A review on the latest advancements in the non-invasive evaluation/monitoring of dental and trans-femoral implants

Abstract

Dental implants and transcutaneous prostheses (trans-femoral implants) improve the quality of life of millions of people because they represent the optimal treatments to edentulism and amputation, respectively. The clinical procedures adopted by surgeons to insert these implants are well established. However, there is uncertainty on the outcomes of the post-operation recovery because of the uncertainty associated with the osseointegration process, which is defined as the direct, structural and functional contact between the living bone and the fixture. To guarantee the long-term survivability of dental or trans-femoral implants doctors sometimes implement non-invasive techniques to monitor and evaluate the progress of osseointegration. This may be done by measuring the stability of the fixture or by assessing the quality of the bone-fixture interface. In addition, care providers may need to quantify the structural integrity of the bone-implant system at various moments during the patients recovery. The accuracy of such non-invasive methods reduce recovery and rehabilitation time, and may increase the survival rate of the therapies with undisputable benefits for the patients. This paper provides a comprehensive review of clinically-approved and emerging non-invasive methods to evaluate/monitor the osseointegration of dental and orthopedic implants. A discussion about advantages and limitations of each method is provided based on the outcomes of the cases presented. The review on the emerging technologies covers the developments of the last decade, while the discussion about the clinically approved systems focuses mostly on the latest (2017-2018) findings. At last, the review also provides some suggestions for future researches and developments in the area of implant monitoring.

Keywords: Dental implants; Non-destructive evaluation methods; Osseointegration; Trans-femoral implants.

Fig. 1

Example of a three parts dental implant. Figure adapted from: https://www.friscooralsurgery.com/procedures/cost-of-dental-implants/

Fig. 2

Example of percutaneous osseointegrated prostheses. Figure adapted from: https://www.prostheticbody.com/percutaneous-osseointegrated-prostheses-for-amputees/

Fig. 3

Example of a resonance frequency analysis performed on the same implant with an Osstell device. a Implant platform, b 1 mm microunit, and c 5 mm microunit. Figure adapted from 10.1371/journal.pone.0181873.g001

Fig. 4

The Penguin RFA. The figure on the left is from https://www.pinterest.com/pin/560276009885439730/. The figure on the right is from https://aseptico.com/store/implant-surgery/implant-systems/penguin-rfa/

Fig. 5

Correlation between the ISQ and the insertion torque. Figure adapted from Fig. 4 of Ref. [75]

Fig. 6

The Integrum OPRA system. Figure adapted from https://integrum.se/opra-implant-system/are-you-a-potential-candidate/transfemoral-above-knee-amputations/ (Date accessed 07 August 2019)

Fig. 7

Photos of the OPL implant system commercialized by Permedica s.p.a. (Italy) and used for the OGAAP-2 procedure. Figure from Ref. [14]

Fig. 8

a Testing a method based on ECT and a strain sensitive thin-film nanocomposite on a prosthesis phantom inserted in a lamb shank. b Change in the electrical permittivity distribution within the ECT electrode array. Figure from [129]

Fig. 9

Schematic of the guided ultrasonic wave based method proposed by Wang and Lynch [120]. Image adapted from Ref. [120]