implants - international magazine of oral implantology

overview I I 19implants4_2012 becomeslesspositive,thefrequenciesoffollow-upvis- itsincrease(Fig.1).Periodontaltherapy“before”implant planning is aimed at saving doubtful (not hopeless) teethwithagraceperiodofatleastthreetosixmonths to evaluate for periodontal treatment outcomes. Thor- ough scaling and root planing frequently results in a mid-term improvement (two years) up to a long-term stabilization(fiveyears)ofpreliminaryaffectedteeth. Thedecisiontomaintaintheperiodontallycompro- miseddentitionundergoesthefollowingcriteria(Fig.2): –Patientswithnopersonalpreferencestocomfort,es- theticsandcosts –Patients willing to accept enhanced tooth mobility, occasionalfoodimpactionandfrequentprofessional toothcleaning –Individuals with chronic diseases and autoimmune disorders. Therecommendationtoreplaceaffectedteethwith implantsisindicatedinthefollowingclinicalsituations andshouldbeplannedon-timeaftercompletionofpe- riodontaltherapy(threetosixmonths): –Patients running a demanding business striving for fixedteeth –Enhancedmasticatoryandcleaningcomfort –Long-termrehabilitationwithlowinputintime,effort andexpenses. Currently, the items above are effective at implant placements within the local bone, minor lateral hard andsofttissuedeficiencies,followingsinusflooreleva- tion, in settings with sufficient implant abutment dis- tancesof3mmandafterperiodontaltherapy.Extended surgicalprotocolsenhancetreatmenttime(Fig.3),ren- der the case prognosis uncertain and may aggravate long-termsuccess. _Implant therapy in advanced periodontal disease The survival rates of teeth with severe periodontal damagepublishedinevidence-basedstudiesarerarely valid for patients inquiring treatment in dental offices (Fig.4).Shortcomingsinoralhygiene,lackinsupportive care,oraldysfunctions,stress,smokingandgeneraldis- orders abbreviate the function times of periodontally- compromisedteethsustainably. Theadvicetoreplaceaffectedteethwithimplantsin advancedperiodontalsettingswithinthemaxillaimpli- cates on-time patient information of the second and thirdmolarremoval:implantplacementandprosthetic bridegworks are scheduled in the functional mastica- toryareauntiltothefirstmolar.Inthemandible,thesec- ondmolarscanbepreservedduetotheirbeneficialroot anatomy. They should be restored, but not included in implantplanning.Followingtheremovalofthefirstmo- lar in the maxilla, implant therapy is often preceded (if thesupportingboneislessthan4mm)oraccompanied byasimultaneoussinuslift.Theimplanttreatmentplan in periodontally compromised patients results in a re- duceddentition(Fig.5): –Fixed bridgeworks in the maxilla and mandible up to thefirstmolar –Maxilla: preservation of premolars and first molars, toothremovalandimplanttherapywithsinusfloorel- evationatfurcationinvolvementlevelIII(Fig.6) –Mandible:preservationofsecondmolars,restoration, noinclusionintobridgeworks Fig. 2_Exclusion criteria for implants with continuation of saving natural teeth after comprehensive periodontal therapy. Fig. 3_Implant therapy should be performed with minimal augmentation. Extended surgical therapy prolongs treatment time, renders case prognosis unsafe and may aggravate long-term success. Fig. 4_Unexpected life-events half cut the survival rates of teeth with advanced periodontal bone loss in daily practice down to 5–7 years. Fig. 5_Guidelines to a safe implant treatment protocol in advanced periodontal disease. Fig. 2 Fig. 3 Fig. 4 Fig. 5