Prosthodontic Implant Driven
Prosthodontic Implant Driven
Prosthodontic Implant Driven
Abstract. Dental implants are established alternatives for replacing missing teeth. Tooth loss for dif-
ferent reasons may leads to alveolar resorption. Shortage of bone can prevent proper positioning of
dental implants according to prosthetic needs and treatment planning, unless the volume of hard and
soft tissues is increased before implantation. In the esthetic area it is essential not only to achieve well-
anchored implants but also sufficient soft and hard tissue in order to obtain natural looking result. This
article will present several treatment modalities to augment the soft and hard tissues in order to obtain
proper insertion of implants according to prosthetic needs and patient satisfaction. (Keio J Med 54 (4):
172–178, December 2005)
Key words: dental implants, ridge augmentation, surgical techniques, prosthetic guidance
Implantology has undergone a number of phases. Alveolar bone is a specialized part of mandibular
The developing phase was the period during which we and maxillary bone that forms the primary support for
determined whether implants could be placed success- teeth. It is composed of bundles of bone, which is built
fully with achievement of osteointegration. The pros- up in layers in a parallel orientation to the coronal-
thetic phase represented the development of prosthetic apical direction of the tooth. The anterior maxillary
components and techniques that would afford the clini- bone is less dense than mandibular bone but more
cian the ability to place esthetic restorations. Today we dense than maxillary posterior bone.5 Alveolar ridge
realize that for a completely functional and esthetic defects and deformities can be the results of trauma,
restoration a complete hard and soft tissue harmony has periodontal disease, surgical treatment or congenital
to be achieved before or during implant placement. maldevelopment. Resorption after tooth loss has been
Augmentation of the resorbed alveolar crest, for ex- shown to follow a certain pattern: the labial site of
ample, can be achieved with soft and hard tissue onlays, alveolar crest is primarily resorbed, which first reduces
bone grafts, membrane techniques, bone distraction and its width and later the height.6,7 Alveolar bone is
bone splitting, maxillary sinus floor elevation and bone resorbed after tooth extraction or avulsion most rapidly
grafting. Bone grafting and guided bone regeneration during the first years. Extraction of anterior maxillary
can increase the width and, to some extent, also the teeth is associated with a progressive loss of bone
height of the alveolar bone.1,2 Lateral widening, but mainly from the labial side.7 The loss is estimated to be
not vertical augmentation, is possible with a crestal 40–60% during the first 3 years and decreases to 0.25–
split technique.3,4 All of these treatments are very 0.5% annual loss thereafter.8 The cause for resorption
technique-sensitive and have clear indication and of alveolar bone has been assumed to be due to disuse
contra-indication. atrophy, decreased blood supply, localized inflamma-
Reprint requests to: Dr. Federico Brugnami, Piazza Prati degli Strozzi, 21, 00195 Rome, Italy, e-mail: [email protected]
172
Keio J Med 2005; 54 (4): 172–178 173
Fig. 3.1 Radiograph of same defect after GBR. Note Titanium Fig. 3.2 Radiograph after 9 months. Note complete resolution of
Membrane and pins. vertical bone defect.
Figs. 3.1 to 3.2 GBR with e-PTFE membrane. In this case Vertical Augmentation with Titanium reinforced membrane and pins.
dures using membranes have been presented.34,35,40–42 necessarily improve the prognosis.47 Lamellar cortical
Vertical increase of a narrow alveolar crest has been splitting can be initiated with a diamond disc or burs
shown to be possible with membranes.34 Membranes and finalized with osteotomes.19 Implants inserted in
are often accompanied with bone grafts beneath them.43 alveolar bone in which the width has been increased by
Also, here autogenous bone chips are superior to dem- means of lateral widening have been shown to give
ineralized allogenic grafts. success rate between 86 and 97%.19,47 This should be
regarded as a very acceptable result and is comparable
Bone Expansion and Split Crest Techniques with implantation without bone augmentation.
Fig. 4.1 View of buccal window. Fig. 4.2 Same view after grafting procedure is completed.
Figs. 4.1 and 4.2 Sinus lift procedure with buccal window approach.
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