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ePaper created 2015-09-15, 12:06:46 | version 1.38.0
I research 08 I implants3_2015 Clinical practice emphasizes a time-tested plan- ningwith(i)removalofseverelycompromisedteeth, (ii) periodontal therapy securing the residual denti- tion, supplemented by (iii) microsurgical revision of deep intrabony pockets prior to implant placement to safeguard inflammation (Figs. 3 & 4). Implant planningresidestentatively.Afinalquotationwillbe drawn after completion of functional relief and 3-D digital evaluation of the implant bone anatomy. Functionaldecompensation Fully and partially edentulous patients fre- quentlyrevealabitereductionbyusage(wear)with loss of front-canine equilibration and a resulting leftandrightgroupedpemolarandmolarsideshift.3 Dysfunction and habits (pressing, grinding etc.) promote further damage. In severe periodontitis, groupsideshiftacceleratesdiseaseprogression,im- pedes post therapy healing and weakens alveloar bone assigned for later implant placement. Early implant planning includes following key issues: 1.Inspectionoftheoralcavitycomprisesevaluationof the mastication muscels (M. temporalis, M. mas- seter) and the temporomandibular joints (M. ptery- goideusmedialisundlateralis)withfocusoftension, indurationandpainpressure. 2.Osteopathic examination of craniocaudal dysfunc- tions: initiated by body statics (inclined position), (mis-)posture,walk(activity)etc.shouldexcludeso- maticsources.Ifapplicablesupportivetherapy.Ifap- plicable, manual osteopathic treatment to improve physiologicfunction,i.e.bodyalignment,symmetry and support homeostasis that has been altered by somaticdysfunctions.4 3.Carefullreductionofprominentprotrusivecontacts (front) and sliding bars during laterotrusion on the operatingside. 4.Placement of a relaxation appliance in the maxilla (overbite and deep bite in the mandible) for func- tionaldecompensationwithafrontalplateauallow- ing a front-canine equilibration and temporary re- liefinmolarsbyverticalreleaseof1mm(Figs.5–7). Fig. 3_Surgical access to deep intrabony periodontal pockets securing the residual dentition and safeguarding inflammation prior to implant placement following completion of non-surgical periodontal therapy. Fig. 4_Microsurgical revision using a vascular pedicle flap to maintain interdental papillae and augment resting periodontal pockets with autogenous bone. Usage of Osteora (antiinflammatory) or Emdogain, if applicable. Fig. 5_Relaxation appliance in the maxilla with a frontal plateau to decompensate age and use related bite reduction prior to final implant planning. Fig. 6_Temporary relief from damage resulting from use (wear) and habits by restoring a front-canine equilibration. Fig. 7_Vertical release of 1 mm achieving premolar and molar relief to promote bone healing following treatment of periodontal compro- mised sites prior to implant surgery. Fig. 3 Fig. 4 Fig. 5 Fig. 7Fig. 6