1) Multicenter Retrospective Analysis of the ITI Implant System Used for Single-Tooth Replacements: Results of Loading for 2 or More Years
Robert A. Levine, DDS*/Donald S. Clem 111, DDS**/Thomas G. Wilson Jr, DDS***/ Frank Higginbottom, DDS****/Gary Solnit, DDS, MS*****
This report involves the retrospective evaluation of ITI implants placed by a group of 12 clinicians located throughout the United States.  Of the original 1 74 single implants placed in 129 patients reported previously, 1 57 were examined in I I 0 patients after 2 or more years (average 40.1 months).  Twenty-two implants remained in the anterior and 1 35 implants (86%) remained in the posterior areas of the mouth, with 81 being restored with an octabutment screw-retained crown and 76 restored with a conical-abutment cemented crown (in function 2 years or longer).  Occlusal screw loosening was observed in 22.2% of implants over both periods, with only I tooth loosening in both study periods (6 months to 2 years and > 2 years).  Loosening of a solid conical abutment occurred in I additional patient, for cumulative conical abutment loosening of 5.3%. Significant radiographic bone loss was observed around 4 implants, with implant fracture noted with 3 additional implants (all mandibular first molars with hollow-screw or hollow-cylinder implant design).  The survival rate at > 2 years was 95.5%. The data suggest that ITI implants can be a satisfactory choice for posterior single-tooth restorations.
INT J ORAL MAXILLOFAC IMPLANTS 1999;1 4:516-520
Our Comments: Findings = 2+ year survival rate same as Nobelbiocare. Almost 25% had screw loosening within 2 years! Lost fixtures were due to implant fracture.

2) Plasma Rich in Growth Factors: Preliminary Results of Use in the Preparation of Future Sites for Implants
EdLAardo Anitua, MD, DDS*
This article presents preliminary clinical evidence of the beneficial effect of the use of plasma rich in growth factors of autologous origin.  The plasma is obtained from the individual patient by plasmapheresis.  The macroscopic and microscopic results obtained with bone regeneration using this technique, which uses no membrane or barrier, can be observed.  The incorporation of these concepts can introduce several advantages, including the enhancement and acceleration of bone regeneration and more rapid and predictable soft tissue healing.
INT J ORAL MAXILLOFAC IMPLANTS 1999;1 4:529-535
Our Comments: Growth factors obtained in concentrated form from a patient's own plasma may accelererate and enhance bone growth and soft tissue healing.

3) Evaluation of Bone-Implant Integration: Efficiency and Precision of 3 Methods
Paul J. McMillan, PhD*/Jay Kim, PhD**/Steve Garrett, DDS, MS***/Max Crigger, DDS, MS****
 Computer-assisted planimetry, computer-assisted lineal analysis, and point-counting stereology have been compared with respect to their reproducibility and the time required to analyze bone-implant  integration. Sections of 6 threaded dental implants selected from a bone augmentation experiment for  their wide range of new bone formation were analyzed by each method 3 times. The bone density and percentage of osseous integration were evaluated at 4 sites around each implant section. It was found eat that computer-assisted planimetry demonstrated a modest but significantly greater variance (P < .05) in bone density estimates when compared to the computer-assisted lineal analysis and point-counting
 methods. Computer-assisted planimetry requires a different method of measuring each parameter and separate fields of view to evaluate fields distant from the implant. However, this can all be accom plished with line probes, as in computer-assisted lineal analysis, which extend from the implant surface into the surrounding alveolar bone. Whereas computer-assisted planimetry requires a separate identification of the perimeter of each field to be analyzed (next to and distant from the implant), computer-assisted lineal analysis allows expansion of the field to be evaluated without creating a new field of  view. Also, following a limited learning curve, both point-counting and computer-assisted lineal analysis required less time to complete than did computer-assisted planimetry.
 INTJ ORAL MAXLLLOFAC IMPLANTS 1999;14:631-638
Our Comments: Well-investigated, detailed study. How much osseointegration is enough? Computer-assisted planimetry more variable. Computer-assisted lineal analysis is a more accurate assessment of  degree of osseointegration. All methods have a large margin of error - all results should be "taken with a grain of salt".

4) Survival of the Branemark Implant in Partially Edentulous jaws: A 1 0-Year Prospective Multicenter Study
Ulf Lekholm, DDS, PhD*/Johan Gunne, DDS, PhD**/Patrick Henry, DDS,PhD***/Kenji Higuchi, DDS, Ms****/Ulf Lind6n, DDS*****/Christina Bergstr6m, MSc******/
Daniel van Steenberghe, DDS, PhD*******
Atotal of127 partially edentulouspatients, treated according to theBranemark protocol, was followed for 10 years after completion of prosthetic treatment.  The patients ranged in age from 1 8 to 70 years, and 57% were female.  Four hundred sixty-one implants were placed in 56 maxillae and 71 mandibles.  In 125 patients, 1 63 fixed partial prostheses were attached to the implants; a majority of the prostheses (83%) were located in posterior regions.  At the end of the 1 0-year period, 73% of the implants could be traced either as failed or in function, providing cumulative implant survival rates of 90.2% and 93.7% for the maxilla and mandible, respectively.  Of the original fixed prostheses, 63% (cumulatively 86.5%) were still in use, whereas the level of continuous cumulative prosthesis function, including primary and remade restorations, was 94.3% at the end of the evaluation period.  Marginal bone resorption at the implants was low (mean = 0.7 mm), and mucosal health was good.  No severe complications apart from the above-mentioned implant and prosthetic failures were reported.  The Branemark Implant System is a safe and predictable method for restoring partially edentulous patients, as demonstrated by this 1 0-year follow-up investigation.
INT J ORAL MAXILLOFAC IMPLANTS 1999;1 4:639-645
Our Comments: Survival rate of implants: maxilla = 90%,  mandible 93%. Found survival rate of prosthesis lower than implants. More prosthetic problems/failures when there are 4 or more implants. Bottom line = single tooth implant survival rate at 10 years same as 5 years.

5) Outcome of Treatment with Implant-Retained Dental Prostheses in Patients with Sjogren Syndrome
Flemming Isidor, DDS, PhD, Dr Odont*/Knud Brondum, DDS**/Hans Jorgen Hansen, DDS, PhD***/John Jensen, DDS, PhD***/Steen Sindet-Pedersen, DDS, Dr Med****
 The purpose of this investigation was to evaluate the outcome of treatment with implant-retained prostheses in patients suffering from Sj6gren syndrome. Eight women were included in the study; all had suffered oral symptoms of Sj6gren syndrome for many years. Seven patients were edentulous in both arches, and I patient was edentulous in the maxilla only. All patients reported poor or very poor comfort levels with their conventional dentures. It was the intention to treat each arch that showed subjective and objective denture problems with a complete fixed prosthesis after placement of 6 implants. In all, 54 Br5nemark dental implants wwe placed in these patients. No implants were lost, but 7 implants in 4 patients were clinically not osseointegrated at the time of the abutment connection procedure. Because of nonosseointegrated implants and lack of jawbone, 3 arches were treated with an implant-retained overdenture. Fixed prostheses were made with a titanium framework of premachined components welded together (Procera) and acrylic resin teeth and flanges. Patients answered a questionnaire regarding their oral function before the onset of treatment and I month and 2 years after treatment. An average radiographic bone loss of 0.7 mm from the time of implant placement to I year after treatment was observed; additional bone loss of less than 0.6 mm was recorded 4 years after treatment. During the first year of function 2 implants lost osseointegration. No prostheses were lost or remade. Treatment with implant-retained prostheses considerably increased the prosthetic comfort and function of the patients. Two years after prosthetic treatment, only 1 patient indicated poor comfort of the prostheses, while the remaining patients reported good or very good comfort levels.
INT J ORAL MAXILLOFAC IMPLANTS 1 999;1 4:736-743
Our Comments:Sjogren Syndrome = auto immune connective tissue disease, one sequelae being decreased or eliminated salivary flow. Can these patients have  implants? Results of study = predictability same as in normal patients. Lack of saliva resulted in increased  gingival irritation from prosthesis.

6) Distraction Osteogenesis to Achieve Mandibular Vertical Bone Regeneration: A Case Report
Giacomo Urboni, MD, DDS*/Giorgio Lombardo, MD, DDS**/Enrico Sonti, DDS***/Ugo Consolo, MD, DDS****
In this case report a surgical technique for vertical ridge augmentation is presented. The procedure, performed in a 30-year-old woman with an atrophied alveolar ridge in the anterior portion of the mandible, is based on the biologic concept of osteogenesis distraction previously introduced in orthopedic and maxillofociol surgery. After elevation of a full-thickness flop a horizontcll osteotomy was performed 7 to 8 mm from the top of the ridge.  Two vertical osteotomies were prepared with drills of increasing diameter (2, 2.8. and 3.25), tapping was performed from the first 5 to 6 mm, and the two distractor base plugs were placed at the base of the osteotomies with a repositioning tool.  An introosseous distraction implont was then inserted and 2 inward vertical cuts were mode in the bone to allow proper distraction to take place.  Correct functioning of the device was checked by distracting the bone fragment I mm using the axial distraction screw A latency distraction healing screw was inserted in each of the distraction implants and the area was left to heal for 5 days. Once primary healing had occurred, the distraction of the newly formed bone callus was activcited each day for 10 days (7 mm per day).  At the end of the distraction period a final distraction screw was left in place and a final healing screw was inserted. During this time there were no complications and the patient on no occasion complained of discomfort.  The distractor device was removed 30 days later leaving the base plugs in place.  One month later a vertical augmentation of 7 mm had been achieved; the base plugs were removed, 3 intraosseous implants were inserted, and a biopsy of the newly formed tissue was obtained.  Histologic evaluation of the biopsy specimen showed woven bone formation approximately 75 days after
the initial procedure.
Int J Periodontics Restorative Dent 1999; 1 9:321-33 1.
Our Comments: Concept originated with Russian orthopedic surgeon in lengthening femur. Bone is surgically "wounded", as healing starts, bone is slightly separated with mechanical screw device, healing clot reorganizes, process is repeated continually until desired lengthening is achieved.

7)  Long-Term Evaluation of 282 Implants in Maxillary and Mandibular Molar Positions. AProspective Study
William Becker,* Burton E. Becker,t Abdulaziz Alsuwyed,t and Sultan Al-Mubarak
Background: Placement of implants into molar positions presents diagnostic, surgical and prosthetic challenges.  There are few reported studies for implants placed into molar positions.  The purpose of this prospective longitudinal study is to report long-term clinical outcomes for 282 implants placed into molar positions.
Methods: Two-hundred-twelve patients received 282 implants.  Implant size, location, jaw shape, and bon*e quality were recorded for all implants placed into molar positions.  Seventy implants were inserted in maxillae and 212 in mandibles.  Marginal bone level changes in maxillae and mandibles were measured from non-standardized periapical radiographs taken at abutment connection and an average follow-up of 3.9 years.  Mesial-distal implant measurements were made from the top of the implant cylinder to the first point of bone to implant contact.  In mandibles, 39 implants were used for single molar replacements, 67 implants were placed into excellent bone quality (type 1) and 113 were in good bone quality (type 11); 145 implants were placed into bone with moderate bone resorption (type B); 166 implants were placed in first molar positions and 46 in second molar sites.
Results: At 6 years the cumulative success rate (CSR) for mandibular implants is 91.5%, and the success rate from the 2 to 3 year fOllOW-UD IS 100%.  Of the 70 implants placed in maxillae, 16 replaced single molars.  Thirty-two implants were placed in jaw shape B with type 2-bone quality.  For maxillary implants, the 6-year CSR was 82.9% and the success rate remained steady at 100% after the 2 to 3 year follow-up.  For maxillary implants, at abutment connection the average marginal bone level was 1.67 mm, while at follow-up it was 1.98 mm.  These differences were statistically significant (P = 0.04), but are not considered to be clinically significant.  For mandibular implants, at abutment connection the mean marginal bone level as measured from radiographs was 2.11 mm, and at follow-up was 2.02 mm. This slight gain in bone level was not statistically significant and is not considered to be clinically significant.
Conclusions: Results of this prospective longitudinal study of implants placed into molar positions indicates favorable clinical outcomes.  These CSR rates (91.5% mandibles, 82.9% maxillae) are less than what has been reported for implants placed into mandibular and maxillary anterior segments.  Differences in outcomes between anterior and posterior locations may be related to bone quality and quantity.
J Periodon tol 1999; 70:896-901.
Our Comments: Study used "regular" 3.75mm implants in molar region, and included "old" Langer-style  5 mm implants with regular table. Cumulative success rate / mandible at 6 years = 91.5% .  CSR / maxilla at 6 years = 82.9%.
 

8) Single implants in the upper incisor region and their relationship to the adjacent teeth. An 8-year follow-up study
 Thilander B, Odman J, Jemt T.
  The aim of the study was to find out if implant-supported crowns in the upper incisor region run the risk of coming into an infraoccluded position later in life. Ten adolescents with 15 implant-supported crowns were included in the study The age of the patients at the implant surgery ranged between 14 and 19 years. They were followed up during an 8-year period.
 No implant loss was observed. A good or acceptable aesthetic appearance at the last observation was found in most subjects. In some of them a change in the vertical position of the implant-supported crown, resulting in infraocclusion, could be registered, especially in subjects with no incisor contact. Throughout the follow-up period, only minor loss of marginal
 bone support was observed at the implants. At the teeth adjacent to the implant, a reduction of the marginal bone level was observed in some patients. Of importance to consider in single implant therapy is that a fixed chronological age is no guidance for implant placement, due to a slight continuous eruption of the adjacent teeth post adolescence. An orthodontic treatment should be performed not only in order to gain space in the implant area, but also to attain good incisor stability to reduce the risk of infraocclusion of the implant-supported crown. Furthermore, 3 cases will exemplify that infraocclusion also may occur in patients who had received single implants at adult ages.
Clin Oral Imp] Res 1999: 10: 346-355
Our Comments:  Growth continues until age 50+. Single-tooth implants placed at an early age may look intruded as patient ages, due to continued growth.

9) Electrically charged GTAM membranes stimulate osteogenesis in rabbit calvarial defects
 Chierico A, Valentini R, Majzoub Z, Piattelli A, Scarano A, Okun L, Andrea Chiericol, Cordioli G.
 Bone neogenesis was studied in membrane-protected defects in a rabbit calvaria defect model using neutral, negatively, and positively charged titanium-reinforced GTAM membranes. Two standardized circular 8 mm wide and I mm deep defects were created in the calvaria of 36 rabbits leaving the inner cortex intact. The defects were subsequently covered with dome-shaped Ti-reinforced GTAM membranes stabilized with a titanium screw allowing the edges of the membranes to be closely approximated to the bone surface. The animals were divided into 6 groups of 6 rabbits each and were sacrificed at 5 days (Group 1), 10 days (Group 2), 3 weeks (Group 3), 5 weeks (Group 4), 10 weeks (Group 5), and 20 weeks (Group 6). The distribution of the 72 membranes according to charge yielded 4 positively charged, 4 negatively charged and 4 neutral domes in each group. Histomorphometric analysis showed a more rapid and increased bone neogenesis with the negatively charged domes. A mean total area of 27.95% of newly-formed bone was observed in the negatively charged membrane sites at 10 days while negligible bone formation occurred with the neutral and positively charged domes at the same evaluation interval. Over time, negatively charged membranes supported more new-bone formation than neutral membranes while positively charged new bone. This work demonstrates negative electrical stimulation accelerates and maintains bone neogenesis.
 These results also suggest the potential applications of negatively charged membranes showed the least new bone. This work demonstrate that negative electrical stimulation accelerate and maintains bone neogenesis. These results suggest the potential applications of negatively charged GTAM membranes in clinical settings.
Clin Oral Impl Res 1999: 10: 415-424
Our Comments: Study was attempt to grow bone outside of skeleton. Manufacturers are able to apply electrostatic charge to membrane, charge does not dissipate. Three groups:
     + charge, - charge, and neutral. There was a difference - negatively charged membrane grew  more bone. Probably the "wave of the future".

10) Histologic Evaluation of Guided Vertical Ridge Augmentation Around Implants in Humans
Stefano Porma-Benfenoti, MD, DDS, MScD*lCorlo Tinti, MD, DDS**L Tomas Albrektsson, MD, PhD, ODhc***ICorino Johonsson, PhD****
Recent experimental and clinical ccise reports demonstrated vertical ridge regeneration in cltrophic posterior mandibles and maxilloe, Although the results from these clinical cases are quite encouraging there is a lock of human histologic dotci on the newly regenerated tissue around commercially available titanium implants.  The oim of the present study was to perform a qualitative and quontitotive histologic analysis of the bone response to previously exposed implant threads after treatment with guided bone regeneration in a series of patients.  A total of 30 Nobel Bioccire implants were consecutively p/oced in 6 pcltients with particilly edentulous mandibles, Of these implants, 6 were planned for removal after I year whereas the remaining 24 implants were inserted to function as support for a fixed partial denture, The 6 experimental implcints were intentionally allowed to protrude occlusally 5 to 7 mm from the bone crest without countersinking, The exposed implant threads were completely covered by outogenous bone chips.  After a 72-month healing period the 6 experimental implants were removed with trephine burs.  Bone-to-metal contact and bone density in the implcint threads were meclsured.  Clinically a// implants were stable and there was complete tissue fi// of the space underneath the membranes.  Histologically a substontial amount of new bone had formed underneath the membrclne in all cases, Histomorphometrically there was a lower bone-to-metol contact percentage in the exposed compared to the nonexposed region in every case, With respect to bone density there was a mean of 43.2% in previously exposed regions compared to 60.3% in previously nonexposed regions.
Int J Periodontics Restorative Dent 1999; 1 9:425-437.
Our Comments: Study from original investigation of reinforced "tent" membranes. Could grow bone on exposed implant threads, but new bone doesn't integrate with implant.