Scientifica implantology

Numeri Uno 12 , 2012, 8-9

IMMEDIATE LOADING POST-EXTRACTION WITH SIMPLE TECHNIQUE AND PLATFORM SWITCHING

The extraction of teeth in aesthetically important areas requires the implant dentist to make a serious evaluation of the existing soft tissues. If the soft tissues (papillae, height of the gingival edge) that surround the tooth to be extracted are adequate, the simplest and most predictable method for maintaining them is certainly a post-extraction implant immediately loaded with a temporary prosthesis that adequately supports the existing gingival tissues on three dimensions. If, on the other hand, the soft tissues are insufficient, it is recommended to adopt a two-stage procedure to reconstruct and increase the bone and gingival tissues with Langer or Ice Cream techniques. In this article we deal with the first case (adequate existing soft tissues).
In choosing the most suitable materials to make a post-extraction implant with immediate loading, it appears very important to use strongly self-threading implants with large spires, able to obtain elevated primary stability even inside morphologically complex sockets. On the subject of temporary prosthetic posts, it appears fundamental to choose posts that have the first apical 2 mm (=biological width) of biocompatible material (titanium) so as to facilitate the attachment of the gingival tissues to the post,
thus preventing an anti-aesthetic apical migration of the tissues. Lastly, an implant with platform switching guarantees less reabsorption of the peri-implant bone, thus allowing the aesthetic result obtained to be maintained over time.

Numeri Uno 11, 2012, 15-17

REHABILITATION WITH FIXED PROSTHESIS WITH COMPLETE MAXILLARY AND MANDIBULAR ARCH ON POST-EXTRACTION IMPLANTS. A CASE REPORT

Immediate implants are a treatment method with a high percentage of success. Chen and coll. have examined the literature to compare the success percentages and the clinical results associated with immediate, early and deferred implants, finding that these percentages were similar in the analysed groups. Some of the advantages with respect to deferred implants are: the reduction of bone loss, the decrease of the treatment times and the absence of second operations. It was found that few studies evaluate patient satisfaction concerning the rehabilitative treatment of an edentulous arch. Moreover, there is no homogeneity in the method adopted to evaluate patient perception. Using VAS, Van Steenberghe and coll. evaluated patient satisfaction with the aesthetics, functionality, phonation and tactile sensation
at a distance of 3 months from immediate loading. There was very high satisfaction as regards aesthetics, functionality and tactile sensation; instead, about half the patients expressed only moderate satisfaction as regards phonation. These authors also recorded the doctor’s opinion regarding aesthetics and functionality,
classifying them as excellent, good, acceptable, unacceptable: 18 out of 24 found excellent functionality and 16 excellent aesthetics; only in one case was the prosthesis judged unacceptable from an aesthetic point of view, due to a marked deviation of the median line, and it was repeated.
The aim of this study was to present a case of oral rehabilitation with fixed prosthesis with complete maxillary and mandibular arch on post-extraction implants. Patient satisfaction with the temporary and final prosthesis, success and loss of marginal bone were evaluated 12 months after prosthetic loading.

Numeri Uno 11, 2012, 15-17

REHABILITATION WITH FIXED PROSTHESIS WITH COMPLETE MAXILLARY AND MANDIBULAR ARCH ON POST-EXTRACTION IMPLANTS. A CASE REPORT

Immediate implants are a treatment method with a high percentage of success. Chen and coll. have examined the literature to compare the success percentages and the clinical results associated with immediate, early and deferred implants, finding that these percentages were similar in the analysed groups. Some of the advantages with respect to deferred implants are: the reduction of bone loss, the decrease of the treatment times and the absence of second operations. It was found that few studies evaluate patient satisfaction concerning the rehabilitative treatment of an edentulous arch. Moreover, there is no homogeneity in the method adopted to evaluate patient perception. Using VAS, Van Steenberghe and coll. evaluated patient satisfaction with the aesthetics, functionality, phonation and tactile sensation
at a distance of 3 months from immediate loading. There was very high satisfaction as regards aesthetics, functionality and tactile sensation; instead, about half the patients expressed only moderate satisfaction as regards phonation. These authors also recorded the doctor’s opinion regarding aesthetics and functionality,
classifying them as excellent, good, acceptable, unacceptable: 18 out of 24 found excellent functionality and 16 excellent aesthetics; only in one case was the prosthesis judged unacceptable from an aesthetic point of view, due to a marked deviation of the median line, and it was repeated.
The aim of this study was to present a case of oral rehabilitation with fixed prosthesis with complete maxillary and mandibular arch on post-extraction implants. Patient satisfaction with the temporary and final prosthesis, success and loss of marginal bone were evaluated 12 months after prosthetic loading.

Journal of Clinical Periodontology, 2012 Jun; 39: 582-589

Considering the great attention devoted by researchers in recent years to the use of post-extraction implants and to the consequent advanced recession of
vestibular tissues, the prestigious Journal of Clinical Periodontology published a systematic review of the topic. The review concludes that there is a lower risk
of recession if the residual post-extraction vestibular bone wall is intact, the gingival biotype is thick, and if a very conservative flapless surgical procedure can be performed. When these parameters are not present, it is advisable to make a careful assessment of the aesthetic risks that may be encountered.

Clinical Oral Implants Research, 2012; 23 (Suppl 5): 39-66

This extensive systematic review of the outcome of immediate post-extraction implants was drawn up during the 6th Expert Meeting of Osteology, with the title Evidence-based Knowledge on Biology and Treatment of Extraction Sockets Including the Placement of Dental Implants. Of the 46 works included in the review, 9 concerned the use of Sweden & Martina implants, which are therefore rated amongst the most highly referenced worldwide. According to the review, the studies included all demonstrate that the survival rate of post-extraction implants is high, while in other studies the results are sometimes not in agreement as regards the success parameters (stability and maintenance of peri-implant tissues). Further studies are therefore necessary to investigate these aspects.

The International Journal of Periodontics & Restorative Dentistry, 2012; 32: 29-37

20 immediate post-extraction implants were inserted in 15 patients with a flapless technique and immediately loaded with temporary prostheses. The implants were followed for a period of 24 months, at the end of which the survival rate was 100%, the marginal gingival level had decreased by 0.22 ±0.15 mm in the first months and then remained unvaried until 24 months. Bone reabsorption at 24 months was 0.83 ± 0.52 mm. The flapless technique is therefore able to preserve soft and hard tissues.

Clinical Oral Implant Research, Early View, First Published online on 2012, January, 6th

This prospective study monitored the behaviour of gingival fenestration around immediate rehabilitations of total edentulism for three months after operation. The variations of the mean buccal height and of the inter-proximal papillae were measured. The mean variation of the buccal height was 0±0.76 mm, the mesial point lost 0.035±1 mm, the distal point 0.05±0.92 mm. The researchers considered these data positive, but further study is needed.

Clinical Oral Implant Research, Early View, First Published online on 2012, January, 6th

This prospective study monitored the behaviour of gingival fenestration around immediate rehabilitations of total edentulism for three months after operation. The variations of the mean buccal height and of the inter-proximal papillae were measured. The mean variation of the buccal height was 0±0.76 mm, the mesial point lost 0.035±1 mm, the distal point 0.05±0.92 mm. The researchers considered these data positive, but further study is needed.

Journal of Periodontology, 2012; 83: 1226-1234

This study sums up the outcome at 10 years of 159 immediate post-extraction implants in 91 patients, with a mean cumulative success rate of 91.8%. In 101 of these implants, inserted coinciding with GBR, at 10 years the survival rate rose to 94.1%. The clinical attachment level and the marginal bone level remained substantially stable for the whole ten-year period.

Clinical Oral Implant Research, 2013; 24: 50-56

In the vestibular portion of immediate post-extraction implants, a graft of connective tissue obtained from the palate was positioned in vivo to test their capacity to preserve hard tissues (Test Group). At 4 months, bone reabsorption did not show any significant differences, with respect to the Control Group in which the graft had not been positioned, but there was a greater amount of mucous tissue in the Test Group. Clinically it is therefore useful to use a connective graft when there is a high aesthetic expectation.