Scientifica implantology

Clinical Oral Implant Research, Early View, First Published online on 2011, September 29th

As a continuation of the study reported in pages 276-277, the authors evaluated the molecular (RANKL and IL-17 biomarkers) and cellular (count of B and T lymphocytes) inflammatory aspects normally correlated to bone loss. In the presence of implant-abutment mismatching differences, no statistically significant diversity was found.

Clinical Oral Implant Research, Early View First Published online on 2011, November 2nd

The switching platform technique with a mismatching of 0.85 mm can maintain the bone level of the buccal crest better than a traditionally loaded implant.

Clinical Oral Implant Research, 22(9), 2011:910

This histological experiment found less bone reabsorption around implants rehabilitated according to the switching platform concept with mismatching from 0.85 mm. This data becomes statistically important at a buccal level.

Numeri Uno, 2014; 20: 20-21

REHABILITATION OF A SINGLE ELEMENT IN POSITION 4.6 WITH A PRAMA IMPLANT

This case report presents a clinical result obtained with a new implant morphology. The characteristics of this new implant system make it different from others, due above all to the distinctly extracrestal positioning of the abutment-implant connection and the morphology of the abutment-implant complex neck with a vertical finish area.
The transgingival healing of the implant allows a second surgical operation to uncover the implant to be avoided.
The peri-implant mucosa tissues heal around the machined titanium surface of the implant neck. These tissues no longer need to be stimulated during the various prosthetic phases, making it possible to eliminate some of the modifications to the bone margin caused by repeated screwing and unscrewing operations for prosthetic components.
In addition, by moving the implant-abutment gap away from the marginal bone crest, the peri-implant bone resorption that always occurs in implant methods where this gap is at the level of the bone margin is eliminated.
The vertical finish area of the abutment-implant neck complex allows the emergence morphology of the prosthetic crown to be used to guide the soft tissues and to adapt them to its anatomy. Furthermore, the ferrule effect that can be obtained by covering not only the abutment but also the implant neck with the prosthetic crown could reduce the possibility of biomechanical complications like the slackening or breakage of the post screw.
The clinical result appeared to be positive, both in functional terms and with respect to the integration of the prosthetic crown with the surrounding tissues.

Numeri Uno, 2014;20:18-19

REHABILITATION OF A SINGLE ELEMENT IN AN AESTHETIC AREA WITH A PRAMA IMPLANT

Implant rehabilitations in aesthetic areas always require the greatest care by clinicians, particularly in cases where a post-extraction implant technique is necessary, and even more so in case of immediate loading. In these cases, the preparation of the clinical case is of fundamental importance to allow as much pre-operative information as possible to be obtained, and so that the materials to be used can be studied. In the case described here, it was necessary to use a screwed-in implant that would allow an insertion torque of no less than 50 Ncm to be reached, and that at the same time would give us the possibility to vary the emergence point of the prosthetic profile. allowing us to perform vertical Platform Switching and giving the operator. The PRAMA implant used combines these main characteristics, and also adds surfaces with a high level of biological performance.
Clinical procedures were complicated by the need to perform guided bone regeneration in the vestibular dehiscence as well, requiring particularly accurate soft tissue management, in line with the indications provided in literature for aesthetic cases.
In addition, the temporary crown was supported in the initial phases by a small splint connected to nearby teeth with composite resins.

Date of procedure 28-02-2014
Data of definitive prosthetization 28-7-2014
Photo and check-up X-ray 13-5-2015

Numeri Uno 2014; 01:6-9

RELIABLE IMPRESSION TECHNIQUES: TWO PROPOSALS FOR THE SAME OBJECTIVE

A patient of 45 years, with no medical history of interest, with a totally edentulous mandible. After the clinical and radiographic study, it was decided to plan the insertion of 6 lower implants and the fitting of an temporary immediate screw-retained prosthesis.
After the standard surgical procedure, which consisted in the insertion of 6 Sweden & Martina Premium implants, 3.8 mm x 13 mm, the transgingival healing posts were positioned, with sutures around them. The transgingival posts were later replaced with PEEK transfers, which were then stabilized with a photopolymerizing resin (Conlight, Kuss Dental, Madrid, Spain). The models made previously were subsequently modified to allow them to enclose the fixed structure obtained, then taking an occlusion impression that would give the laboratory technician information on occlusion before the operation. The interior of the model was filled with a polymer (Impregum, 3M ESPE, Seefeld, Germany) and a closed-mouth impression was taken, positioning a material for registration on the occlusal faces of the teeth (Occlufast, Zhermack, Italy). After the polymerization time (3 minutes), the impression was removed and sent to the laboratory to allow the temporary prosthesis to be made.
Three months later, final rehabilitation was commenced, envisaging a hybrid screw-retained CAD/CAM prosthesis with a titanium structure.
The final impression was made using transfers with an open tray fixed with a 1.5 mm titanium bar. This procedure was completed using the Dent Weld intraoral welding machine. This device has a handpiece with forceps that transmits energy capable of generating the heat necessary to melt titanium.
Before starting the protocol, an OptraGate retractor (Ivoclar Vivadent, Schaan, Liechtenstein) was used to facilitate the opening of the patient’s mouth and improve access to the transfers. The Dent Weld device was then configured with the Single programme with a selected power value (54% at 162 joules for a titanium bar thickness 1.5 mm), and the electrodes were connected to the two transfers. The bar was cut with a diamond milling blade at right angles and irrigation, and the procedure continued on the subsequent transfer with a new welding bar. In this way it was possible to avoid the “memory effect” of the titanium bar, which could produce a distortion of the assembled transfers on detachment of the impression.
After all the transfers had been fixed two-by-two, the correct positioning of the custom-made tray was verified. The impression was then taken with the closed-tray technique, using a double mixture of light and heavy silicone (Virtual, Ivoclar, Schaan, Liechtenstein).

Numeri Uno 2014;18:12-14

CHAIRSIDE ELECTRICALLY-WELDED CONOMETRIC IMPLANTOPROSTHESIS WITH IMMEDIATE LOADING ? A CLINICAL CASE

The patient presented with the need to rehabilitate third quadrant in the region of elements 35 and 36, following the avulsion of element 36, seriously compromised. At the patient’s request, we did not proceed with the immediate post-extraction insertion of the implants, but opted instead for deferred insertion. Four 4 months after extraction we therefore used the flapless technique to insert two Shelta implants (Sweden & Martina), respectively of diameter 3.80 mm and length 11.5 mm at position 35 and diameter 4.25 mm and length 11.5 mm at position 36. On both implants an insertion torque of 65 Ncm was used. Two final conical posts with reduced diameter were positioned on the implants, for use with the conometric prosthetic system (Sweden & Martina). In the same surgical phase the preformed conometric caps were positioned (Sweden & Martina). The caps were fixed by intraoral welding (Dent Weld, Sweden & Martina), using a titanium bar with diameter 1.5 mm. The result was an extremely precise removable prosthesis that allowed us to make a temporary prosthesis for immediate loading.
The welded caps were removed to check their passivity and to verify that they could be incorporated into the prefabricated temporary prosthesis. After the electrically-welded structure was repositioned on the posts, the temporary prosthesis was directly relined, so as to be able to incorporate the structure itself to obtain a reinforced removable prosthesis that would also have the advantage of stabilizing the implants.
Conclusions: The case presented shows that with this technique an implantoprosthesis for immediate loading that respects the concepts of platform switching can be made quickly and easily, positioning the final post that will remain in place in the surgical phase, thanks to the availability of posts with different transgingival heights. The use of prefabricated conometric caps allows a very high level of precision to be obtained, and fixing with electric welding makes it possible to stabilize the inserted implants and to proceed with the chairside construction of a temporary prosthesis that is not only extremely resistant, but that can also be easily removed by the dentist at any time. The standardization of the method and its adaptability to the various Sweden & Martina implant systems the reasons for its ease of use and consequent inexpensiveness.

Italian Dental Journal 2014; 29, agosto

CONOMETRIC TECHNIQUE WITH AN ELECTRICALLY WELDED TEMPORARY PROSTHESIS FOR IMMEDIATE LOADING

In both these articles, Dr. Panadero describes cases treated with a new technique of prosthetic rehabilitation, using an overdenture with a secondary structure anchored by means of horizontal insertion to a primary structure. This solution makes it possible to the recover the horizontal dimension, avoiding the need to resort to invasive reconstruction operations.

Journal of Oral Implantology 2014; 8 [Epub ahead of print]

In both these articles, Dr. Panadero describes cases treated with a new technique of prosthetic rehabilitation, using an overdenture with a secondary structure anchored by means of horizontal insertion to a primary structure. This solution makes it possible to the recover the horizontal dimension, avoiding the need to resort to invasive reconstruction operations.

Gaceta Dental 249, 2013; 100-112

AN OVERDENTURE FOR HORIZONTAL INSERTION

This article presents Horizontal Denture, an interesting alternative to conventional techniques for overdentures on implants, capable of combining the advantages of conventional removable prostheses with those of hybrid prostheses.