Dental Tribune United Kingdom Edition

21Implant TribuneMay 23-29, 2011United Kingdom EditionUnited Kingdom Edition ing.40 Smoking has been shown to be one of the most signifi- cant factors predisposing to implant failure.41 Individuals who use alcohol in excess may have inadequate nutrition in- cluding vitamin deficits which may compromise initial site healing.42 Diabetes It is well known that diabetic patients are at higher risk for developing periodontitis and are also more prone to infec- tion.43 It is very likely that per- formance of dental implant will be affected as well. Poor metabolic control in diabetic patients increases the risk of peri-implantitis. Biologic width Crestal bone remodeling to es- tablish “biologic width” or soft tissue seal in peri-implant mu- cosal tissues is considered to be an important factor contrib- uting to early crestal bone loss with all types of endosseous dental implants (Fig. 4).45, 46 Factors known to affect this crestal bone loss include the level of micro-gap in rela- tion to the bone crest, platform switching achieved either by implant body design and/or by using an abutment smaller in diameter than the implant body and tooth-implant or inter-implant horizontal dis- tance. Another factor with del- eterious effect on crestal bone resorption is considered to be the repeated removal and re- placement of abutments be- cause of disruption of the soft tissue seal.47 The biologic width has changed horizontally within the platform switched implant. Level of the micro-gap The connection between im- plant body and prosthetic abutment is termed “micro- gap” and, in most cases, it is susceptible to microbial seed- ing and micro-movements be- tween the parts during clinical function. Both micro-gap and micro- movements may lead to localised inflammation and associated crestal bone loss if the micro-gap is within a mini- mum distance from the alveolar crest. Biologic width around the neck of a dental implant consti- tutes a mucosal seal intended to protect the underlying bone. Itisformedapicallytothemicro- gap and requires a minimum of about 1.5mm of fibrous con- nective tissue between bone and epithelial attachment of the gingival sulcus of the implant (Fig. 5).48, 49 Platform switching This design feature can be created in an implant body or achieved by the clinician us- ing a compatible abutment of a narrower diameter than the implant platform. It can be ac- quired even with the healing abutment in case of nonsub- merged approach. The purpose of platform switching is to cre- ate a horizontal component for the total linear distance between micro-gap and bone crest required for biologic width50 and eventually to shift page 22DTà ‘Smoking has been shown to be one of the most significant factors predisposing to implant failure’ *  The Dental Advisor,   Vol. 23, No. 3, p. 2-5 Overcoming opposites. Honigum – Made by DMG. Honigum Professional precision, now available as putty as well! Honigum-Putty  from  DMG  is  the  new  kneadable  VPS   precision  impression  material  in  the  user-friendly  450  ml   can.  Its  DMG-developed  Snap-Set  technology  facilitates  a   so far unrivaled combination of comfortable working time  and short time in the mouth.  Honigum-Putty is the ideal partner for Honigum-Light which  received  the  best  clinical  ratings*  of  all  tested  VPS  by  the   noted test institute »The Dental Advisor«, not least thanks to  its  DMG-patented  rheologically  active  matrix.  For  precise  and  detailed  impressions  Honigum-Putty  also  offers   excellent recovery characteristics after deformation.  DMG. A smile ahead. Additional information is available at www.dmg-dental.com AZ_HG_E_1004.indd 1 21.04.10 16:20