Implants Continued » 4. Intimate knowledge of the mate-
rials, techniques and recommended implant components required 5. Experience in management of surgical and restorative implant complications and challenges 6. Knowledge of laboratory tech- niques and materials with access to an onsite dental laboratory 7. Comprehensive knowledge of the oral anatomy and advanced surgical planning techniques including CBCT interpretation 8. Experience in advanced surgical techniques including mental nerve location, sinus mapping, alveolar ridge reduction and soft tissue resection 9. Immediate extraction and implant placement techniques 10. Design and use of radiographic and surgical guides 11. Use of grafting materials and barrier membranes 12. Achieving adequate primary stability in all bone types and imme- diate loading concepts 13. Full arch bridge design concepts for long-term maintenance and oral hygiene 14. Surgical and non-surgical management of soft and hard tissue implant complications. Despite the challenges in
providing this treatment option, there is significant marketing by dentists and implant companies alike about the concept. The reasons for this can be attributed to the significant advantages over previous options, which the patient may benefit from: 1. Implants are placed and a bridge is fitted on the same day, avoiding the need for a complete denture 2. There is only one surgical experience for the patient. Conven- tionally implants were covered under the gingivae and a second surgical appointment was required to uncover them 3. Patients previously requiring sinus grafts or onlay grafts may now be treated in one visit more cost effectively and without the need for a two stage six to 10-month healing period 4. In a periodontally or restor- atively compromised dentition patients may proceed from dentate to implant supported bridgework without ever having to experience a denture
“Patients need to be made aware that the procedure is not designed to give them their teeth back, but to offer them a replacement for having no teeth”
5. A predictable long-term result 6. With only using four implants costs can be significantly lower than previous full arch alternatives 7. Maintenance and oral hygiene measures can be performed much more easily than on more conven- tional bridgework 8. Significant aesthetic compro- mises can now be immediately improved and self confidence regained (figures 9 and 10). Disadvantages specific to this
technique are few, but need to addressed at the earliest opportu- nity: 1. Realising expectations – the final restoration is, in effect, a screw- retained palateless denture. Patients need to be made aware that the procedure is not designed to give them their teeth back, but to offer them a replacement for having no teeth. Essentially, it is the replace- ment of a body part with a prosthesis in much the same way that a missing arm or leg may be replaced 2. There may be short and long- term challenges such as failure to achieve the required primary stability for immediate loading, restoration fracture, speech and functional changes (figure 11) 3. Despite being more cost effec- tive than options involving more implants, a brief review of costs advertising the technique, using the recommended Nobel Biocare implant systems, shows costs in the region of £10,000 to £15,000. These are still significant and need to be carefully discussed and explained prior to any treatment being carried out. Achieving a positive patient
outcome requires careful planning and execution. We will over the next two articles review two cases showing how the treatment was planned and executed from consul- tation and differential treatment planning through surgical implant placement, final restoration and long term maintenance procedures.
REFERENCES
1 . Int J Oral Surg. 1981 Dec;10(6):387-416.
A 15-year study of osseointe- grated implants in the treatment of the edentulous jaw. Adell R, Lekholm U, Rockler B, Brånemark PI
2. Int J Prosthodont. 2003 Nov-Dec;16(6):602-8. Implant treatment in the eden- tulous mandible: a prospective study on Brånemark system implants over more than 20 years.
Ekelund JA, Lindquist LW, Carlsson GE, Jemt T.
3. Clin Implant Dent Relat Res. 2012 May 29. doi: 10.1111/j.1708- 8208.2012.00453.x. [Epub ahead of print]
Ten Years Later. Results from a Prospective Single-Centre Clinical Study on 121 Oxidized (TiUnite) Brånemark Implants in 46 Patients.
Ostman PO, Hellman M, Sennerby L.
4. Comparisons of precision of fit between cast and CNC-milled titanium implant frameworks for the edentulous mandible. Ortorp A, Jemt T, Bäck T, Jälevik T. Int J Prosthodont. 2003 Mar-Apr;16(2):194-200.
5. Int J Oral Maxillofac Implants. 2003 Mar-Apr;18(2):250-7. Immediate functional loading of Brånemark system implants in edentulous mandibles: clinical report of the results of develop- mental and simplified protocols. Wolfinger GJ, Balshi TJ, Rangert B. Source
6. Int J Oral Maxillofac Implants. 1997 May-Jun;12(3):319-24. Immediate loading of threaded implants at stage one surgery in edentulous arches: ten consecu- tive case reports with one to five-year data.
Tarnow DP, Emtiaz S, Classi A.
7. Clin Implant Dent Relat Res. 2003;5 Suppl 1:81-7.
Early loading of maxillary fixed cross-arch dental prostheses supported by six or eight oxidized titanium implants: results after 1 year of loading, case series. Olsson M, Urde G, Andersen JB, Sennerby L.
8. Clin Implant Dent Relat Res. 2003;5 Suppl 1:2-9.
All-on-Four immediate-function concept with Brånemark System implants for completely edentu- lous mandibles: a retrospective clinical study.
Maló P, Rangert B, Nobre M.
9. Clin Implant Dent Relat Res. 2005;7 Suppl 1:S88-94. All-on-4 immediate-function concept with Brånemark System implants for completely edentulous maxillae: a one-year retrospective clinical study. Maló P, Rangert B, Nobre M.
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