implants - international magazine of oral implantology International Edition

I research Fig. 17_Rx pre op. Fig. 18_Rx after three months of loading (preparation with mixed technique). Fig. 19_Rx after six months of temporary loading with a perfect bone level. _Mixed technique for the initial preparation of the implant site through piezoelectric inserts Once an appropriate full-thickness flap is executed inordertoexposetheedentulousarea,thetechniqueof initial preparation of the implant site through piezo- electricinsertsprovidesthefollowingthreeintra-surgi- calfundamentalphases: 1) Initial pilot osteotomy by using a Mectron IM 1S piezoelectric insert. 2) UseoftheIM2insert(AorPdependingonthearea treated). Optimization of the concentricity of the implantsitepreparationbetween2/3mmindiam- eter through an IP 2–3 piezoelectric insert, OT 4 in case of need for correcting the inclination. 3) Ifrequired,furtherenlargementoftheimplantsite through a Mectron IM 3 piezoelectric insert (A or P depending on the area treated). The next stage of completion and optimisation of the implant-prosthesic site was carried out using a handpieceimplantrotatingburspecificallydedicated tothesystemused,neededtoobtain,attheendofthe preparation, the exact diameter expected by the op- eratorforboththeimplantandthetypeofbonecon- cerned.Itisknownthat,dependingonthechosenim- plantsystemorthetypeofboneconcerned,different preparation methods are required (over- or under- preparation).Theauthorsbelievethatthisapproachof- fersthefollowingadvantages: −Highprecision; −possibility to optimise the inclination of the implant axis; −reducedtissuetrauma; −compliance with the operating sequence of the im- plantsystemimplemented; −morepredictableclinicalsuccess. _Results In total, 64 implants were inserted, including 25 in thelowerjawand39intheupperjaw,dividedasfollows: −21 implants placed in Group 1 (exclusive use of con- ventional dental drills, specifically dedicated to the corresponding implant system), including 13 in the upperjawand8inthelowerjaw. −22implantsplacedinGroup2(exclusiveuseofpiezo- electricinserts),including12intheupperjawand10 inthelowerjaw. −21implantsplacedinGroup3(useofpiezoelectricin- sertsonlyduringtheinitialpreparationoftheimplant site, while the last phase of preparation of the same surgicalsitewascompletedwiththebursspecifically dedicated to the implant system implemented), in- cluding14intheupperjawand7inthelowerjaw. The terms of clinical success were divided in short (removalofthesutureknotsintheeighthday),medium (6/8 weeks after surgery) and long term (about 36 monthsafterthedefinitiveprosthesisplacement). As mentioned above, the following criteria were usedtoassesstheclinicalsuccess: −Primary stability measured by the torque in Nm (and detectedusingthesurgicalmotorBienAirmodeliChi- ropro,Fig.24)andwithverificationoftheImplantSta- bilityQuotient(ISQ)throughOstell®(Fig.25) −Secondarystability(throughISQ) −Periimplantbleedingindices(from1to3) −Plaqueindices(from1to3) −DegreeofPatient'ssatisfaction(from1to3). In all rehabilitated cases, the long-term success was noticed and none of the 64 implants inserted failed. However, due to the aforementioned intraop- erative histological samples taken (see the previous section “Materials and Methods”), considering the histological point of view, significant differences wereobservedinthebonetissuedamagebetweenthe three different methods of implant site preparation implemented (Figs. 20–23). In particular, in the cases treatedwithmixedtechnique(Group3),betterresults were noticed in terms of: − Correct positioning of fixtures; − healing in the medium-and long-term; − localised tissue trauma. With respect to the histological findings, in both techniques providing the use of piezoelectric inserts, abetterhealthconditionofthebonemarginadjacent to the implant site preparation was observed. _Conclusions Based on the results achieved, as well as on data reportedintheliterature12 ,wecansaythattheuseof 20 I implants4_2013 Fig. 16 Fig. 17 Fig. 18 Fig. 19