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ePaper created 2016-11-23, 14:26:06 | version 1.38.0
| industry 24 implants 4 2016 The use of narrow implants Author: Dr Huub van’t Veld, Netherlands The development of very narrow implants can pro- videasolutionforinterdentalspacesintheaesthetic zone that are smaller than 5–6 mm and in which im- plantology is indicated to fill the diastema with an implant-supportedcrown.Increasingly,inthechoice of the implant not only the quantity (> 1 mm) and quality of the surrounding bone are important but also the support function of the bone to obtain a good mucosal seal. The major implant brands have developed small diameter implants for these narrow spaces. Nobel has the 3.0 mm NobelActive implant, about which many publications have already ap- peared; Astra has the OsseoSpeed 3.0 mm implant and DENTSPLY has the Xive 3.0 implant. In 1976, the FDA already defined implants with a diameter of 3.0 mm and greater as conventional dental implants. In 1997, this institute defined im- plantswithadiametersmallerthan3.0asSDI(small diameter implants). This mainly concerns one piece implants used in very narrow jaws for a removable device or as an anchor for orthodontics. These im- plants often consist of one piece due to the fragility of the connection between the implant and abut- mentinsuchanarrowdiameter.Unfortunately,they offer too few options for a crown because it is not possible to choose abutments with different angles for a perfect prosthetic solution. Therefore, the practitioner has to choose an implant with a sepa- rateabutment.Mostnarrowimplantshaveaconical connection between the implant and abutment. This connection is screwed together. Stress tests have shown that the screw is the most limiting fac- tor with stress. A solid abutment and a conical con- nection with a morse taper of sufficient length and aconeofbetween1.5and4degreesresultinanearly leak-proof and rigid connection between abutment and implant. This is a so-called ‘cold weld’. This makes such an implant almost as strong as a one- piece implant. Iwouldliketotalkyouthroughthetreatmentpro- cedure for two patients I treated with a 2.8 mm Anthogyr Axiom implant, and share the final result with you. Case 1 The first patient was referred to me by her dentist due to a persistent 53 (Fig. 1), which occasionally caused pain and also began to show mobility. 13 is agenetic, as is 23, which I had already replaced with an implant with a crown in 2011 (Fig. 2). At the time, theleftsideoftheupperjawstillhadsufficientspace for a 3.4 mm implant (Ankylos). In the top right at 53, I only measured an interdental space of 4.8 mm. I de- cided to use a 12 x 2.8 mm implant with 4 mm 1.5° morsetaper.Ichosethisimplantontheonehandbe- Fig. 2 Fig. 1 Fig. 1: Initial situation with the strongly resorbed 53 in situ. Fig. 2: OPT at intake. 42016