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ePaper created 2018-01-31, 10:01:59 | version 1.38.0
| research Immediate restoration in the digital workflow Drs José Eduardo Maté Sánchez de Val & José Luis Calvo Guirado, Spain Endosseous implants have consistently achieved high success rates in partially and completely edentulous patients. Clinicians have therefore begun to offer selected patients imme- diate and early implant place- ment options. The long-term success of immediately loaded implants has been investigated in animals1,2 and humans,3 with encouraging results. However, most of the studies were per- formed with implants placed in the anterior mandible, where primary implant stability is easily achieved. SKY elegance abutment. Fig. 1: Implants and abutments used (left to right). blueSKY implant, SKY esthetic abutment titanium, In addition to several ideas aimed at limiting crestal bone resorption, the concept of platform switching ap- pears 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 perime- ter of the IAJ inward toward the central axis of the implant.12,13 The time limita- tion in implant treatments is an import- ant bias when it comes to planning and developing rehabilitation therapies. In this sense, the inclusion of new mate- rials that allow for immediate loading in a single session without having to replace prosthetic components facili- tate optimal results in terms of gingival attachment and minimize peri-implant bone loss after prosthetic abut- ments have been manipulated. Ceramically reinforced PEEK is of great interest as it allows a single attach- ment to be retained in place throughout the entire treat- ment and avoids handling-related overload. Its mechan- ical and physical properties have been tested in animal experiments and in humans, showing the material to be ideal for one-step Xprotocols. The physical and mechanical properties of the pros- thetic components govern the success of the long-term restoration. Resistance to occlusal loads such as masti- catory movements and parafunction should be adequate to allow denture survival. The modulus of elasticity and bending resistance of the material should be adequate to prevent undesirable fractures or micromovements.13 Furthermore, components used require a high degree of biocompatibility to prevent the occurrence of abnor- mal tissue reactions such as initial peri-implant inflam- mation and mucositis, which may result in more severe complications such as peri-implantitis.14 Polyetherether- ketone (PEEK) is a polymer from the polyaryletherketone family, a relatively newly developed family of high-tem- perature thermoplastic polymers having of an aromatic backbone interconnected by ketone and functional ether groups.1 In medicine, PEEK has been found to be an excellent substitute for titanium in orthopaedic appli- In the anterior maxilla, clinicians seeking to load im- plants immediately must be concerned not only about achieving adequate implant stability, but also about ful- filling patients’ desires for aesthetic results that resem- ble the natural dentition. To achieve this, it is essential to maintain as much of the bone height around the implant neck as possible, 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 integration of the implant or later.5 This phenomenon occurs whether the implant is loaded or not and appears to be unrelated to the type of implant surface.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 com- ponent 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 bio- logic width is in the wake of such osseous changes, the soft-tissue architecture, including the appearance of the papillae, is affected. The interproximal bone influences the interdental papillae by acting as a guidepost for the soft-tissue contours. 08 CAD/CAM 1 2018