Peri-implant evaluation of osseointegrated implants subjected to orthodontic forces: results after three years of functional loading
Identifieur interne : 000623 ( Pmc/Corpus ); précédent : 000622; suivant : 000624Peri-implant evaluation of osseointegrated implants subjected to orthodontic forces: results after three years of functional loading
Auteurs : Bruna De Rezende Marins ; Suy Ellen Pramiu ; Mauro Carlos Agner Busato ; Luiz Carlos Marchi ; Adriane Yaeko TogashiSource :
- Dental Press Journal of Orthodontics [ 2176-9451 ] ; 2016.
Abstract
The objective of this study was to clinically and radiographically assess the peri-implant conditions of implants used as orthodontic anchorage.
Two groups were studied: 1) a test group in which osseointegrated implants were used as orthodontic anchorage, with the application of 200-cN force; and 2) a control group in which implants were not subjected to orthodontic force, but supported a screw-retained prosthesis. Clinical evaluations were performed three, six and nine months after prosthesis installation and 1- and 3-year follow-up examinations. Intraoral periapical radiographs were obtained 30 days after surgical implant placement, at the time of prosthesis installation, and one, two and three years thereafter. The results were compared by Kruskal-Wallis test.
There was no statistically significant difference in clinical probing depth
(
Results suggest that the use of stable intraoral orthodontic anchorage did not compromise the health of peri-implant tissues or the longevity of the implant.
Url:
DOI: 10.1590/2177-6709.21.2.073-080.oar
PubMed: 27275618
PubMed Central: 4896285
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Peri-implant evaluation of osseointegrated implants subjected to
orthodontic forces: results after three years of functional loading</title><author><name sortKey="Marins, Bruna De Rezende" sort="Marins, Bruna De Rezende" uniqKey="Marins B" first="Bruna De Rezende" last="Marins">Bruna De Rezende Marins</name><affiliation><nlm:aff id="aff1">Graduate student in Oral and Maxillofacial Surgery, Universidade Estadual do Oeste do Paraná (UNIOESTE), School of Dentistry, Cascavel, Paraná, Brazil.</nlm:aff></affiliation></author><author><name sortKey="Pramiu, Suy Ellen" sort="Pramiu, Suy Ellen" uniqKey="Pramiu S" first="Suy Ellen" last="Pramiu">Suy Ellen Pramiu</name><affiliation><nlm:aff id="aff2">Undergraduate student, Universidade Estadual do Oeste do Paraná (UNIOESTE), School of Dentistry, Cascavel, Paraná, Brazil.</nlm:aff></affiliation></author><author><name sortKey="Busato, Mauro Carlos Agner" sort="Busato, Mauro Carlos Agner" uniqKey="Busato M" first="Mauro Carlos Agner" last="Busato">Mauro Carlos Agner Busato</name><affiliation><nlm:aff id="aff3">Professor, Universidade Estadual do Oeste do Paraná (UNIOESTE), Department of Orthodontics, School of Dentistry, Cascavel, Paraná, Brazil.</nlm:aff></affiliation></author><author><name sortKey="Marchi, Luiz Carlos" sort="Marchi, Luiz Carlos" uniqKey="Marchi L" first="Luiz Carlos" last="Marchi">Luiz Carlos Marchi</name><affiliation><nlm:aff id="aff3">Professor, Universidade Estadual do Oeste do Paraná (UNIOESTE), Department of Orthodontics, School of Dentistry, Cascavel, Paraná, Brazil.</nlm:aff></affiliation></author><author><name sortKey="Togashi, Adriane Yaeko" sort="Togashi, Adriane Yaeko" uniqKey="Togashi A" first="Adriane Yaeko" last="Togashi">Adriane Yaeko Togashi</name><affiliation><nlm:aff id="aff4">Professor of Periodontology and Oral Implantology, Universidade Estadual do Oeste do Paraná (UNIOESTE), Department of Implantology, School of Dentistry, Cascavel, Paraná, Brazil.</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27275618</idno><idno type="pmc">4896285</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4896285</idno><idno type="RBID">PMC:4896285</idno><idno type="doi">10.1590/2177-6709.21.2.073-080.oar</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">000623</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000623</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Peri-implant evaluation of osseointegrated implants subjected to
orthodontic forces: results after three years of functional loading</title><author><name sortKey="Marins, Bruna De Rezende" sort="Marins, Bruna De Rezende" uniqKey="Marins B" first="Bruna De Rezende" last="Marins">Bruna De Rezende Marins</name><affiliation><nlm:aff id="aff1">Graduate student in Oral and Maxillofacial Surgery, Universidade Estadual do Oeste do Paraná (UNIOESTE), School of Dentistry, Cascavel, Paraná, Brazil.</nlm:aff></affiliation></author><author><name sortKey="Pramiu, Suy Ellen" sort="Pramiu, Suy Ellen" uniqKey="Pramiu S" first="Suy Ellen" last="Pramiu">Suy Ellen Pramiu</name><affiliation><nlm:aff id="aff2">Undergraduate student, Universidade Estadual do Oeste do Paraná (UNIOESTE), School of Dentistry, Cascavel, Paraná, Brazil.</nlm:aff></affiliation></author><author><name sortKey="Busato, Mauro Carlos Agner" sort="Busato, Mauro Carlos Agner" uniqKey="Busato M" first="Mauro Carlos Agner" last="Busato">Mauro Carlos Agner Busato</name><affiliation><nlm:aff id="aff3">Professor, Universidade Estadual do Oeste do Paraná (UNIOESTE), Department of Orthodontics, School of Dentistry, Cascavel, Paraná, Brazil.</nlm:aff></affiliation></author><author><name sortKey="Marchi, Luiz Carlos" sort="Marchi, Luiz Carlos" uniqKey="Marchi L" first="Luiz Carlos" last="Marchi">Luiz Carlos Marchi</name><affiliation><nlm:aff id="aff3">Professor, Universidade Estadual do Oeste do Paraná (UNIOESTE), Department of Orthodontics, School of Dentistry, Cascavel, Paraná, Brazil.</nlm:aff></affiliation></author><author><name sortKey="Togashi, Adriane Yaeko" sort="Togashi, Adriane Yaeko" uniqKey="Togashi A" first="Adriane Yaeko" last="Togashi">Adriane Yaeko Togashi</name><affiliation><nlm:aff id="aff4">Professor of Periodontology and Oral Implantology, Universidade Estadual do Oeste do Paraná (UNIOESTE), Department of Implantology, School of Dentistry, Cascavel, Paraná, Brazil.</nlm:aff></affiliation></author></analytic><series><title level="j">Dental Press Journal of Orthodontics</title><idno type="ISSN">2176-9451</idno><idno type="eISSN">2177-6709</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>ABSTRACT</title><sec><title>Objective:</title><p> The objective of this study was to clinically and radiographically assess the
peri-implant conditions of implants used as orthodontic anchorage. </p></sec><sec><title>Methods:</title><p> Two groups were studied: 1) a test group in which osseointegrated implants were
used as orthodontic anchorage, with the application of 200-cN force; and 2) a
control group in which implants were not subjected to orthodontic force, but
supported a screw-retained prosthesis. Clinical evaluations were performed three,
six and nine months after prosthesis installation and 1- and 3-year follow-up
examinations. Intraoral periapical radiographs were obtained 30 days after
surgical implant placement, at the time of prosthesis installation, and one, two
and three years thereafter. The results were compared by Kruskal-Wallis test. </p></sec><sec><title>Results: </title><p>There was no statistically significant difference in clinical probing depth
(<italic>p</italic> = 0.1078) or mesial and distal crestal bone resorption
(<italic>p</italic> = 0.1832) during the study period. After three years of
follow-up, the mean probing depth was 2.21 mm for the control group and 2.39 mm
for the test group. The implants of the control group showed a mean distance
between the bone crest and implant shoulder of 2.39 mm, whereas the implants used
as orthodontic anchorage showed a mean distance of 2.58 mm at the distal site.
</p></sec><sec><title>Conclusion: </title><p>Results suggest that the use of stable intraoral orthodontic anchorage did not
compromise the health of peri-implant tissues or the longevity of the implant.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Adell, R" uniqKey="Adell R">R Adell</name></author><author><name sortKey="Lekholm, U" uniqKey="Lekholm U">U Lekholm</name></author><author><name sortKey="Rockler, B" uniqKey="Rockler B">B Rockler</name></author><author><name sortKey="Branemark, Pi" uniqKey="Branemark P">PI Branemark</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Carri N, Jp" uniqKey="Carri N J">JP Carrión</name></author><author><name sortKey="Barbosa, Ir" uniqKey="Barbosa I">IR Barbosa</name></author><author><name sortKey="L Pez, Jp" uniqKey="L Pez J">JP. López</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Jones, Sd" uniqKey="Jones S">SD Jones</name></author><author><name sortKey="Jones, Fr" uniqKey="Jones F">FR. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Dental Press J Orthod</journal-id><journal-id journal-id-type="iso-abbrev">Dental Press J Orthod</journal-id><journal-id journal-id-type="publisher-id">dpjo</journal-id><journal-title-group><journal-title>Dental Press Journal of Orthodontics</journal-title></journal-title-group><issn pub-type="ppub">2176-9451</issn><issn pub-type="epub">2177-6709</issn><publisher><publisher-name>Dental Press International</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27275618</article-id><article-id pub-id-type="pmc">4896285</article-id><article-id pub-id-type="doi">10.1590/2177-6709.21.2.073-080.oar</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group></article-categories><title-group><article-title>Peri-implant evaluation of osseointegrated implants subjected to
orthodontic forces: results after three years of functional loading</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Marins</surname><given-names>Bruna de Rezende</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Pramiu</surname><given-names>Suy Ellen</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Busato</surname><given-names>Mauro Carlos Agner</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Marchi</surname><given-names>Luiz Carlos</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Togashi</surname><given-names>Adriane Yaeko</given-names></name><xref ref-type="aff" rid="aff4"><sup>4</sup></xref></contrib></contrib-group><aff id="aff1"><label>1</label>Graduate student in Oral and Maxillofacial Surgery, Universidade Estadual do Oeste do Paraná (UNIOESTE), School of Dentistry, Cascavel, Paraná, Brazil.</aff><aff id="aff2"><label>2</label>Undergraduate student, Universidade Estadual do Oeste do Paraná (UNIOESTE), School of Dentistry, Cascavel, Paraná, Brazil.</aff><aff id="aff3"><label>3</label>Professor, Universidade Estadual do Oeste do Paraná (UNIOESTE), Department of Orthodontics, School of Dentistry, Cascavel, Paraná, Brazil.</aff><aff id="aff4"><label>4</label>Professor of Periodontology and Oral Implantology, Universidade Estadual do Oeste do Paraná (UNIOESTE), Department of Implantology, School of Dentistry, Cascavel, Paraná, Brazil.</aff><author-notes><corresp id="c1">Contact address: Adriane Yaeko Togashi Rua Universitária, 2069 - Jd.
Universitário, Cascavel/PR - Brasil CEP: 85.814-110 - E-mail:
<email>adriane.togashi@unioeste.br</email></corresp><fn fn-type="con" id="fn1"><p>Author contributions Conception or design of the study: MCAB, LCM, AYT. Data
acquisition, analysis or interpretation: BRM, SEP, MCAB, LCM, AYT. Writing the
article: BRM, SEP, MCAB, LCM, AYT. Critical revision of the article: BRM, SEP,
AYT. Final approval of the article: BRM, SEP, MCAB, LCM, AYT. Obtained funding:
AYT. Overall responsibility: BRM, SEP, MCAB, LCM, AYT.</p></fn></author-notes><pub-date pub-type="epub-ppub"><season>Mar-Apr</season><year>2016</year></pub-date><pmc-comment>Fake ppub date generated by PMC from publisher
pub-date/@pub-type='epub-ppub' </pmc-comment>
<pub-date pub-type="ppub"><season>Mar-Apr</season><year>2016</year></pub-date><volume>21</volume><issue>2</issue><fpage>73</fpage><lpage>80</lpage><history><date date-type="received"><day>05</day><month>10</month><year>2015</year></date><date date-type="accepted"><day>08</day><month>1</month><year>2016</year></date></history><permissions><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open-access article distributed under the terms of the Creative
Commons Attribution License</license-p></license></permissions><abstract><title>ABSTRACT</title><sec><title>Objective:</title><p> The objective of this study was to clinically and radiographically assess the
peri-implant conditions of implants used as orthodontic anchorage. </p></sec><sec><title>Methods:</title><p> Two groups were studied: 1) a test group in which osseointegrated implants were
used as orthodontic anchorage, with the application of 200-cN force; and 2) a
control group in which implants were not subjected to orthodontic force, but
supported a screw-retained prosthesis. Clinical evaluations were performed three,
six and nine months after prosthesis installation and 1- and 3-year follow-up
examinations. Intraoral periapical radiographs were obtained 30 days after
surgical implant placement, at the time of prosthesis installation, and one, two
and three years thereafter. The results were compared by Kruskal-Wallis test. </p></sec><sec><title>Results: </title><p>There was no statistically significant difference in clinical probing depth
(<italic>p</italic> = 0.1078) or mesial and distal crestal bone resorption
(<italic>p</italic> = 0.1832) during the study period. After three years of
follow-up, the mean probing depth was 2.21 mm for the control group and 2.39 mm
for the test group. The implants of the control group showed a mean distance
between the bone crest and implant shoulder of 2.39 mm, whereas the implants used
as orthodontic anchorage showed a mean distance of 2.58 mm at the distal site.
</p></sec><sec><title>Conclusion: </title><p>Results suggest that the use of stable intraoral orthodontic anchorage did not
compromise the health of peri-implant tissues or the longevity of the implant.</p></sec></abstract><trans-abstract xml:lang="pt"><title>RESUMO</title><sec><title>Introdução:</title><p> o objetivo do presente estudo foi avaliar, clínica e radiograficamente, as
condições peri-implantares de implantes usados como ancoragem ortodôntica. </p></sec><sec><title>Métodos: </title><p>dois grupos foram estudados: 1) Grupo Teste - no qual os implantes
osseointegráveis foram utilizados como ancoragem ortodôntica, com aplicação de uma
força de 200cN; e 2) Grupo Controle - no qual os implantes não foram submetidos à
ancoragem ortodôntica, apenas serviram de suporte para fixação de prótese
implantossuportada. Avaliações clínicas foram realizadas aos 3, 6 e 9 meses após a
instalação das próteses, e após 1 e 3 anos de acompanhamento. Radiografias
periapicais intrabucais foram obtidas 30 dias após a colocação do implante, no
momento da instalação da prótese e após 1, 2 e 3 anos de acompanhamento. Os
resultados foram comparados pelo teste de Kruskal-Wallis. </p></sec><sec><title>Resultados: </title><p>não houve diferenças quanto à profundidade clínica de sondagem (<italic>p</italic>= 0,1078) e a reabsorção das cristas ósseas mesial e distal (<italic>p</italic> =
0,1832) durante o período avaliado. Após três anos de acompanhamento, a média de
profundidade de sondagem foi de 2,21mm para o Grupo Controle e de 2,39mm para o
Grupo Teste. Os implantes do Grupo Controle apresentaram distância média de 2.39mm
entre a crista óssea e o ombro do implante, enquanto os implantes usados como
ancoragem ortodôntica mostraram distância média de 2,58mm na distal. </p></sec><sec><title>Conclusão: </title><p>esses resultados sugerem que o uso de uma ancoragem intrabucal estável não
compromete a saúde dos tecidos peri-implantares ou a longevidade do implante.</p></sec></trans-abstract><kwd-group><title>Keywords:</title><kwd>Bones</kwd><kwd>Dental implants</kwd><kwd>Orthodontic appliances</kwd><kwd>Osseointegration</kwd></kwd-group><counts><fig-count count="6"></fig-count><table-count count="5"></table-count><equation-count count="0"></equation-count><ref-count count="30"></ref-count><page-count count="8"></page-count></counts></article-meta></front><body><sec sec-type="intro"><title>INTRODUCTION</title><p>Osseointegrated titanium implants were initially used as abutment for prosthetic
reconstruction in fully edentulous patients in order to increase masticatory
function.<xref rid="B1" ref-type="bibr"><sup>1</sup></xref><sup>,</sup><xref rid="B2" ref-type="bibr"><sup>2</sup></xref><sup>,</sup><xref rid="B3" ref-type="bibr"><sup>3</sup></xref> The implants were later used extensively to replace missing teeth in partially
edentulous patients, allowing for preservation of the remaining dental structures.<xref rid="B1" ref-type="bibr"><sup>1</sup></xref><sup>,</sup><xref rid="B4" ref-type="bibr"><sup>4</sup></xref><sup>,</sup><xref rid="B5" ref-type="bibr"><sup>5</sup></xref><sup>,</sup><xref rid="B6" ref-type="bibr"><sup>6</sup></xref> Other indications have been proposed for osseointegrated implants, such as
orthodontic or maxillofacial anchorage,<xref rid="B7" ref-type="bibr"><sup>7</sup></xref><sup>-</sup><xref rid="B11" ref-type="bibr"><sup>11</sup></xref> since decayed or missing teeth can impair orthodontic treatment due to absence
of appropriate dental anchorage for orthodontic movement. </p><p>The advantage of osseointegrated implants for orthodontic anchorage is the absolute
immobility of the implant, as the periodontal ligament is inexistent, allowing for the
application of controlled orthodontic forces without bone resorption. This phenomenon is
known as "absolute anchorage."<xref rid="B12" ref-type="bibr"><sup>12</sup></xref> Thus, the implant will first function as intraoral orthodontic anchorage and
later as prosthetic anchorage, providing stability, biocompatibility and comfort.<xref rid="B13" ref-type="bibr"><sup>13</sup></xref></p><p>Since several studies have demonstrated that anchorage of orthodontic forces on implants
seems to be a good alternative in partially edentulous patients who require orthodontic
treatment,<xref rid="B7" ref-type="bibr"><sup>7</sup></xref><sup>,</sup><xref rid="B14" ref-type="bibr"><sup>14</sup></xref><sup>-</sup><xref rid="B18" ref-type="bibr"><sup>18</sup></xref> the present study proposed to assess the long-term peri-implant behavior of
implants subjected to orthodontic anchorage. Thus, the objective of this study was to
clinically and radiographically assess implants used as orthodontic anchorage, as well
as the success rate of such implants over a period of three years after the installation
of prostheses over them.</p></sec><sec sec-type="materials|methods"><title>MATERIAL AND METHODS</title><sec><title>Patient selection and study design</title><p>A prospective clinical study using titanium implants as orthodontic anchorage was
conducted. The patients were recruited from the Undergraduate and Postgraduate
clinics of the Department of Dental Implantology, School of Dentistry, Universidade
Estadual do Oeste do Paraná (UNIOESTE), Brazil. The study was approved by the Ethics
Committee of the same university (Process 301/2008-CEP) and were asked to sign a free
informed consent form after receiving detailed information about the study.</p><p>After patient selection according to inclusion and exclusion criteria, the sample was
randomly divided into two groups: 1) test group in which osseointegrated implants
were used as orthodontic anchorage (n = 26 implants); and 2) control group in which
the implants were only used as support for prostheses (n = 24 implants).</p><p>Criteria for inclusion in the study were: 18 years of age or older (mean patient age
was 41 years, with a range of 35 to 56 years old); willingness to cooperate with the
requirements of the study; no systemic health condition; good oral hygiene; good
periodontal health; sufficient alveolar bone volume at the implant recipient site
(width: ≥ 6 mm and height: ≥ 8 mm) exclusively for the study group; and type I-III
bone quality. Exclusion criteria were: pregnancy or breast-feeding; smoking and use
of alcohol or drugs; previous reconstruction at the implant recipient site;
insufficient alveolar bone volume at the implant recipient site (width: < 6 and
height: < 8 mm); presence of residual roots at the recipient site; type IV bone
quality; keratinized mucosa < 2 mm at the implant recipient site; stomatological
and periodontal diseases; and clinical signs of temporomandibular dysfunction and
bruxism.</p><p>The implants were installed according to the number of missing teeth and bone
availability in the posterior region of the mandible, which required prosthetic
rehabilitation and dental movements.</p></sec><sec><title>Surgical procedures</title><p>Titanium implants were placed under local anesthesia by a dental surgeon and within a
single intervention. The surgical procedure consisted of an incision in the alveolar
ridge crest for preservation of the keratinized mucosa. Subsequently, lingual and
buccal mucoperiosteal flaps were carefully elevated from the top of the alveolar
crest. The implants were placed supracrestally, according to the protocol of the
system, and primary stability was always achieved. The mucoperiosteal flaps were
repositioned for healing by first intention. After one week, the sutures were removed
and postoperative control was performed. The patient was advised to properly clean
the treated area.</p><p>The surgical phase of implant installation consisted of the use of self-tapping
external hexagon titanium implants (Dentoflex Comércio e Indústria de Materiais
Odontológicos, São Paulo, Brazil), installed according to Branemark's surgical
protocol.<xref rid="B19" ref-type="bibr"><sup>19</sup></xref> Implants with a diameter of 3.75 or 4.0 mm and 8, 10 and 11.5 mm in length
were used according to bone availability.</p><p>Patients were advised to avoid any trauma to the implant sites and to rinse the mouth
with 0.12% chlorhexidine digluconate for at least one minute, twice a day, for one
week. </p></sec><sec><title>Clinical sequence</title><p>Four months after implant placement, the period corresponding to osseointegration,
reopening and placement of healing abutments were performed. Subsequently, the
implant was transferred and the crowns were screwed in place with a torque of 45 Nm.
Molds of each patient were taken and each case was planned by an implantodontist and
two orthodontists participating in the study.</p><p>Occlusion of the provisional acrylic resin screw-retained restorations was
established with contact in maximum intercuspation and no contact in excursive
movements. In the test group, provisional screw-retained restorations received the
following orthodontic accessories: TMA wire cantilever (0.018 x 0.025-in, Morelli,
Sorocaba, Brazil) and NiTi spring (0.25 mm diameter - Morelli, Sorocaba, Brazil). The
maximum force applied to the implants was 200 cN. Orthodontic force was used in order
to correct minor dental movements, such as molar uprighting and incisor relationship,
and to improve the occlusal relationship with the objective of obtaining prosthetic
space for implant placement. Orthodontic treatment period varied between 9 and 12
months. At the end of orthodontic treatment, provisional restorations were replaced
with definitive prostheses.</p></sec><sec><title>Clinical evaluation</title><p>Clinical evaluations were performed three, six and nine months after prosthesis
installation. The 1- and 3-year follow-up examinations included the following
parameters: 1) modified plaque index (mPlI)<xref rid="B20" ref-type="bibr"><sup>20</sup></xref> for all implants; 2) modified bleeding index (mBlI)<xref rid="B20" ref-type="bibr"><sup>20</sup></xref> for all implants; 3) pocket probing depth (PPD): distance between the
gingival margin and pocket depth in millimeters;<xref rid="B21" ref-type="bibr"><sup>21</sup></xref><sup>,</sup><xref rid="B22" ref-type="bibr"><sup>22</sup></xref> and 4) keratinized mucosa width (KMW): distance between the keratinized
gingival-mucosa junction and the free gingival margin in millimeters for implants.
All measurements were performed at six aspects of each implant site by means of a
Hu-Friedy PCP-UNC probe (Hu-Friedy, Chicago, IL, USA) .</p></sec><sec><title>Radiographic evaluation</title><p>Intraoral periapical radiographs were obtained before implant placement and 30 days
after surgery for implant placement at the time of prosthesis installation and one,
two and three years thereafter (<xref ref-type="fig" rid="f1">Fig 1</xref>). The
paralleling technique was used. Radiographs were taken with the aid of a digital
radiographic sensor (Kavo-Kerr), an individual acrylic positioning device, and an
exposure time of 0.4 seconds. For the evaluation of changes in peri-implant crestal
bone height, a single examiner measured the linear distance (in mm) from the implant
shoulder to the most coronary part of the mesial and distal bone crest,<xref rid="B23" ref-type="bibr"><sup>23</sup></xref> using the Image Tool analysis program (UTHSCSA, Texas, USA).</p><p><fig id="f1" orientation="portrait" position="float"><label>Figure 1</label><caption><title>Intraoral periapical radiographs of the control and test groups before
implant placement, 30 days after implant installation, at the time of
prosthesis installation, and one, two and three years thereafter.</title></caption><graphic xlink:href="2176-9451-dpjo-21-02-00073-gf1"></graphic></fig></p><p>Crestal bone measurements were made on the periapical radiographs obtained for the
8-mm, 10-mm and 11.5-mm implants. The length of the implant represents the reference
to compensate for radiographic distortion. Subsequently, crestal bone measurements
were obtained on the mesial and distal side for all implants at the pre-established
intervals.<xref rid="B24" ref-type="bibr"><sup>24</sup></xref></p></sec><sec><title>Follow-up and maintenance</title><p>Periodic visits were held for maintenance and reinforcement of oral hygiene
instructions at 3-month intervals during the first year after prosthesis
installation, and at 6-month intervals during the subsequent two years. </p><p>Clinical parameters were evaluated at three, six and nine months and one and three
years after prosthesis installation. Radiographic analysis was performed 30 days
after surgery for implant placement at the time of prosthesis installation and one,
two and three years thereafter. </p><p>Success criteria established for the present study followed those of Karoussis et
al;<xref rid="B21" ref-type="bibr"><sup>21</sup></xref> i.e., absence of mobility, absence of subjective complaints (pain, foreign
body sensation, and/or paresthesia), no probing depth of 5 mm or more and positive
modified sulcus bleeding index (mSBl), absence of continuous radiolucency around the
implant, and an annual vertical bone loss not exceeding 0.2 mm after the first year
since installation.</p><p>The results of the clinical parameters as well as bone crestal distance mesially and
distally were compared by Kruskal-Wallis test. A <italic>p</italic>-value < 0.05
was considered to indicate statistical significance, and all calculations were
performed by means of GraphPad InStat and GraphPad Prisma 5 software (GraphPad
Software Inc, USA).</p></sec></sec><sec sec-type="results"><title>RESULTS</title><p>Clinical, radiographic and peri-implant parameters showed that the biological response
of gingival tissue and bone structure surrounding the implant subjected to orthodontic
anchorage was similar to control. Peri-implant health was maintained for approximately
one year of anchorage on the implant and over a period of three years of follow-up. </p><p>The mean bone crest/shoulder distance of the implant during a period of 30 days after
implant installation, at the time of prosthesis installation, and one, two and three
years thereafter revealed similar bone remodeling of the implant crests for the test and
control groups, with no statistically significant difference between groups, since the
time of implant placement, during the application of orthodontic force and throughout
the study period (<xref ref-type="fig" rid="f2">Fig 2</xref> and <xref ref-type="table" rid="t1">Table 1</xref>). However, the mean bone crest/implant shoulder distance was
2.58 ± 1.19 mm on the distal surface for the test group and 2.39 ± 0.79 mm for the
control group after three years of follow-up.</p><p><fig id="f2" orientation="portrait" position="float"><label>Figure 2</label><caption><title>Comparison of the bone crest-implant shoulder distance of the implant
during a period of 30 days after implant installation, at the time of
prosthesis installation and after one, two and three years. Crestal bone
measurements were obtained on the mesial (mc) and distal (dc) side for all
implants, on groups Control (C) and Test (T), at the pre-established time
points. </title></caption><graphic xlink:href="2176-9451-dpjo-21-02-00073-gf2"></graphic></fig></p><p><table-wrap id="t1" orientation="portrait" position="float"><label>Table 1</label><caption><title>Mean values of the bone crest/shoulder distance of the implant during a
period of 30 days after implant installation, at the time of prosthesis
installation and one, two and three years thereafter. Crestal bone measurements
were obtained on the mesial (mc) and distal (dc) side for all implants at the
pre-established time points. </title></caption><table frame="hsides" rules="groups"><colgroup span="1"><col span="5"></col></colgroup><thead><tr><th align="center" colspan="12" rowspan="1">Bone crest/shoulder distance of
the implant (mm) mean ±SD </th></tr><tr><th align="center" rowspan="3" colspan="1">Group</th><th align="center" colspan="10" rowspan="1">Periods </th><th align="center" rowspan="3" colspan="1">p </th></tr><tr><th align="center" colspan="2" rowspan="1">30 days </th><th align="center" colspan="2" rowspan="1">0 </th><th align="center" colspan="2" rowspan="1">1 year </th><th align="center" colspan="2" rowspan="1">2 years </th><th align="center" colspan="2" rowspan="1">3 years </th></tr><tr><th align="center" rowspan="1" colspan="1">mc</th><th align="center" rowspan="1" colspan="1">dc</th><th align="center" rowspan="1" colspan="1">mc</th><th align="center" rowspan="1" colspan="1">dc</th><th align="center" rowspan="1" colspan="1">mc</th><th align="center" rowspan="1" colspan="1">dc</th><th align="center" rowspan="1" colspan="1">mc</th><th align="center" rowspan="1" colspan="1">dc</th><th align="center" rowspan="1" colspan="1">mc</th><th align="center" rowspan="1" colspan="1">dc</th></tr></thead><tbody><tr><td align="center" rowspan="1" colspan="1">Control</td><td align="center" rowspan="1" colspan="1">2,13 (0.72)</td><td align="center" rowspan="1" colspan="1">2.33 (0.79)</td><td align="center" rowspan="1" colspan="1">2.09 (0.74)</td><td align="center" rowspan="1" colspan="1">2.27 (0.84)</td><td align="center" rowspan="1" colspan="1">2.15 (0.52)</td><td align="center" rowspan="1" colspan="1">2.47 (0.78)</td><td align="center" rowspan="1" colspan="1">2.22 (0.64)</td><td align="center" rowspan="1" colspan="1">2.53 (0.71)</td><td align="center" rowspan="1" colspan="1">2.14 (0.63)</td><td align="center" rowspan="1" colspan="1">2.39 (0.79)</td><td align="center" rowspan="2" colspan="1">0.1832 (NS) </td></tr><tr><td align="center" rowspan="1" colspan="1">Test</td><td align="center" rowspan="1" colspan="1">2.17 (0.74)</td><td align="center" rowspan="1" colspan="1">2.45 (1.02)</td><td align="center" rowspan="1" colspan="1">2.08 (0.59)</td><td align="center" rowspan="1" colspan="1">2.28 (1.03)</td><td align="center" rowspan="1" colspan="1">2.22 (0.68)</td><td align="center" rowspan="1" colspan="1">2.06 (0.96)</td><td align="center" rowspan="1" colspan="1">2.32 (1.02)</td><td align="center" rowspan="1" colspan="1">2.41 (1.11)</td><td align="center" rowspan="1" colspan="1">2.36 (0,92)</td><td align="center" rowspan="1" colspan="1">2.58 (1.19)</td></tr></tbody></table><table-wrap-foot><fn id="TFN2"><p>Data are expressed as mean (SD). Kruskal-Wallis test, * <italic>p</italic>< 0.05; NS = non significant (<italic>p</italic> > 0.05). Crestal bone
measurements: mesial (mc) and distal (dc) sides.</p></fn></table-wrap-foot></table-wrap></p><p>There was no significant difference in pocket probing depth between groups throughout
the study period (<xref ref-type="fig" rid="f3">Fig 3</xref> and <xref ref-type="table" rid="t2">Table 2</xref>). The mean probing depth was 2.57 ± 0,40 mm and 2.39 ± 0.45
mm three months and three years after prosthesis installation, respectively, for
implants of the test group, and 2.30 ± 0.54 mm and 2.21 ± 0.47 mm for the control group,
showing that mean probing depth was unchanged throughout the study period. </p><p><fig id="f3" orientation="portrait" position="float"><label>Figure 3</label><caption><title>Comparison of pocket probing depth (PPD) measurements of implant at 3, 6
and 9 months and at 1 and 3 years after prosthesis installation, on Control (C)
and Test (T) groups. </title></caption><graphic xlink:href="2176-9451-dpjo-21-02-00073-gf3"></graphic></fig></p><p><table-wrap id="t2" orientation="portrait" position="float"><label>Table 2</label><caption><title>Comparison of pocket probing depth (PPD) measurements of the implant at
three, six and nine months and at one and three years after prosthesis
installation. </title></caption><table frame="hsides" rules="groups"><colgroup span="1"><col span="4"></col></colgroup><thead><tr><th align="center" colspan="7" rowspan="1">Pocket probing depth (mm) </th></tr><tr><th align="center" rowspan="2" colspan="1">Group</th><th align="center" colspan="5" rowspan="1">Periods </th><th align="center" rowspan="2" colspan="1">p </th></tr><tr><th align="center" rowspan="1" colspan="1">3 m</th><th align="center" rowspan="1" colspan="1">6 m</th><th align="center" rowspan="1" colspan="1">9 m</th><th align="center" rowspan="1" colspan="1">1 y</th><th align="center" rowspan="1" colspan="1">3 y</th></tr></thead><tbody><tr><td align="center" rowspan="1" colspan="1">Control</td><td align="center" rowspan="1" colspan="1">2.30 (0.54)</td><td align="center" rowspan="1" colspan="1">2.10 (0.41)</td><td align="center" rowspan="1" colspan="1">2.39 (0.56)</td><td align="center" rowspan="1" colspan="1">2.25 (0.27)</td><td align="center" rowspan="1" colspan="1">2.21 (0.47)</td><td align="left" rowspan="2" colspan="1"><italic>p</italic> = 0.1078 (NS)</td></tr><tr><td align="center" rowspan="1" colspan="1">Test</td><td align="center" rowspan="1" colspan="1">2.57 (0.40)</td><td align="center" rowspan="1" colspan="1">2.39 (0.29)</td><td align="center" rowspan="1" colspan="1">2.24 (0.78)</td><td align="center" rowspan="1" colspan="1">2.51 (0.64)</td><td align="center" rowspan="1" colspan="1">2.39 (0.45)</td></tr></tbody></table><table-wrap-foot><fn id="TFN3"><p>Data are expressed as mean (SD); Kruskal-Wallis test, *: <italic>p</italic>< 0.05; NS = non significant (<italic>p</italic> > 0.05).</p></fn></table-wrap-foot></table-wrap></p><p>Keratinized mucosa width (KMW) did not differ significantly between groups during the
study, with mean values of 1.43 ± 0.21 mm for the control group and 1.54 ± 0.40 mm for
the test group, three months after prosthesis installation, and of 1.51 ± 0.47 mm and
1.56 ± 0.51 mm, respectively, after three years of follow-up (<xref ref-type="fig" rid="f4">Fig 4</xref> and Table 3). Thus, keratinized mucosa width remained stable
and in sufficient quantity to protect the implant and the health of peri-implant tissue,
providing better safety regarding the maintenance of peri-implant health.</p><p><fig id="f4" orientation="portrait" position="float"><label>Figure 4</label><caption><title>Comparison of keratinized mucosa width (KMW) measurements of the implant at
3 and 9 months and at 1 and 3 years after prosthesis installation, on Control
(C) and Test (T) groups. </title></caption><graphic xlink:href="2176-9451-dpjo-21-02-00073-gf4"></graphic></fig></p><p><table-wrap id="t3" orientation="portrait" position="float"><label>Table 3</label><caption><title>Comparison of keratinized mucosa width (KMW) measurements of the implant at
three and nine months and at one and three years after prosthesis installation.
</title></caption><table frame="hsides" rules="groups"><colgroup span="1"><col span="4"></col></colgroup><tbody><tr><td align="center" colspan="6" rowspan="1">Keratinized mucosa width (mm)
</td></tr><tr><td align="center" rowspan="2" colspan="1">Group</td><td align="center" colspan="4" rowspan="1">Periods </td><td align="center" rowspan="2" colspan="1">p</td></tr><tr><td align="center" rowspan="1" colspan="1">3 m</td><td align="center" rowspan="1" colspan="1">9 m</td><td align="center" rowspan="1" colspan="1">1 y</td><td align="center" rowspan="1" colspan="1">3 y</td></tr><tr><td align="center" rowspan="1" colspan="1">Control</td><td align="center" rowspan="1" colspan="1">1.43 (0.21)</td><td align="center" rowspan="1" colspan="1">1.51 (0.34)</td><td align="center" rowspan="1" colspan="1">1.50 (0.64)</td><td align="center" rowspan="1" colspan="1">1.51 (0.47)</td><td align="left" rowspan="2" colspan="1"><italic>p</italic> = 0.1987 (NS)</td></tr><tr><td align="center" rowspan="1" colspan="1">Test</td><td align="center" rowspan="1" colspan="1">1.54 (0.40)</td><td align="center" rowspan="1" colspan="1">1.54 (0.55)</td><td align="center" rowspan="1" colspan="1">2.03 (0.85)</td><td align="center" rowspan="1" colspan="1">1.56 (0.51)</td></tr></tbody></table><table-wrap-foot><fn id="TFN4"><p>Data are expressed as mean (SD); Kruskal-Wallis test, *: <italic>p</italic>< 0.05; NS = non significant (<italic>p</italic> > 0.05).</p></fn></table-wrap-foot></table-wrap></p><p>The mean mBlI values did not differ significantly between groups, with both groups
maintaining healthy peri-implant tissues throughout the three years of follow-up after
prosthesis implantation (Fig 5 and <xref ref-type="table" rid="t4">Table 4</xref>).
However, the test group revealed a trend towards an increase <italic>(p</italic> >
0.05) three and nine months after prosthesis installation.</p><p><fig id="f5" orientation="portrait" position="float"><label>Figure 5</label><caption><title>Comparison of the modified bleeding index (mBlI) for all implants at 3, 6
and 9 months and at 1 and 3 years after prosthesis installation. </title></caption><graphic xlink:href="2176-9451-dpjo-21-02-00073-gf5"></graphic></fig></p><p><table-wrap id="t4" orientation="portrait" position="float"><label>Table 4</label><caption><title>Comparison of the modified bleeding index (mBlI) for all implants at 3, 6
and 9 months and at 1 and 3 years after prosthesis installation. </title></caption><table frame="hsides" rules="groups"><colgroup span="1"><col span="4"></col></colgroup><tbody><tr><td align="center" colspan="7" rowspan="1">Modified bleeding index </td></tr><tr><td align="center" rowspan="2" colspan="1">Group</td><td align="center" colspan="5" rowspan="1">Periods </td><td align="center" rowspan="2" colspan="1">p </td></tr><tr><td align="center" rowspan="1" colspan="1">3 m</td><td align="center" rowspan="1" colspan="1">6 m</td><td align="center" rowspan="1" colspan="1">9 m</td><td align="center" rowspan="1" colspan="1">1 y</td><td align="center" rowspan="1" colspan="1">3 y</td></tr><tr><td align="center" rowspan="1" colspan="1">Control</td><td align="center" rowspan="1" colspan="1">0.13 (0.29)</td><td align="center" rowspan="1" colspan="1">0.15 (0.29)</td><td align="center" rowspan="1" colspan="1">0.06 (0.15)</td><td align="center" rowspan="1" colspan="1">0.01 (0.05)</td><td align="center" rowspan="1" colspan="1">0.01 (0.05)</td><td align="center" rowspan="2" colspan="1">0.017</td></tr><tr><td align="center" rowspan="1" colspan="1">Test</td><td align="center" rowspan="1" colspan="1">0.24 (0.40)</td><td align="center" rowspan="1" colspan="1">0.13 (0.12)</td><td align="center" rowspan="1" colspan="1">0.12 (0.35)</td><td align="center" rowspan="1" colspan="1">0.03 (0.10)</td><td align="center" rowspan="1" colspan="1">0.0 (0.0)</td></tr></tbody></table><table-wrap-foot><fn id="TFN5"><p>Data are expressed as mean (SD). Kruskal-Wallis test: * = p < 0.05;
superscript a = p < 0.05, for T9m group versus C6m and C3y groups;
superscript b = p < 0.05, for T1y group versus C3m, T3m, C6m, T6m and C3y
groups; NS = non significant: p > 0.05.</p></fn></table-wrap-foot></table-wrap></p><p>The mean mPlI values did not differ significantly between groups. By evaluating
different periods of control and test groups, we observed an increase in the mean mPlI
values in the test group at nine months and one year, compared to control at three, six
months and three years, and test group at three and six months (<xref ref-type="fig" rid="f6">Fig 6</xref> and <xref ref-type="table" rid="t5">Table 5</xref>); thus,
indicating that the test group presented significantly higher plaque formation on the
peri-implant gingiva during the period orthodontic forces were applied to the
implants.</p><p><fig id="f6" orientation="portrait" position="float"><label>Figure 6</label><caption><title>Comparison of the modified plaque index (mPlI) for all implants at 3, 6 and
9 months and at 1 and 3 years after prosthesis installation.</title></caption><graphic xlink:href="2176-9451-dpjo-21-02-00073-gf6"></graphic></fig></p><p><table-wrap id="t5" orientation="portrait" position="float"><label>Table 5</label><caption><title>Comparison of the modified plaque index (mPlI) for all implants at 3, 6 and
9 months and at 1 and 3 years after prosthesis installation. </title></caption><table frame="hsides" rules="groups"><colgroup span="1"><col span="4"></col></colgroup><tbody><tr><td align="center" colspan="7" rowspan="1">Modified plaque index </td></tr><tr><td align="center" rowspan="2" colspan="1">Group</td><td align="center" colspan="5" rowspan="1">Periods </td><td align="center" rowspan="2" colspan="1">p </td></tr><tr><td align="center" rowspan="1" colspan="1">3 m</td><td align="center" rowspan="1" colspan="1">6 m</td><td align="center" rowspan="1" colspan="1">9 m</td><td align="center" rowspan="1" colspan="1">1 y</td><td align="center" rowspan="1" colspan="1">3 y</td></tr><tr><td align="center" rowspan="1" colspan="1">Control</td><td align="center" rowspan="1" colspan="1">0.01 (0.05)</td><td align="center" rowspan="1" colspan="1">0.0 (0.0)</td><td align="center" rowspan="1" colspan="1">0.09 (0.30)</td><td align="center" rowspan="1" colspan="1">0.09 (0.30)</td><td align="center" rowspan="1" colspan="1">0.0 (0.0)</td><td align="center" rowspan="2" colspan="1">p < 0.0001</td></tr><tr><td align="center" rowspan="1" colspan="1">Test</td><td align="center" rowspan="1" colspan="1">0.01 (0.04)</td><td align="center" rowspan="1" colspan="1">0.01 (0.04)</td><td align="center" rowspan="1" colspan="1">0.46 (0.49)<sup>a</sup></td><td align="center" rowspan="1" colspan="1">0.46 (0.60)<sup>b</sup></td><td align="center" rowspan="1" colspan="1">0.08 (0.27)</td></tr></tbody></table><table-wrap-foot><fn id="TFN6"><p>Data are expressed as mean (SD); Kruskal-Wallis test: * = p < 0.05;
superscript a = p < 0.05, for T3m group versus T3y group; NS = non
significant (p > 0.05).</p></fn></table-wrap-foot></table-wrap></p><p>The rate of implant success was 100%, according to the criteria proposed by Karoussis et
al.<xref rid="B21" ref-type="bibr"><sup>21</sup></xref> No implant showed radiographic changes in the bone-implant interface; no annual
vertical bone loss exceeded 0.2 mm after the first year since installation, thereby
indicating successful osseointegration of implants; and no implant mobility was
observed. </p></sec><sec sec-type="discussion"><title>DISCUSSION</title><p>Difficulty controlling anchorage is a significant aspect in Orthodontics. Standard
anchorage devices, such as extraoral appliances and elastics, rely on patient's
cooperation, which may compromise treatment results. The introduction of implants for
orthodontic anchorage has decreased the need for patient's cooperation, compared to
extraoral appliances, and has provided absolute anchorage biomechanics.<xref rid="B9" ref-type="bibr"><sup>9</sup></xref><sup>,</sup><xref rid="B14" ref-type="bibr"><sup>14</sup></xref><sup>,</sup><xref rid="B25" ref-type="bibr"><sup>25</sup></xref></p><p>In the present study, osseointegrated implants placed according to the method proposed
by Branemark<xref rid="B19" ref-type="bibr"><sup>19</sup></xref> were clinically successful, fulfilling the proposed outcome criteria. In
addition, the implants kept direct bone anchorage throughout the study period, in
agreement with the results reported by Roberts et al<xref rid="B26" ref-type="bibr"><sup>26</sup></xref> and Higuchi and Slack.<xref rid="B8" ref-type="bibr"><sup>8</sup></xref> In the test group, it was possible to perform dental movement with an implant as
anchorage, without any reciprocal action on the remaining teeth. The amount of
peri-implant bone resorption of this group was similar to control.</p><p>Orthodontic forces on implants not only all the implants remained firm, but also
maintained gingival relationships. This study provides evidence that orthodontic
anchorage can have a favorable effect on marginal peri-implant gingival situation. In
the test group, a slight increase (<italic>p</italic> > 0.05) was detected in
keratinized mucosa width during orthodontic force application on implants, followed by a
trend towards the reduction of such after three years of follow-up.</p><p>After the application of orthodontic force, there was clinical and radiographic
peri-implant stability, as illustrated in <xref ref-type="fig" rid="f1">Figures
1</xref>-6 and <xref ref-type="table" rid="t1">Tables 1</xref>-5. Results showed a 100%
success rate for implants subjected to orthodontic forces of 200 cN; thus, indicating
that, after orthodontic treatment, these implants can receive a fixed prosthesis
replacing the missing teeth, in addition to improving patient's dental occlusion.
Similarly, Cravero et al<xref rid="B7" ref-type="bibr"><sup>7</sup></xref> reported a 100% success rate and satisfactory occlusion with 93 implants placed
in the maxilla and mandible.</p><p>In the present study, we observed that implants maintained direct bone anchorage
throughout orthodontic treatment, in agreement with data reported by Roberts et al<xref rid="B26" ref-type="bibr"><sup>26</sup></xref> and Higuchi and Slack.<xref rid="B8" ref-type="bibr"><sup>8</sup></xref> Trisi et al<xref rid="B25" ref-type="bibr"><sup>25</sup></xref> also used implants for orthodontic anchorage in 41 adult patients. The implants
were placed in different areas, all continued to be stable and were osseointegrated 12
months after prosthesis placement. These studies demonstrated that it was possible to
perform small tooth movements without a reciprocal action, and that the dental occlusion
of orthodontically treated patients was significantly improved. </p><p>On the other hand, there have been no reports demonstrating the association between
anchorage orthodontic and peri-implant conditions. Different time points of the test
group showed an increase in the mean mPlI values after nine months and one year of
prosthesis installation. This difference became more pronounced during the application
of orthodontic forces. The results showed that the mean mPlI values in the test group
with bonded orthodontic devices were higher in comparison to control group without
orthodontic devices. The influence of impaired oral hygiene was considered; however,
mPlI for the test group did not improve in spite of detailed oral hygiene instructions.
The result of the mPlI reveals the difficulty performing oral hygiene for the test group
during tooth movement. After completion of orthodontic treatment, the mean mPlI values
became normal. Over a 3-year follow-up, peri-implant parameters were considered
satisfactory in terms of gingival health. The reason for higher susceptibility to
biological complications around implants may be discussed in the light of bacterial
plaque accumulation in partially edentulous dentitions or the host response to the
bacterial challenge. The microbiota associated with periodontitis and peri-implantitis
has supported the concept that periodontal pathogens are important etiological factors
of peri-implant infections.<xref rid="B20" ref-type="bibr"><sup>20</sup></xref><sup>,</sup><xref rid="B27" ref-type="bibr"><sup>27</sup></xref> It is, therefore, obvious that the status of peri-implant health is of utmost
importance for the longevity of implants installed.</p><p>According to Werbein and Merz<xref rid="B28" ref-type="bibr"><sup>28</sup></xref> and Pinho et al,<xref rid="B29" ref-type="bibr"><sup>29</sup></xref> intraosseous titanium implants yield the best results for orthodontic use; thus,
reducing treatment time. </p><p>Furthermore, osseointegrated implants have proved to resist displacement forces of 100
to 200 cN on all planes, and to function as a unit of orthodontic anchorage.<xref rid="B7" ref-type="bibr"><sup>7</sup></xref><sup>,</sup><xref rid="B30" ref-type="bibr"><sup>30</sup></xref> After orthodontic treatment, implants also served as abutment for permanent
fixed prostheses in edentulous areas, which could not have been properly carried out
without implant anchorage.</p></sec><sec sec-type="conclusions"><title>CONCLUSION</title><p>On the basis of the present results, we suggest that subjecting osseointegrated implants
to orthodontic forces can be a safe technique for prosthetic rehabilitation and an
alternative for the orthodontic treatment of partially edentulous patients, since there
was no significant peri-implant bone loss after orthodontic activation. Additionally,
there were no changes in peri-implant probing depth or in the gingiva, and no bleeding
or presence of peri-implant plaque was observed during a 3-year follow-up after
installation of implant-supported prosthesis.</p></sec></body><back><fn-group><fn fn-type="other"><label>»</label><p> The authors report no commercial, proprietary or financial interest in the products
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