implants - international magazine of oral implantology

industry report _ TRIPOD procedure I deed,onlytherearpartofthedrill(thusfarfromthetip) can be cooled efficiently, and thereby probably makes the cooling procedure ineffective. In contrast, during thedescribedTRIPODprocedure,theguideisplacedon the gingiva at the time of fabrication, leaving an open spaceforcoolingatthetimeoftheopenflapsurgery.In addition, the bone becomes visible, which allows the practitionertovisualisethedepthmarksofthedrillright atthecrestalridge,makingtheinstrumentationlessex- pensive and easier, as no special drill with mechanical depth limitation is required. Site preparation may be modifiedbyusingpiezoelectricbonesurgery,sincethis devicecangrindboneonaparticularwallfromthepre- viousdrilling,incontrasttoconventionaldrilling,which grindsallwallsfromthepreviousdrilling,withaprefer- enceforsoftertissueandresultinginfacialboneperfo- ration. In some situations, one might also consider changingfromdrillstobonespreaders;thiswouldcom- pact the surrounding bone and provide additional sta- bilitytothecorrespondingimplant.Finally,theimplant could be adapted to a recipient site by choosing an ap- propriate diameter, length and even the profile (e.g. from conical to conical-cylindrical) once site prepara- tionhasalmostbeencompleted. The previously placed implants not only add useful precision to implant site preparation with the guide, but also provide essential stability to immediately loadedbridgeworkinanareawherestabilityintheini- tialhealingphaseisprobablyvitaltosuccess.Mostpa- tients are already older, with a history of periodontitis, toothlossandassociatedimpairedmedicalconditions, andpossiblyreducedhealingcapacity.Therefore,itisof majorinteresttobeabletoassessthehealingcapacity by the stability of previously placed implants, before undergoing and performing a full-arch maxillary bridge immediately loaded on implants, preferably with advanced surface technology. Most of the cases require some sort of bone grafting in the posterior ar- easandthistechniqueleavestimeforinitialhealingbe- fore occlusal loading. In fact, some of the implants would be subjected to immediate loading, while oth- ers—the most critical in terms of bone volume avail- ability and location—could be loaded according to a classical schedule. This should be considered when makingacomparisonwithotherprocedureswithsur- gicalguides. The INICELL® surface found on Thommen Medical implantsshowedmorebone-to-implantcontactand a higher removal torque at two weeks than uncondi- tioned implants did.15 This aspect should be particu- larly useful in the early stages of healing and provid- ing additional security in this crucial phase. In addi- tion, this company provides implants of various di- ameters,lengthandprofilestosatisfyvariousimplant site requirements and which provide the best possi- ble stability. _Conclusion The TRIPOD protocol is based on our latest clinical experience.ItutilisesCBCT,aswellasthevastdevelop- ments of implant placement planning software and computer-guided implant dentistry. The efficiency of thetechniquemuststillbevalidatedbyanalysisofim- plantsurvivalindifferentclinicalenvironments,specif- ically investigating adequate positioning between plannedandfinalimplantposition,andtheneedtover- ify the surgical guide after the learning process has been completed. Finally, a study on patients’ satisfac- tion with the procedure in terms of pain and aesthetic outcome needs to be performed. We must still deter- minewhetherthebenefitsofopenflapsurgeryincom- binationwithsurgicalguidesoutweightherelateddis- comfort and pain for the patient: does this pose a ma- jor problem for patients, are the final aesthetics im- provedbypreservingkeratinisedtissue,anddoessuch a technique fulfil expectations, considering that bone volumelossisoftendifficulttolimitintheseareas? The proposed TRIPOD procedure is certainly more labour-intensive than current flapless guide systems, since a flap has to be raised and no definitive prosthe- sis is placed right after surgery. Nevertheless, it is also moreversatilebecausemaintainingorincreasingbone volume is considered in the treatment plan and is adapted to the individual situations. The risk of failure is considerably reduced by connecting immediately placedimplantstoosseointegratedimplants.Further- more, this procedure allows using the last millimetre, astypicalcasesshowreducedbonevolumeandrequire thewidestandlongestimplantswithinanatomicalre- strictions. Although knowledge and close collabora- tion with the laboratory technician are required, this procedure adds fundamental security and pre- dictability for success, and will certainly be adapted to different practice situations and one-day proce- dures._ Editorial note: A list of references is available from the publisher. I 35implants3_2011 Dr Jean-Nicolas Hasson 5 Rue duWerkhof 68100 MULHOUSE France Tel.:+33 389 458984 Fax:+33 389 563112 E-mail:hasson@hrnet.fr _contact implants