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Dental Tribune United Kingdom Edition

page 16DTà M ark Lin (ML): What is ‘Fixed Teeth in a Day?’ Steven Bongard (SB): The Fixed Teeth in a Day protocol delivers same day, full arch rehabilitation utilising four or more implants to support fixed, immediately functional, aesthetic prostheses. ML: How does Fixed Teeth in a Day compare with conven- tional rehabilitations? SB: Fixed Teeth in a Day is less invasive, reduces morbidity, is less disruptive and less costly. The principal surgical differ- ence is in the implant place- ment. Posterior maxilla im- plants are placed on an angle, just anterior to the maxillary sinus, into the denser bone of the pre-maxilla, avoiding the need for sinus augmentation while still enabling a short- ened posterior cantilever. In the mandible, implants are placed between the mental foramina, angled in the pos- terior, engaging the more pre- dictable, denser bone of the anterior mandible. More than seven years and a thousand patients, our short-term im- plant survival rates are com- parable to the two-stage ap- proach and the few problems have involved breakage of the transitional prostheses, which have now been modified. ML: Is there any published data on Fixed Teeth in a Day? SB: I can refer you to at least nine studies and follow-up studies, all reporting positive conclusions. ML: How do you decide on the number of implants you use? SB: Some clinics use only four implants; we find that softer bone may require up to six implants to limit early micro- movement. When planning each case we always consider bone quality and the anticipat- ed bite forces generated by the opposing arch. ML: Traditionalists pre- fer axial loading of the im- plants, while Fixed Teeth in a Day calls for tilted implants. How do you respond? SB: We tilt the implants to shorten cantilevers and im- prove force distribution; to eliminate the need for sinus augmentation; to allow en- gagement of the denser an- terior bone, and to allow the use of longer implants where there is limited vertical bone. ML: Many fear that tilted implants will cause prob- lems with bone reaction or prosthetics. SB: Our tilting implants are rigidly connected to other im- plants, creating a totally differ- ent force dynamic compared to a single off-angle implant. We have not seen any significant difference in bone reaction. ML: Is there any research supporting tilted implants? SB: A Swedish five-year longi- tudinal study (Koutouzis and Wennstrom 2007) found that implant inclination has no ef- fect on peri-implant bone loss. (Clin Oral Implants Res. 2007 Oct;18(5):585-90. Epub 2007 Jun 30). Another five-year study found a 98 per cent suc- cess rate in the maxilla and a 100 per cent in the mandi- ble (Krekmanov et al Inter- national Journal of Oral and Maxillofacial Implants 2000). A 1999 study (Implant Treat- ment without bone grafting in severely resorbed edentulous maxillae; Mattson et al Inter- national Journal of Oral and Maxillofacial Surgery - with a 10-year follow-up study by Rosen and Gynther IJOMS 2007) showed a high success/ survival rate for tilted implants placed nearly 20 years ago. Simulation studies also report favourable biomechanics. ML: How do differences in bone density affect your ap- proach? SB: Our surgical protocols are designed to maximise predict- able primary stability. In the maxilla the implants are an- gled to avoid the less dense posterior bone. The pre-max- illa generally has fairly dense, compatible quality bone to that of the intra-foramina region of the mandible. We haven’t seen any significant difference in survival rates for either arch. ML: What are the minimum clinical prerequisites for Fixed Teeth in a Day with immediate loading? SB: Ideally, minimum require- ments are 5mm of bone width Fixed Teeth in a Day: An interview with Dr Steven Bongard Interviewer_Dr Mark Lin Fig 1 Example of Fixed Teeth in a Day with five implants in the maxilla and four in the mandible sirona.com The new CEREC Omnicam combines powder-free ease of handling and natural color reproduction to provide an inspiring treatment experience. Discover the new simplicity of digital dentistry – exemplified by Sirona’s premium camera portfolio: CEREC Omnicam and CEREC Blue- cam. Enjoy every day. With Sirona. UNRIVALLED HANDLING POWDER-FREE SCANNING IN NATURAL COLOR C-530-01-7600-V0 Elegant design and easy handling are a winning combination. CEREC OMNICAM THE EVOLUTION OF SIMPLICITY January 21-27, 2013United Kingdom EditionUnited Kingdom Edition