Decision Making in Dental Implantology: Atlas of Surgical and Restorative Approaches offers an image-based resource to both the surgical and restorative aspects of implant therapy, presenting more than 2,000 color images with an innovative case-by-case approach.
* Takes a highly pictorial approach to all aspects of implant dentistry
* Discusses both the surgical and restorative aspects of implant therapy in a single resource
* Describes a wide range of clinical scenarios likely to be encountered in daily practice
* Covers anterior, posterior, and full-mouth restorations
* Presents more than 2,000 color images showing the basic concepts and clinical cases
Current Status of Clinical Practice with Dental Implants: An Evidence-Based Decision Making Overview
Osseointegration and its Application to the Treatment of Completely or Partially Edentulous Patients in Clinical Practice
Since the first experimental study from the end of 1960s , the titanium implant has been used as a biocompatible feasible alternative in the treatment of completely or partially edentulous patients. Basically, the systematic use of dental implants in dentistry as a scientifically proven therapeutic approach occurred in the 1980s, while in the 1990s it strongly grew in terms of potential clinical applications (Figure 1.1 and 1.2).
Figure 1.1 (A) Initial clinical status with several missing teeth before the full-mouth reconstruction. (B) After osseointegration around six implants in the maxilla the remaining teeth were extracted. (C) The abutments and the three four-unit porcelain-fused-to-metal restorations: two posterior screw-retained restorations and one anterior cemented restoration. (D, E) Clinical view of the final rehabilitation in position - occlusal and buccal views. (F) Panoramic radiograph.
Figure 1.2 (A) Patient smile before treatment. (B) Initial clinical status with several missing teeth before the full-mouth reconstruction. (C) Initial panoramic radiograph. (D) First mockup shows the unfavorable position of teeth #6, 7, and 11 regarding the planning for restorative treatment. (E) Occlusal view of the anterior teeth. (F) Panoramic radiograph after the placement of six implants in the maxilla. (G, H) Clinical views after implant placement before and after teeth extraction. (I) The three four-unit porcelain-fused-to-metal restorations prior to installation. (J) Clinical try-in of the three four-unit screw-retained porcelain-fused-to-metal restorations. (K) Occlusal view of the abutments. (L) Right-side partial fixed restoration before the pink gingival application. (M) Pink gingival simulation with acrylic resin. (N, O) Restorations completed - occlusal and buccal views. (P) Patient smile after treatment. (Q) Panoramic radiograph.
Currently, titanium implant-based procedures are seen as the gold standard for the replacement of teeth lost as a consequence of periodontitis, caries, endodontic pathology, and trauma. As a result, it can be argued with a high degree of certainty that implant-based therapies alone or in association with hard- and soft-tissue reconstructive procedures (most of them developed during the same period) are essential for the achievement of excellent clinical treatment in dentistry. These principles are grounded in the accomplishment of so-called osseointegration between the implant surface and living alveolar bone, (i.e. a direct bone deposition on implant surfaces at the light microscopic level) . Additionally, others factors have influenced implant therapy among professionals over the last 20 years: the high success rates and the clinical/functional predictability of prosthetic restorations examined by long-term periodontal and implant dentistry research (Figure 1.3 and 1.4) [3-8].
Figure 1.3 Two implant sites in tooth #30 with different characteristics. (A) Tooth #30 is missing and a bone defect is present at the alveolar ridge. (B) Implant site with thin bone walls. (C) Implant in position (4.1 mm diameter). A dehiscence-type defect is present at the buccal aspect. (D) Tooth #30 is missing and the alveolar ridge contour is well preserved. (E) Implant site with thick bone walls (more than 2 mm of width). (F) A wide-diameter implant (4.8 mm diameter) in position.
Figure 1.4 (A) Tooth #19 is missing. (B) Implant bed. (C) A wide-diameter implant (4.8 mm diameter) was placed. (D) Wound closure. Non-submerged healing. (E) Aspect one week after operation. (F) Aspect eight weeks after operation. (G, H) Porcelain-fused-to-metal screw-retained restoration in occlusion and lingual views. (I) Eight-year follow-up shows healthy peri-implant soft tissue. (J) Screw-retained restoration. (K) Restoration replaced in position. (L, M) Eight-year follow-up cone beam computerized tomography (CBCT) image shows excellent bone levels around the implant.
Anatomical Implications to Implant Therapy and the Current Impact of Guided Bone Regeneration
The success rate of this treatment modality has been influenced by many elements, such as the successful osseointegration of the dental implants, smoking, the relationship between the final restoration(s) and the adjacent teeth, occlusal loading, and the health of the surrounding soft and hard tissue [9-18]. However, and apart from them, the initial anatomical conditions of the site intended to receive an implant merit close attention as they will drive the initial treatment path.
The bone defects in the alveolar ridge have always been considered a major obstacle to clinical therapy with osseointegrated dental implants, especially in partially edentulous patients. Tooth loss leads to changes of the alveolar ridge anatomy (i.e. bone resorption in both height and thickness) and to the development of bone defects: (a) limited bone thickness, (b) reduced bone height, (c) vertical bone defects, (d) bone defects' combined height and thickness, (e) periodontal attachment loss of the teeth adjacent to the edentulous area, and (f) large bone loss resulting from infections/dentoalveolar trauma or previous surgical procedures (Figure 1.5 and 1.6) [19-24]. These features may not only significantly hinder the placement of implants but also affect the proposed restorative therapy in terms of function and aesthetics.
Figure 1.5 (A, B) Tooth #14 is missing. CBCT shows limited bone height because of the sinus floor presence. (C) Initial clinical aspect. (D) Sinus grafting using the lateral window technique (sinus lifting procedure). (E) Bone substitute filling the sinus followed by implant placement (simultaneous approach). (F) Healing aspect six months after procedure. (G) Buccal view of the final restorations. (H) One-year follow-up periapical radiograph.
Figure 1.6 (A-D) Extended periapical lesion associated with teeth #7 and 8 compromising direct implant placement. (E, F) Surgical treatment - buccal and palatal views - after apicoectomy of tooth #7 and extensive bone defect cleaning. (G) Deproteinized bovine bone matrix (DBBM (Bio-Oss® collagen)) filling the transmaxillary defect. (H, I) Collagen membrane covering the defect - buccal and palatal aspects. (J) Wound closure with interrupted sutures. (K, L) Two-year clinical follow-up after surgery - buccal and palatal views. (M) CBCT control two years after surgery shows no residual bone defect.
From the late 1980s and early 1990s, the introduction of the principles of guided bone regeneration (GBR) in implantology dramatically changed the treatment of the areas presenting anatomical limitations [19,21-23]. This therapy involves the application of bone-filling materials (in particles or blocks) covered by barrier membranes isolating the overlying soft tissue in order to allow cells to populate the bone defect area. As a result, areas previously contraindicated for implant therapy could be treated with bone augmentation techniques, prior to or simultaneously with implant placement .
Biomaterials for bone filling, or bone substitutes, have shown significant progress over the past two decades. Currently, there are options of biomaterials with osteoconductive properties that can be effectively and safely used in clinical practice . It is noteworthy that these materials are responsible for maintaining the space at the defect area (i.e. the three-dimensional configuration of the future regenerated bone), providing support for the membrane. It is well known that membranes are essential for the application of GBR techniques, as is that absorbable materials are currently the most widely used membranes, owing to their user-friendliness compared to traditional, non-absorbable materials (i.e. expanded polytetrafluoroethylene (e-PTFE)) (Figure 1.7 and 1.8).
Figure 1.7 (A-D) Adult female with several missing lower posterior teeth. Localized alveolar ridge defects are present both sides. (E, F) CBCT images. (G) Implant placement - left side. (H) Buccal cortical perforation for blood supply at the defect site - right side (I) Bone substitute DBBM (Bio-Oss collagen) filling the bone defect area - right side (J-L) Wound closure bilaterally (nylon 5-0). (M, N) Healing aspect one week after operation. (O, P) Healing aspect 16 weeks after operation.
Figure 1.8 (A) Presence of infection with fistula associated with tooth #13. (B) Intraoral radiographic exam shows periapical lesion around tooth #13. (C) After remission of the acute phase, tooth #13 was extracted followed by an immediate implant placement. (D) The bone defect was filled with biphasic calcium phosphate (Straumann® BoneCeramicT). (E) Absorbable collagen membrane covering the grafted site. (F) Restorative treatment consisted of a screw-retained porcelain-fused-to-metal restoration. Healthy soft tissue with no signs of infection. (G) Three-year follow-up intraoral radiograph.
Furthermore, several implant surfaces, designs, and materials have been settled to increase bone-implant contact (BIC) and primary implant stability. These advances promote substantial improvements in success...