implants - international magazine of oral implantology

Fig. 7_Case of 40 implants, five-year follow-up (2005). Fig. 8_Dr Eduardo Topete presenting his case at the University of Texas Health Science Center (2003). Fig. 9_Case of 44 implants in a 57-year-old male patient (2005). haveaminimumoffiveyearsof goodfunctiontobeconsidered a success. If we insert the max- imum number of implants while planning the position and alignment that the roots used to have perfectly, we can avoid future resorption8 and most importantly, pain, in- flammation, stress and the time that sinus elevation sur- gerytakes,aswellastheplace- ment of autogenic bone blocks ortherepositioningoftheden- tal nerve. Since 1994, the following protocol has been in use: the threerootsofamaxillarymolar are replaced with three implants placed in the loca- tionsofthemesial,distalandpalatalroots.Thisallows an increased surface area in a region in which an in- creasednumberofimplantsisparticularlyimportant, owing to compromised strength and high occlusal loads. Themaxillarymolarsustainsmasticatoryforcesof 44kg;therefore,itisrecommendedthatitbereplaced with three implants rather than one or two short im- plants. These three implants act as a tripod to sustain thepressureandforcesgeneratedintheposteriorre- gion. When a sinus graft is not part of the treatment plan,asinusliftmaybeperformedfrominsidetheim- plant osteotomy. Mesial and distal implants are usu- ally8mmorgreaterinlength.Thepalatalimplantmay be longer to substitute the palatal root of the first maxillary molar. A modified treatment plan includes the use of at least two implants for each molar. In a case of maxillary molars, 4 mm implants were placed inthealveolarsocket(afterextraction)usingimplant insertionwithoutsoft-tissuereflectionandadelayed immediateloadingtechnique.Aretrospectiveclinical study of implant restorations showed that a greater numberofimplantsplacedinsuchawayresultedina lower bone resorption.10 Another important issue that needs to be consid- ered is that the diameter of clinical crowns is not the sameforallpieces.Inordertoensuregreaterprecision in collocating individual crowns on molar implants, the use of the Implant Positioning Space Paralelome- ter System (I.P.S.P.S.) is recommended. With this sys- tem,itispossibletoequalthediameterofthelostmo- lars by using two or three implants without resorting to the use of voluminous and heavy implants that are unable to provide the necessary bipod or tripod sup- port needed in posterior pieces. If we are to meet the aesthetic and functional de- mands encountered in our modern and fast-paced world,amoreefficientandimmediateunitaryindivid- ual reposition of lost pieces is needed. This goal can best be achieved by inserting implants without inci- sions and without soft-tissue reflection. Such a tech- nique offers an enormous advantage.9 At the same time, it is strongly recommended that the least possi- ble osteotomy be performed, on the basis of the prin- ciples of osteo-compression. Otter proved physiolog- icallythatutilisingosteo-compressionresultsinapo- tentiallymassiveincreaseinvenouspressurethatpro- motesossification.AsSalzsteinandEricksonpointout, bone compression causes extra-cellular fluids to flow around the surface of cells charged with osteoblasts, and this produces faster osseous regeneration. Histological studies carried out at Louisiana State University by Block and Meffert have demonstrated theprincipleofcontrolledfunctionalosteo-compres- sion. Within three months, single-piece implants im- mediately exposed to loads showed more than twice the bone density on the implant interface than two- pieceimplants(implantpluspost)withoutimmediate load exposure. Currently, single-piece implants with built-in posts substantially improve the surgical- prosthetic protocol, since their insertion is faster re- gardless of whether the angle is 0, 16 or 26°, as is the case using One-Stage Implants. Previously, complications have arisen with pros- theticparts,buttheinsertionofsingle-pieceimplants with osteo-compression will undoubtedly improve the surgical, as well as the prosthetic prognosis. The bone-compression technique especially improves bone quality at the implant location. Special instru- ments devised for this procedure ensure that the im- plants are inserted into the posterior maxillary with- out elevation of the cavity, since the insertion of im- plants in the posterior maxillary quadrant is generally recognised as a challenge, even to the most experi- enced implantologist. This area has very poor bone quality (D4) and deficiency adversely affects the pos- I case report _ prevention of implant resorption 10 I implants3_2011 Fig. 8 Fig. 9 Fig. 7