Risks in early loading in all implant types
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Transcript of Risks in early loading in all implant types
KIEW
07.04.2015
Frank Spahn, Cannes France
RisksinearlyloadinginallimplanttypesandtheconsequentrulesofBranemark
UnilateralSituations are dangerousinearly loading
-here loading afterhealing inbone graftafter4monthsRemarks:Interferences and hyperferences inlateraldeviationNo correction of curve of SpeePossibly tosmall graftnotofferingenough lateralstability and resistance
Situationafterimpactation:Friction gives primary stabilityOsteoclastswillwork against stability
Lateralvectors canirritate bone and initiate resorption
Local overcharge of bone caninitiate resorptionInflammationwilllead toresorption
Initial Branemark-rules before 1980
Completely healed extraction socket, 12 months,better more
At least 13mm bone above or below an obstacle,better more
At least 1mm bone on the lingual and vestibular sidebetter more
At least bone class III, better II
All loading before 12 months is seen as early loading
Advantages of Impactation of PEEK:
• No damages by pressure
• No damages by heating when screwing
• Open insertion channel permits exsudation andsuppuration for regeneration and healing of bone
Workinginbad bone qualitylow bone volumewith long cantilever
innotyet mineralized ,notyethealed insertions channels,with notyet reestablished irrigation
requires as less lateralvectors,lessscissor-forces as possible
Alternative:bone graftor otherinvasivemethods
Branemark rules up from 1984
Implant after 3 months healing time for socketBone height 10-mm, be aware of riskBone largeness <1mm, be aware of riskBone class III, be aware of risk
Load after 3-6 months in the lower, be aware of riskLoad after 4-8 months in the upper, be aware of risk
Different risks added in the same case, will lead to failure
Bigrisk for immediateloading:Implantinsertion obviously suboptimal,especially inthe upper.Recommendation :use 18and 28andatointegrate „temporary“implant inregion 21or 12as base forfixed bridge and let the „main“implants heal-infor more than 6monthsPerfect equilibration needed inany case
There are more risks:
Operation phase good planning
Healing phase information
Patients compliance recall system
Technician work radiography
Doctors precision fixed procedures
General risks developping by the time communication
Patients compliance in the longterm recall
Evenif well equilibrated occlusion,pay attention tothe technicianwork:Less risk with metal or PEEK-infrastructure even for provisional temporary bridgesBetter work with temporary implants toprotect the „definite“implants
Immediateloading with impacted implantsinfull mouth rehabilitations atrophic teethless jawsonly onpatients with good compliance and assuredcontrol possibilitiesOcclusion willchange considerably inthe first 6weeks and after
Consentment ofcustomersusingPEEK-PERSO-TechniqueThecustomersconsentinusingthetechniqueinthefirst18months
- intwo-stepprocedure,awareofthenecessityofloadablebone-reconstruction- inearly-loadingtoinstallbilaterallyequilibratedbalancedocclusiononlyinpatientswithapprouvedcompliance.
- Thecustomersareequippedwithmachineryandinstrumentspermittingonitsbesttofollowtheproposedprotocolls- Thecustomersmakesignthepatientaconsentment forthe
implantationwhereisfixedthatthecontractualfollow-upwillberespectedfor18monthswithcontrol-conebeamsafter6weeks,6months,12monthsand18months;thatthepatienthastostayinthetreatmentoftheprofessionalfor18monthsifeveraquestionshouldcomeup.
Internatio InternationalSocietyforPromotionofKnowledgeaboutIsoelasticMaterialsinIntraOSSeous Surgery
PEEK-PERSO-Technique delivers reproductible results and isapprouved for the treatment of caseswhere Titanium implants have failed
and where more invasiveadjuvant therapiesadd risk to the pureimplant risk.
Thetechnique should be employed following theSurgical and prosthetical protocolls fixed
by IsoSS.
https://www.en.sisomm.com/procedures/
Theprocedures PEEKPERSO
Post-Operation Phase:Day 1 to day 365 depending from your planningprepare the loading phase
-install bilateral equilibrated balanced occlusion-regularly adapt occlusion pattern
Start loading phase:conserve the datas and transfer to technicianinclude the definite abutments in impressiontry-in and check hyperferences in lateral deviation
MODELL-ANALYSIS
PositionDirectionSizeLength
of abutmentsto make work antagonists in one axe
Choice of abutments
monobloc-primary abutmentshape the abutment using diamantswith alternating water supply
divided-secondary abutmentchoice following your prosthetical planning-ciment-fixed construction-screw-fixed construction
5c
https://www.en.sisomm.com/procedures/
Theprocedures PEEKPERSO
INSTALLthe ABUTMENTSCrestal divided techniqueand basaltechnique aftersubmucosal healing
Openthe implant site conserving softtissue inaesthetical regions-takeaway the healing screw-(first with little flame central cut,then OFR5,turning left,20rpm)
or Install acentral whole with thread onthe implant platform helped byOZIEL,OFR7,OFR8and OT25
Crestal Monobloc and Basaltransgingival healingShapethe choosen abutment tothe required
size,length,direction
PEEK-abutments have two ends
Cut the not needed 2nd end of the installed abutment; conserve it,
eventually resterilize it for use in another context!
OABU1UNIVERSAL
PEEK-Abutments for PERSO-B- and PERSO-C-technics
OABU2Standard
OAXE SPECIAL
First function part
Second function part
Mayserveas-cicatrization screw-prolounger threadto combinewithOAXE2ndpart
Mayserveas-gingiva-former-combinewith threadfor aOABU2
Overbridge distancesbetween implantandprostheticalconstruction 12-28mmParallelization 1-6°
Forstandarddistance5-12mmbetweenimplantandprostheticalconstructionParallelization 1-6°
Forparallelization ofmorethan 6° -20°Forscrew-fixation ofprosthetics
La partie de l'image avec l'ID
On Operation day: No use of Silicones for impressions
CHOICE the ABUTMENT
KEEPall parametersfrom former prosthetical constructionsfor easier to optimize inthephase oftemporary bridge
Materiel for bridges•8mmheight of bone,bone class II(Misch)
•Allmaterials,- CR-CO,Circonium,Ti• - PEEK• - Ceramic feldspatic (if little bridges)
• Less than 8mmor bone class III/IV• Lightest materialPEEK
Design of limits of crowns and bridge-elements
Non-esthetical region: 1mm distance to gingivaEsthetical region: use switching platform
Switching platform installed virtuallyor with OAXE in real
PEEK is the ONLY INERT material
Use artificial gingiva only in esthetical zones
No obstacles in lateral deviation before day 365
BilderLabille mitKeramik
BildervonScanpost-op
Bilateral Equilibrated Balanced Occlusionwithout Obstaclesinlateral Deviation
Perfect bone healing afterzystectomies andextractionswith simoultanous incorporationof implants.
Loading of implants after4to 6months
Latemineralisation inthecenter of former zystregionsMineralization after12months is stronger aroundthe implants than informer zysts
•CONDITIONS sine qua non forearly loading in atrophic situations:
• Enough cortical bone surrounding the implants for lateral stability(1mm at least)
• Bone class II quality• Exact surgical cut with exactly cutting tools
• Frameworkfor temporary bridges inhibiting torsions and flexions orreducing toaminimum
• Bilateralequilibrated and balanced occlusion,controlled in(inthebeginning)short intervalls,cooperative patient
• Cleanneckconditions ,no ciment rests irritating the marginalgingiva
BilderLabille mitKeramik
BildervonScanpost-op
Aerea of implant interface
Incisal border lower jaw
Step of 2-3,5 cm
PATN° 5
PATN° 5
Attention to sinus-reaction post-extractionPATN° 5
SubtileOcclusalEquilibrationrequired inatrophiesifimmediately loaded
4 yearspost-op
PATN° 5
5yearsPost-op
PATN° 5
THANK YOUFOR YOUR ATTENTION