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ePaper created 2016-11-23, 14:26:06 | version 1.38.0
| industry 28 implants 4 2016 Conclusion and commentary Iinsertedthefirst2.8implantin2013.Initially,Ihad some doubts about implants of such small diameter andhadquestionssuchas:Istheconstructionstrong enough?Willitnotbreak?Willtheabutment-implant connectionremainintact?However,althoughtheuse ofsuchnarrowimplantsremainsachallenge,ithasso faronlyyieldedpositiveresults.Nevertheless,Iwould like to make some comments following these experi- ences: 1. All the major brand implant systems marketing narrow implants have paid much attention to the root shape of the implant with windings that have a condensing effect. This significantly in- creases the primary stability, which enhances osseointegration. 2. This primary stability also results in greater usabil- ity in immediate placement and also provides the option to make a temporary crown immediately. 3. The PEEK abutment used in this system has proven to allow trouble-free retention over a longer time. Because in this case, the implant was placed sub- crestally and despite the small space, there is still enough bone around, I observed good support of the mucosa and the presence of a good mucosal seal. In this case, a 2.8 mm platform was used as a superstructure with a platform switch. As a result, a proper emergence profile was achieved with the temporary crown. 4. Particularly with regard to reduced mesiodistal spaces,theuseofanimplantwithasmalldiameter is a solution, but only in the aesthetic zone, where no extreme transverse stress can be placed on the implant. 5. Ibelievethatwithexcessivestressandlargeforces, because the implant is so narrow, the abutment- implant connection could be the limiting factor. 6. Thefaciolingualbonethicknessislessrestrictivein the application of a narrow diameter implant be- cause with several techniques, such as bone-split- ting, harvested autologous bone with the Dentak K-system or possibly with a bone graft, more vol- ume can be created in a less invasive way. 7. Toachieveagoodresult,itisnecessaryfortheprac- titioner to have the choice of different abutments. Therefore, one of the two-piece implant systems will be chosen. A narrow one-piece implant is less suitable for the aesthetic zone. 8. The solid connection between abutment and im- plant with the morse taper connection is indeed strongandgivesnoriskofscrewfracture,butthere is no way back. The implant becomes a ‘one-piece implant’ with the solid abutment. By using a grade 5 titanium, strength is also assured: extensive stress tests have been carried out up to 200 N. The positioning and permanent fixing of the resto- ration do require more attention than with a screwed abutment. For instance, a break in the crownmayonlyberepairedbytakingtheabutment asanewimpressionofthecrownstump.Itisunfor- tunate that only titanium abutments are available (due to the strength). However, this is so narrow that there is enough body for the crown to make this aesthetically pleasing. The use of a narrow implant in a very limited space requiresawellthought-outdiagnosis,greatprecision ofwork,andagooduseofandexperiencewithdiffer- ent implant techniques. These practical examples did not use any guided surgery, but this could be recom- mended for precise implant positioning._ contact Dr Huub van’t Veld Engelstraat 3 6922 JG Duiven, Netherlands Tel.: +31 316 282502 tandartsvtveld@planet.nl www.tandartsvtveld.nl Author details Fig. 19 Fig. 20a Fig. 20b Fig. 19: Clinical picture immediately after insertion of the permanent crown and adjustment of gingival line. Fig. 20a: X-ray image three months after inserting the crown. Fig. 20b: Clinical image three months after inserting the crown. 42016 Tel.: +31316282502