risks in early loading in all implant types

KIEW

07.04.2015

Frank Spahn, Cannes France

RisksinearlyloadinginallimplanttypesandtheconsequentrulesofBranemark

UnilateralSituations are dangerousinearly loading

-here loading afterhealing inbone graftafter4monthsRemarks:Interferences and hyperferences inlateraldeviationNo correction of curve of SpeePossibly tosmall graftnotofferingenough lateralstability and resistance

Situationafterimpactation:Friction gives primary stabilityOsteoclastswillwork against stability

Lateralvectors canirritate bone and initiate resorption

Local overcharge of bone caninitiate resorptionInflammationwilllead toresorption

Initial Branemark-rules before 1980

Completely healed extraction socket, 12 months,better more

At least 13mm bone above or below an obstacle,better more

At least 1mm bone on the lingual and vestibular sidebetter more

At least bone class III, better II

All loading before 12 months is seen as early loading

Advantages of Impactation of PEEK:

• No damages by pressure

• No damages by heating when screwing

• Open insertion channel permits exsudation andsuppuration for regeneration and healing of bone

Workinginbad bone qualitylow bone volumewith long cantilever

innotyet mineralized ,notyethealed insertions channels,with notyet reestablished irrigation

requires as less lateralvectors,lessscissor-forces as possible

Alternative:bone graftor otherinvasivemethods

Branemark rules up from 1984

Implant after 3 months healing time for socketBone height 10-mm, be aware of riskBone largeness <1mm, be aware of riskBone class III, be aware of risk

Load after 3-6 months in the lower, be aware of riskLoad after 4-8 months in the upper, be aware of risk

Different risks added in the same case, will lead to failure

Bigrisk for immediateloading:Implantinsertion obviously suboptimal,especially inthe upper.Recommendation :use 18and 28andatointegrate „temporary“implant inregion 21or 12as base forfixed bridge and let the „main“implants heal-infor more than 6monthsPerfect equilibration needed inany case

There are more risks:

Operation phase good planning

Healing phase information

Patients compliance recall system

Technician work radiography

Doctors precision fixed procedures

General risks developping by the time communication

Patients compliance in the longterm recall

Evenif well equilibrated occlusion,pay attention tothe technicianwork:Less risk with metal or PEEK-infrastructure even for provisional temporary bridgesBetter work with temporary implants toprotect the „definite“implants

Immediateloading with impacted implantsinfull mouth rehabilitations atrophic teethless jawsonly onpatients with good compliance and assuredcontrol possibilitiesOcclusion willchange considerably inthe first 6weeks and after

Consentment ofcustomersusingPEEK-PERSO-TechniqueThecustomersconsentinusingthetechniqueinthefirst18months

- intwo-stepprocedure,awareofthenecessityofloadablebone-reconstruction- inearly-loadingtoinstallbilaterallyequilibratedbalancedocclusiononlyinpatientswithapprouvedcompliance.

- Thecustomersareequippedwithmachineryandinstrumentspermittingonitsbesttofollowtheproposedprotocolls- Thecustomersmakesignthepatientaconsentment forthe

implantationwhereisfixedthatthecontractualfollow-upwillberespectedfor18monthswithcontrol-conebeamsafter6weeks,6months,12monthsand18months;thatthepatienthastostayinthetreatmentoftheprofessionalfor18monthsifeveraquestionshouldcomeup.

Internatio InternationalSocietyforPromotionofKnowledgeaboutIsoelasticMaterialsinIntraOSSeous Surgery

PEEK-PERSO-Technique delivers reproductible results and isapprouved for the treatment of caseswhere Titanium implants have failed

and where more invasiveadjuvant therapiesadd risk to the pureimplant risk.

Thetechnique should be employed following theSurgical and prosthetical protocolls fixed

by IsoSS.

https://www.en.sisomm.com/procedures/

Theprocedures PEEKPERSO

Post-Operation Phase:Day 1 to day 365 depending from your planningprepare the loading phase

-install bilateral equilibrated balanced occlusion-regularly adapt occlusion pattern

Start loading phase:conserve the datas and transfer to technicianinclude the definite abutments in impressiontry-in and check hyperferences in lateral deviation

MODELL-ANALYSIS

PositionDirectionSizeLength

of abutmentsto make work antagonists in one axe

Choice of abutments

monobloc-primary abutmentshape the abutment using diamantswith alternating water supply

divided-secondary abutmentchoice following your prosthetical planning-ciment-fixed construction-screw-fixed construction

5c

https://www.en.sisomm.com/procedures/

Theprocedures PEEKPERSO

INSTALLthe ABUTMENTSCrestal divided techniqueand basaltechnique aftersubmucosal healing

Openthe implant site conserving softtissue inaesthetical regions-takeaway the healing screw-(first with little flame central cut,then OFR5,turning left,20rpm)

or Install acentral whole with thread onthe implant platform helped byOZIEL,OFR7,OFR8and OT25

Crestal Monobloc and Basaltransgingival healingShapethe choosen abutment tothe required

size,length,direction

PEEK-abutments have two ends

Cut the not needed 2nd end of the installed abutment; conserve it,

eventually resterilize it for use in another context!

OABU1UNIVERSAL

PEEK-Abutments for PERSO-B- and PERSO-C-technics

OABU2Standard

OAXE SPECIAL

First function part

Second function part

Mayserveas-cicatrization screw-prolounger threadto combinewithOAXE2ndpart

Mayserveas-gingiva-former-combinewith threadfor aOABU2

Overbridge distancesbetween implantandprostheticalconstruction 12-28mmParallelization 1-6°

Forstandarddistance5-12mmbetweenimplantandprostheticalconstructionParallelization 1-6°

Forparallelization ofmorethan 6° -20°Forscrew-fixation ofprosthetics

La partie de l'image avec l'ID

On Operation day: No use of Silicones for impressions

CHOICE the ABUTMENT

KEEPall parametersfrom former prosthetical constructionsfor easier to optimize inthephase oftemporary bridge

Materiel for bridges•8mmheight of bone,bone class II(Misch)

•Allmaterials,- CR-CO,Circonium,Ti• - PEEK• - Ceramic feldspatic (if little bridges)

• Less than 8mmor bone class III/IV• Lightest materialPEEK

Design of limits of crowns and bridge-elements

Non-esthetical region: 1mm distance to gingivaEsthetical region: use switching platform

Switching platform installed virtuallyor with OAXE in real

PEEK is the ONLY INERT material

Use artificial gingiva only in esthetical zones

No obstacles in lateral deviation before day 365

BilderLabille mitKeramik

BildervonScanpost-op

Bilateral Equilibrated Balanced Occlusionwithout Obstaclesinlateral Deviation

Perfect bone healing afterzystectomies andextractionswith simoultanous incorporationof implants.

Loading of implants after4to 6months

Latemineralisation inthecenter of former zystregionsMineralization after12months is stronger aroundthe implants than informer zysts

•CONDITIONS sine qua non forearly loading in atrophic situations:

• Enough cortical bone surrounding the implants for lateral stability(1mm at least)

• Bone class II quality• Exact surgical cut with exactly cutting tools

• Frameworkfor temporary bridges inhibiting torsions and flexions orreducing toaminimum

• Bilateralequilibrated and balanced occlusion,controlled in(inthebeginning)short intervalls,cooperative patient

• Cleanneckconditions ,no ciment rests irritating the marginalgingiva

BilderLabille mitKeramik

BildervonScanpost-op

Aerea of implant interface

Incisal border lower jaw

Step of 2-3,5 cm

PATN° 5

PATN° 5

Attention to sinus-reaction post-extractionPATN° 5

SubtileOcclusalEquilibrationrequired inatrophiesifimmediately loaded

4 yearspost-op

PATN° 5

5yearsPost-op

PATN° 5

THANK YOUFOR YOUR ATTENTION