Scientifica implantology

International Journal Oral and Maxillofacial Implants, 23:841-846, 2008

In this study the implants inserted immediately after tooth extraction in well-preserved sockets and in the presence of bone defects requiring regeneration, obtained a better result with the fl ap technique than with the flapless technique.

Numeri Uno, 3 (12-3); 2009, 04-07

THE FLAPLESS TECHNIQUE: INDICATIONS AND THRESHOLDS

Over the years, the improved surgical techniques for inserting implants have become diversifi ed following increasing requests by patients for rehabilitation more attentive to function but also to aesthetics, with minimal invasive surgery. In fact, the trend is to continue to improve both the functional and aesthetic aspect, but above all, to minimise the surgical aggressiveness of the surgery in order to improve the patient’s post-operative course.
This study involved evaluating the clinical cases performed with the fl apless method in order to define its indications and thresholds compared to other methods. The study examined 83 implants inserted in 30 patients (19 female and 11 male) whose conditions were such to allow inserting the implants using the fl apless method.
Patients having conditions that could interfere with the osseointegration processes (smoking, diabetes, bone metabolism pathologies, parafunctions) were excluded from the study.
All patients underwent initial preparation prior to treatment. In 13% of the cases, the rehabilitation occurred with immediate loading, in 87% of the cases with deferred loading.
The advantages of the fl apless technique are:
• The possibility to perform a non-traumatic surgery, respectful of the bone physiology and noninvasive;
• Reduced surgery time;
• No need to prepare surgical fl aps, therefore no stitches;
• Greater comfort for the patient;
• Less pain and bleeding;
• Possibility to associate immediate loading of the implant, if requested;
• The respect of the biological width and soft tissues around the implant, thanks to the positioning of the smooth neck of the implant outside the bone;
• The positioning of connecting elements, which constitute points of weakness and retention of the plaque above crestal level, thanks to the use of the single-step technique.

The disadvantages connected to the use of this method are:
• The impossibility to combine with bone or tissue augmentation techniques;
• The danger of deviating from the correct trajectory, piercing the cortical layers;
• The risk of the epithelium colonising the implant site;
• Impossibility to manage the soft tissues for increasing the attached gingival band;
• Learning curve for being able to take full advantage of the potentials that this method has to offer.


An interesting study conducted with conical implants used in post-extraction sites with flapless technique: the clinical results showed the validity of this surgical procedure.

Clinical Oral Implant Research, Early View, First Published online on 2013, January 25th

The different positioning of immediate post-extraction implants was tested in vivo: in one group the implants were placed with the smooth portion of the neck at crestal level, in the other group 2 mm subcrestal. Within the limits of this study, the implants positioned at subcrestal level showed less bone reabsorption, as well as higher BIC values.

Il Dentista Moderno, 4:115-122, 2003.

International Journal of Periodontics & Restorative Dentistry, 30:639-645, 2010.

The extremely wide use of implants leads to more frequent complications and failures. General research and the numerous contributions made by Professor Covani’s research team have highlighted the excellent prognosis of immediate implants and their immediate prosthetization. Therefore, it was obvious that Professor Covani’s team should examine the theme of immediate replacement of the implant, when they meet complications that otherwise could not be treated. This subject has already been dealt with by the author and today, with this new publication, paves the way not only for immediate replacement, but also for immediate prosthetization. Pending large-scale studies, the authors present the case report of a 58 year-old non-smoking male, who had an implant that is no longer osseointegrated due to an infection. Since the patient refused to use a removable provisional prosthesis, the possibility to apply an immediate loading protocol was considered. The implant failed and it was carefully removed. The post-extraction socket was curetted to completely remove any trace of remaining granulation tissue. The prosthetic treatment then began with the patient still under local anaesthetic. By taking advantage of the great initial stability of a Premium implant (Sweden & Martina), excellent results were obtained in
both functional and aesthetic terms. This protocol – which does not require the element to be placed in occlusion in order to minimise the masticatory load until healing – allowed a perfect modelling of the tissues around the implant and a full recovery of the damaged site.

Journal of Clinical and Experimental Dentistry 2015;7(1):e175-9

Numeri Uno, 2014, 19, 22-24

IMMEDIATE LOADING

The case presented involved total rehabilitation in a patient aged 58 years, a smoker with serious endodontic-periodontal impairment in both arches, in a situation of serious deep bite not resolved by previous prostheses.
Surgical procedures were performed in two sessions.
During the first session the impaired teeth were removed from the upper arch and implants were inserted immediately, at the same time performing regeneration with synthetic bone particulate and resorbable membranes, adding PRGF where necessary. All implants were inserted at immediate post-extraction sites, except for the implant inserted at position 14.
During the same session, immediate loading was carried out with the disparallel screw-retained prosthesis technique (DSP), followed by the intraoral welding of a titanium bar onto the temporary sleeves using argon syncrystallization. The temporary prosthesis, to remain in place for 6 months, made it possible to achieve raised mastication for an initial correction of the deep bite.
In the second session, an implant was inserted at position 37 in the lower arch and 4 implants were inserted in the rear portion of the lower right-hand quadrant, where a split-crest procedure was carried out with the simultaneous insertion of implants with a small diameter.
At the same time temporary prostheses were fitted to the teeth of the frontal group.
After six months re-entry was performed on both the upper and lower arches, and impressions were made for the production of the final prostheses.
On the upper arch, between the canines the DSPs were removed and personalized posts were inserted suitable for the support of single crowns in lithium disilicate (cemented technique). The DSPs in rear areas were maintained, and a screw-retained metal-ceramic prosthesis was fitted.
In the lower arch, the teeth were prosthesized with a zirconium-ceramic structure, and in the rear areas, on the right a screw-retained ceramized chrome-cobalt structure was fitted, completed by two lithium disilicate crowns on the left. Cementation was carried out for both disilicate and zirconium with composite materials.

Numeri Uno, 2014, 19, 22-24

IMMEDIATE LOADING

The case presented involved total rehabilitation in a patient aged 58 years, a smoker with serious endodontic-periodontal impairment in both arches, in a situation of serious deep bite not resolved by previous prostheses.
Surgical procedures were performed in two sessions.
During the first session the impaired teeth were removed from the upper arch and implants were inserted immediately, at the same time performing regeneration with synthetic bone particulate and resorbable membranes, adding PRGF where necessary. All implants were inserted at immediate post-extraction sites, except for the implant inserted at position 14.
During the same session, immediate loading was carried out with the disparallel screw-retained prosthesis technique (DSP), followed by the intraoral welding of a titanium bar onto the temporary sleeves using argon syncrystallization. The temporary prosthesis, to remain in place for 6 months, made it possible to achieve raised mastication for an initial correction of the deep bite.
In the second session, an implant was inserted at position 37 in the lower arch and 4 implants were inserted in the rear portion of the lower right-hand quadrant, where a split-crest procedure was carried out with the simultaneous insertion of implants with a small diameter.
At the same time temporary prostheses were fitted to the teeth of the frontal group.
After six months re-entry was performed on both the upper and lower arches, and impressions were made for the production of the final prostheses.
On the upper arch, between the canines the DSPs were removed and personalized posts were inserted suitable for the support of single crowns in lithium disilicate (cemented technique). The DSPs in rear areas were maintained, and a screw-retained metal-ceramic prosthesis was fitted.
In the lower arch, the teeth were prosthesized with a zirconium-ceramic structure, and in the rear areas, on the right a screw-retained ceramized chrome-cobalt structure was fitted, completed by two lithium disilicate crowns on the left. Cementation was carried out for both disilicate and zirconium with composite materials.

Doctor OS, 14 (4): 366-379 , 2003

RETROSPECTIVE EVALUATION OF THE POSTEXTRACTIVE TECHNIQUE: 10 YEARS FOLLOW UP

This retrospective, together with an in-depth review of the literature, compared the immediate and early delayed technique on single implants using different implant systems and demonstrated its success in both immediate and deferred prosthetic loading.

Journal of Periodontology, 77 (11):1914-1920, 2006

In case of individual teeth, this study demonstrates how the use of
immediate post-extraction implants with immediate non-functional loading is a predictable rehabilitation procedure and at the same time less invasive for the patient.