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ePaper created 2015-06-05, 15:15:11 | version 1.38.0
case report I I 17implants2_2015 Figs. 8 & 9_Sandwich technique with autologous bone, allograft and xenograft. ensure that there was no cement around the emer- genceprofile. _Discussion In recent decades, numerous reviews have shown howosseointegrationworksandwhatroughnessand surfacecharacteristicspromotethedesiredtissuere- sponse. These studies have also investigated how a suitable microstructure advances bone regeneration around implant surfaces. Furthermore, independent from additive or subtractive production processes, production faults, inaccuracies, impurities, residue, andincompatibilityofdesignandroughnessmethods donotinfluenceosseointegrationpositively.10–16 Findingsliketheabovearecurrentlythesubjectof controversialdebate.Theirinfluenceonosseointegra- tion has not been proven yet. Nonetheless, such pro- ductionissuescannotpromoteimplanthealing.Aswe will see in the next part of this case series, debris and residue on the surface reduce implant–bone contact andthusendangerosseointegration.Thesamenega- tive progress can be observed when surface rough- nessisreduced,forexample,byanincompleteandin- homogeneous surface treatment.17–20 It would be in- teresting to investigate how often implant failures can be ascribed to production failures by the manu- facturer. Therearenumerousstepsthatperformedwrongly could lead to implant failures, from surgery to pros- theses, and including mouth hygiene, medicaments and habits. If we eliminate iatrogenic and hygienic factors, dental implants will remain workpieces that areabundantlydefective. Implant manufacturers are responsible for the product they market, just as we bear the responsibil- ity for our treatment of our patients. Good quality controlisnotrandom,butdealswitheachcomponent systematically. In this case, the patient received im- plantswiththesameserialnumberinregions#24and 26. Implants #15 and 16 were from the same manu- facturer but with different serial numbers. A recall of implants with specific serial numbers, three months postoperatively,wasdeclaredadocumentationfault. For those implants that had been inserted, operators werebecalmed,althoughimplantswiththosespecific serialnumbersbegantofailinsuccession. Recalls must be justified honestly, so that imper- fections can be corrected. The relationship between manufacturers and users is based on confidence. Opennessandfranknesssolidifythisconfidence.Vis- itstotheproductionsiteandclosecontactwithserv- icestaffandcolleaguesareimportantutilitiesforthe user. Finally,itisimportanttounderstandthatnotevery surface and surface treatment is compatible with everymacroandthreaddesign.Combininggoodfea- tures in a product does not automatically result in a superior product. It is rather the consequence of the underlying research and development that has evolvedtheproductorafeaturetoareliablyperform- ingworkpiece.Adeeperunderstandingofmechanics, physics and material science will allow us to evaluate dental implants and their components during the healing period and in the long term when interacting withtheorganismandthestomatognathicsystem. _Conclusion InPartIIofthisseries,macro-imagesofvariousim- plantsthatfailedandthecorrespondingsterile-pack- aged ones will be shown. In Part III, failed and sterile- packaged implants from the various manufacturers will be compared under a scanning electron micro- scope._ contact Dr Nikolaos Papagiannoulis Dental Esthetics Bahnhofstr.64 69151 Neckargemünd Germany www.fsde.com.gr info@fsde.com.gr Fig. 7 Fig. 9Fig. 8