Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2015-10-15, 17:20:52 | version 1.38.0
science & practice12 ICOI World Congress XXXII Implants are becoming increas- ingly popular with low-cost offers promoting this development. The numberofcustomerspreferringim- plants to customary restorations is expanding. The variety of client demands, individual settings, treat- ment options and risks related to inflammation and bone damage following implant treatment advo- cate evident, comprehensible and durablesolutions. Safeguarding implant treatment commences with careful tooth re- moval, pre-implant treatment and implant planning respecting four keyissues: 1.Early decision making to ensure implantbonesupportwithlimited number of implant placements. Sound tooth removal to protect bonelossbyintraalveolarrootdis- section. 2.Accuracy of implant diagnosis and implant placement by 3-D vi- sualization(DVT)ofimplantsurgi- calaccess. 3.Minimal surgical involvement with short and low diameter im- plants while restricting augmen- tation to prosthetic relevant set- tings. Planning EarlyDecisionMaking Early implant decision making comprises anatomical, functional andeconomicissues: a)Anatomy: Treated severe peri- odontitis usually displays clinical stability with further drawbacks aroundimplantsupportedboneat buccal plates or interapproximal sitesbyinflammation(Figs.1&2).1 b) Function: Following untreated periodontal diseases or tooth re- moval,shiftingofsingletoothini- tiates due to myofunctional im- balance. By loss of front-canine equilibration, a group side shift emerges with further bite reduc- tion as result of age and mis- usage.2 c)Dues: Periodontal therapy of se- verely compromised teeth with bone loss >50% often results in a later date implant treatment that doubles dental efforts and bills. Economicissuesshoulddownreg- ulatethisstrategy. d)Oral comfort: Stability, oral hy- giene and esthetics become fos- tered by timely implant place- mentandoptimizedimplantpros- thetics. Clinical practice emphasizes a time-tested planning with (i) re- moval of severely compromised teeth,(ii)periodontaltherapysecur- ing the residual dentition, supple- mented by (iii) microsurgical revi- sionofdeepintrabonypocketsprior to implant placement to safeguard inflammation (Figs. 3 & 4). Implant planning resides tentatively. A final quotation will be drawn after com- pletion of functional relief and 3-D digital evaluation of the implant boneanatomy. Functionaldecompensation Fully and partially edentulous patients frequently reveal a bite re- duction by usage (wear) with loss of front-canine equilibration and a re- sultingleftandrightgroupedpemo- lar and molar side shift.3 Dysfunc- tion and habits (pressing, grinding etc.) promote further damage. In se- vere periodontitis, group side shift acceleratesdiseaseprogression,im- pedes post therapy healing and weakens alveloar bone assigned for later implant placement. Early im- plant planning includes following keyissues: 1.Inspection of the oral cavity comprisesevaluationofthemasti- cation muscels (M. temporalis, M. masseter) and the temporo- mandibular joints (M. ptery- goideus medialis und lateralis) with focus of tension, induration andpainpressure. 2.Osteopathic examination of cran- iocaudal dysfunctions: initiated bybodystatics(inclinedposition), (mis-) posture, walk (activity) etc. shouldexcludesomaticsources.If applicable supportive therapy. If applicable, manual osteopathic treatment to improve physiologic function,i.e.bodyalignment,sym- metry and support homeostasis that has been altered by somatic dysfunctions.4 3.Carefull reduction of prominent protrusive contacts (front) and sliding bars during laterotrusion ontheoperatingside. 4.Placement of a relaxation appli- ance in the maxilla (overbite and deep bite in the mandible) for functional decompensation with a frontal plateau allowing a front- canine equilibration and tempo- raryreliefinmolarsbyverticalre- leaseof1mm(Fig.5). The primary objective is the de- compensation of use-related dys- functionstoachieverelief,vascular- ization and mineralization of the alveolarbonepriortoimplantplace- ment. Subsequent realization of the issues 1–4 ensures dispenses of the habitual use patterns after 4 to 6 weeks wearing. Due to hygiene and stabilization, the intraoral appli- ances are manufactured as strew splints in a dimension of 1.5mm with extension limited to the first molars. Digitalimaging3-D Digitization means information and safeness. The generation of a DVT in early implant planning har- bors3vantages: –Commitment: The expenses of 120–180eurodependingtoextent, area of analysis and institute dis- play a motivational factor ensur- ing consent with the treatment plan. Young patients and IT em- ployees ask for the benefit of 3-D imaging during the first or second visit of implant planning to safe- guard and minimize surgical im- plantplacement. –Anatomy: Additional information about vicinity to N. alveolaris, ex- tent of sinus maxillaris and anatomical septa, characteristics and mineralization of implant bone (following tooth removal) and implant positioning related to adjacent teeth (Figs. 6 & 7). How- ever, inclined DVT readings result in measurement errors up to 1mm.5,6 –Precision: The benefit of a time-in- tense 3-D implant evaluation is a more precise, controlled and risk- reducedplanning,andeasessurgi- cal implant placement. These ad- vantages should be utilized by all dentalhealthcareproviders,even with longterm clinical expertise even those with long-term clinical expertise. If you are not a DVT owner, oral surgeons (specialists) and diagnos- tic radiology clinics are appropri- ate contact addresses. Regard: For the intended 3-D image, always al- locate the exact DVT area, details and viewer suitable for your PC software. The expenses both of the DVT and the digital analysis and evaluation are subjects to private cash. Interimplantdistance Ifanimplantisplacedadjacentto a tooth, the interdental papilla re- Implant planning affects periimplant diseases A time shift link By Rainer Buchmann1,2 ,DanielTorres-Lagares2 ,Guillermo Machuca-Portillo2 1 University of Düsseldorf,Germany; 2 University of Seville,Spain Prof.RainerBuchmannisaspecialistinperiodonticsandpreventivedentistry.Heworksatapri- vatepracticeinDüsseldorfinGermanyandholdsteachingpositionsatHeinrichHeineUniversity Düsseldorf and the University of Seville in Spain. He can be contacted at info@perioimplant.eu. Fig.1:Severeperiodontitis,residualinflammationandbacteremia.Poorhygieniccapability,comfortandestheticswithfurcationcaries. Fig.2:Drawn-outexpectationperiodinadvancedperiodontaldiseaseat#15,16withhorizontalalveloar bone resorption at assigned implant site. 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 periodon- tal 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: Advanced horizontal alveolar bone atrophy in the mandible with small ridge, vestibular slop- ing plateau, proximity to n. alveolaris and small keratinized gingiva. Fig. 7: Securing implant planning (implant length, positioning, diameter and surgery) by DVT review (Cranium Bonn, Germany, 2014). Fig. 8: Interimplant distances of 7 mm atfrontandpremolarsiteswith11mminmolarstosafeguardvascularizationandperiimplantdamage,assignedfromprosthodontics.Surgery:DrG.Kochhan. Fig.9:Inadequateimplantbonesupportwithvestibularbonydefectfollowingtooth loss due to traumatic crossbite relationship in the left upper maxilla. Fig. 10: Promotion of perfusion and healing by micro-invasive implant surgery with implant abutment insertion into vascularized blood-supplied alveolar bone. Fig. 11: Si- nus elevation # 26 with implant placement prior to periimplant enlargement. Fig. 12: Free gingival graft in situ prior to suturing. Fig. 13: Unstable periimplant gingiva with poor hygiene capability, persistent inflammation # 34 and chronic sen- sitivity. Fig. 14: Unobtrusive healing for 8 weeks posttherapy with functional relief by enlargement and periimplant stabilization. Fig. 15: Long-cone implantoprosthetic abutments undergo no self-cleaning frequently initiating periimplant sensitivity. 1 4 532 6 9 1087 11 14 151312 14532 691087 1114151312