implants - the journal of oral implantology UK Edition

18 I implants1_2012 Icase report _ multiple implants planning of a case will lead to failure. In his confer- ence paper, “Plan it or lose it”, he recounted that any case must entail planning for adequate function in the future and must have a minimum of five years of good function to be considered a success. If we insert the maximum number of implants while plan- ning the position and alignment that the roots used to have perfectly, we can avoid future resorption8 and most importantly, pain, inflammation, stress and the time that sinus elevation surgery takes, as well as the placement of autogenic bone blocks or the reposi- tioning of the dental nerve. Since1994,thefollowingprotocolhasbeeninuse: the three roots of a maxillary molar are replaced with three implants placed in the locations of the mesial, distal and palatal roots. This allows an increased sur- face area in a region in which an increased number of implants is particularly important, owing to compro- mised strength and high occlusal loads. The maxillary molar sustains masticatory forces of 44kg; therefore, it is recommended that it be replaced with three implants rather than one or two short im- plants. These three implants act as a tripod to sustain the pressure and forces generated in the posterior region. When a sinus graft is not part of the treat- ment plan, a sinus lift may be performed from inside the implant osteotomy. Mesial and distal implants are usually 8 mm or greater in length. The palatal implant may be longer to substitute the palatal root of the first maxillary molar. A modified treatment plan in- cludes the use of at least two implants for each molar. In a case of maxillary molars, 4 mm implants were placed in the alveolar socket (after extraction) using implant insertion without soft-tissue reflection and a delayed immediate loading technique. A retrospec- tive clinical study of implant restorations showed that a greater number of implants placed in such a way resulted in a lower bone resorption.10 Another important issue that needs to be consid- ered is that the diameter of clinical crowns is not the same for all pieces. In order to ensure greater pre- cision in collocating individual crowns on molar im- plants, the use of the Implant Positioning Space Para- lelometer System (I.P.S.P.S.) is recommended. With this system, it is possible to equal the diameter of the lost molars by using two or three implants without resorting to the use of voluminous and heavy im- plants that are unable to provide the necessary bipod or tripod support needed in posterior pieces. If we are to meet the aesthetic and functional de- mands encountered in our modern and fast-paced world, a more efficient and immediate unitary indi- vidual reposition of lost pieces is needed. This goal can best be achieved by inserting implants without incisions and without soft-tissue reflection. Such a technique offers an enormous advantage.9 At the same time, it is strongly recommended that the least possible osteotomy be performed, on the basis of the principles of osteo-compression. Otter proved physi- ologically that utilising osteo-compression results in a potentially massive increase in venous pressure that promotes ossification. As Salzstein and Erickson point out, bone compression causes extra-cellular fluids to flow around the surface of cells charged with osteo- blasts, and this produces faster osseous regeneration. Histological studies carried out at Louisiana State University by Block and Meffert have demonstrated the principle of controlled functional osteo-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- piece implants (implant plus post) without immedi- ate 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- thetic parts, but the insertion of single-piece implants 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 implants are inserted into the posterior maxillary without elevation of the cavity, since the insertion of implants in the posterior maxillary quadrant is gen- erally recognised as a challenge, even to the most experienced implantologist. This area has very poor bone quality (D4) and deficiency adversely affects the possibility of inserting sufficiently stable implants in this area. In the presence of deficient alveolus crests, osteo- compression and artificial bone implants are recommended by Palti and Steigmann. If we use the “implants without surgery” tech- 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). Fig. 7 Fig. 8 Fig. 9