implants - international magazine of oral implantology

I case report _ prevention of implant resorption 12 I implants3_2011 sibility of inserting sufficiently stable implants in this area. In the presence of deficient alveolus crests, os- teo-compressionandartificialboneimplantsarerec- ommended by Palti and Steigmann. If we use the “implants without surgery” technique developedin1997,thegeneralanaesthesia,theanxiety and,mostimportantly,thetraumaticsurgerycanallbe avoided,achievingashorterhealingtimeandosseoin- tegration.Thereisnoinflammationandnopainduring oraftertheprocedure.9 _Clinical case report In 1991 for the first time, a total oral rehabilitation was performed, with 27 crowns on 27 implants in a 51-year-oldmalepatient.Eachcrownwasindividually inserted, and the crowns were neither physically nor chemicallybondedtooneanother.8 Theclinicalgoalwastofollowtheexamplesetbyna- tureandcopytheoriginalhumandentitionascloselyas possible by setting individual crowns on implants.9 A physiologicalprophylaxisofthealveolarbonestructure was made, replacing each tooth lost with one implant, through the radicular insertion of intra-osseous im- plants.7 Naturedidnotprovideuswithbridgeprosthe- ses but with individual pieces, each having to achieve optimum mastication function. The patient was clini- cally evaluated daily for one week following the inser- tionoftheimplantsandtheprovisionalprosthesis.Sim- ilar clinical evaluation was continued following the placementofthepermanentcrownsforthefirstyearto observe the ongoing osseointegration process. There- after,thepatientwascheckedinthree-monthintervals for three years after the procedure. After three years, however,resorptionofbonesurroundingthemaxillary andmandibularmolarswasobserved,andespeciallyso aroundthemaxillary.Ontheotherhand,noresorption wasobservedaroundthefrontteeth.Theseclinicalob- servations made in 1994 motivated clinicians to seek a solutionthatwouldmorecloselyimitatetheshape,di- rection, size, and number of roots that evolution pro- vided for us. The goal was to recreate, as faithfully as possible, a copy of the natural masticatory apparatus with all its unique root structural configurations, whetherunipod,bipodortripodinnature. The idea immediately arose of replacing lost pieces andtheirindividualrootsaccordingtooneimplantper rootlostbyusingthesamealveolusthatnaturehadcre- atedforthispurpose.Thisprocedurewasdevelopedfur- ther,resultingultimatelyinthecollocationofimplants withoutsoft-tissuereflection.Thistechniqueistermed “implantswithoutsurgery”(withoutsoft-tissuereflec- tion)andwaspresentedforthefirsttimeataninterna- tionalcongressin1997.9 Based on the extensive professional experience ob- tained since 1974, the recreation of the more natural alveoliforeveryoneofthe40rootsthatnatureprovided for our dentition is recommended. (Neither the third molarsandthetwoseparaterootsofthemaxillaryfirst bicuspids nor the two fused roots of the maxillary sec- ondbicuspidswereconsidered.) The case pictured here was completed in May 2000 andwascloselymonitoredthoroughcheck-upsthatin- cluded orthopantomograms, digital X-rays and CT scanseverythreemonths.Noapparentresorptionwas observedinthis58-year-oldmalepatient.Hecontinued toshownoperiodontalcomplications,noranycompli- cationsassociatedwithhisimplants.Hewasinstructed ontheimportanceofmaintainingdailydentalhygiene, includingflushingandcleaningoftheareasofcontact between the implants, gum and crowns with a pres- surised water spray, vibrating brushes and vibrating pointdevicesinordertoavoidbacterialplaquebuild-up. It is well known, however, that this principle and ideal techniqueofoneimplantperrootlostcannotbeimple- mented with all patients. In addition to the great care that patients have to observe in hygienic terms (as we all do), the patient must have sufficient height and width of the maxillary or mandibular bone selected for the insertions. It is also very important to have experi- ence in achieving total oral rehabilitation with 28 indi- vidualcrownson40implants(oneimplantperrootlost) and without surgery (without soft-tissue reflection). Suchacasewaspresentedduringthe2002–2003Pre- ceptorship in Dental Implantology course held at the University of Texas Health Science Center at San Anto- nio,USA. Recently,alltherootsthatmadeupahumandenti- tionwerereplaced,onebyone.Inthiscaseofa57-year- old male patient, 44 implants were inserted (including maxillary bicuspids with two implants). The goal of Fig. 10 Fig. 11 Fig. 10_Case of 44 implants in a 55-year-old female patient (2006). Fig. 11_One implant per root lost. Fig. 12_Three implants in each max- illary molar (first and second). Fig. 12