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ePaper created 2017-04-05, 10:39:28 | version 1.38.0
C.E. article_ implant innovation I Fig. 2 out many years, I’ve utilized several different implant systems to replace the patient’s teeth. As a result, the patient has implants with internal as well as external hex connections, ranging from an outdated blade- form design to the very latest tapered implant. The experience I’ve had both designing and placing these implants for this patient and thousands of others has given me the unique opportunity to observe my re- sults and determine what designs and protocols work and what can be improved, as I’ve strived to advance implant design throughout the years. _The implants • JAH 2000 Blade Implant (Fig. 3): I first placed an implant for this patient in 1988. It was the JAH 2000, which I designed as a flat, two-piece implant with wings. The blade implant was indicated for thin ridges where a root-form implant could not be placed without bone grafting. Blade implants were typically connected to other implants or teeth, and could be cut, shortened and shaped to align with the anatomy of the bone, which was commonly required when placing blade-form implants at the time. For this patient, two teeth anterior to the implant were prepared, an incision was made, a trough was drilled in the patient’s very narrow ridge, the implant was placed and a five-unit bridge was delivered to replace three teeth in the posterior mandible. Notice that I adjusted the distal inferior portion of the implant so as not to impinge on the mandibular nerve. The JAH 2000 was a significant improvement over what was on the market at that time. I designed the neck to extend lower than the tops of the wings, al- lowing more bone to integrate around the neck of the implant. Decades after implant placement, this blade design continues to serve many of my patients well. • Steri-Oss HL (Fig. 4): The Steri-Oss HL implant in the area of tooth #26 is HA-coated and was placed immediately into an extraction site of a tooth that was lost to severe caries. Beginning in 1986, my practice was one of mul- tiple centers conducting a 12-year study on nearly 3,000 Steri-Oss implants.1 We gained provisional ADA approval for extraction with immediate implant placement and loading. The Steri-Oss HL had a machined collar, which facilitates excellent hard- and soft-tissue preserva- tion. As the clinicians in the 12-year study noted at the two-year follow-up, there was little to no bone loss radiographically around the machined collar. That’s why I decided to include a machined collar in my later designs. • Replace® Select Tapered (Fig. 5): I placed sev- eral Replace Select implants (Nobel Biocare; Yorba Linda, Calif.) for this patient throughout the years, and the tapered shape simplified positioning within the available bone, especially in the area of the pre- maxilla. Prior to the Replace Select, most implants were parallel-walled, and in 1993 I came up with the concept of a tapered design, although it didn’t come to market until 1997. The idea arose from my experi- ence with single-tooth replacements in the anterior maxilla, where I’d often need to tilt parallel-walled implants to the facial to avoid perforating the sub- nasal fossa. The roots of natural teeth are tapered, so implants 1_2017 I 05