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  • 1.
    Göthberg, C.
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health. Department of Prosthetic Dentistry, Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Gröndahl, K.
    Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health. Department of Oral & Maxillofacial Radiology, Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Omar, O.
    Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Thomsen, P.
    Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Slotte, C.
    Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health. Department of Periodontology, Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Bone and soft tissue outcomes, risk factors, and complications of implant-supported prostheses: 5-Years RCT with different abutment types and loading protocols2018In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 20, no 3, p. 313-321Article in journal (Refereed)
    Abstract [en]

    Background: Data on risk factors and complications after long-term implant treatment is limited. The aims were to evaluate the role of various fixation modes and to analyze complications and risks that affect long-term use of implant-supported partial fixed dental prostheses.

    Materials and Methods: Fifty partially edentulous subjects received three Brånemark TiUnite™ implants. Superstructures were attached directly at implant level (IL) or via abutments: machined surface (AM) and an oxidized surface (AOX, TiUnite™). Implants were immediately loaded (test) or unloaded for 3 months (control). Examinations occurred over a 5-year period.

    Results: Forty-four subjects were re-examined after 5 years. Cumulative survival rates in test and control groups were 93.9% and 97.0%, respectively. Marginal bone loss (MBL; Mean [SEM]) was significantly lower at superstructures connected to AM (1.61 [0.25] mm) than at sites with no abutment IL (2.14 [0.17] mm). Peri-implantitis occurred in 9.1% of subjects and in 4.0% of implants. Multiple linear regression indicated that increased probing pocket depth (PPD), periodontal disease experience, deteriorating health, and light smoking (≤10 cigarettes/day) predict greater MBL, whereas increased buccal soft tissue thickness and higher ISQ predict lower MBL.

    Conclusions: The results show that MBL was influenced by the connection type. A machined abutment, instead of connecting the superstructure directly at the implant level, was beneficial. The following factors influenced MBL: PPD, periodontal disease experience, deteriorating health, light smoking, buccal soft tissue thickness, and ISQ. The results on peri-implantitis underscore the need for long-term maintenance care. Further, the abutment material surface properties constitute additional target for strategies to minimize MBL.

  • 2.
    Sayardoust, Shariel
    et al.
    Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, Sweden, and Department of Periodontology, Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Omar, Omar
    Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Norderyd, Ola
    Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, Sweden, and Department of Periodontology, Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Thomsen, Peter
    Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, and BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, Sweden.
    Clinical, radiological, and gene expression analyses in smokers and non-smokers, Part 2: RCT on the late healing phase of osseointegration2017In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 19, no 5, p. 901-915Article in journal (Refereed)
    Abstract [en]

    Background: The mechanisms behind the impact of smoking on osseointegration are not fully understood.

    Purpose: To investigate the initial clinical and molecular course of osseointegration of different implants in smokers and non-smokers in a randomized controlled trial (RCT).

    Materials and Methods: Smoking (n = 16) and non-smoking (n = 16) patients received 3 implant types: machined, oxidized, and laser-modified surfaces. Baseline bone biopsies were retrieved from the implant sites. After 60 and 90 days, the pain score, implant stability quotient (ISQ), and peri-implant crevicular fluid (PICF) gene expression were analyzed. Furthermore, radiological and clinical assessments were made at 90 days.

    Results: At 90 days, no pain was reported, irrespective of smoking habit. A higher ISQ was found in smokers compared with non-smokers. Marginal bone loss (MBL) was greater in smokers than in non-smokers. The comparison of implant surfaces revealed greater MBL exclusively at the machined implants in smokers. At 90 days in smokers, the PICF around machined implants revealed a higher expression of the proinflammatory cytokine, interleukin-6 (IL-6), and a lower expression of the osteogenic gene, osteocalcin (OC), compared with the PICF around modified implants. Furthermore, OC expression was lower at machined implants in smokers compared with machined implants in non-smokers. After adjustment for age and implant location (maxilla/mandible), multivariate regression revealed the following predictors of MBL: smoking, bleeding on probing at 90 days, hypoxia-inducible factor 1 alpha (HIF-1α) expression at baseline and IL-6 expression in PICF at 90 days.

    Conclusions: During the early phase of osseointegration, non-smokers and smokers present a similar, high implant survival. In contrast, smokers present a greater MBL, particularly at machined implants. HIF-1α baseline expression in the recipient bone and IL-6 expression in PICF cells are important molecular determinants for MBL after 90 days. It is concluded that smoking has an early effect on osseointegration, which is dependent on the implant surface properties and the local host response. 

  • 3.
    Sayardoust, Shariel
    et al.
    Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, BIOMATCELL, VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, Sweden, and Department of Periodontology, Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Omar, Omar
    Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, and BIOMATCELL, VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, Sweden.
    Thomsen, Peter
    Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, and BIOMATCELL, VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, Sweden.
    Gene expression in peri-implant crevicular fluid of smokers and nonsmokers. 1. The early phase of osseointegration2017In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 19, no 4, p. 681-693Article in journal (Refereed)
    Abstract [en]

    Background: Smoking is a risk factor for dental implants. The mechanisms behind the impact of smoking on osseointegration are not fully understood.

    Purpose: To investigate the initial molecular and clinical course of osseointegration of different titanium implants in smokers and nonsmokers.

    Materials and Methods: Smoker (n = 16) and nonsmoker (n = 16) patients were included. Each patient received three implant types: machined, oxidized and laser-modified surfaces. After 1, 7, 14, and 28 days, the peri-implant crevicular fluid (PICF) was sampled for gene expression analysis of selected factors involved in early processes of osseointegration. Furthermore, pain-score (VAS), resonance frequency analysis (RFA) and baseline clinical assessments were performed.

    Results: Early failure of osseointegration, associated with a high and sustained perception of pain, was encountered in 3/32 patients. In general, high pain scores were reported during the first days after implantation, irrespective to smoking habit, which correlated to high levels of pro-inflammatory cytokines during the first days after implantation. Higher ISQ values were found in smokers compared to nonsmokers. In smokers exclusively, ISQ values correlated to harder and less atrophic bone quality and quantity, respectively. Smokers displayed a higher expression of osteocalcin (OC), but later peak and lower expression of bone morphogenetic protein (BMP-2) (at 7 days) compared to nonsmokers. In comparison to machined implants, surface-modified implants were associated with higher expression of alkaline phosphatase (ALP) and cathepsin K (CatK) at 28 days in nonsmokers.

    Conclusions: During the early phase of osseointegration, postoperative pain is linked to the inflammatory cell response and, may tentatively serve as an indicator of biological complication and implant loss. The present study suggests that smokers have an altered bone composition and (ultra)structure based on the observations that ISQ values are higher and correlate to recipient bone quality and quantity in smokers.

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