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ePaper created 2015-09-15, 12:06:46 | version 1.38.0
I research 14 I implants3_2015 Maxilla: 1. Close anatomical relationship to sinus maxillaris. 2. Atrophied or edentulous maxilla following long- term appliance of removable dentures. Horizontal alveolar bone defects, as result i.e. of longstandingperiodontitis,arecompensatedsurgi- cally during implant placement to avoid extended implanto-prosthetic abutments susceptible for re- current soft tissue infection (Fig. 30). Fixed im- planto-prosthetic restorations of the partially en- dentulous mandible are achieved with axially screwed, uncemented and unlocked crowns to improve hygiene and avoid further damage by cementing and periimplantitis. Integration in clini- cal practice is successful with focus on tissue biol- ogy and both renunciation from mechanical dentistry and interlocking theories. Diameter- reduced (<4mm), small implants (minis) allowing transgingival healing. According to their material properties (fracture) and restricted implanto-pros- theticindicationsandcompatibility,Minisarelimited to individual applications in multi-morbid subjects withedentulousmandible,enhancedriskforsurgery i.e.advanceddiabetesmellitusorhematopoieticdis- easesandhandicapsfororalhygiene.17 _Augmentation and revision Exceptforsinusfloorgrafting,thenumberofaug- mentative implant surgery is declining and confined to reconstruction following trauma and tumor by verticaldistractionorindividualprostheticoresthetic settings.18 Theindicationsforsurgicalaugmentation duringimplantplacementinclude: a)Toothlossincross-bitesettings. b)Lateral alveolar bone defects (premolars and mo- lars). c) Modelling of periimplant bone in esthetically de- manding situations at incisors and canines (emergence profile). Theauthorshaverecentlyreportedabouttheuse andimplementationofautogenousboneandspon- gious bone chips and their synthetical alternatives in implant surgery in detail.19 The regressive developments of implant aug- mentation in clinical practice implicate direct recommendations for surgical revision of periim- plant defects. The following procedure is advis- able.20 (Tab. 1): Mucositis: –Defect depths ≤ 3 mm: Oral hygiene and implant cleaning(hygienist). Fig. 23_Indication for short and diameter-reduced implants in the mandible with unilateral tooth loss and low vertical alveolar bone height. Fig. 24_Initial OPG (pre-therapy) with demineralization and lateral alveolar bone atrophy # 35, 36. Fig. 25_Securing the implant planning and surgery by 3-D visualization with reduced implant length of 7 mm. Ridge resorption and vicinity to n. alveolaris (Radiology: Fürther Freiheit, Germany, 2014). Fig. 26_Intrasurgical setting following placement of short implant abutments (7 mm) with diameter of 4.3 und 5.0 mm. Fig. 27_Vertical enlargement of resorption-related thin periimplant gingiva by 1 mmm oral horizontal ridge incision during surgical implant exposure. Fig. 28_Unobtrusive X-ray following surgical implant exposure with prevention of N. alveolaris avoiding augmentation. Fig. 29_Single implant crown restoration (unlocked) with implanto-prosthetic relationship of 1:1. Fig. 30_Long-cone implanto- prosthetic abutments undergo no self-cleaning frequently initiating periimplant sensitivity. Fig. 23 Fig. 24 Fig. 25 Fig. 26 Fig. 27 Fig. 28 Fig. 29 Fig. 30