Numerous authors have dealt with the need to avoid

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1 The Effect of Static Load on Dental Implant Survival: A Systematic Review Patchanee Rungruanganunt, DDS, MSD 1 /Thomas D. Taylor, DDS, MSD 2 / Steven E. Eckert, DDS, MS 3 /Matthias Karl, Priv-Doz Dr Med Dent 4 Purpose: The purpose of this study was to systematically review the current evidence related to the effects of static loading on the long-term stability of the osseointegrated interface. Materials and Methods: The literature search was conducted using Medline supplemented by SCOPUS and the Cochrane databases as well as hand searching from references of reviewed papers. Relevant studies were selected according to predetermined inclusion and exclusion criteria. Key words used in the search included: dental implant passive fit, dental implant misfit, dental implant static load, dental implant overload, orthodontic forces, and dental implants. Results: The initial database search yielded 192 relevant titles. After the subsequent filtering process, 36 studies were finally selected. Twenty-eight articles involved animal studies and eight articles involved human studies. Conclusions: The results of this systematic review demonstrate that there is no apparent detrimental effect of static loading on osseointegrated dental implants. Int J Oral Maxillofac Implants 213;28: doi: /jomi.2888 Key words: dental implant, misfit, passive fit, overload, orthodontic forces, static load Numerous authors have dealt with the need to avoid static loading (misfit) of implant supported restorations 1. Natural teeth have the capacity to shift within their periodontal ligament and orthodontic movement will occur in response to constant pressure that is placed upon the tooth. In contrast to natural teeth, the ankylotic nature of osseointegration is thought to preclude orthodontic movement and one must assume that the strain generated between multiple implants by a prosthesis that is not passive will remain a permanent, unremitting strain within the implant/prosthesis complex. It has been suggested that such permanent strain could have a deleterious effect on the bone 1 Associate Professor, Department of Reconstructive Sciences, School of Dental Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA. 2 Professor and Head, Department of Reconstructive Sciences, School of Dental Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA. 3 Emeritus Professor, Mayo School of Medicine, Rochester, Minnesota, USA. 4 Associate Professor, Department of Prosthodontics, University of Erlangen-Nuremberg, Germany. Correspondence to: Dr Thomas D. Taylor, Department of Reconstructive Sciences, School of Dental Medicine, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 63, USA. Fax: ttaylor@uchc.edu 213 by Quintessence Publishing Co Inc. adjacent to the implants and could potentially cause attachment loss around the implants, leading to implant failure. Two questions must be addressed regarding this topic. First and foremost, is static loading (misfit) damaging to the bone adjacent to osseointegrated dental implants? Second, does strain generated by a misfitting prosthesis tend to dissipate over time, or does osseointegration allow for a reduction in misfit strain over time through osseous remodeling of the bone adjacent to the implant, resulting in bodily movement or shifting of the implant? The purpose of this systematic literature review was to determine current evidence related to these questions and to assess what the effects of prosthetic misfit or static loading may be on the long-term stability of the osseointegrated interface. Materials and Methods A search of the literature was undertaken to identify publications that addressed the issue of misfit and/or static loading on dental implants. Search engines used included Medline supplemented by SCOPUS and the Cochrane databases as well as hand searching from references of reviewed papers. Dates of inclusion were July 1, 1982 through December 31, 211. Key words used in the search included: dental implant passive fit, dental implant misfit, dental implant static load, dental implant overload, orthodontic forces, and dental implants. A master list of articles was established using 1218 Volume 28, Number 5, BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.

2 the key words. The titles and abstracts were reviewed to ensure that articles met inclusion or exclusion criteria. Inclusion criteria were human clinical trials with or without controls and animal studies with controls. The inclusion of orthodontic literature in the search was an attempt to elucidate the effect of static load on dental implants utilized for orthodontic anchorage. Differences in magnitude of forces between those studies examining prosthesis misfit versus those on orthodontic anchorage were not accessible from the papers reviewed, and therefore the orthodontic references were included as sources of information relative to static loading of implants. Articles were excluded if they contained no specific data, were only descriptive, or represented case reports. The full text of articles included was reviewed and data were extracted for tabular display (Tables 1 and 2). Results A total of 192 titles were identified using the key words. Of the initial 192 titles, were selected as having fulfilled the inclusion criteria and were analyzed for content. These are listed in Table 1 along with specific parameters measured. No randomized, controlled clinical trials in humans were found and only eight articles involving human case series or retrospective review were found. Twenty-eight animal studies with controls were found. The majority of studies demonstrated no implant loss when implants were subjected to static or misfit loads. Six of the 36 included studies 13,2,25,28,3,34 reported implant loss (Table 3) and of those 5 dealt with orthodontic use of implants, including mini-implants, while only one 2 reported on prosthetic (misfit) use. Discussion Due to the difficulties of performing human experimentation in this area, it was deemed necessary to include publications that used animal experiments to determine the effects of misfit and static loading on osseointegrated dental implants. Regarding the first question, as to whether misfit or static load can cause deleterious effects to the bone adjacent to implants, examination of the scientific literature currently available on this subject does not demonstrate a negative effect of misfit or static loading of bone adjacent to dental implants The study by Carr et al 7 was not able to demonstrate that static loading was detrimental to bone support of the experimental implants in primates, and the authors speculated that a combination of static and dynamic loading might be necessary to cause clinical or radiographic evidence of bone loss. The same group attempted a further study in rabbits, in which implants were placed in the tibia of nine rabbits, with half being unloaded and half having a 4 micrometer misfit between pairs of implants. The authors were unable to find differences between experimental and control in any of the parameters examined. 26 Another study compared static and dynamic loading to a nonloaded control in a rabbit tibia model and was able to demonstrate differences in bone response to dynamic load compared to static load. 12 Radiographically, bone levels were lower adjacent to dynamically loaded implants, and cratering osseous defects were noted histologically. The differences were statistically significant. Several of the cited studies actually demonstrated higher bone to implant contact (BIC) and/or increased crestal bone levels in misfitting specimens than in controls, leading one to potentially conclude that static loading may in fact be beneficial to the osseointegrated interface. 3,14,22 Gotfredsen et al, 14 in the first of three papers dealing with static loading of multiple implants in the dog model, concluded that there was greater and more dense bone apposition adjacent to statically loaded implants than adjacent to the control nonloaded implants. Other authors 4,9,22,36 demonstrated no histologic or radiographic differences between heavily loaded test implants and unloaded controls. Jemt and Book 2 followed two groups of seven patients each with clinically nonpassive prostheses, one group for 1 year and one group for 5 years. These studies identified no correlation between misfit and bone loss or implant failure. None of the articles reviewed showed evidence that static loading through orthodontic forces or prosthesis misfit caused any recognizable deleterious consequence in the surrounding bone or in the level of osseointegration achieved and maintained. The question as to whether dental implants move through bone or whether the ankylotic connection of osseointegration precludes such movement was addressed in several articles. The combined results do not provide a clear answer to this question. In two articles 14,15 in the series by Gotfredsen et al in dogs, no apparent movement between implants loaded statically was observed, but in the third paper 16 the authors noted that there appeared to be approximately.2 mm of movement of the implant posts measured on casts which could not be confirmed radiographically. The authors postulated that the change in position may have been caused by plastic deformation of the posts themselves rather than by bodily shifting of implants through bone. In another study in the rabbit tibia model, Duyck et al 11 found that implants loaded immediately after placement demonstrated movement through bone of.5 mm on average, while similar implants loaded in a delayed protocol moved substantially less (.2 mm). The International Journal of Oral & Maxillofacial Implants BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.

3 Table 1 Summary of Each Study Study Summary Model Akin-Nergiz et al 2 No significant displacement of implants for any force level. The mobility of the fixtures increased Turkish sheepdogs slightly by about 1 Periotest value (PTV) at the end of experiment. Plasto-elastic bone compression may have resulted from the force on the implants. Aldikacti et al 3 2 g (2 N) load for 52 weeks. Increased radiodensity around the loaded implants and histologic Turkish sheepdogs evidence of increased bone remodeling around test implants. No apparent movement of implants relative to steel ball markers embedded in the arch. Asikainen et al 4 In the histological specimens, no signs of infection or bone loss found around the implants. Sheep No evidence of movement due to orthodontic forces. Buchter et al 5 No movement of implants in bone found in the experimental groups when tipping forces Gottinger minipigs (1, 3, 5 cn) used. Implant loosening only when load was higher than 9 cn mm. Immediate loading used. Buchter et al 6 No movement of implants in bone was found in experimental groups for any applied loads. Gottinger minipigs (observed histology, histomorphometry, SEM in specimens as Buchter et al 5 ) Carr et al 7 Fit group, mean, 38 micron gap; misfit group, mean 345 micron gap; 1 animal sacrificed at each Baboons time point. No statistically significant differences between fit and misfit groups histologically. No occlusal loading. Chen et al 8 Some loaded micro-implants had significant displacement and tipping, average.98 mm (maxilla), Dogs.53 mm (), dependent on bone quality. This may be the result of healing period. De Pauw et al 9 29 regular-size implants total; 3 implants placed in each zygoma of 5 dogs (1 dog only received Dogs 5 implants because of lack of space). 2 used for orthodontic anchorage (5 N) for 8 weeks before animals were sacrificed. No difference in any parameter measured. Duyck et al 1 In vitro: effect of of the torque sequence on the final pre-load was neither statistically significant for axial forces, nor for bending moment. In vivo: presence of external pre-load because of misfit, no clinically relevant problems observed. Duyck et al 11 Immediate loading group with misfit of about 5 µm appeared to move and caused reduction of microgap between prosthesis and implant at 12 weeks. Delayed group did not demonstrate same amount of movement (413 µm mean reduction vs 195 µm for control, large SD). Duyck et al 12 1 static load (4.4 Ncm), 1 dynamic load (73.5 Ncm), and 1 unloaded (control). Results showed bone cratering around dynamic but not in other 2 groups. No difference in BIC. Freire et al 13 Evaluate bone response to statically loaded machined-surface Ti-6Al-4V 2.5 mm mini-implants. Beagle dogs Low-intensity immediate or early orthodontic static loads did not affect performance. Gotfredsen et al 14 3 implant pairs loaded to.2 mm expansion screw opening with 25 g orthodontic load: Beagle dogs 3 pairs at.4 mm, 3 pairs at.6 mm and 3 at (control). Retightened every 4 weeks. No estimate of the applied load. No movement evident, no radiographic difference, higher bone density on loaded groups. Gotfredsen et al 15 3 pairs with machined surface implants and 3 pairs with titanium plasma spray (TPS). Labrador dogs Both groups loaded with.6 mm gaps in expansion screws. No apparent movement, machined showed less BIC than TPS, and more marginal bone loss on machined than TPS. Gotfredsen et al 16 3 implants placed in each quadrant of. Right side loaded to.6 mm at week 1 and Beagle dogs then every 2 weeks up to 1.6 mm. Left side unloaded for 36 weeks then same.6 to 1.6 mm loading protocol for 1 weeks. No difference, appeared to be about.2 mm movement, unable to confirm radiographically. Gotfredsen et al 17 No apparent negative effect of static load on bone levels or density in normal or infected sites. Beagle dogs Hsieh et al 18 No significant change in distance between abutment and mm implants when loaded with Beagle dogs 1 or 2 g. When loaded with 5 g, two adjacent implants moved in a tipping manner after 3 and 6 mo loading (measurements performed on cast and radiograph). Hurzeler et al 19 Repeated mechanical trauma showed no histologic effect on the peri-implant bone loss in Monkeys healthy or in diseased implant sites. Jemt and Book 2 2 groups, 7 patients each. One group followed prospectively for 1 year, other group evaluated retrospectively after 5 years. No prosthesis was completely passive. No correlation between misfit and bone loss or implant failure. Implants seemed to be stable and did not move even after several years in function with misfit prostheses. Jemt and Lekholm 21 Distortion of metal frame observed at time of tightening misfitting screws on 4 implant bridges. Observed complex and inconsistent pattern of deformation, where framework as well as bone may flex up to more than 1 µm as a result of induced misfit. Head of the central implant seemed to show corresponding displacement toward the framework. Jemt et al frames; 9 passive (control), and 15 loaded between 15 and 26 Ncm for 2 3 weeks. More bone formed at the tip of the implant thread for heavily-loaded implants compared to other groups. *Implant number recorded after dropouts. 122 Volume 28, Number 5, BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.

4 Force direction Patients/animals Implants* Follow-up Location Horizontal 3 24 n = 2, 2 wk; n = 5, 24 wk; 1 control implant (per dog) Implant failures Mandible Horizontal wk (long-term loading) 3 Maxilla; 5 Horizontal mo Forehead Horizontal (transverse force by tension coil spring) Horizontal (transverse force by tension coil spring) mini-implants 22 d; 7 d Mandible mini-implants 22 d; 7 d Mandible Horizontal h, 48 h, 1 wk, 2 wk, 3 wk, 4 wk Mandible Horizontal force 2 g immediately 4 6 micro-implants 9 wk Maxilla and Horizontal wk Zygoma Axial force and bending moment (hybrid) In Vitro: 4 fixed fullprostheses on 6 imp In Vivo: 13 pts 77 Mean, 4 9 y ( y) 4 Maxilla, 9 Vertical mo Tibia Torsional d Tibia Horizontal wk Mandible 8 lost after loading Horizontal wk Mandible Horizontal wk Mandible Horizontal wk; 46 wk Mandible Horizontal wk Mandible Horizontal between two-abutment orthodontic pulling force mo Maxilla and Complex occlusal load mo Mandible Vertical y; 5 y Maxilla 5 Vertical 4 12 (observation at loading only) Tibia Vertical wk Tibia The International Journal of Oral & Maxillofacial Implants BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.

5 Table 1 Summary of Each Study (continued) Study Summary Model Jemt and Lekholm 21 Distortion of metal frame observed at time of tightening misfitting screws on 4 implant bridges. Observed complex and inconsistent pattern of deformation, where framework as well as bone may flex up to more than 1 µm as a result of induced misfit. Head of the central implant seemed to show corresponding displacement toward the framework. Jemt et al frames; 9 passive (control), and 15 loaded between 15 and 26 Ncm for 2 3 weeks. More bone formed at the tip of the implant thread for heavily-loaded implants compared to other groups. Linder-Aronson et al 23 No distance change between implant at mandibular molar and canine tooth due to ortho-traction force. No resorption of bone around the implant. Green vervet monkeys Liou et al 24 No movement, in 9 patients. In 7 patients, evidence of tipping of screw head mm. zygoma Authors hypothesized that screws were not osseointegrated due to length of waiting period. Majzoub et al 25 One test implant with good initial stability at insertion showed displacement.5 mm in direction of force. Histology found fibrous encapsulation throughout most of the fixture length. No displacement for other implants. Michaels et al 26 2 implants in each tibia, rabbit sacrificed at 6 weeks for baseline. 8 passive and 8 with 4 µm misfit introduced. No diffs in any of the parameters studied. Miyamoto et al 27 4-wk loading group and 12-wk loading group. Controlled static 25 µm on cantilever. Marginal bone Beagle dogs loss was significantly greater in 12-wk group. Authors suggested overload caused marginal bone loss over time because it exceeds the biologically acceptable range. No evidence of movement. Mortensen et al 28 The linear displacement of the miniscrew implants were associated with load amount rather than Beagle dogs implant length. Average movement is mm. Ohmae et al 29 All mini-implants (anchorage of orthodontic intrusion) remained stable during orthodontic tooth Beagle dogs movement without any mobility or displacement. Palagi et al 3 Shortening the healing for the application of orthodontic forces did not seem to affect the success of osseointegrated implants used as anchorage. Maximum orthodontic force = 2 g. Roberts et al 31 Femoral fracture occurred in both animals with immediately loaded implants. Marta and Carlos 32 Implants were used as an anchorage for orthodontic movement. Force between 1 2 g. No movement was found for all implants. Trisi and Rebaudi 33 Especially in low-quality bone, some implants showed movement in first days of applied traction, showed fixed position after a few weeks. One implant showed some histological evidence of implant possibly having moved approximately 1 mm although the image is very poor. Turley et al 34 All implants that were loaded with orthodontic or orthopedic forces remained stable throughout the period of force activation. No detectable implant movement. alveolar bone Dogs Wang et al 35 Wehrbein et al 36 Wehrbein et al 37 *Implant number recorded after dropouts. Predrilled and self-drilling miniscrews were all significantly displaced. Loading was performed after 2 weeks of healing period. Both were correlated to the length and the loading period. The displacements were. 1.6 mm with extrusion, 1.5 mm with forward or backward tipping at the screw tail, and 1.5 mm with forward tipping at the screw head. No evidence of movement of endosseous titanium implants during and after orthodontic load. Some subperiosteal bone growth around loaded implants. SLA surface implants placed in the mid-palatal and the retromolar pad are successful integration with continuous forces in the order of magnitude of 2 6 N. Foxhounds A large standard deviation was also noted. In their study in humans, Jemt and Book 2 noticed that even after 5 years of static loading with misfitting prostheses there did not appear to be reduction of the levels of misfit, and there was no apparent movement of the implants through bone. In a study in rabbits, Jemt and Lekholm 21 reported that in a three-implant system, in which the two terminal implants are bicortically fixed in the bone and the center implant is only fixed in the superior cortex, both the attached bar and the bone surrounding the central implant deformed upon tightening of the abutment screw connecting the central implant to the bar. These implants were not followed over time, so it could not be determined whether the implants bodily moved through bone, or whether the deformation was elastic in nature and caused solely by 1222 Volume 28, Number 5, BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.

6 Force direction Patients/animals Implants* Follow-up Location Implant failures Vertical 4 12 (observation at loading only) Tibia Vertical wk Tibia Horizontal (traction force between implant and tooth) Horizontal after 2 wk healing Horizontal after 2 wk healing wk Mandible mo (n = 1, 15 g; n = 1, 25 g) Zygoma g for 8 wk Calvaria 1 Horizontal wk Tibia Vertical (cantilever) wk healing + 12 wk loading; 2 wk healing + 4 wk loading Mandible Horizontal wk Maxilla and Vertical wk Mandible 15 Horizontal y Mandible 2 were lost due to lack of osseointegration Horizontal loaded; 28 nonloaded 8 wk Femur Horizontal mo Maxilla and Horizontal after 2 mo healing 41 7 implants removed for histology 2 12 mo (series, 2, 4, 6, 8, 12 mo) 2, palatal; 39, Horizontal wk Maxilla,, temporal bone, zygoma Oblique self-drilling 16 predrilled At least 5 mo Infrazygomatic crest of maxilla 18 Horizontal wk Maxilla and Horizontal and oblique mo Maxilla and the strain of tightening the screws. In another study Jemt and Book 2 found no evidence that misfit of prostheses decreased over time, leading to the assumption that implant displacement did not occur. Of the 23 papers in which the authors examined the presence or absence of displacement of implants, in ,14 15,2 21,23,25,29,32,34,36 no displacement was found, while in 8 8,11,16,18,24,28,33,35 implant displacement was noted. Of those in which displacement was noted, four 8,24,28,35 involved the use of mini- or microorthodontic anchors utilizing either immediate loading or loading at 2 weeks post-placement, which might have had some negative effect on the generation of an osseointegrated interface. It may also be assumed that the implants in question were not osseointegrated. Two were in dog models, with the Gotfredsen et al study 16 The International Journal of Oral & Maxillofacial Implants BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.

7 Table 2 In Vivo Studies Grouped by Displacement and Loading Study model Implant displacement No displacement Orthodontic loading Misfit Dog Chen et al 8 Gotfredsen et al 16 Hsieh et al 18 Mortensen et al 28 Akin-Nergiz et al 2 Aldikacti et al 3 Gotfredsen et al 14,15 Ohmae et al 29 Turley et al 34 Wehrbein and Diedrich 36 Akin-Nergiz et al 2 Aldikacti et al 3 Chen et al 8 Gotfredsen et al 14,15 Hsieh et al 18 Mortensen et al 28 Ohmae et al 29 Turley et al 34 Wehrbein and Diedrich 36 Pig Buchter et al 5 Buchter et al 6 Buchter et al 5 Buchter et al 6 Monkey Linder-Aronson et al 23 Linder-Aronson et al 23 Liou et al 24 Trisi and Rebaudi 33 Wang and Liou 35 Jemt and Book 2 Liou et al 24 Marta and Carlos 32 Marta and Carlos 32 Trisi and Rebaudi 33 Wang and Liou 35 Jemt and Book 2 Rabbit Duyck et al 11 Jemt and Lekholm 21 Majzoub et al 25 Duyck et al 11 Majzoub et al 25 Jemt and Lekholm 21 Sheep Asikainen et al 4 Asikainen et al 4 Table 3 Studies with Implant Loss Implants lost in Implants lost in Study Model Implants placed Implants lost prosthetic studies orthodontic studies Freire et al 13 Beagle dogs Jemt and Book Majzoub et al Mortensen et al 28 Beagle dogs Palagi et al Turley et al 34 Dogs Total describing what appeared to be about.2 mm movement of one implant on a cast made from a dog s mouth, but this could not be confirmed radiographically. The other study utilizing a dog model (Hsieh et al 18 ) utilized one dog with multiple implants loaded to 1, 2, or 5 grams, and found movement only in the 5 gram pair of implants after 3 months of loading. In one study involving human subjects, Trisi and Rebaudi 33 made the observation, Some of the implants seemed to move during the first days of traction in the direction of the traction and to find a fixed position after a few weeks of traction, especially when they had been placed in very low-quality bone. The method of measurement was not defined and all implants were loaded with between 8 and 12 grams of orthodontic traction after 2 months of undisturbed healing. In a study conducted in the rabbit tibia, Duyck et al 11 noticed significant plastic deformation in misfitting prosthesis/implant constructions and suggested that continued implant displacement could result in lowered misfit strain between the implant and the prosthesis, although these results were not statistically significant. It is not clear from this review whether titanium implants that are osseointegrated before static load is applied remain immobile in the bone with no reduction of static loading, or whether there is some adjustment through osseous remodeling which decreases the static load associated with a misfitting prosthesis or orthodontic anchorage. Conclusions The results of this systematic review demonstrate that there is no apparent detrimental effect of misfit/static loading on osseointegrated dental implant survival. Negative effects caused specifically by nonpassively adapted prostheses or by excessive orthodontic loading have not been described in the literature. Whether osseointegrated implants can be made to change posi 1224 Volume 28, Number 5, BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.

8 tion in the bone over time due to static loading is unclear at this time as some studies have demonstrated what is described as bodily tipping or movement of implants while others have demonstrated a complete absence of bodily movement of osseointegrated implants. AcknowledGMent The authors reported no conflicts of interest related to this study. REFerenCes 1. Finger I, Guerra L. Development of the Occlusal Scheme in Implant Prosthodontics. In: Block MS, Kent JN. Endosseous Implants for Maxillofacial Reconstruction. Philadelphia: W.B. Saunders, 1995: Akin-Nergiz N, Nergiz I, Schulz A, Arpak N, Niedermeier W. Reactions of peri-implant tissues to continuous loading of osseointegrated implants. Am J Orthod Dentofacial Orthop 1998;114: Aldikacti M, Acikgoz G, Turk T, Trisi P. Long-term evaluation of sandblasted and acid-etched implants used as orthodontic anchors in dogs. Am J Orthod Dentofacial Orthop 24;125: Asikainen P, Klemetti E, Vuillemin T, Sutter F, Rainio V, Kotilainen R. Titanium implants and lateral forces. An experimental study with sheep. Clin Oral Implants Res 1997;8: Buchter A, Wiechmann D, Koerdt S, Wiesmann HP, Piffko J, Meyer U. Load-related implant reaction of mini-implants used for orthodontic anchorage. Clin Oral Implants Res 25;16: Buchter A, Wiechmann D, Gaertner C, Hendrik M, Vogeler M, Wiesmann HP. Load-related bone modeling at the interface of orthodontic micro-implants. Clin Oral Implants Res 26;17: Carr A, Gerard D, Larsen P. The response of bone in primates around unloaded dental implants supporting prostheses with different levels of misfit. J Prosthet Dent 1996;76: Chen Y, Kang ST, Bae S, Kyung H. Clinical and histologic analysis of the stability of microimplants with immediate orthodontic loading in dogs. Am J Orthod Dentofacial Orthop 29;136: De Pauw GAM, Dermaut LR, Johansson CB, Martens G. A histomorphometric analysis of heavily loaded and non-loaded implants. Int J Oral Maxillofac Implants 22;17: Duyck J, Oosterwyck V, Sloten JV, Cooman M, Puers R, Naert I. Pre-load on oral implants after screw tightening fixed full prostheses: An in vivo study. J Oral Rehabil 21;28: Duyck J, Vrielinck L, Lambrichts I, Abe Y, Schepers S, Politis C. Biologic response of immediately versus delayed loaded implants supporting ill-fitting prostheses: An animal study. Clin Implant Dent Relat Res 25;7: Duyck J, Ronold H, Oosterwyck H, Naert I, Sloten J, Ellingsen J. The influence of static and dynamic loading on marginal bone reactions around osseointegrated implants: An animal experimental study. Clin Oral Implants Res 21;12: Freire JNO, Silva NR, Gil JN, Magini RS, Coelho PG. Histomorphologic and histomophometric evaluation of immediatedly and early loaded mini-implants for orthodontic anchorage. Am J Orthod Dentofacial Orthop 27;131:74.e1 e Gotfredsen K, Berglundh T, Lindhe J. Bone reactions adjacent to titanium implants subjected to static load. A study in the dog (I). Clin Oral Implants Res 21;12: Gotfredsen K, Berglundh T, Lindhe J. Bone reactions adjacent to titanium implants with different surface characteristics subjected to static load. A study in the dog (II) Clin Oral Implants Res 21;12: Gotfredsen K, Berglundh T, Lindhe J. Bone reactions adjacent to titanium implants subjected to static load of different duration. A study in the dog (III) Clin Oral Implants Res 21;12: Gotfredsen K, Berglundh T, Lindhe J. Bone reactions at implants subjected to experimental peri-implantitis and static load. A study in the dog. J Clin Periodontol 22;29: Hsieh Y, Su C, Yang Y, Fu E, Chen H, Kung S. Evaluation on the movement of endosseous titanium implants under continuous orthodontic forces: An experimental study in dog. Clin Oral Implants Res 28;19: Hurzeler MB, Quinones CR, Kohal RJ, Rohde M, Strub JR, Teuscher U. Changes in peri-implant tissues subjected to orthodontic forces and ligature breakdown in monkeys. J Periodontol 1998;69: Jemt T, Book K. Prosthesis misfit and marginal bone loss in edentulous implant patients. Int J Oral Maxillofac Implants 1996;11: Jemt T, Lekholm U. Measurements of bone and framework deformations induced by misfit of implant superstructure. A pilot study in rabbits. Clin Oral Implants Res 1998;9: Jemt T, Lekholm U, Johansson C. Bone response to implant-supported frameworks with differing degrees of misfit preload: In vivo study in rabbits. Clin Implant Dent Relat Res 2;2: Linder-Aronson S, Nordenram A, Anneroth G. Titanium implant anchorage in orthodontic treatment: An experimental investigation in monkeys. Eur J Orthod 199;12: Liou EJW, Pai BCJ, Lin JCY. Do miniscrews remain stationary under orthodontic forces? Am J Orthod Dentofacial Orthop 24;126: Majzoub Z, Finotti M, Miotti F, Giardino R, Aldini NN, Cordioli G. Bone response to orthodontic loading of endosseous implants in the rabbit calvaria: Early continuous distalizing forces. Eur J Orthod 1999;21: Michaels GC, Carr AB, Larsen PE. Effect of prosthetic superstructure accuracy on the osteointegrated implant bone interface. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;83: Miyamoto Y, Koretake K, Hirata M, Kubo T, Akagawa Y. Influence of static overload on the bony interface around implants in dogs. Int J Prosthodont 28;21: Mortensen MG, Buschang PH, Oliver DR, Kyung H, Behrents RG. Stability of immediately loaded 3- and 6-mm miniscrew implants in beagle dogs A pilot study. Am J Orthod Dentofacial Orthop 29;136: Ohmae M, Saito S, Morohashi T, Seki K, Qu H, Kanomi R. A clinical and histological evaluation of titanium mini-implants as anchors of orthodontic intrusion in the beagle dog. Am J Orthod Dentofacial Orthop 21;119: Palagi LM, Sabrosa CE, Gava ECB, Baccetti T, Miguel JAM. Long-term follow-up of dental single implants under immediate orthodontic load. Angle Orthod 21;8: Roberts WE, Smith RK, Ziberman Y, Mozsary PG, Smith RS. Osseous adaptation to continuous loading or rigid endosseous implants. Am J Orthod 1984;86: Marta RC, Carlos IJ. Assessing double acid-etched implants submitted to orthodontic forces and used as prosthetic anchorages in partially edentulous patients. Open Dent J 28;2: Trisi P, Rebaudi A. Progressive bone adaptation of titanium implants during and after orthodontic load in humans. Int J Periodontics Restorative Dent 22;22: Turley PK, Kean C, Schur J, et al. Orthodontic force application to titanium endosseous implants. Angle Orthod 1988;58: Wang Y, Liou EJW. Comparison of the loading behavior of selfdrilling and predrilled miniscrews throughout orthodontic loading. Am J Orthod Dentofacial Orthop 28;133: Wehrbein H, Diedrich P. Endosseous titanium implants during and after orthodontic load An experimental study in the dog. Clin Oral Implants Res 1993;4: Wehrbein H, Merz BR, Hammerle CHF, Lang NP. Bone-to-implant contact of orthodontic implants in humans subjected to horizontal loading. Clin Oral Implants Res 1998;9: The International Journal of Oral & Maxillofacial Implants BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.

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