Practical Implant Dentistry

The Science and Art

Ashok Sethi, Thomas Kaus

• Publisher: Quintessence Publishing
• Year: 2019
• eBook ISBN: 9781850974000
• Edition: 2
• Topic: Medicina
• Subtopic: Odontología

The science and art of implant dentistry encompasses both complex surgical protocols and advanced prosthodontics, and no beginner can achieve excellence in this discipline without a clear understanding of the step-by-step guidelines. This established textbook, written by clinicians for clinicians, presents evidence-based protocols and focuses on the technical skill and practical craftsmanship that are essential to predictable outcomes in implant placement, augmentation, and restoration. Detailed clinical algorithms facilitate understanding of the various treatment options available, and checklists ensure that the proper protocol is followed before advancing to the next phase of therapy. Updated throughout, the book now features new sections on the use of cone beam imaging, computer-based diagnostics, and CAD/CAM restorative laboratory procedures. This book provides the perfect introduction to implantology with instruction to advance the skills and extend the clinical scope of every practitioner.

section III

Augmentation

‘Medicine is not only a science; it is also an art. It does not consist of compounding pills and plasters; it deals with the very processes of life, which must be understood before they may be guided’

(Paracelsus, 1493–1541)

Chapter 11

Overview

Introduction

A number of factors must be taken into account when treatment involving the use of implant-supported restor­ations is considered. Not only must the high success rate that is integral to implant dentistry be met but also the treatment should be carried out in a predictable manner. As far as patients are concerned, it is essential that their aesthetic and functional needs are met.

Therefore, the relationship of the residual ridge to the future tooth position must not be overlooked as the clinician assesses volume and quality of bone. The supporting bone will need to resist functional and parafunctional loads, and these must be assessed and related to the region being treated.

Several grafting techniques that attempt to correct bone deficiencies have been described. These include the use of resorbable and non-resorbable membranes in conjunction with the technique of guided bone regeneration (GBR).163–172 Particulate material from a variety of sources has been used as a space maintainer with varying results. However, the best particulate material is reported to be autogenous bone.173

Membranes have also been used in conjunction with autogenous block bone grafts with good results.174 The use of titanium mesh has been reported in the literature but largely as a means of containing autogenous bone or a mixture containing other materials together with autogenous bone.175–180 These have been used simultaneously at the time of implant placement or in a staged approach. A single-stage approach is reported to lead to poorer bone-to-implant contact than a staged approach.181,182

Although a variety of techniques are available, the use of an autogenous block of bone that has been shaped to correct the deficiency is considered to provide the best method of reconstructing a deficient ridge.183–186 Here again, a two-stage approach is reported to result in a better clinical outcome than a single-stage approach.187,188

More recently, manipulation techniques such as bone expansion and distraction osteogenesis have been described and reported to have high success rates, but not without the incidence of complications.189–195

Combining manipulation and grafting may become necessary, for example where a skeletal correction needs to be made as a part of preprosthetic surgery, when a graft can be used in combination with a maxillary (Le Fort I) osteotomy.

Causes of Deficiencies

Extensive loss of bone, either labial or palatal, can have a number of causes. Deficiencies are traditionally classified based on aetiology:

• • congenital deficiencies
• • neoplasm
• • trauma
• • infection
• • disuse atrophy
• • atrophy accelerated by parafunctional load.

These are discussed below and their relevance to clinical implant dentistry addressed.

Congenital Deficiencies

Congenital deficiencies that result in discontinuity of hard and soft tissues, such as a cleft palate, are best treated by clinicians who have experience of such repairs. Subsequent treatment with implants can provide these patients with excellent function.

Congenitally missing teeth can result in inadequately d...

Table of contents

• Cover
• Impressum
• Titel
• Inhalt
• Forewords
• Preface
• Acknowledgements
• Section I
• Section II
• Section III
• References
• Glossary of Terms