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implants – international magazine of oral implantology

research I Interimplantdistance Ifanimplantisplacedadjacenttoatooth,thein- terdental papilla remains. If two implants are in- sertedsidebyside,thesupracrestalbiologicalwidth and the papilla as result disappear, independent of the implant type used.7 The effects of implants with platform switching, concave abutments, microma- chined neck or implant abutment micro-move- mentsontothestabilityofcrestalboneandsofttis- suesarelimitedtosubclinicalnotice.8,9 Theinterim- plant distances primarily follow prosthetic require- mentsoftheresidualdentition.10 Fromanatomy,the present rules occur: 1. Minimal distance between single-rooted teeth incl. premolars: 7 mm. 2. Inmolarsinterimplantdistancesofatleast11mm (Fig. 11). Forappropriateimplantplacementaccordingto prosthetics, the local bone anatomy is often inade- quate, especially in patients with cross-bite or long-termperiodontaldamageetc.(Figs.12–14).If the clinical setting implicates deficient implant bone support, 3-D digital imaging of alveolar bone including individualized implant positioning with diameter-reducedimplantsisallocated.Note:Prior to surgery, calculate additional efforts, extent and expenses of alternative augmentation, bone graft- ing or allogeneic bone grafts including pedicle flap surgery and infection due to soft tissue advance- ments. _Implant placement Perfusion Maintenance of vascularized implant bone is in- dispensabletoavoidfurtherperiimplantdamageas result of spongious bone tissue injury during im- plant surgery (early implant failures). Within im- plant insertion, bleeding of cortical bone following drilling is a necessary requirement for uneventful healing and integration of the implant into sur- rounding tissues (Fig. 15).11 The following step by step procedure has been proven effective: a) Utilization of keen pilot und multi-use tapping drills (renew early, otherwise high drilling forces anddangerofdeviationfromdrillingaxisoccur). b) Intermitted implant bed preparation under per- manent cooling with 0.9 % saline. c) Prior to implant placement, wait until implant bed has been replenished with blood. d) Wetting of implant surface with blood prior to implant insertion. e) Limited rotation speed < 800 r.p.m during im- plant bed preparation, hand implant placement with torque key, max. 10–30 Ncm, if applicable (Fig. 16). A slight subcrestal position of the implant is ad- visable as drilling endpoint.12 To ensure healing, a primary fixation of the implant is mandatory for all implant types (cylindrical, root-formed etc.), bone quality and anatomical localization. The authors strongly discourage from further „screwing“ to avoidongoingtissueinjuryoftheimplant-bone-in- terface.13 Periimplanttissue(volumen) Duetoalveolarbonedefectsresultingfromtooth removal, periodontitis or dysfunction, the condi- tions of periimplant keratinized gingiva around im- plants are not adequate.14 Safeguarding implant planningandsurgery,theadditionalduesofsofttis- sue surgery to enlarge periimplant gingiva should be implemented into the quotation: Enlargement: Initially, implant planning (not to forget cast models)and implantplacement.Duringimplantin- I 11implants3_2015 AD

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