Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2017-05-12, 09:42:21 | version 1.38.0
| research Immediate restoration in the digital workflow Part I Authors: José Eduardo Maté Sánchez de Val & José Luis Calvo Guirado, Spain Endosseous implants have consistently achieved high success rates in partially and completely eden- tulous patients. Clinicians have therefore begun to offer selected patients immediate and early implant place ment options. The long-term success of im- mediately loaded implants has been investigated in animals1,2 and humans,3 with encouraging results. However, most of the studies were performed with implants placed in the anterior mandible, where primary implant stability is easily achieved. In the anterior maxilla, clinicians seeking to load implants immediately must be concerned not only about achieving adequate implant stability, but also about fulfilling patients’ desires for aesthetic results that resemble the natural dentition. To achieve this, it is essential to maintain as much of the bone height around the implant neck as possi- ble, controlling the biologic width.4 Bone loss around the implant always occurs when an abutment is connected to a dental implant at the crestal level. It has been demonstrated that the gap between the implant and the abutment has a direct effect on bone loss, regardless of whether the two parts are connected at the time of integra- tion of the implant or later.5 This phenomenon occurs whether the implant is loaded or not and ap- pears to be unrelated to the type of implant sur- face.5,6 Hermann et al. demonstrated that crestal bone remodels to a level about 2.0 mm apical to the implant-abutment junction (IAJ),5,7,8 while Lazzara and Porter reported crestal bone levels about 1.5 to 2 mm below the IAJ at one year after restoration.9 Tarnow et al. documented a horizontal component that results in 1.3 to 1.4 mm of resorption from the IAJ to the bone in a horizontal direction.10,11 When the biologic width is in the wake of such osseous changes, the soft-tissue architecture, including the appearance of the papillae, is affected. The inter- proximal bone influences the interdental papillae by acting as a guidepost for the soft-tissue contours. In addition to several ideas aimed at limiting crestal bone resorption, the concept of platform switching appears to be promising. Platform switching refers to the use of a smaller-diameter abutment on a larger-diameter implant collar. This type of connection shifts the perimeter of the IAJ inward toward the central axis of the implant.12,13 The time limitation in implant treatments is an im- portant bias when it comes to planning and devel- oping rehabilitation therapies. In this sense, the in- clusion of new materials that allow for immediate loading in a single session without having to re- place prosthetic components facilitate optimal re- sults in terms of gingival attachment and minimize peri-implant bone loss after prosthetic abutments have been manipulated. Ce- ramically reinforced PEEK is of great in- terest as it allows a single attachment to be retained in place throughout the entire treatment and avoids han- dling-related overload. Its mechani- cal and physical properties have been tested in animal experiments and in hu- mans, showing the material to be ideal for one-step Xprotocols. Fig. 1: Implants and abutments used (left to right). blueSKY implant, SKY esthetic abutment titanium, SKY elegance abutment. 06 implants 2 2017