Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2018-02-22, 10:04:34 | version 1.38.0
10 mCME Dental Tribune Middle East & Africa Edition | 4/2017 Long-term clinical success in the management of compromised intertooth spaces utilizing small-diameter implants CAPP designates this activity for 1 CE Credits mCME articles in Dental Tribune have been approved by: HAAD as having educational content for 1 CME Credit Hours DHA awarded this program for 1 CPD Credit Points By Dr Paul S. Petrungaro, USA Management of edentulous sites in the oral cavity with dental implants has been well documented in den- tal literature during the last 25 plus years.1-3 Patients seeking tooth re- placement for partial or totally eden- tulous situations have been able to enjoy natural appearing and func- tioning prosthesis that are fi xed, sta- ble and, in some cases, so natural it’s diffi cult to ascertain a dental implant restoration for a tooth restoration. Using dental implants to replace the natural tooth system in the es- thetic zone has also seen an increase in restorative treatment plans and, with the advent and perfection of immediate restoration protocols initially reported in the literature4-7, achieving natural soft-tissue esthet- ics around dental implants can be predictable and successful. However, certain clinical situations can com- plicate or negate the procedure all together. One of these complications is insuf- fi cient intertooth spacing between natural teeth and, most commonly, congenitally missing lateral incisors following orthodontic treatment8. Often as a solution to this, the den- tist chooses a removable partial den- ture or some type of resin-bonded bridge, both of which may not be appealing to younger individuals. In extreme cases, the dentist may elect to proceed with a fi xed bridge, which would cause excessive destruction to the natural teeth serving as abut- ments and, for a young individual, this could be devastating to these teeth during a 40-50 year period, if not sooner.8 To properly form an ovate pontic type emergence profi le in the soft tissue, which is required for a fi xed bridge to have a natural clinical ap- pearance, consideration must be given to the intertooth edentulous space.9-12 This is also very important when choosing dental implants for natural tooth replacement. Wallace, mCME SELF INSTRUCTION PROGRAM CAPPmea together with Dental Tribune provides the opportunity with its mCME - Self Instruction Program a quick and simple way to meet your continuing education needs. mCME offers you the fl exibility to work at your own pace through the material from any location at any time. The content is international, drawn from the upper echelon of dental medicine, but also presents a regional outlook in terms of perspective and subject matter. Membership Yearly membership subscription for mCME: 1,100 AED One Time article newspaper subscription: 250 AED per issue. After the payment, you will receive your membership number and allowing you to start the program. Completion of mCME • • • • • • • • mCME participants are required to read the continuing medical education (CME) articles published in each issue. Each article offers 2 CME Credit and are followed by a quiz Questionnaire online, which is available on www.cappmea.com/ mCME/questionnaires.html. Each quiz has to be returned to events@cappmea.com or faxed to: +97143686883 in three months from the publication date. A minimum passing score of 80% must be achieved in order to claim credit. No more than two answered questions can be submitted at the same time Validity of the article – 3 months Validity of the subscription – 1 year Collection of Credit hours: You will receive the summary report with Certifi cate, maximum one month after the expiry date of your membership. For single subscription certifi cates and summary reports will be sent one month after the publication of the article. The answers and critiques published herein have been checked carefully and represent authoritative opinions about the questions concerned. Articles are available on www.cappmea.com after the publication. For more information please contact events@cappmea.com or +971 4 3616174 FOR INTERACTION WITH THE AUTHORS FIND THE CONTACT DETAILS AT THE END OF EACH ARTICLE. Fig. 1. Pre-treatment clinical view Fig. 2. Pre-operative periapical radiograph Fig. 3. Ovate pontic type defect created Fig. 4. Dentatus ANEW implant seated minimally invasive pro- tocol Misch and Salama, et al,9-11 stated that an implant site requires, for a nor- mal two-piece implant, the implant should be placed at least 1.5 mm from the adjacent teeth. As a result, using a 3.5 mm diameter implant, the mini- mum inter-tooth space to support interproximal bone and natural soft- tissue papillary contours should be 6.5 mm, and with a 3.0 mm diameter implant, 6.0 mm for the edentulous space. Often, the intertooth space in these types of cases is smaller than 6.0 mm. Taking these parameters into ac- count, small-diameter (or, mini) im- plants (3.0 mm is the smallest from most dental implant manufacturers) should not be used in cases with less than 6.0 mm of inter-tooth space, to prevent potential tooth root dam- age, crestal bone loss and unnatural- appearing gingival tissues and papil- lae. Small-diameter implants were de- veloped more than 20 years ago and, initially, the recommended use was to support temporary removable prostheses during the healing phase for advanced bone-grafting proce- dures and/or conventional implant placement.12-13 Their use was later expanded into immediate conver- sion of full dentures into implant- supported dentures, support for partially edentulous cases and for anchorage of single tooth implant restorations in compromised inter- tooth spaces.14-15 Implants are available from 1.8 mm diameter to 2.8 mm diameter and offer a fi xed permanent tooth re- placement option for patients that otherwise would not be able to have implants placed and restored. Their ease of use and atraumatic place- ment utilizing a fl apless approach, with only one coring procedure, as well as simplistic abutment transfer and provisional construction, make the use of these implants in the aforementioned sites a must for the dental implant practice. The following case report will dem- onstrate the use of the Dentatus ANEW (Dentatus USA, Ltd, New York, N.Y.) implant for the management of the compromised, congenitally missing lateral space in a 17-year-old teenage girl and a 10-year clinical fol- low up. Case report A 17-year-old, non-smoking female presented for tooth replacement in the congenitally missing maxillary left lateral incisor site (Fig. 1). The pa- tient had recently completed ortho- dontic therapy, and the orthodontist and general practitioner had agreed this was the fi nal obtainable result in regard to the remaining intertooth space between the maxillary left central incisor and maxillary left ca- nine (Fig. 2). The resultant intertooth space was less than 5 mm, and con- ventional two-stage implants with abutment options were ruled out. The patient and her parents ruled out conventional tooth-replacement options and chose the minimally in- vasive procedure: a small-diameter implant, 1.8 mm in diameter, which would allow for natural papillary contours to be developed. After administration of an appro- priate local anesthetic, an ovate pontic contour was created utiliz- ing a football-shaped diamond in the attached, keratinized tissue of the edentulous site (Fig. 3). This scal- loped-type tissue contour helps in the creation of the natural-appearing papillary contours. The small-diameter implant chosen, a 1.8 mm x 14 mm Dentatus ANEW Implant was then placed after a sin- ÿPage 10