Dental Tribune United Kingdom Edition

October 22 - 28, 201224 United Kingdom EditionClinical perform a bone augmentation each time?” “Why should the whole treatment take almost a year and cost much more than the MIMI® treatment although with MIMI®, I hardly felt any pain and the treatment was com- pleted within a few days?” It is important to be mindful of the primary goal of perform- ing a non-traumatic and painless implantation successfully, such as the MIMI® minimally invasive surgical procedure, which often makes bone augmentations un- necessary. For us as dentists, our priority is the benefit for the pa- tient. Instead of bragging about our know-how and skills, the successful results should be the priority for every profession. For instance, the goal of a pilot is not to brag about brilliant flight ma- neuvers but to ensure that the airline passengers have a good and safe flight to the right desti- nation. Our objective as dentists is not to show patients how well we can perform complicated im- plantations, flap open the mu- cosa, suture, and perform bone augmentations. Instead, it’s the successful treatment result that counts. When implanting using MIMI®, bone augmentations can be avoided in about 80 per cent to 90 per cent of the cases. In cases where implants can be immedi- ately loaded (if there are more than three implants/teeth that can be splinted), restorations can be fit immediately, sometimes al- ready within five days! Implantology conferences are sometimes oriented towards classical implant industry, which tends to be influenced by indus- try-led dogmas and which tends not to be adapted to the day- to-day work in dental offices. Sometimes, lecturers who have not had enough hands-on expe- rience in dental offices for years talk about these dogmas. Current studies have cast doubt on these conventional assumptions. These theses have sometimes been em- phasised during conferences by referring to studies of the eighties that have been increasingly ques- tioned. For instance, some den- tists said that flapless minimally invasive implantation would require the use of a DVT-based navigation-guided drilling tem- plate, which has not been proven true for all dental implant sys- tems and bone condensing dental implant systems. In order to place a Champi- ons® implant, you slowly drill in the bone with small-diameter conical triangular drill at a drill- ing speed of 250 rpm. The muco- sa thickness is measured with the drill. Then, before placing the im- plant, the bone cavity is checked with a BCC (Bone Cavity Check) probe after each drilling and step. The titanium grade 4 im- plants (available in diameters of 3.0 mm, 3.5 mm, 4.5 mm and 5.5 mm) are inserted at torques rang- ing from 40 to 60 Ncm to achieve primary stability. A 4.5 mm-di- ameter implant should only be inserted if primary stability can- not be achieved at a torque of 30 Ncm with a 3.0 mm condenser in the D3/D4 bone. In this case, a 4.5 mm-diameter implant was placed in the sites 16 and 26/27. The bone anatomy does not de- termine which implant diameter is to be used. Rather, the diam- eter of the implant is determined by the achieved primary stabil- ity. If a 3.5 mm-diameter implant achieves primary stability at a torque of 40 Ncm, it will be suf- ficient! From a physiological/ im- plantological point of view, insert- ing a 4.5 mm or 5.5 mm-diameter Champions® implant with force can cause poor peri-implant nu- trition if sufficient primary stabil- ity could also have been achieved with an implant with a diameter of less than 4.5 mm. In addition, the use of drill templates is not al- ways useful, but it is essential to feel bone with the BCC probe. Ac- tually, the dentist himself/herself can evaluate the clinical situation better than any computer soft- ware-guided navigation system. Scientific studies on the accuracy of the placement of implants that were assisted by a navigation- guided template have shown apical deviations of 1000 µm on average. Drilling templates are particularly useful when the di- ameter of the drilled cavity with cylinder drills is almost the same as the diameter of the implant that will be placed. One of the benefits of the flapless MIMI® method is that the implant serves as osteotome. Bone can be well-nourished by the intact periosteum. That’s na- ture! Summary MIMI® does not require the mu- coperiosteal flap reflection, and excellent soft tissue and hard tis- sue conditions can be observed after surgery. In recent years, literature has shown that the flapless MIMI® method, which has been applied since 1994, is very beneficial1-3 . Classical im- plantation methods have been increasingly questioned4 . MIMI® treatment has been shown to be effective in protecting bone and significantly reducing the risk of inflammatory soft tissue condi- tions in the first 12 weeks post surgery. The peri-implant bone is al- most completely nourished by the histological, double-layered membrane of the bone, which is richly supplied with blood vessels and nerve fibers: the in- ner cambium layer (Stratum osteogenicum) is rich in cells. It is composed of stem cells (os- teoblasts!!), ensuring bone re- generation, as well as of nerves and blood vessels. The outer fi- brous layer (Stratum fibrosum) is connective tissue, which is not page 23DTß Fig. 1-3: Clinical initial situation after anesthesia in the maxilla: Teeth 14, 13, 21, and 25 had been extracted four weeks before surgery. Then, a temporary interim prosthesis was fit. During the same implantation session, Teeth 23 and 26 were extracted. Fig. 4-6: The 11 square-shaped one-piece Champions® implants were placed with MIMI® in just one hour. After each step, the bone cavity was checked with a “BCC” (Bone Cavity Check) probe. Primary stability was obtained with a torque ranging from 40-60 Ncm. Since at least 8 implants/ teeth were necessary to support a fixed restoration, 11 implants were placed for static reasons. Results of DVT imaging show the optimal distribution in both quadrants. An impression can be made without transfer caps because the four grooves of the square-shaped one-piece Champions® allow a reliable transfer of the clinical situation to the model in the laboratory. page 26DTà ‘One of the ben- efits of the flapless MIMI® method is that the implant serves as osteotome. Bone can be well- nourished by the intact periosteum. That’s nature!’ Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8