Editorial 1

Editorial (Volume 2 - Sept 2010)

Message from the Director’s Desk

Greetings from School of Dental Implants ... We are please to announce that we have started our school in 2007, exclusively to impart training in Dental Implants and have succesfully completed six intensive training programmes limitting the participants to only ten participants per batch.

Dental Implantology has become the most sought after area in the field of dentistry. One of the greatest dental innovations of the century, dental implants represents tremendous potential for oral rehabilitation of thepatient.

This course will offer the participants the opportunity to learn the practical skills in diagnosis, treatment planning, clinical use of dental implants and get an overview of the state of the art in implant dentistry, which is now a must in every dental practice.

With a number of dental implant systems now available in the market, it is difficult to select the right system. Every company wants to sell their brand of Implants. Some are very expensive, others are relatively reasonable. Every implant system has its own advantages and disadvantages. At School of Dental Implants we have more than 12 different implant kits and armamentarium which are available in India. So you can see, view and work on these different implant fixtures, their designs, the prosthetic components available with us. This course will guide you through this dilemma while looking at clinical reality and practical success.

The objective of this course is to help the participants to integrate dental implants into their day to day practice after having understood the underlying science behind successful implantology, together with clinical tips that make things work. Because of the overwhelming response and the feedback received, we have come out with 3 different packages which will suit all sectors of dentists - budding dentists, interms, General practitioners, Post graduate students, Dental Specialists, DDS. Regiser today, fora scientific based practice oriented course in oral implant dentistry.

Inside this Issue

  • Message from Director’s desk
  • Implant Article
  • Photogallery
  • Testimonials
  • About School of Dental Implants
    • Mission
    • Vision
    • SDI Fellowship Benefits
    • SDI Membership Benefits
    • Packages
    • Modules
    • Speakers
  • Submit an Article
  • Upcoming Articles in the next issue
IMPLANT ARTICLE
IMMEDIATE IMPLANT PLACEMENT : POSITIVES & NEGATIVES

Ever since, Branemark in 1952 discovered that osseointegration can occur between titanium implants and tested pure titanium fixtures, known as dental implants. He termed it osseointegration and defined it as a “direct structural and functional connection between ordered, living bone, and the surface of an implant under light microscope.” Branemark’s original protocol for dental implant placement was 6 to 8 months healing postextraction; sterile conditions using a mucobuccal flap and placing machined titanium implants in a 2-stage approach; 3 to 6 months stress-free healing period for temporary removable prosthesis for an extended amount of time. The entire treatment time would be 1 year or longer, hence resulting in a significant delay between implant placement and the final restoration.

Other concerns with using a 2-stage approach, such as Branemark’s protocol, include: volume loss of alveolar bone, increased time, edentulism, longer treatment time, additional surgical procedure, and psychological impact on the patient. After tooth extraction, the alveolar ridge undergoes bone remodeling, especially within the first year. One study reported that an overall decrease of 4.0mm in ridge height and 25% loss of total bone volume occurred within 1 year postextraction. This same study reported that the volume of bone lost increased 40% to 60% in 3 years. Consequently, the necessity of a 2-stage approach has been questioned since the introduction of immediate placement of implants into fresh extraction sockets, in the 1970s. patient’s demand for quicker treatment in the implant field has resulted in immediate implant placement becoming more relevant and popular.

There are 3 approaches to implant placement: immediate, early, and delayed. Immediate implant placement is defined as a placement of a dental implant at the time of tooth extraction, into the extraction socket. This has been claimed to shorten treatment time due to reduction the number of surgical procedures, maintain soft tissues, and possibly preserve surrounding bone tissue and guide for implant placement. Early placement is 2-to 4-week postextraction to allow soft tissue healing, which also has a shorter treatment time, but requires an extrasurgical intervention. Delayed approach, the conventional approach, is 4 to 6 months after extraction. This approach has the longest treatment time, bone resorption during socket healing, and requires extra surgical procedures. However, trend shows to have less implant failures in this approach. The main advantages of the immediate approach are reduced number of surgical procedures and sortened overall treatment time when compared to delayed implant placement. In addition, there is a psychological benefit for patients by replacing a tooth loss with an implant simultaneously. However, there is higher risk for implant failure, unpredictable future hard and soft tissue levels, and difficulty to achieve implant stability. The short-term survival rate of implant placemtnt seems similar between immediate, early, and delayed approaches. However, there is little data on the success of immediate and early placement compared to delayed placement.

IMMEDIATE IMPLANT PLACEMENT INDICATIONS AND CONTRAINDICATIONS

Critical evaluation of smile line, bone and gingival architecture, and hard and soft tissue levels are essential for implant esthetics. Kois addresses 5 diagnostic factors for predictable single tooth peri- implant estetics when immediately placing implants in extraction sockets. They are (1) tooth position relative to the free gingival margin, (2) form of the periodontium, (3) biotype of the periodontium, (4) tooth shape, and (5) position of the osseous crest before tooth extraction. Three of the 5 factors is critical Fordeterminig if the patient has the right diagnostic factors to allow for predictable success. Surgical approach for an immediate implant approach is almost similar to the delayed approach except the immediate implant placement a consideration if implant shift to the buccal side should be taken into consideration. Thia is due

to thin buccal plate with high content of bundle bone as well the nature of self tapping implants that we used these days. Thick biotype is resilient and prone to pocket formation whereas thin biotype is more prone to gingival recession after mechanical or surgical manipulation. A sufficient amount of crest ridge with width of 4 to 5 mm and high of 10 mm or more minimal requirements for predictable immediate implant placement the high is necessary for a stable implant and marinating a safety distance from vital anatomical structures (mandibular canal, maxillary sinus, or nasal floor).A diatnce of < 5mm from alvealor crest to the future prosthesis contact point can ensure the appearance of dental implant papillae. In regards to immediate approach.the ideal extraction socket would present little or no periodontal bone loss.

Currently it is a great that implants can be successfully placed at the time of extraction. in peri apical lesion site as long as the infection is removed and an implant primary stability is achieved .the indications and absolute and relative contraindications for immediate implant placement.

Funato et al created a classification indicating or limiting immediate placement baased on the characteristics of bucccal bone and soft tissue profile.this 4-class classification provided the guidelines for immediate implant placement and timing between extraction and implant placement.class I has intact buccal bone with thick biotype and indicated to have optimal results with immediate placemant without flap reflection.class II has intact buccal bone with thin biotype and indicated to have good results with immediate placement with a connective tissue graft procedure. classIII has deficient buccal within the alvealor housing and indicated to have limited and acceptable result with immediate placement with a guided bone regeneration plus connective tissue graft.class IV has deficient buccal bone deviating and unacceptable for immediate placement,delayed approach is recommended. This classificationb system supports the idea.the case selection is important for determining whether immediate impant placement should be considered and that hard and soft tissue parameters are important in this selection,

Generally it is considered that immediate implant placement can be challenging due to unpredictable hard and soft tissue healing.carefullt case selection is necessary to avoid treatment failures and esthetics complitations. hence, discussing the risks, benefits, limitations of immediate implant placement to avoid any future misunderstanding.