implants - the journal of oral implantology UK Edition

20 I Icase report _ multiple implants implants1_2012 total oral rehabilitation with 28 individual crowns on 40 implants (one implant per root lost) and without surgery (without soft-tissue reflection). Such a case was presented during the 2002–2003 Preceptorship in Dental Implantology course held at the University of Texas Health Science Center at San Antonio, USA. Recently, all the roots that made up a human dentition were replaced, one by one. In this case of a 57-year-old male patient, 44 implants were inserted (including maxillary bicuspids with two implants). The goal of recreating all the roots equally within the entire masticatory system was achieved on 11 March 2005. In March 2006, 44 implants were inserted in a 55-year-old female patient, including thin implants passing along the sides of the wall of the left sinus, according to one implant per root lost. _Materials and method As maxillary molars are exposed to a high level of stress (masticatory forces of approximately 44 kg), it is recommended that lost roots be replaced with three implants rather than one or two short ones. The three implants will then act as a tripod and resist the forces and pressure generated in the upper posterior regions of the mouth. The length used for mesial and distal implants is usually 8, 10, 12mm or, if possible, a longer implant. The palatal implant can be somewhat longer, since it is replacing the palatal root of a maxil- lary molar, which is the longest. Mandibular molars support chewing forces of ap- proximately 31kg. Therefore, the replacement of each of the two roots with implants of 8, 10, 12 or 14mm in length is recommended, if the lower dental con- duct is too low.10 Maxillary bicuspids support forces of 22 to 28kg. The first one has two roots separated in the apex. This can be replaced with two implants of 3.26mm in di- ameter. 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. These implants will give the bicuspids the balance of vestibular and palatal roots. Maxillary and mandibular incisors receive masti- catory forces of about 15 to 16kg. Since they natu- rally have only one root, a single implant of the same length as the extracted root is sufficient. When pos- sible, a larger implant may be used (within anatomic limitations).3 _Conclusion It is recommended that in the bone of the posteri- or quadrants clinicians use two or three implants ac- cording to “one implant per root lost in molars”10 with an osseous quality of D4 to create a greater predict- ability of treatment outcome. When pieces are sub- stituted 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 developed in 1997, in combination with the technique of osteo-compression for the in- sertion of one-piece implants, any need for additional appointments to attend to the possible complications of prosthetic components may be negated. The use of these effective, cost- and time-saving techniques will ultimately save the patient unnecessary anguish, fear, stress, or even the possibility of complicated and traumatic surgery. This technique ensures the possi- bility of replacing all the 44 roots, one by one, with implants that conform a natural human dentition. The techniques mentioned also have the advan- tage of avoiding pain and inflammation both during and after the procedure, which allows for a more rapid healing and osseointegration of the implants.9 Most importantly, these techniques allow reposition and immediate load (with provisional acrylic or poly- carbonate crowns) of each lost piece quickly, simply, effectively, economically and with aesthetic concerns in mind. Also, these techniques are less invasive and more affordable; so, they can be considered viable alternatives to extensive augmentation procedures._ Note:Alistofreferencesisavailablefromtheauthor. implants_contact info Prof Dr Eduardo Topete A. Av. Justo Sierra No. 2450 44600 Guadalajara Mexico dentalimplantsmcoi@prodigy.net.mx www.implantesdentalestopete.com Fig. 13 Fig. 14 Fig. 15 Fig. 16 Fig 13_Two implants in each mandibular molar. Fig 14_Two implants in a first maxillary 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 3.26mm in diameter and 16mm in length.