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ePaper created 2015-05-22, 13:20:24 | version 1.38.0
May 2014United Kingdom Edition12 Implant Tribune page 11DTß 12 1) The Shuttle: The two-piece Champions (R)Evolution® im- plant system consists of an inte- grated bacteria-proof “Shuttle”/ Insert, which remains in the implant for at least eight weeks post surgery until the final pros- thodontic restoration is fit. Dur- ing the healing phase in the first weeks, the implant internal thread will not be contaminated with bacteria. During implanta- tion, the Shuttle and micro-close connection protects the internal thread from contamination with bacteria, blood or saliva. With these two-piece implant systems and also one-piece implants, there is very little risk of bone loss. Sufficient primary stabil- ity at a torque of at least 35Ncm is a prerequisite for a successful implantation17 . The implant with the Shuttle can be inserted at a torque of up to 70/80Ncm and achieve sufficient primary stabili- ty without deforming or breaking the outer part and inner thread and without loosening the abut- ment during the prosthodontic phase. 2) Platform Switching & Opti- mised Cone Connection: It has been found that crestal bone loss can be prevented with implants with an integrated Platform- Switching design15,16 . In addition, internal cone connections should have an angle of 5° to 10°, and the cone should be long enough in order to prevent bacterial mi- gration even if, for example, a 3.5mm-diameter two-piece im- plant is loaded with a force of 200 N12. Since one-piece implant systems have no micro-gap at all, they are bacteria-proof as well. The one-piece implant system is particularly indicated for the rehabilitation of four or more implants/teeth. In order to com- pensate insertion divergences, Prep-Caps (zircon or titanium) can be cemented. The impres- sion can be cast with super hard plaster (no Laboratory Analogs!) in the dental laboratory. If done correctly, the cement will not be pressed subgingivally so that there is no risk of periimplanti- tis because of cement remains in these one-piece implant Prep- Caps (“abutments”). 3) Due to the flapless MIMI® pro- cedure and the fact that a second or third session is not necessary (implant exposure, subgingi- val impression), the biological width can be formed and is not disturbed because of a second Fig. 4-6: For the implant site preparation, the conical triangular drills (not twist drills!) are used, which allow for bone condensation. You prepare the bone cavity depth that corresponds to the endosseous implant length, except if you perform an indirect sinus lift. To ensure periimplant nourishment through the intact periosteum, the 3.0 mm and 3.5 mm-diameter reduced implants are used. The 2.5 mm-diameter implants are only used in individual cases. Fig. 7 -13: With conical triangular drills, you prepare the bone cavity depth that corresponds to the implant length, except if you perform an indirect sinus lift. For the D1 bone, the twist drills can also be used. Contrary to what critics might think, MIMI® surgery is not a “blind procedure”. After each drilling and preparation with condensers, it is an absolute must to palpate and check thoroughly in all dimensions by means of a thin probe. Autologous blood for humidifying the bone cavities is recommended. Only if primary stability is not achieved with condensers or diameter-reduced implants, can you insert an implant with a larger diameter (for example, a 4.5 mm or 5.5 mm-diameter implant). Fig. 14 - 16: Due to a lack of a Platform-Switching function or a too short or too large cone of many implant systems, for example with diameters of 3.8 mm or 4.1 mm, there is a risk of bacterial migration into the micro-gap. In studies, a relatively wide gap was observed when certain implant systems were loaded with forces of only 100 N. In such a case, there is a risk of bacterial penetration into the inner thread and outer part of the implant, which can induce periimplantitis. Fig. 17 - 18: By comparison, two-piece implant systems with an optimized cone-implant-abutment connection can be loaded with strong forces, causing just an extremely small micro-gap or none at all. For instance, this picture shows a 3.5 mm-diameter Cham- pions- (R)Evolution® implant that was loaded with a force of 200 N in a study led by engineer Holger Zipprich. No micro-gap was observed12. Fig 4 Fig 5 Fig 6 Fig 7 Fig 8 Fig 9 Fig 10 Fig 11 Fig 12 Fig 13 Fig 14 Fig 15 Fig 16 Fig 17 Fig 18