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ePaper created 2017-11-09, 09:28:26 | version 1.38.0
overview | doctrine, one millimeter bone around the implant is no longer necessary for ceramic implants. As long as the ce- ramic implant is primarily stable, it will heal. This poses the requirement to learn to “think in ceramic”: This simply means that those areas of the implant that are completely surrounded by bone form the actual implant and those areas where periosteum or gingiva is fixed around the im- plant form the abutment. Since the periosteum and gin- giva creepingly attach to the ceramic, completely new methods of ceramic implantology are possible. There is no attached gingiva to titanium or other metal abutments. Therefore, a ceramic abutment is the absolute standard even in usual, titanium-based implantology. Patient case In early October 2016, a patient presented with pros- thetically and conservatively insufficiently restored adult dentures. A bridge region 34 to 37 (Figs. 7–9) was in es- pecially high need of renewal and the devitalised tooth 37 exhibited apical alterations in the form of radicular cysts (Fig. 10). These teeth were not viable for another pros- thetic restoration due to their deficiencies. The apical findings in region 35 and 37 were confirmed by the CBCT, verifying the clinically noticeable pressure pain in region 35 and occlusal pain in region 37. Patient and dentist agreed on immediate implantation with two-piece ce- ramic implants as an ideal form of socket preservation. Immediate implantation can thus be achieved in spite of chronically apical inflammation. In cases such as this, the perioperative preparation of the patient is decisive. Two weeks ahead of implantation, the patient’s physiological constitution and metabolism are primed for bone- and soft-tissue regeneration by a se- lection of nutrients (BHP® according to Dr Nischwitz). The patient’s immune system is optimally prepared. During surgery, the alveolus must be thoroughly cleaned and dis- infected, as ceramic implants only become incorporated in healthy bone. For disinfection, ozone is used. Periodon- tal fibres and any granulation or cystic tissues must be re- moved completely. The implant can be viewed as the “bo- nus on top”, supporting the whole alveolus when inserted primarily stable. In this case, the author opted for two- piece ceramic implants in order to prevent any tongue pressure and to allow for absolute rest during healing. This surgical procedure can be standardised, has a high success rate and is both painless and minimally inva- sive—the results speak for themselves (Figs. 11–14). Conclusion Ceramic implants, particularly immediately inserted ones (SCC®—Short Cut Concept according to Dr Karl Ulrich Volz), offer huge advantages over titanium implants. While immediate titanium implants, particularly in the posterior region, are only possible in a few cases, imme- Fig. 14 Fig. 14: OPG after surgery. diate implantation with ceramic implants is possible in al- most all cases of tooth extraction. Therefore, immediate implantation with ceramic implants is the gold standard, provided a strictly followed protocol. If both the systemic support of the bone and tissue regeneration are well-func- tioning, the dentist is working carefully and the alveolus is disinfected properly and precisely examined for iso- lated osteolysis, ceramic implants are ideal for socket preservation. It then works almost like a plug. Since the alveolus is smaller than the implant, the wounded area, which has to heal, is also smaller. At this stage, endog- enic regenerations processes in bone and tissue are working at full power. Particularly with regard to aesthet- ics, immediately inserting ceramic implants is the ideal time to operate according to the author. With a success rate of over 90 per cent, complicated immediate implants can also be carried out as routine in the posterior region in most cases. Following this procedure means that the patient does not require an additional implantation appointment, the bone- and soft-tissue are immediately supported and— in addition to the significantly more efficient process for patient and dentist—the immediate implantation is gen- erally completely painless. contact Dr Dominik Nischwitz Specialist in Biological Dentistry and Ceramic Implants DNA Health&Aesthetics Heerweg 26 72070 Tübingen, Germany Tel.: +49 7071 975977 info@dnaesthetics.de dnaesthetics.de Author details implants 1 2017 21