Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2015-05-22, 13:20:24 | version 1.38.0
13Implant TribuneMay 2014United Kingdom EditionUnited Kingdom Edition Registeronlinetodayat www.ct-dent.co.uk - Scans are taken by trained and registered radiographers - Quick turn around of 1 to 2 working days - Walk in appointments - View your scans instantly anytime, anywhere - Lowest radiation and smallest field of view - Full support for all third party software and Apple MAC London 2 Devonshire Place, London W1G 6HJ Manchester Mansion House, 3 Bridgewater Embankment, WA14 4RW Birmingham 2nd Floor, Varsity Medical Centre, 1a Alton Road, B29 7DU Manchester Birmingham London OPG/CEPH from £39.99 | CBCT scans from £99.99 | Radiologist reports from £45 Areyoustillusingonly2D imagesforyourImplantcases? intervention (exposure). During surgery, the periosteum, which nourishes peri-implant bone on the long-term, can be preserved. Peri-implant bone nourishment shall be ensured. The minimally invasive implantation method has proven beneficial to the peri- osteum18-23 . In this way, the su- pracrestal bone/bone’s sensitive outer membrane connection can be protected. The peri-implant bone is almost completely nour- ished by the histological, double- layered bone membrane, which is richly supplied with blood vessels and nerve fibres: the in- ner cambium layer (Stratum osteogenicum) is rich in cells. It is composed of stem cells (os- teoblasts!!), ensuring bone regen- eration, as well as of nerves and blood vessels. The outer fibrous layer (Stratum fibrosum) is con- nective tissue, which is not cell- rich but rich in collagen fibers. The Sharpey’s fibers, which pass from the outer layer through the inner layer, are embedded in the Substantia compacta of the bone and secure the periosteum to the bone. The iatrogenic detach- ment of the periosteum can lead to poorly nourished bone after weeks, months or years. Conse- quently, an iatrogenic mucoperi- osteal flap is not recommended. However, if the gingival thickness is 4 mm or more, crestal incisions (also flapless) can be performed. The peri-implant, gingival structures and the periosteum, which nourishes bone, remain intact. Physiological bone loss is very unlikely to occur. Current studies and clinical findings over 16 years have shown that the periosteum preserving flapless MIMI® method is very benefi- cial18-23 . Drilling templates have not always shown to be particularly accurate to perform MIMI®. On the one hand, the diameter of the Champions® implant is not con- gruent with the diameter of the conical triangular drills. On the other hand, studies have compared virtually planned implant positions using current DVT-based navigation-guided templates with achieved implant positions, also involving the use of drills with diameters congru- ent with the implant diameters. Apical deviations of 500 μm have been observed24 . Implants for at least four implants/teeth that will be splinted (including fixed, pre- pared teeth that are positioned mesially from the implants) can be immediately loaded with a final implant-supported restora- tion within the first 14 days post surgery. Current studies have demonstrated good treatment outcome with regard to stable soft and hard tissue conditions af- ter immediate restoration – also in conjunction with immediate implantation. This success rate is comparable to the one obtained in conventionally loaded im- plants three to six months after implantation25-31 . In addition, im- mediately restored/loaded and delayed loaded implants showed similar bone-implant interface contact rates28 . In addition, a biologically optimised surface enhances bone cell regenera- tion19,32 . With these techniques, the risk of physiological bone loss can be reduced or even elimi- nated. Currently, Tarnows theory that there should be a distance between the implants of at least 3mm is controversial. DT Bibliography 1) Zarb GA, Albrektsson T.: To- wards optimized treatment outcomes for dental implants. J Prosthet Dent. 1998 Dec;80(6):639- 41. 2) Tarnow, D. P. and R. N. Eskow . Preservation of implant esthet- ics: soft tissue and restorative con- siderations. J Esthet Dent 1996. 8:12–19. 3) Tarnow DP, Cho SC , Wallace SS: The effect of inter-implant distance on the height of inter- implant bone crest. J Periodontol 2000; 71:546-549 4) Tarnow, D. , N. Elian , and P. Fletcher . et al. Vertical distance from the crest of bone to the height of the interproximal papilla be- tween adjacent implants. J Peri- odontol 2003. page 14DTà ‘The peri-implant bone is almost com- pletely nourished by the histologi- cal, double-layered bone membrane’