Implant Tribune Italian Edition

21Congresso Nazionale SICOI • Milano TRA I VANTAGGI DEL NOSTRO KIT KEXIM® NE ABBIAMO SCELTI TRE: KIT DA ESPIANTO D´IMPIANTI DENTALIL´UNICO EFFICACE SUL MERCATO UNIVERSALE FACILE ATRAUMATICO Offerta lancio 1111UNIVERSALE1UNIVERSALEUNIVERSALEUNIVERSALE1UNIVERSALEUNIVERSALE 22FACILE2FACILEFACILE 11 2 11FACILE 1FACILEFACILE2FACILEFACILE 1FACILEFACILE 33ATRAUMATICO3ATRAUMATICOATRAUMATICO 22 3 22 Se sei interessato alla nostra offerta lancio, scannerizza questo codice BIDI col tuo SmartPhone o tramite nostro sito web www.bti-biotechnologyinstitute.comSegui la nostra evoluzione su BTI Implant Italia Pazzale Piola, 1 20131 Milano | Italia Tel: (+02) 7060 5067 | Fax: (02) 7063 9876 bti.italia@bti-implant.it | www.bti-biotechnologyinstitute.it PUBLI EXTRACCION ITA.indd 1 24/07/12 16:57 RELATORI Congresso Nazionale SICOI << segue The immediate post extraction protocol is very popular because it speeds up the treatment for both dentist and patient: the patient comes in for the planned extraction and in the same pro- cedure the implant is placed. A implant with high primary stability can receive a provisional and the patient goes home with the missing tooth replaced! All in one minimally invasive session. There are some undeniable advantages of this procedure: beside the ones mentioned before, the tissue support after the extraction is taken over by the provisional on the implant and it looks like we preserve the site in an ideal way! Unfortunately dur- ing the maturation phase reces- sion of the gingival margin and flattening of the buccal contour are normal phenomena demon- strated in numerous publications. So we can conclude that this protocol linked with an optimal esthetic outcome has a limited indication and should be planned carefully: a diagnostic landmark is the presence of buccal bone. Also soft tissue grafting to compensate shrinkage is man- datory, especially in patients with a thin biotype. Submerged heal- ing seems to bring more control in the interface area of implant neck-bone-soft tissue. The buccal Bundle Bone being a weak link, dictates slightly palatal implant placement, and grafting of the gap with demin- eralised bovine bone. The post extraction protocol with early placement is indicated in all the post extraction cases in which we encounter (buccal) bone defects or active infections. It can be seen as a 2 step procedure: the tooth is removed and the socked is cleaned and prepared for sealing with an inlay graft. After 5-7 weeks the implant can be placed with less risks and the architecture of the site can be restored with bone regeneration and soft tissue grafting. As a healed site I consider an edentulous single tooth gap of the ridge were a tooth or a failed implant have been missing for at least 3-6 months. Mostly we need beside implant placement a bone and soft tissue build-up to obtain optimal implant esthetics. How do you ideally treat patients with a “downhill or failing dentition” when they are highly motivated and asking you for a high end solution? Before I answer this question I want to make clear that work- ing with implants doesn’t mean automatically that the remaining teeth have to be extracted! On the contrary I see may beneficial solutions in which we maintain teeth and combine them with implant supported C&B work, preferable metal-free. Conditions for maintaining the natural abutments are: a good long term prognoses after treatment (perio/endo), an acceptable cost -benefit ratio, and they should somehow fit positively in an function- al-esthetic plan: for example if we can save some of the anterior teeth when they still have good interdental papillae is preferable over the implant solution. The situation changes when we can obtain improvement in the oral as well as facial esthetic situation by drastically changing the tooth positions involving even the ortognatic jaw relationship. A patient with for example a failing class II subdivision 2 dentition can become with the new implant supported full arch bridges a class I patient, looking much better and younger! (lip support). The Recipe is again the diagnostic analysis as a starting point combined with a radical implant treatment plan in which we abandon completely the original tooth inclination and position! Mock-ups, provisional full dentures to pre-test the new set-up of the teeth combined with good team work are of paramount importance before we finally do the implant surgery. Functional, phonetic and esthetic fine tuning is always done with a fixed implant supported provisional which is also used for soft tis- sue shaping. This Provisional will eventually be the blueprint for the final screw retained bridges. The complete workflow has a duration of 1-2 years, which is quite long, but the results are amazing and also seem to be more stable in time compared with orthodontic or orthognatic surgical corrections of the same type of defects!