Scientifica implantology

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.

Clinical Oral Implants Research 2014; 25(Suppl. 10)

The author compared the presence of cement remnants in the peri-implant sulcus after rehabilitation with 2 different cementation techniques: standard intraoral (control group) or extraoral (test group), both shoulderless and chamfer abutments.
In the test group, cement remnants were removed from the abutments extraorally, while inserted into implant replicas.
The results showed that in the test group, significantly lower quantities of cement remnants were found than in the control group. There were no statistically significant differences between the two types of abutment used. Extraoral cementation may be the most effective method possible in limiting cement remnants.

Journal of Craniofacial Surgery 2014;25:822-827

The importance of precision in taking impressions for correct prosthesis preparation is well known. The authors performed comparative dimensional tests between 2 different techniques for impressions:

1. impressions made using conventional transfer techniques;
2. impressions made directly on the posts connected to the implants in their final position (interceptive technique).

Numeri Uno 12, 2012, 4-6

The aim of this work was to evaluate the structural properties of integral ceramic both as regards conservative and implantoprosthetic rehabilitation; integral ceramic has till now been considered a highly aesthetic material but it has been little used for rehabilitations on implants.
Integral ceramic is now widely used for making prosthetic rehabilitations with a very high aesthetic value, it can be used for making crowns, facets and implantoprosthetic posts. One of the characteristics that distinguishes integral from traditional ceramic is that it allows prosthetic preparation at juxta-gingival
level, thus avoiding the risk of seeing a dark area at sulcular level. Integral ceramic is also used for making posts on implants with excellent results also as regards the resistance to masticatory loads. This clinical case describes the rehabilitation of the upper front sector with integral prosthesis on implants and integral facets on natural posts. The clinical case concerns a male patient aged 48 with agenesis of 12, 22 and ectopic canines. The patient was motivated and wanted to solve his situation from both an aesthetic and a functional point of view. We therefore proposed orthodontic therapy to create sufficient space for inserting two Premium implants in position 13 and 23; it was also proposed to make facets on 11 and 21, facets on the two canines “transforming” them into lateral incisors and making two integral ceramics on the implants with an integral prosthetic post to reobtain the two canines, in order to rehabilitate the appearance of the front sector. Satisfied with the plan, the patient decided to start rehabilitation immediately, obviously beginning with a professional hygiene session, with instructions for maintenance and motivation. At the following
control he appeared to have kept up the oral hygiene and was motivated, so it was decided to start the orthodontic therapy.
A cephalometric tracing was used to obtain a complete view of the brachyfacial skeletal type and to check the cephalometric values. After the extraction of element 63 a fixed orthodontic treatment was carried out with the Ricketts technique, using springs with light compression to create the necessary space for inserting the implants. Next we inserted two Premium implants (Sweden & Martina) 3.30 x 100 and waited for their integration.
During the osseointegration period the job of the orthodontic device was to maintain the space. When the osseointegration period was ended the orthodontic device was removed and the four front elements were prepared; the impression was then taken at the same time as the impression on the implants with a transfer for open tray technique with perforations. For greater precision the articulation wax was registered with the facial arch.
A week after the impression we carried out the “untreated” test of the four facets and the test of the two integral posts with the respective crown in integral ceramic. When the laboratory phase was completed the prosthetic products were cemented with an integrally adhesive system.
The patient was completely satisfied with the work done from both an aesthetic and a functional point of view.

Numeri Uno 12; 2012, 14-17

ANALYSIS OF THE FUNDAMENTAL FACTORS IN THE SURGICAL PLANNING OF POST-EXTRACTION PROSTHESES WITH IMMEDIATE LOADING ON INCLINED AND NON INCLINED IMPLANTS

In recent years on the implantoprosthetic scene there is an ever increasing use of the post-extraction implant prosthesis with immediate loading. In this context the method of distal implants positioned in an inclined position is frequently adopted; this is indicated when there is bone atrophy in the rear sectors with consequent anatomical problems regarding the position of the emergence of the alveolar nerves and pneumatisation of the maxillary sinus.
This type of operation is necessary when it is not possible to consider the resolution, with bone regeneration, of the lower and upper rear atrophies. Although the positioning of the inclined distal implants in the operative phase and of the more medial implants in a position perpendicular to the crest may seem fairly facilitated by the quantity and by the stable type of bone present in the pre-extraction phase, numerous problems often occur connected to problematic conditions in the surgical phase. The factors to be respected for immediate loading in fact require absolute primary stability, but they do not exclude those fundamental principles for aesthetic requirements, the creation of the temporary prosthesis in a short space of time, post-operative comfort, etc.
Numerous difficulties may be encountered especially when, in the post-extraction phase, we find various bone complications determined by the prolongation of inflammatory and infective factors; these are represented, on the alveolar bone, by gaps and atrophies of various kinds that cause variations in the form of the three planes of the space in the bone where we have to position the implants. This problem will inevitably influence the stability, the aesthetic aspect and the need to deliver an immediate temporary prosthesis in a short time.
This work analyses the fundamental factors of the pre-surgical phase in chronological order, so as to obtain a protocol that acts as a guide to as predictable a result as possible and allows a linear and facilitated execution that ensures the rehabilitations will be long-lasting.
The author concludes by indicating the validity of post-extraction implant prosthesis with immediate loading as regards both the functional and aesthetic aspect and long duration. Correct planning and programming of the prosthesis are important, taking into account a correct analysis in the phase of the anamnesis and pre-surgical planning.

Numeri Uno 14; 2012, 8-11

COMPLEX PROSTHETIC REHABILITATION OF THE UPPER MAXILLARY WITH THE USE OF PAD COMPONENTS AND FINAL PROSTHESIS WITH A DEVICE IN MONOLITHIC ZIRCONIA AND CERAMIC

In recent years the post-extraction implant prosthesis with immediate loading has become more and more the primary choice for the prosthetic restoration of complex cases also in the atrophic upper maxillary using the premaxillary bone with long implants and angled components that allow the avoidance of more complex surgical strategies (sinus lift), therefore remaining in the sphere of less invasive surgery. Thanks to dental scientific research, implant manufacturers have put more and more evolved implant components on the market which offer the possibility of making immediate temporary prostheses in a shorter space of time. The ever increasing demand for aesthetic appearance associated with function leads us to use materials of the latest generation such as zirconium oxide, which is being used more and more as an alternative material for the construction of biocompatible prostheses that remain stable over time and have a high aesthetic value. A circular screwed prosthesis was made with a pink aesthetic finish in monolithic zirconia and ceramic. The clinical case examined concerns a male patient aged 62 affected by chronic evolving periodontitis with multiple edentulism, a smoker, with recurrent episodes of acute abscess inflammation, who asked for the rehabilitation of the upper arch, with functional and aesthetic restoration. On the upper arch the patient wore a fixed temporary post in acrylic alloy, cemented onto the remaining teeth that were mostly
irremediably compromised, with widespread multiple bone defects. The OPT X-ray examination showed that there was still a good quantity of bone in the premaxilla, so we were able to chose a postextraction implant solution with immediate loading using long implants (18 mm) angled at 30 degrees at the two ends. The 3D examination clearly showed the presence of adequate bone volumes despite the presence of widespread bone defects linked to periodontitis. The operation was conducted with an intrasulcular incision from sixteen to twenty-six with detachment of two flaps with total thickness; the extractions were performed followed by cleaning of the alveolar cavities and of their cystic inflammatory contents with remodelling of the alveolar crests. Six fixtures were inserted, two of which with an angle of 30 degrees at the ends, taking care to under-prepare the site so as to be able to use high inserting torques; the P.A.D. and the transfers were positioned and the intra-operative impression was taken in plaster for the construction of the screwed prosthesis with immediate loading.

Numeri Uno 11; 2011, 12-14

IMPLANTOPROSTHETIC TECHNIQUE WITH IMMEDIATE LOADING BY DR. PAULO MALÒ WITH ANGLED IMPLANTS, CLINICAL CASES

Today each one of us tends to interpret the concept of the “quality of life” as a sense of well-being, perceived on the basis of our own experiences and expectations in the social and cultural environment in which we live. The health of the stomatognathic system has a strong influence on a person’s quality of life; the loss of teeth is often viewed as a pronounced social, psychological and functional disability, to the extent that the World Health Organization (WHO) has recognised this disability under the ICF classification (International Classification of Functioning, Disabilities and Health), since it is a serious handicap and difficult to conceal. The importance of the physical appearance in western society is assuming a more and more decisive role in every age group; today even elderly people consider a pleasant appearance just as important as younger people. The media contribute to the creation of models of beauty that do not allow for signs of ageing. The loss of teeth causes important changes in the aesthetic appearance of a face due to the loss of support for the lips and a consequent change in expression; remember that the teeth and eyes are the
points of the face where the interlocutor’s attention is most focussed during a conversation. People who wear dentures are acutely aware of these aspects linked to their social life and are generally worried about their instability; consequently they may develop a tendency to shun interpersonal relations and develop depressive behaviour. This report on Malò’s technique offers the best interpretation of the diagnostic, surgical and prosthetic phases of an upper case and a lower case (with some slight variations and customisations) through the eyes of our clinical experience based on the treatment, to date, of more than one hundred and twenty cases.

International Journal of Oral and Maxillofacial Implants, 2012, 27: 428-434

The authors carried out a 36-month follow-up of 44 full-arch prostheses, 24 in the maxilla and 20 in the mandible, all supported by 4 implants, two axial and two tilted according to the ”All on Four” protocol. The patients were assigned at random to two groups, (a) resin prosthesis, (b) metalreinforced prosthesis. At three years in the two groups the implant survival rate was 100% for axial implants and 96.59% for tilted implants; the crestal reabsorption measured at 12, 24 and 36 months was not significantly different between axial and tilted implants. The authors conclude that in this type of prosthetic protocol the presence of metal reinforcement in the prosthesis gave the same clinical result for both axial and tilted implants.

Numeri Uno 12; 2012, 12-13

In November 2009 a patient came to us who had previously been treated in March 2009 with positioning of implants in the lower arch. The male patient, aged 48 and a non-smoker, asked us if we could replace his old “mobile job”, a removable partial denture that he had been wearing for years, with a fixed prosthesis. Specifically he asked us, in a short period of time, to replace the two incisors (11 and 21) and the first left upper premolar (24), therefore asking for a fixed prosthesis with the lowest possible cost. The objective examination showed considerable crestal reabsorption in zones 11 and 21, both horizontal and vertical, compensated by the resin part of his removable denture. Dyschromia was also noted, loss of enamel and old fillings on the lateral incisors 11 and 22. The need to rehabilitate a zone of such high aesthetic value while trying to keep down the costs led us to choose the following treatment: 2 Kohno implants by Sweden & Martina with screwed composite crowns, direct facets in composite material on the laterals and implant on 24. This choice will be extremely advantageous as regards both the economic aspect and the healing times.