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implants - international magazine of oral implantology

I overview 20 I implants4_2012 Fig. 6_The piezosurgical access to the lateral sinus is the best approach to promote implant supported bone in the maxilla. Short implants are not advocated, internal lifts technique-sensitive. Fig. 7_Volume thickening with a free gingival graft in an initial thin tissue with buccal perforation. Fig. 8_Short implants are advised in critical anatomic situations when the alveolar bone width is sufficient. Functionally, they represent no alternative to classical augmentation protocols. (Photo: Kochhan) Fig. 9_Insertion of short implants close to the alveolar nerve in the mandible with sufficient alveolar bone width. (Photo: Kochhan) Fig. 10_Implants require a comprehensive maintenance care. Periimplant inflammations display foreign body infections that are more harmful for the body health than periodontal diseases. Fig. 11_Periodontal therapy lowers the inflammatory burden and promotes health while optimizing body metabolism with stimulating effects onto the vascular system. –Volume thickening with free autogenous gingival graftsininitialthinbiotypesettings(Fig.7) –Short implants in both esthetically and functionally less demanding situations as an alternative to surgi- calaugmentation(Fig.8). Low bone quality (D3/D4), lateral hard-tissue defi- ciencies and increased mechanical loading are con- traindicationsforshortimplants.Accordingtoconven- tionalimplantrehabilitation,thehorizontalwidthofthe alveolarbonecrestisthefundamentforfunctionalsta- bilization,vascularizationandnutrition,thusforimplant survivalandclinicalsuccess(Fig.9). _Inflammation and hygiene Clinical healthy and stable implants are completely covered within the alveolar bone by osseointegration. They also are attached to the periimplant gingiva and thereby become functionally included into the body’s metabolism.Thisexplainsthehighoverallsurvivalrates oforalimplantsbetweeneightandmorethan15years. Thecombinationof –a thin biotype gingiva with lack of soft tissue protec- tion –functional overload due to stress, habits or a missing front-canineequilibration,and –lossofbiofilmprotectionbyperiodontaldiseases often causes mid-term damages (two years after func- tionalloading)oftheimplant-to-boneinterface.Likepe- riodontallyaffectedteethwithlackofhygieneaccessand enhancedbiofilmaccumulation,implantsdevelopapo- tentialriskofinflammationwhenbacteriaentertheim- plant-to-boneinterface(Fig.10).Iftheclosehardandsoft tissuesealingdisappearsirreversibly,foreign-bodyinfec- tionsoccurwithintheoralcavitywhicharemoreharm- fulfortheimplant-supportingboneandthebodyhealth than periodontal diseases. The best protection against periimplant inflammation is not avoiding implants: a careful implant placement strategy with concomitant thickening of the surrounding tissues and relief from functional overload preceded by comprehensive peri- odontal therapy (hygiene) are the best therapeutic helpersforimplantsurvivalandoralhealth(Fig.11). _Summary In advanced periodontal diseases, the network be- tween medical progress and ever-expanding patient’s expectations requires a time-tested schedule with a grace period of three to six months to evaluate the af- fecteddentitionforperiodontaltreatmentoutcomes.If patients anticipate immediately fixed and esthetic restorations, on-time implant therapy with minimal augmentativesolutionsisrecommended.Preservation of periodontally compromised natural teeth is advised whenpatientsdisplaynopreferenceforfurthercomfort andesthetics.Periodontaltherapyiscontinued,supple- mented with surgery in advanced intrabony settings where oral hygiene is impaired. The long-term success forthenaturaldentitionandimplantssimilarlydepends on patient’s medical and local risik factors that cannot beforecastedwithanygeneticorsusceptibilitytestfor sale._ Fig. 6 Fig. 7 Fig. 8 Fig. 9 Fig. 10 Fig. 11 Prof Dr Rainer Buchmann Practice limited to Periodontics Königsallee 12,40212 Düsseldorf,Germany Tel.:+49 211 8629120 E-Mail:info@rainer-buchmann.de www.rainer-buchmann.com _contact implants