implants - the journal of oral implantology UK Edition

I 19implants1_2012 case report _ multiple implants I nique developed in 1997, the general anaesthesia, the anxiety and, most importantly, the traumatic surgery can all be avoided, achieving a shorter healing time and osseointegration. There is no inflammation and no pain during or after the procedure.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-old male patient. Each crown was individu- ally inserted, and the crowns were neither physically nor chemically bonded to one another.8 The clinical goal was to follow the example set by nature and copy the original human dentition as closely as possible by setting individual crowns on implants.9 A physiological prophylaxis of the alveolar bone structure was made, replacing each tooth lost with one implant, through the radicular insertion of intra-osseous implants.7 Nature did not provide us with bridge prostheses but with individual pieces, each having to achieve optimum mastication func- tion. The patient was clinically evaluated daily for one week following the insertion of the implants and the provisional prosthesis. Similar clinical evaluation was continued following the placement of the permanent crowns for the first year to observe the ongoing os- seointegration process. Thereafter, the patient was checked in three-month intervals for three years after the procedure. After three years, however, resorption of bone surrounding the maxillary and mandibular molars was observed, and especially so around the maxillary. On the other hand, no resorption was ob- served around the front teeth. These clinical obser- vations made in 1994 motivated clinicians to seek a solution that would more closely imitate the shape, direction, size, and number of roots that evolution provided for us. The goal was to recreate, as faithfully as possible, a copy of the natural masticatory appara- tus with all its unique root structural configurations, whether unipod, bipod or tripod in nature. The idea immediately arose of replacing lost pieces and their individual roots according to one implant per root lost by using the same alveolus that nature had created for this purpose. This procedure was de- veloped further, resulting ultimately in the collocation of implants without soft-tissue reflection. This tech- nique is termed “implants without surgery” (without soft-tissue reflection) and was presented for the first time at an international congress in 1997.9 Based on the extensive professional experience obtained since 1974, the recreation of the more natu- ral alveoli for every one of the 40 roots that nature provided for our dentition is recommended. (Neither the third molars and the two separate roots of the maxillary first bicuspids nor the two fused roots of the maxillary second bicuspids were considered.) The case pictured here was completed in May 2000 and was closely monitored thorough check-ups that included orthopantomograms, digital X-rays and CT scans every three months. No apparent resorp- tion was observed in this 58-year-old male patient. He continued to show no periodontal complications, nor any complications associated with his implants. He was instructed on the importance of maintaining daily dental hygiene, including flushing and cleaning of the areas of contact between the implants, gum and crowns with a pressurised water spray, vibrating brushes and vibrating point devices in order to avoid bacterial plaque build-up. It is well known, however, that this principle and ideal technique of one implant per root lost cannot be implemented 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 maxil- lary or mandibular bone selected for the insertions. It is also very important to have experience in achieving Fig. 10 Fig. 11 Fig. 12 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 maxillary molar (first and second).