossification at 4 and 12 weeks were assessed by histologic and histomorphometric analysis. No adverse reactions or negative consequences were noted. Mean new bone formation was 22.12 (SD, 15.68), 18.62 (SD, 13.11), and 9.56 (SD, 11.11)% in the groups 1, 2, and the control, respectively. Statistically, significant higher new bone formation was evident in the groups 1 and 2 as compared to the control group (p < 0.01). However, these differences were no more discernable after 12 weeks of healing. The results of the present investigation showed excellent in vivo biocompatibility but insufficient biodegradation of the iCaP in the center of the defect area. Further attempts are required to expedite the biodegradation of the iCaP.
Part of the book: Dental Implantology and Biomaterial
As a result of the increase of the life expectancy, elder people live with diverse diseases or conditions like systemic disorders, immune-related disorders, and psychiatric issues. Consecutively, practicing clinicians are faced with serving dental implant treatments in such a population comprised of medical and demographic characteristics. Most commonly, implant therapy is performed among patients above middle ages; therefore, clinicians often encounter medically compromised patients. The patients are usually with adverse conditions like bleeding disorders, bone diseases, cardiovascular disease (CVD), and/or immunologic conditions like cancer therapy, steroid or immunosuppressive or antiresorptive medication, alcoholism, smoking, and many others. Nevertheless, only few conditions could be stated for contraindication to dental implant therapy. Besides the broad range of the mentioned dental implant comorbidities smoking seems less prevalent compared to the general population. Dental implants in smoking patients are certainly affected in relation to the failure rate, marginal bone loss, and some other risks of postoperative complications. Hence, smoking or other similar conditions could be accounted as a chronic systemic disorder just like diabetes mellitus or drug usage. Briefly, it seems that establishing the medical and demographic conditions prior to implant therapy along with controlling the systemic diseases or disorders may be more important than the presence of compromise.
Part of the book: Clinical Trials in Vulnerable Populations