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The clinical and scientific evolution behind the development of the basic concept of XA prosthesis

21/02/2017

The main preoccupation of the practitioner is to limit the inexorable bone reabsorption and the apical migration of soft tissues to a minimum, as these generate many problems that are not solely aesthetic, but that can instead also be linked to the medium-term and long-term survival of the rehabilitation, due to peri-implantitis. What we are talking about is a paradigm shift, given that with the use of XA posts and an adequate rehabilitation protocol, not only can apical migration be avoided, but coronal migration of the bone and of soft tissues can also be promoted over time. This implies both aesthetic improvements and greater protection against the onset of peri-implantitis.
We believe that the best way of demonstrating the evolution of the XA concept is to analyze the various protocols that we have adopted in our work in recent years, with the final aim of stabilizing tissues. 

1. Implant without Platform Switching (PS) presenting an anatomical profile (divergent) that mimics the form of the tooth, and a protocol that envisions prosthesis disconnections. In this situation, tissues showed a tendency to apical migration. The inevitable gingival recession generated not only an aesthetic risk, but also the possibility of peri-implantitis.

2. Implant with PS presenting an anatomical profile (divergent) and a protocol that envisages prosthesis disconnections. The introduction of the concept of PS has allowed us to reduce peri-implant bone reabsorption, improving tissue stability. This concept allowed us to learn more about the relationship between the shape of posts and the stabilization of tissues by means of the circular fibres of connective tissue.

3. Implant with PS presenting a straight profile and a protocol that envisages prosthesis disconnections. The use of straight posts allowed us to increase tissue thickness and to improve results in a predictable way.

4. Implant with PS presenting a conical profile (convergent) of the XA posts and absence of disconnections. Finally, the introduction of XA posts for screw-retained and cemented prostheses allowed us not only to stabilize tissues, but also to promote their coronal migration over time.

The tapering of these posts promotes the short-term and long-term coronal migration of tissues. The absence of a margin (marginless) makes it possible to avoid the repeated disconnections and reconnections that are typical of conventional rehabilitation protocols, causing tissue destabilization.
The presence of micro-threads at the base of the posts promotes the alignment of fibroblasts, accelerating and increasing the production of collagen (contact guidance), a crucial factor for biological sealing.
The apparent simplicity of this concept satisfies a multitude of biological criteria that contributes in the search for the best possible tissue response. The use of the components is simple and facilitates the work of both the dentist and the dental technician. We took care to ensure that the posts were compatible with the different operating protocols (screw-retained or cemented prostheses), and that they could be used in all clinical situations (anterior and posterior sectors, immediate or deferred loading). For the first time, posts act as a guide for connective tissue and for the periosteum, in turn promoting bone growth. All these reasons lead us to believe that we are truly faced with a paradigm shift.

Insanity?
The definition of insanity is doing the same thing over and over and expecting different results.
A. Einstein

Dr. Xavier Vela Nebot
Dr. Xavier Rodríguez Ciurana
Centro BORG (Barcelona Osseointegration Research Group)

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