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ePaper created 2015-03-04, 10:43:31 | version 1.33.01
I research Fig. 1_Morphology of the Aadva implant with the various locations where roughness was measured and where SEM images were taken. SEM image of micro-threads at the shoulder; SEM image of the middle of the implant; and SEM image of the implant apex. Figs. 2a & b_Cumulative percentage of bone loss around the implants. Changes between the loading time and 1 (upper) or 2 (lower graph) years later respectively. _Several long-term studies have confirmed that oral implants can offer a predictable solution for the replacement of one or more teeth.1, 2 The number of failuresduringthefirstyearsislimited.However,there are currently numerous disturbing reports about late infections around implants. Some authors have reported incidences of peri-implantitis above 50per cent after 10 years of loading3 , while oth- ershavepublishedmorefavourabledata.4, 5 Ofcourse,unliketheoriginal,verystrictproto- col(withahealingperiodof6monthsafterextrac- tion, an osseointegration period of 3 to 6 months, splinting of the implants, minimum ridge width >7mm,minimumimplantlengthof10mm,etc.)6, 7 ,the more recent procedures are much more flexible and perhaps even too flexible (immediate placement, im- mediate loading, narrow ridge, limited bone height, guidedboneregeneration,etc.). The implants themselves have also undergone a tremendousevolution.Theirdesignhasbeenadjusted (body shape, threads, connection type, platform switch)andalotofchangeshavebeenmadetotheim- plant surface. This has come in response to funda- mentalresearch8 whichshowedthataroughenedim- plant surface would increase the chances of osseoin- tegration and in particular accelerate osseointegra- tion (ideal for fast loading). Today, implants are cate- gorised as minimally rough implants with Sa <1 µm, moderately rough implants with Sa 1–2 µm, and rough implants with Sa >2 µm.9 Very rough im- plants(forexample,implantswithSa>3µm)ap- pear to be more susceptible to peri-implantitis, probably because of accelerated biofilm forma- tion.2 Moderately rough implants show a clearly higher chance of integration at the expense of onlyaslightlyincreasedriskofperi-implantitis.10-13 Some major risk factors for peri-implantitis have now been identified. For example, it was found that a historyofchronicadultperiodontitisandespeciallyof aggressive periodontitis significantly increases the risk of peri-implantits.14–17 This can probably be ex- plainedbytheabsenceofaneffectiveimmunesystem. In such patients it is extremely important to offer a thoroughfollow-upprogramme.18, 19 Earlybonelosscanalsobeinducedbythesurgeon, for example through excessive bone compression,20 failure to respect the biological dimensions,21 or re- peatedremovalofanabutment.22 Aadva implant in private practice Author_Dr Jean Pierre Brun, Dr Philippe Leclercq, Prof. Joe Merheb, Dr Willem Frederik Simons, Prof. Bart Van Meerbeek, Prof. Marc Quirynen, Belgium 16 I implants1_2015 Fig. 2a Fig. 2b