2001immediateimplant-100831061859-phpapp02

8/12/2019 2001immediateimplant-100831061859-phpapp02

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Various studies of implant

2001/2/4 per io-prostho seminars


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Topic

Immediate implant vs delayed

immediate implant )

Wide-diameter implant vs standard-diameter implant )

Single-stage vs Two-stage )

Immediate loading vs progressive

loading )


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Brnemark group traditional protocol

recommends a 12-mon th heal ing per iod

between tooth extraction and placement ofimplants.(Adell R et al 1981 In t J Oral Surg)

Preserve alveolar bone conceptimmediate implant concept


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Schulte(1984)

Tuebinger implant

Frial i t-2 imp lant

Stepped-tapered root

analog


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Immediate implant

Advantage

Preservation of the alveolar bone

Esthetic(extracted tooth has a desirable alignment)ideal implant position

natural scalloping and distinct papillae are easier

to achieve

maximal soft tissue support

Fewersurgicalinterventions

Reduction in treatment t ime & cost


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Immediate implant

Disadvantages

Misalignment of the extracted tooth may lead to

unfavorable angulation of the fixture

Stabilization may require more bone than is

available beyond the apex

Localized peri-implant bone defect Primary soft tissue closure

( submerged vs transmucosal implant)


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Indication for Immediate implant

Root fracture

Trauma not affecting the alveolar he

alveolar bone

Decay without purulence

Endodontic failure

Severe periodontal bone loss

Residual root


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Contraindication for Immediate

implant

Presence of pus

Lack of bone beyond the apex or close

relationship to the anatomical vitalstructures


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Extraction site defects

Residual defect

morphology and the

regenerative potential at

the extraction sites

Salama H & Salama M

1993 IJPRD


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Type I ideal site for immediate implant

4-/3-wall socket with minimal bone

resorption (


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Type II need orthodontic extrusion

Dehiscence > 5mm

Substantial discrepancy between the

fixture head & neck of the adjacent teeth

Significant gingival recession or esthetics .


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Type III not suitable for immediate

implant

inadequate vertical &B-L bone dimension

Recession and severe loss of labial bone

Severe circumferential and angular defect


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The decision to submergeshould base onthe following factors

Plaque control Smoking

Periodontal conditions

The degree of stability The presence of provisional removable

denture


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Submerged implant

Primary closure

Bowers & Donahue(1988)

Edel (1995) ,Chen & Dahlin(1996)

Rosenquist(1997)


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Rotated palatal flap for

immediate implant

Nemcovsky CE

2000 COIR


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Transmucosal immediate implant

Cochran & Douglas(1993);Brgger et al (1993)

Schultz(1993) ;Lang(1994)

Brgger et al (1996);Hmmerle et al (1998)

Evidences emphasize the importance of

in fect ion con tro lfor a successful tx. of

outcome following immediate implant oftransmucosal implants


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Transmucosal immediate implant

Original peri-implant defectwas the

most critical factor relating to the final

amount of bone-to-implant contact Horizontal defect dimensions of >4mm

resulted in a lower bone-to implant

contact than dimension of 1.5mm or lessWilson et al 1998 JOMI


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Conclusion about immediate

implants

There is no consensus regarding aboutthe need for gap filling and the best graft

materials The use of membrane does not imply

better results on the contray ,membraneexposure may carry complications

The absolute need for primary closure

Schwartz-A rad D et al 1997


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Immediate vs non-immediate

implantation for full-arch fixed

reconstruction following extraction of allresidual teeth : A retrospective comparative

study

Schwartz-A rad D et al 2000 JP


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Results

5-year cumulative survival rate(CSR)

Immediate implant (96%) non-immediate(89.4%)

Mean potential contact area(PCSA) 230mm2

Significant differences in CSR in maxilla(96.6%

vs 82.9%)

Posterior Max.Immediate imp lant (100%) non-immediate(72%)


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Conclusions

Survival rates of implants placed to support full-arch

ceramo-metal prosthesis can be ranked as follows :

bone qual ity , immediate implant,PCSA Immediate implantation exerts its effect through

higher PCSA values by a compensatory effectfor

bone quality

Immediate implant does not carry additionalmorbidity


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Spontaneous in situ

gingival augmentation

Bu rton Langer

IJPRD 1994;14:525-535


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Delayed immediate implant

Alveolar bone changes during the healingperiod

Strong tendency for the defects to f i l l- inin thehorizontal plan and bone growth to occur in thevertical plane of the height of the cover screw .

Good shor t -term prognos is w i th bone

regenerat ionoccurring around the defectwithout the use of barrier membranes or bonesubstitutes

Nir -Hadar O et al (1998)


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After an average follow-up of 12.4 months, peri-implant pocket depth , the ging ival index, the

hygienic index, and the degree of bone

resorpt ionwere examined. A life-tableapproach (Kaplan-Meier) was applied forstatistical analysis, and showed no differencebetween primary and secondary immediateimplants. Also, none of the parameters

examined demonstrated a statisticallysignificant difference between the twogroups.

Mensdor ff-Pouil ly et al 1994 JOMI


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However, compared with the groups of

secondary immediate implants, the group of

primary immediate implants showed atendency towards deeper pocket formation

and an increased frequency of membrane

dehiscencesthat may be due to the poorer

quality of the soft tissue covering.Mensdor ff-Pou il ly et al 1994 JOMI


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3-year Prospective Multicenter

Follow-up

No clinical difference with respect to socketdepth or when comparing the differentplacement methods.

Higher failure rate was found for short implantsin the posterior region of maxilla .(extracted forperiodontitis)

Mean marginal bone resorption : (from loadingto 1yr F/U) Max.(0.8mm),mand(0.5mm)

Implant survival : Max(92.4%);Mand(94.7%)

Grunder U et al 1999 JOMI


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Generally,

primary immediate implant

max. anterior

secondary immediate implant

mandible,posterior maxilla

Mensdorff-Pou il ly et al 1994 JOMI


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Thanks for your attention!!

E id f i i f


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Evidence for osseointegration of

immediate implant

Experimental animal studies (Kohal et al

1997)

Controlled human studies(Palmer et al1994)

E id f i t ti f


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immediate implant

Root-analogue titanium implants

Lundgren et al (1992) beagles dog study

Kohal et al(1997) monkeys


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E id f i t ti f


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immediate implant

Clinical studies

Becker et al(1998) prospective clinical

human trials of 47 immediate implantswithout bone augmentation

cumulative success rate of 93% followed

between 4 to 5 years


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Bone augmentation in combination

with immediate implant

GBR-barrier membranes

Experimental animal studies

Dahlin(1989)rabbits

Becker et al (1991) barriers enhance

predictability of bone fill in immediate

extraction sockets when compared with

a mucoperiosteal flap


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e-PTFE membrane

Lazarra(1989)

Becker &Becker(1990)

Nyman(1991)

Hammerle(1998)


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e-PTFE membrane

Becker (1994) 49 immediate implantwith e-PTFE alone

--- 93.6% bone fill ,1-year functional

loading success rate 93.9%


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Collagen membrane( Cosci&Cosci 1997)

polyglactin (balshi 1991)

Polylactic acid (Lundgren 1994)

Fascia lata (Callen & Rohrer 1993)

Autogenous gingival grafts(Evian & Cutler

1994)


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Barrier membrane exposure

Compromised results

Simion (1994) bone fill (97% vs 42%)

Augthun(1995) Successful bone regeneration & complete bone

filling ,but strict infection control is followed

Mellonig (1993)

Shanaman(1994)

Rominger & Triplett (1994) 96.8%


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GBR and bone grafts

DFDBA ( negative )

animal study

Becker (1992) dogs study

Becker (1995) dogs study

Kohal(1998) dogs study

Clinical study

Gelb(1993)


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GBR and bone grafts

DFDBA ( positive )

Callan (1990)

Mellonig (1993)

Landsberg (1994) combined with Tc

Gher (1994)


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GBR and bone grafts

Hydroxyapatite

Wachtel et al (1991) biopsies taken on

3M showed enhanced bone regeneration

than non-grafted sites.

Knox (1993)

Novaes & Novaes (1993)


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Compromised sites infection

Pecora(1996)

32 teeth due to root fx.,perforation,endo-

perio complication ,F/u 16M Rosenquist & Grenthe(1996)

periodontal disease (92%)

trauma,root fx.,endodontic failure (95%)

Novaes(1995,1998)


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Compromised sites infection

Immediate implantation at chronically

infected sites may be successful,the

extent of the defect ,the implant primarystability,and esthetic consideration of

future restoration must be considered.

Biologically active bone


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Biologically active bone-

differentiating substances

Cook (1995) recombinant human

osteogenic protein-1(rhOP-1)

Cochran et al(1997) recombinant humanbone morphogenetic protein-2(rhBMP-2)

Hedner & Linde(1995) membrane + BMP

compromised blood supply

Future about biologically active


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Future about biologically active

bone-differentiating substances

Identification of the ideal carrier substrate

Dose application

The effect of combination


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Late implants

A period of >6 months for healing of the

extraction site is recommendation prior to

implant placement

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