implants - internationalmagazine of oral implantology

I clinical study _ extraction plus technique 20 I implants4_2011 well as the cost. This scenario means that we have to findagoodsolutionforthosepatientswhocannotun- dergo such a difficult procedure, bearing in mind that theuseofshortimplantsaloneisnotadvisableinmany cases. The onus is on us to come up with a simple and standardmeansofimplantationtosavetimeandpain and to minimise the risk of complication and failure. Theprincipleofthenewtechniqueproposedhere—the extractionplustechnique—istheextractionandsacri- fice of the adjacent natural tooth, followed by the in- sertion of a long implant to support shorter implants thatareinsertedwhereboneheightislimited.Through thisnewtechnique,wecanconvertacomplicatedpro- cedure(guidedboneregeneration–GBR)intoasimple standardprocedurewithlesspain,savingtimeandcost andminimisingtheriskofcomplications. _Materials and methods Method Thesuccessandapplicationofthetechniquedis- cussed in this article were determined through two surveys and a clinical case. Two questionnaires were administered to the respondents (surveys 1 and 2). The respondents were then asked to rank the alter- native techniques (including extraction plus tech- nique) as a good alternative means of treatment for eachofthetwocasespresented.Theyweregiventhe following options: the first choice of alternative treatment (most preferable; indicated with +++); the second choice (more preferable; indicated with ++); the third choice (preferable; indicated with +); and not considered a viable alternative treatment (indicated with -). Survey Forsurvey1(Table1),caseA1wasafree-endsad- dle mandible with atrophic alveolar bone height about 8 mm above the inferior alveolar nerve canal but with sufficient width; and case B1 was an atro- phiedfree-endsaddlemaxillawithteeth#26and27 missing and an alveolar ridge height of about 5 to 7 mm to the sinus floor and sufficient alveolar width. For survey 2 (Table 2), the two cases pre- sentedwerethesame,exceptthatincaseA2thefirst premolar and in case B2 the second premolar had a peri-apical cystic lesion and were considered un- healthy teeth. Fig. 5_Panoramic radiographic with partial denture and limited alveolar bone height 7–9mm above the inferior alveolar. Fig. 6_Panoramic radiographic with the treatment plan drawing. Tab. 1_Survey 1 which presented Case A1 and Case B1 and all the alternatives under each case and clinicians can mark. Fig. 7_Post-operative panoramic radiographic revealed the implant placement as planned. Fig. 8_The flaps were re-positioned in a submerged surgical approach except the extracted site implants. Fig. 9_shows the impression caps and synOcta positioning cylinders snapped into place prior to the final impression. Fig. 5 Fig. 6 Fig. 8 Fig. 9 Fig. 7 Table I