Dental Tribune United Kingdom Edition

October 22 - 28, 201226 United Kingdom EditionClinical cell-rich but rich in collagen fib- ers. The Sharpey’s fibers, which pass from the outer layer through the inner layer, are embedded in the Substantia compacta of the bone and secure the periosteum to the bone. The iatrogenic de- tachment of the periosteum can lead to poorly nourished bone after weeks, months or years. Following radiologic examina- tion, pocket depths of more than 3mm, bleeding and peri-implant inflammation are clinically diag- nosed as crater-shaped defects and bone loss around the implant. In combination with D2 to D4 bone spreading during implanta- tion, 3.0 mm or 3.5 mm-diameter implants can also be placed in a narrow jaw, and the implants will be surrounded by sufficient- ly solid bone in all dimensions. If flapless surgery is performed correctly, there will be very little risk of bone resorption or loss or soft tissue loss. With flapless sur- gery, optimal bone nutrition can be ensured on the long-term. Re- cent studies in conjunction with immediate restoration/ immedi- ate loading have shown that flap- less surgery results in good bone nutrition and good soft and hard tissue outcomes5-16 . For 18 years, these techniques have been per- formed with the Champions® implants and other implant sys- tems. A flapless MIMI®- treatment should be performed by an ex- perienced Implantology special- ist because if the mucosa is not flapped open, beginners in Im- plantology might fear not to see exactly in which precise site they are to insert the implant. Contra- ry to what skeptics might think, MIMI® surgery, which is related to key-hole surgery, is not a “blind procedure”. Before inserting the implant, it is an absolute must to palpate and check the bone cav- ity thoroughly in all dimensions by means of a BCC (Bone Cav- ity Check) probe each time after drilling and each step. You should be able to feel solid bone in all dimensions. Not only is it nec- essary that the surgeon and the implantologist have considerable manual dexterity and a lot of ex- perience with implantation and with the MIMI® procedure (and eventually also with the classi- cal “full-flap” method) to apply the MIMI® method successfully, a suitable implant system is also necessary for the MIMI® method. Thanks to the MIMI® tech- nique, augmentation (external sinus lift or bone transplanta- tion) can be avoided in many cases. Long-term complications and periimplantitis can be sig- nificantly reduced or eliminated. Patient compliance is important as well, but patients will become real fans of this flapless MIMI® method. The implantological and prosthodontic treatments that were demonstrated in this case report were completed in only five days following a periodontal pre-treatment. Immediately after implantation, the patient left the dental office with a temporary fixed bridge. A day after surgery, the patient was able to resume his daily activities as a business man without feeling any pain. In addition, the treatment was far less expensive than it would have been in many other dental clin- ics/dental offices. DT • References available from the publisher page 25DTß ‘Thanks to the MIMI® technique, augmentation (ex- ternal sinus lift or bone transplanta- tion) can be avoid- ed in many cases’ About the author Dr Armin Nedjat, dentist, Implantol- ogy specialist, Diplomate ICOI Champions-Implants GmbH Bornheimer Landstraße 8 D-55237 Flonheim, Germany Tel.: +49 (0) 67 34 / 91 40 80 Fax: +49 (0) 67 34 / 10 53 info@champions-implants.com www.champions-implants.com Fig. 7-12: With transfer caps, which were manufactured and delivered by the laboratory, a “navigated prepa- ration” of the implants/teeth was performed in the second session. We purposely did not prepare the crown edges that were positioned about 0.4 mm subgingivally. The navigated preparation allowed a framework to be passively fit (in this case, the framework was laser-sintered). The preparation, the framework, and the 2nd bite registration in the mouth of the patient were done three days post surgery and without anesthesia, which was not necessary in this case. Fig. 9 Fig. 10 Fig. 11 Fig. 12 Fig. 13 Fig. 13 – 18: The laminated ceramic crowns were fit only 5 days after im- plantation. Restorations supported by many teeth/implants are usually fit with Implant Link semi (which is also avail- able via the Champions®- Liga). The restorations can be easily removed by the dentists. If necessary, they can be relined with ceramic. According to our experi- ence, relining is not absolutely necessary because healthy gingiva tolerates ceramic very well, leading to healthy appearance instead of causing gingival recession. Fig. 14 Fig. 15 Fig. 16 Fig. 17 Fig. 18 Fig. 19 Fig. 20 Fig. 19: The secret of success for perform- ing a minimally invasive implantation: the conical triangular yellow, black and white drills allow flapless transgingival drilling and ensure lateral bone condensing. Fig. 20: View of a 3D DVT image of an implantation that was performed using the flapless MIMI® method 18 years ago. The D2 bone only had a width of 3.0 mm. Bone was drilled with conical drill with a maximum diameter of 1.8 mm. Then, 3.5 mm-diameter implants were placed and ensured excellent lateral bone condens- ing/spreading. The periost was intact. The implants achieved primary stability at a torque from 40-60 Ncm. Then, they were immediately loaded. Even 15 years after implantation, no resorption and perforation were observed. Instead, bone spreading was observed. 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!