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case report _ prevention of implant resorption I I 13implants3_2011 Fig. 13_Two implants in each mandibular molar. Fig. 14_Two implants in a first maxil- lary bicuspid that recreate a more natural root configuration. Fig. 15_Two implants in a maxillary second bicuspid that recreate a more natural two-root fusion. Fig. 16_Replacement of each lost tooth with individual implants of 4.10, 3.76 and 3.26 mm in diameter and 16 mm in length. recreatingalltherootsequallywithintheentiremasti- catorysystemwasachievedon11March2005.InMarch 2006,44implantswereinsertedina55-year-oldfemale patient,includingthinimplantspassingalongthesides ofthewalloftheleftsinus,accordingtooneimplantper rootlost. _Materials and method As maxillary molars are exposed to a high level of stress (masticatory forces of approximately 44 kg), it is recommendedthatlostrootsbereplacedwiththreeim- plantsratherthanoneortwoshortones.Thethreeim- plantswillthenactasatripodandresisttheforcesand pressuregeneratedintheupperposteriorregionsofthe mouth.Thelengthusedformesialanddistalimplantsis usually8,10,12mmor,ifpossible,alongerimplant.The palatal implant can be somewhat longer, since it is re- placingthepalatalrootofamaxillarymolar,whichisthe longest. Mandibular molars support chewing forces of ap- proximately 31 kg. Therefore, the replacement of each of the two roots with implants of 8, 10, 12 or 14 mm in length is recommended, if the lower dental conduct is toolow.10 Maxillarybicuspidssupportforcesof22to28kg.The firstonehastworootsseparatedintheapex.Thiscanbe replacedwithtwoimplantsof3.26mmindiameter.The second one with two fused roots ending in one at the apex can be replaced with two implants of 3.26 mm in diameter.Theseimplantswillgivethebicuspidsthebal- anceofvestibularandpalatalroots. Maxillary and mandibular incisors receive mastica- tory forces of about 15 to 16 kg. Since they naturally haveonlyoneroot,asingleimplantofthesamelength as the extracted root is sufficient. When possible, a larger implant may be used (within anatomic limita- tions).3 _Conclusion It is recommended that in the bone of the posterior quadrantscliniciansusetwoorthreeimplantsaccord- ingto“oneimplantperrootlostinmolars”10 withanos- seous quality of D4 to create a greater predictability of treatment outcome. When pieces are substituted with individual crowns over the implants8 on maxillary and mandibular molars, a greater positive outcome can be predicted. Alternatively, by using the implants without surgery technique (without soft-tissue reflection)9 de- veloped in 1997, in combination with the technique of osteo-compression for the insertion of one-piece im- plants,anyneedforadditionalappointmentstoattend tothepossiblecomplicationsofprostheticcomponents may be negated. The use of these effective, cost- and time-savingtechniqueswillultimatelysavethepatient unnecessaryanguish,fear,stress,oreventhepossibility of complicated and traumatic surgery. This technique ensuresthepossibilityofreplacingallthe44roots,one by one, with implants that conform a natural human dentition. The techniques mentioned above also have the ad- vantageofavoidingpainandinflammationbothduring and after the procedure, which allows for a more rapid healingandosseointegrationoftheimplants.9 Mostim- portantly,thesetechniquesallowrepositionandimme- diate load (with provisional acrylic or polycarbonate crowns) of each lost piece quickly, simply, effectively, economicallyandwithaestheticconcernsinmind.Also, thesetechniquesarelessinvasiveandmoreaffordable; therefore,theycanbeconsideredviablealternativesto extensiveaugmentationprocedures._ Editorial note: A list of references is available from the author. Fig. 13 Fig. 14 Fig. 15 Fig. 16 Prof Dr Eduardo Topete A. Av.Justo Sierra No.2450 44600 Guadalajara Mexico dentalimplantsmcoi@prodigy.net.mx www.implantesdentalestopete.com DrTopete is a member of the International Con- gress of Oral Implantologists Board of Directors, Consejo Mexicano de Implantologia Oral,Mexican College of Oral Implantology and Preceptorship in Oral Implantology University ofTexas Health Science Center. _contact implants