School of Dental Medicine University of Belgrade, Serbia • November 2015

Clinical outcomes following horizontal ridge augmentation with bone block grafts

Assoc Prof Dr Snezana Colic (School of Dental Medicine University of Belgrade, Serbia)

The aim of this study was to analyze clinical outcome of horizontal augmentation with autologous bone block grafts for the reconstruction of narrow edentulous ridge before implant placement. Eighteen partially edentulous patients, presenting insufficient bone width (less than 4mm) in the sites for implant placement were selected.
One or multiple cylindrical block grafts were harvested with trephine burrs from retromolar region and stabilized with titanium miniscrews. Fixed grafts were covered with deproteinised bovine bone mineral granules (DBBM) and collagen membrane (CM). The average amount of bone gain was 3,6 mm. One of the 24 block grafts was lost during the early healing period. Five months later, during the re-entry for implants placement, the gain of ridge width obtained were measured. All implants were placed in correct position and considered successfully integrated during the observation period. Three month after the implant placement prosthetic rehabilitation was started.
The mean follow up after prosthetic load has been 25,4 months.

This technique is reliable means for the correction of narrow edentulous ridge. Close contact between the bone graft and recipient bed surface ensure fast and intense vascularization and subsequent osseointegration of the graft. Adding bovine bone mineral and collagen membrane over bone block minimize resorption during healing.
In all cases all planned implants could be placed in the correct positions.
The mean duration of follow up of the implants was 25,4 months. Prosthodontics rehabilitation involved single crowns or bridges.
Not a single implant was lost during the observation period. All implants were successful both aesthetically and functionally.

 

References

1. Albrektsson T., Zarb G., Wothington P. & Ericsson A.R. (1986) The long-term efficacy of currently used dental implants: A review and proposed criteria of success. International Journal of Oral and Maxillofacial Implants 1:1-25.

2. Araujo, M.G., Sonohara, M., Hayacibara, R., Car- daropoli, G.
& Lindhe, J. (2002) Lateral ridge augmentation by the use of grafts comprised of autologous bone or a biomaterial. An experiment in the dog. Journal of Clinical Periodontology 29:1122–1131.

3. Buser, D., Dula, K., Belser, U. C., Hirt, H. P. & Berthold, H.
(1995) Localized ridge augmen- tation using guided bone regeneration. II. Surgical procedure in the mandible. International Journal of Periodontics and Restora- tive Dentistry 15,10–29.

4. Buser D., Dula K., Hirt H.P., & Schenk R. (1996) Localized ridge augmentation using autografts and barrier membranes: A clinical study with 40 partially edentulous patients. Journal of Oral and Maxillofacial Surgery 54:420-432

5. Buser, D., Dula, K., Hess, D., Hirt, H.P. & Belser, U.C. (1999) Localized ridge augmentation with autografts and barrier membranes. Periodontology 2000 19:151–163.

6. Buser, D., Ingimarsson, S., Dula, K., Lussi, A., Hirt, H. P. & Belser, U. C. (2002) Long-term stability of osseointegrated implants in aug- mented bone: a 5-year prospective study in partially edentulous patients. International Journal of Periodontics and Restorative Dentistry 22,109–117.

7. Chiapasco M, Romeo E & Vogel G. (1998) Three-dimensional reconstruction of a knife-edge edentulous maxilla by sinus elevation, onlay grafts and sagittal osteotomy of the anterior maxilla: preliminary surgical and prosthetic results. Journal of Oral and Maxillofacial Implants, 13:394-399

8. Chiapasco M., Abati S., Romeo E., Vogel G. (1999) Clinical outcome of autogenous bone blocks or guided bone regeneration with e-PTFE membranes for the reconstruction of narrow edentulous ridges. Clin Oral Impl Res 1999:10:278-288

9. Chiapasco, M., Zaniboni, M. & Boisco, M. (2006) Augmentation procedures for the rehabilitation of deficient edentulous ridges with oral implants. Clin- ical Oral Implants Research 17 (Suppl.):136–159.

10. Cordaro, L., Amade, D. S. & Cordaro, M. (2002) Clinical results of alveolar ridge aug- mentation with mandibular block bone grafts in partially edentulous patients prior to implant placement. Clinical Oral Implants Research 13,103–111.

11. Cordaro, L., Torsello, F., Accorsi Ribeiro, C., Libera- tore, M. & Mirisola di Torresanto, V.M. (2010) Inlay– onlay grafting for three-dimensional reconstruction of the posterior atropic maxilla with mandibular bone. The International Journal of Oral and Maxillofacial Surgery 39:350–357.

12. Cordaro L., Torsello F., Morcavallo S, Mirisola di Torresanto V. (2011) Effect of bovine bone and collagen membranes on healing of mandibular bone blocks: a prospective randomized controlled study. Clin. Oral Impl. Res. 22,2011;1145–1150.

13. Ha ‘mmerle, C.H. & Karring, T. (1998) Guided bone regeneration at oral implant sites. Periodontology 2000 17:151–175.

14. Jensen SS, Aaboe M, Pinholt EM, Hjorting-Hansen E, Melsen F, Ruy- ter IE. Tissue reaction and material characteristics of four bone substitutes. Int J Oral Maxillofac Implants 1996:11:55– 66.

15. Kuboki, Y., Jin, Q., Kikuchi, M., Mamood, J. & Takita, H. (2002) Geometry of artificial ECM: sizes of pores controlling phenotype expression in BMP-induced osteogenesis and chondrogenesis. Connective Tissue Research 43:529–534.

16. Lekholm U & Zarb G.A. (1995) Patient selection and preparation. In: Tissue-integrated prostheses: Osseointegration in clinical dentistry. Pp. 199-209. Chicago: Quintessence

17. Machtei, E.E. (2001) The effect of membrane ex- posure on the outcome of regenerative procedures in humans: a meta-analysis. Journal of Perio- dontology 72:512–516.

18. Misch, C. M. (1997) Comparison of intraoral sites for onlay grafting prior to implant placement. Journal of Oral and
Maxillofacial Implants, 6:767-776

19. Maiorana, C., Beretta, M., Salina, S. & Santoro, F. (2005) Reduction of autogenous bone graft resorption by means of bio-oss coverage: a prospective study. International Journal of Periodontics and Restorative Dentistry 25:19–25.

20. McAllister, B.S. & Haghighat, K. (2007) Bone aug- mentation techniques. Journal of Periodontology 78:377–396.

21. Nkenke, E., Schultze-Mosgau, S., Radespiel-Tro ‘ger, M., Kloss, F. & Neukam, F.W. (2001) Morbidity of harvesting of chin grafts: a prospective study. Clinical Oral Implants Research 12:495–502.

22. Sander, L., Frandsen, E.V., Arnbjerg, D., Warrer, K. & Karring, T. (1994) Effect of local metronidazole application on periodontal healing following guided tissue regeneration. Clinical findings. Journal of Periodontology 65:914–920.

23. Schwarz F., Ferrari D., Balic E., Buser D., Becker J., Sager M. Lateral ridge augmentation using equine- and bovine-derived cancellous bone blocks: a feasibility study in dogs. Clin. Oral Impl. Res. 21,2010;904–912.

24. Simion M., Baldoni M., Rossi P. & Zaffe D. (1994) A comparative study of the effectiveness of a e-PTFE membranes with and without early exposure during healing period. International Journal of Periodontology and Restorative Dentistry 14:167-180

25. Von Arx, T & Buser, D. (2006). Horizontal ridge augmentation using autogenous block grafts and the guided bone regeneration technique with collagen membranes: a clinical study with 42 patients. Clinical Oral Implants Research 17:359–366

Erste Daten eines neuartigen Implantatsystems • November 2015

Frankfurt University – FORM • EL Study Presentation

Authors: Jonas Lorenz – University Hospital Frankfurt · Department of oral, maxillofacial and plastic surgery, Henriette Lerner – HL DENTCLINIC, Robert A. Sader– Goethe-Universität Frankfurt am Main · Center of Stomatology and Shahram Ghanaati – Goethe University of Frankfurt/Main; Universitätsmedizin der Johannes Gutenberg-Universität Mainz · Department for Oral, Craniomaxillofacial and Facial Plastic Surgery; Institute of Pathology
Study: Frankfurt orofacial regenerative medicine
University: Universitätsklinikum Frankfurt

Long-term stability peri-implant hard and soft tissue after immediate implantation: Initial data of a new Morse locking implant system

Objective
Immediate implantations have become established as a reliable therapy option in recent years. Taking into account some essential conditions, such as the preservation of the bony alveoli, it is possible to achieve comparable survival rates at a low complication rate. The aim of the present study was to investigate for the first time a new Morse locking implant system and its characteristics and performance with immediate implantation.

Material & Methods
In this retrospective study, 21 patients who had received 50 implants (C-Tech Implants Esthetic Line, C-Tech Implants, Bologna, Italy) over the past three years were clinically and radiologically immediately after extracting unsupported teeth in the upper and lower jaws reexamined. After 2 years, the condition of peri-implant hard and soft tissue (width and thickness of the buccal peri-implant gingiva, probing depth (ST), bleeding on probing (BOP)) and the red esthetics PES)) and the stability of the peri-implant bone.

Results
No implant loss, implant loosening or acute infections in the area of the peri-implant tissue occurred during the examination period of 2 years. All implants had a sufficent range of attached peri-implant gingiva, a stable attachment with ST of 2.25 mm and BOP of 34% on average. The peri-implant bone was also stable in the radiological 2-year follow-up with a decrease of 0.83 mm on average.

Serbian Dental Journal • October 2015

Immediate loading of dental implants using intraoral welding technique – case report

Dr Kristian Gerga Center of cosmetic dentistry Dr Gerga Banatsko Novo Selo – Digital Dentistry Society Memeber

Patients demands on immediate functional and esthetical dental rehabilitation has resulted in development of immediate implant placement and immediate loading.
Immediate implant loading is loading with temporary or permanent dental restorations which generate mild occlusal contacts with the antagonist, and are set on the implants immediately or up to 48 hours after the surgical procedure.
The aim of this article is to present a clinical case of immediate implants loading using the technique of intraoral welding.

The patient age 63 came to our clinic with pain and swelling in his upper jaw. Clinical examination shows the presence of old metal ceramic crowns with improper marginal sealing, root caries lesions, chronically inflamed gingiva, periodontal pockets, all teeth loose.
Performed analysis of 3D and OPT indicated extraction of remaining teeth.
Patient wanted fixed prosthetic restoration.
Treatment plan was: 6 implants in upper and 6 in lower jaw, intraoral welding and immediate loading.

EL implant system (C-Tech, Italy) we used in this case was able to meet most of our demands thanks to its design and prosthetic solutions.

Magazine PIP • Practical implantology and implant prosthetics • May 2020

A new phase of life (quality) Implant-supported fixed denture

Dr. med. dent. Peter Randelzhofer

A restoration with a full denture requires the complete loss of all teeth. Formerly it was known as an important but often not popular restoration. On implants, the removable bridge restoration with palate-free complete denture represents an aesthetically and functionally complete restoration with fixed denture.
The 60-year-old patient came to our dental clinic with discomfort, and she no longer liked the appearance of her teeth (Fig. 1-3). After clinical and radiological diagnostics, it turned out that the remaining teeth represented a potentially “empty jaw condition”, since all teeth had to be extracted due to the periodontal and prosthetic situation (Fig. 4).

A 55 year old female patient was referred to our office for a full mouth rehabilitation. Upon clinical examination and a CBCT, we have decided to implant 4 EL C-Tech conical Morse tapered connection implants in the upper jaw for a bar retained over denture and due to financial considerations; was to perform extraction of all remaining lower teeth and immediate post extraction implantation of SD C-Tech mini dental implants. A full muco-periosteal flap was released, teeth were extracted, an alveotomy was performed to achieve an optimal bone platform for the SD mini dental implants and to obtain a bigger vertical dimension for the overdenture!

Magazine PIP – Issue:2/2015 • May 2015

Improved Success Rate, Bone Stability, Esthetic Advantages

Author: Dr Henriette Lerner HL DENTCLINIC

Abstract
Implant success nowadays means more than just the achievement of osseointegration. We must also take into account the esthetic results. The present case study shows the treatment of a partially edentulous 65-year-old female patient with high aesthetic issues. All teeth showed a degree of loosening of grade II.
The system used for the treatment used to treat the patient was endowed with a conical Morse connection which is currently the most stable connection.
The stability of the bone using this characteristic has been widely proven.
It is also scientifically proven that resulting cold weld seal reduces the width of the connection micro-gap and consequently reduced the micro-movement that can cause bone loss.

EL Clinical Study • April 2015

Bone stability and aesthetics using an innovative implant design

Treatment of a 65-year-old patient by DR HENRIETTE LERNER (HL DENTCLINIC), BADEN-BADEN, GERMANY

Implant success today consists of more than just “osseointegration accomplished”. We also have to take into account the aesthetic result. The present clinical case with high aesthetic patient expectations illustrates the treatment of a partially edentulous 65-year-old female patient with grade 2 mobility in all teeth.

The Morse-tapered conical connection has been shown to be the most stable connection available at this time.
There is scientific evidence that micro-movements rather than the size of the microgap are the reason for bone loss. In a Morse-tapered conical connection, the internal line angle between the implant and the connector is less than 0.25 degrees. The microgap is smaller (1.1–1.5 μm) than a bacterium (2–6 μm) [2].
Therefore, this connection is the most stable connection currently known and associated with the lowest incidence of screw loosening (0.37 per cent).

Discussion and conclusion
This case study uses an innovative implantological and prosthetic concept that allows the creation and stabilization of the peri-implant bone and gingival complex. Relevant scores were recorded for up to two years, yielding overall implant success rates near 100 per cent (99.7 per cent).

(BDIZ EDI) Implant-Study 2014/2015 • March 2015

Quantitative and qualitative element-analysis of implant-surface by SEM and EDX

Prof. Dr. Dr. Joachim E. Zöller Interdisciplinary Polyclinic for Oral Surgery and Implantology Dept. for Cranio Maxillofacial and Plastic Surgery, Dr. med. dent. Dirk U. Duddeck Head of Surface Analyses, In cooperation with the European Association of Dental Implantologists BDIZ-EDI Quality & Research Committee

Background and Aim
Implant surfaces are modified by microstructures and surface extension to improve osseointegration. Numerous studies showed an increased adhesion and osteoblastic matrix-production on retentive titanium surfaces.

In 2008 the University of Cologne, Germany and the BDIZ EDI (European Association of Dental Implantology) with its Quality and Research (Q&R) Committee (www.bdizedi.org) performed a scanning electron microscopic study and analyzed the surfaces of 23 enossal titanium implants of several manufacturers at the Interdisciplinary Policlinic for Oral Surgery and Implantology, Department for Craniomaxillofacial and Plastic Surgery, University Cologne(1). The tested implants showed isolated and/or extensive deposits. Depending on manufacturing process, accumulations of organic material (carbon) or inorganic material like aluminum, silicon, phosphor, sulfur, chlorine, potassium and calcium were found.

In 2011-2012 we performed the same protocol on 57 dental implants from different manufacturers. However, the manufacturing of implants requires an adequate system of quality controls. Although some manufacturers have made substantial improvements since our first survey in 2008, the study in 2011-2012 again singled out a few implants with larger areas of surface blasting residue and selective organic impurities(2).

The BDIZ EDI(3), representing more than 5,500 active implantologists in Europe, was asked in its general meeting to continue these analyses periodically and to publish the results in the European EDI Journal.

While using the same material and methods regarding the technical setup this study allows comparisons to the results of previous studies.

As a continuance of the two studies cited above the aim of study is to verify improvements of manufacturing and quality management as well as to demonstrate the high quality level of the participating manufacturers and implant companies.

1)Duddeck DU; Comparative investigation of various implant surfaces by SEM-Analysis. (Posterpresentation) 18th Annual Scientific Meeting of the European Association of osseointegration, 30 September-3 October 2009, Monaco, France

2)Duddeck, DU. et. al; Surface characteristics and quality of implants in sterile packaging, EDI Journal 2013-1

3)The BDIZ EDI has set the preliminary standards for a qualifying procedure of all implant systems and maintains structured continuing education. The primary tasks of BDIZ EDI are to provide members with support and advice and to improve the quality of implant materials

EL Clinical Study • February 2015

How to combine bone stability and aesthetic benefits through innovative implant design Treatment of a 65-year-old patient

Henriette Lerner HL DENTCLINIC, Dentist, Baden-Baden, Germany

We present a clinical case with extensive aesthetic requirements, illustrating the treatment of a 65-year-old patient with a partial edentular situation with all the teeth having a mobility grade of 2. All the maxillary teeth were extracted and the implants were immediately set.

Introduction
It has been demonstrated that the cone Morse connection is the most stable type of connection. It has been scientifically proven that bone loss is caused by micro-movements and not by the size of micro-gaps (Hermann et al.). It has been reported that normally the micro-gap in implant connections, which allows accumulation of bacteria, measures 21 to 60 μm, facilitating the development of local inflammations and bone loss. The cone Morse connection is distinguished by an inner wall angle of the connection that is less than 25°. Consequently, this is the safest connection against bacterial accumulation since the size of the micro-gap (1.1-1.5 μm) is smaller than that of a bacterium (2-6 μm).
It is also the most stable connection known to date, as well as having the lowest incidence of screw loosening (0.37%). Furthermore, it has shown high resistance to bending during shear tests at 800 N at 30 degrees.

Discussion and conclusion
For this clinical case an innovative implant and prosthetic concept was implemented, allowing the dentist to create and stabilise the peri-implant bone and gingival structure. This implant design and treatment method seems to allow a better aesthetic result in situations where there are adjacent implants.

EL Clinical Study • September 2014

Innovative dental implant design shows
improved success rate, bone stability and esthetic benefits

A retrospective study over 3 years including 2-year follow-up Henriette Lerner, DMD Director of HL Dentclinic (private practice focussed on implantology)

The aim of this research is to retrospectively evaluate an innovative implant and prosthetical design by applying the following criteria:
1. implant success rate,
2. bone loss and stability of bone level at the collar of the implant (The Morse tapered conical connection is proven to be the most stable connection at the present time. Therefore, some implant systems have already started to implement it, and they have proved the stability of the bone level using this connection (Bicon, Ankylos),
3. esthetics in terms of pink esthetic score,
4. thickness of the gingiva at 3 mm from the free gingival margin,
5. width of the keratinized gingiva around implants,
6. height of the gingiva around the implants

The study is comprised of the data of 137 patients with 608 implants (C-Tech, Bologna, Italy).

Results: Only two implants were lost (after 6 months), both relating to a single patient. The success rate for those included in the 6-months, 12-months, 18-months and 24-months was 100 percent. Bone loss was not found in any participant of the study. The soft tissue scores indicated a highly esthetic result.

Conclusion: The implant system employed in the present study showed high success rates both for the stability in situ and for the esthetic aspects. Therefore, within the scope of the data collected it may be recommended for use in the population at large.

 

References

1. Rudolf Fürhauser, Dionisie Florescu, Thomas Benesch, Robert Haas, Georg Mailath and Georg Watzek: Evaluation of soft tissue around single-tooth implant crowns: the pink esthetic score. Clinical Oral Implants Research, Volume 16, Issue 6, pages 639-644, December 2005

2. Shalabi MM, Gortemaker A, Van‘t Hof MA, Jansen JA, Creugers NH: Implant surface roughness and bone healing: a systematic review. J Dent Res 2006 Jul;85(7):670

3. K Anselme, A Ponche, and M Bigerelle: Relative influence of surface topography and surface chemistry on cell response to bone implant materials. Part 2: biological aspects. Proceedings of the Institution of Mechanical Engineers, Part H: J Engineering in Med December 2010,Vol.224, no.12 1487-1507. DOI:10.1243/09544119JEIM901

4. Daniel Sartorelli Marques de Castro, Maria Angelica Rehder de Araujo, Cesar Augusto Magalhães Benfatti, Carlos dos Reis Pereira de Araujo, Adriano Piattelli, Vittoria Perrotti, and Giovanna Lezzi: Comparative Histological and Histomorphometrical Evaluation of Marginal Bone Resorption Around External Hexagon and Morse Cone Implants: An Experimental Study in Dogs. Impl Dent, Volume 23, Number 3

5. K Anselme, A Ponche, and M Bigerelle: Relative influence of surface topography and surface chemistry on cell response to bone implant materials. Part 2: biological aspects. The manuscript was received on 19 July 2010 and was accepted after revision for publication on 12 August 2010,Vol.224, no.12 1487-1507. DOI:10.1243/09544119JEIM901

6. Shen WL, Chen CS, Hsu ML: Influence of implant collar design on stress and strain distribution in the crestal compact bone: a three-dimensional finite element analysis. Int J Oral Maxillofac Implants 2010 Sep-Oct;25(5):901-10

7. Xavier Vela-Nebot, Xavier Rodríguez-Ciurana, Carlos Rodado-Alonso, and Maribel Segalà-Torres,: Benefits of an Implant Platform Modification Technique to Reduce Crestal Bone Resorption. Impl Dent, Volume 15, Number 3 (2006) 313-318

8. Yun-Chi Wang Joseph Y. K., Kan Kitichai Rungcharassaeng, Phillip Roe, Jaime L. Lozada: Marginal bone response of implants with platform switching and non-platform switching abutments in posterior healed sites: a 1-year prospective study. Clin Oral Impl Res 0,2014, 1-8

9. Hurzeler M, Fickl S, Zuhr O, Wachtel HC: Peri-implant bone level around implants with platform-switched abutments: preliminary data from a prospective study. J Oral Maxillofac Surg (2007) Jul; 65(7 Suppl 1):33-9

10. Frederic Hermann, Henriette Lerner, and Ady Palti: Factors Influencing the Preservation of the Periimplant Marginal Bone. Impl Dent, Volume 16, NUMBER 2 (2007) 165-175

11. de Oliveira RR, Novaes AB Jr, Taba M Jr, Papalexiou V, Muglia VA: Bone remodeling adjacent to Morse cone-connection implants with platform switch: a fluorescence study in the dog mandible. Int J Oral Maxillofac Implants (2009) Mar-Apr;24(2):257-66

12. Almeida EO, Freitas AC Jr, Bonfante EA, Marotta L, Silva NR, Coelho PG. Int J Oral Maxillofac Implants: Mechanical testing of implant-supported anterior crowns with different implant/abutment connections. (2013) Jan-Feb;28(1):103-8. doi: 10.11607/jomi.2443

13. Sannino G, Barlattani A.: Mechanical evaluation of an implant-abutment self-locking taper connection: finite element analysis and experimental tests. Int J Oral Maxillofac Implants 2013 Jan-Feb;28(1):e17-26. doi:10.11607/jomi.2058

14. Tara B. Taiyeb-Ali, Chooi Gait Toh, Chong Huat Siar: Influence of Abutment Design on Clinical Status of Peri-Implant Tissues. Impl Dent, Volume 18, Number 5 (2009) 438-446

15. Tomas Linkevicius, Peteris Apse, Simonas Grybauskas, and Algirdas Puisys: Influence of Thin Mucosal Tissues on Crestal Bone Stability Around Implants With Platform Switching: A 1-year Pilot Study. JOMS (2010)

16. Su H, Gonzalez-Martin O, Weisgold A, Lee E: Considerations of implant abutment and crown contour: critical contour and subcritical contour. Int J Periodontics Restorative Dent (2010) Aug;30(4):335-43

17. M Redemagni, S Cremonesi, G Garlini: Soft tissue stability with immediate implants and concave abutments. Eur J Esthet Dent, Volume 4, Number 4 (2009)

18. Richard J. Lazzara, Tiziano Testori, Alan Meltzer, Craig Misch, Stephan Porter, Robert del Castillo, Ronnie J. Goené: IMMEDIATE OCCLUSAL LOADING™ (IOL™) OF DENTAL IMPLANTS: Predictable Results Through DIEM™ Guidelines Supplement top a Montage Media publication.

Stomatolog / vol.19 – July 2013

Immediate loading – What is new from the C-TECH implant system?

Dr. Zoran Lazić sci stom. klinika za stomatologiju VMA, beorad – Dr. Marko Magić stom. privatna ordinacija Dental Clinic Lazić Beograd

The studies of Brånemark and associates from Gothenburg University have laid the foundation of modern implantology on which the immediate loading procedure is based.

Immediate loading means loading procedure immediately after implantation. Use of the concept of immediate loading of dental implants became topical in the last ten years.

Immediate loading presents ability to do the surgical and prosthetic phase in the same day or within few days. Success of the immediate loading procedure largely depends on osseointegration factors: the implant shape and design, bone quantity and quality and surgical procedure.

Primary implant stability: Primary implant stability is the key to successful implant integration regardless of loading protocol. For immediately loaded implants it is especially important to restrict micro movements within the limits of tolerance.

Macro design of implant: Shape of the implant plays a significant role in primary stability. Tapered implants and implants with extended neck provide greater stability than cylindrical implants and as such they have advantage in cases of immediate loading. When using tapered implants precise bone preparation is demanded for achieving accurate apico-coronal position of the implant.
Micro design of implant: Effect of the implant surface in bone healing process is reflected as the limit of tolerance for loading is higher in textured implant surface than in smooth, machined surface.

Micro design of implant: Effect of the implant surface in bone healing process is reflected as the limit of tolerance for loading is higher in textured implant surface than in smooth, machined surface.

Effect of the bone on implant stability – Bone height: The Implant must be surrounded with at least one millimeter of the cortical bone, and in frontal region of maxilla where high esthetics are demanded this thickness should be at least two millimeters.

C-TECH implant system
Use of the immediate loading procedure has become the standard in everyday implant rehabilitation. Within the C-TECH implant system, Esthetic Line (EL) is specially designed for immediate procedures. Its goal is achieving as high as possible primary implant stability and it satisfies the highest implantation demands in esthetic region.

Case report
Female patient (age 48 years) was admitted for rehabilitation of completely toothless upper jaw. After clinical and radiographic analysis it was noticed that the floor of maxillary sinus is lowered and that implantation is impossible in posterior regions of maxilla.

Conclusion
This case report shows how it is possible to solve completely toothless maxilla and immediately load implants if indications were appointed correctly. All immediate loading principals were followed, and special attention has been paid to alveolar ridge structure, selection of the implants, mechanical forces affecting the implant and also to surgical procedure and number of placed implants. C-TECH Esthetic Line implants combined with PEEK abutments showed great success in this complicated case of immediate loading.

References

1. Misch CE, Wang HL. Immediate occlusal loading for fixed pros-theses in implant dentristry. Dent Today. 2003 Aug.; 22(8):50-6

2. Szmukler-Moncler S, Piattelli A, favero GA, Dubruille JH. Considerations preliminary to the application of the early and immediate loading protocols in dental implantology. Clin Oral Implants Res. 2000 Feb;11(1):12-25

3. Romanos G, Froum S, Hery C, Cho SC, Tarnow D. Survival rate of immediate vs delayed loaded implants: analysis of the current literature. J Oral Implantol. 2010; 36 (4)315.24

4. Shayesteh YS, Khojasteh A, Siadat H, Monzavi A, Bassir SH, Hosaini M, Alikhasi M. A A comparative study of crestal bone loss and implant stability between osteotome and conventional implant insertion techniques: a randomized controlled clinical trial study.
Clin Impant Dent retal Res. 2011 Aug 4

5. Misch CE, Degidi M. Five-year prospective study of immediate/early loading of fixed prostheses in completeley edentulous jaws with a bone quality-based implant system. clin Implant Dent Relat Res. 2003;5(1):17-28

6. Quinlan P, Nummikoski P, Schenk R, Cagna D, Mellonig J, Higginbottm F, Lang K, Busr D, Cochran D,. Immediate and early loading of SLA ITI single-tooth implants: an in vivo study. Int J Oral Maxillofac Implant. 2005 May-Jun; 20(3):360-70

7. Romanos GE, Malmstrom H, Feng C, Ercoli C, Caton J, Immediately Loaded Platform-Switched Implants in the Anterior Mandible with Fixed Prostheses: A Randomized, Slit-Mouth, Masked Prospective Trial. Clin IMplant Dent Relat Res. 2013 Mar 28

8. Romanos G, Toh CG, Siar CH, Swaminathan D, Ong AH, Donath K, Yaacob H, Nentwing GH. Peri-implant bone reactions to immediately loaded implants. An experimental study in monkeys. J Periodontol. 2001 Apr.; 72(4):506-11

9. Miyahara T, Dahlin C, Galli S, Parsafar S, Koizumi H, Kasugai S. A novel dual material mouthguard for patients with dental implants. Dent Traumatol. 2012 Jul 31

10. Tawil G, Mawla M. Sinus floor elevation using a bovine bone mineral (Bio-Oss with or without the concomitant use of a bilayered collagen barrier (Bio-Gido): a clinical report of immediate and delayed implant placement. Int J oral Maxillofac Implants. 2001 Sep-Oct;16(5):713-21

Stomatolog / vol.18 • December 2012

Immediate implantation following tooth extraction. A clinical case study.

Dr. Winfried Walzer

The placement of the implant in a post-extraction bed is a technique, that has been developed especially within the last 10 years.

For immediate implant placement we have the option for an incision and detachment or for a flapless surgery. Generally there is a tendency for a flapless procedure when there is adequately keratinized gingival and a correctly aligned gingival margin.

Since primary stability is more difficult to achieve in immediate implant placement the aspect of choosing the ideal implant body becomes more important.

Case Description: A 53 year old patient presents himself with a reduced dentition in the mandible.
To give the patient a fixed restoration, five implants have been inserted – two in the left, and three in the right mandible.

The implant of choice here was a BL (bone level) Morse conical connection Implant D4,3/L13mm from C-TECH. The shape, angle and depth of the threads are specifically conceived to increase contact surface with the bone and improve primary stability. The root form anatomical design with a slight taper at the implant collar is the ideal design to achieve good bone contact and reduce the gap between implant and bone at the alveolar crest.

The second stage surgery is minimal invasive through the internal hex connection. The shape of the healing abutment minimizes the trauma on the soft tissue, since we do not expose the implant sholder by elevating a flap. The Morsel locking tapered internal conical hex connection of the BL Implant comprises two proven elements in implant prosthetics; a tapered Morse conical connection with a hex at the base. The conical taper provides a cold welding seal which locks the abutment into its final seated position. The hex at the base of the implant provides an optimal positioning index. The combination of taper and hex deliver a high level of prosthetic precision while ensuring against abutment loosening.

Summary: There is not enough reliable evidence proving higher success of immediate implant placement over delayed implantation. Post-extraction implants have survival rates similar to implants placed in healed sites.

If primary stability is achieved, immediate implant placement following tooth extraction can be a viable alternative to delayed placement.
The benefit of immediate implant placement for the patient is obvious:
First of all it reduces the treatment time and if immediate loading is an option, a temporary removable denture can be avoided.

References

1. Schulte W, Himke G. The Tübinger immediate implant quintessence 1976; 27:17-23

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