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INTRODUCTION:
Two stage surgical protocol was given by Branemark, but it has veral pre-requisites(1)-1.Countersinking the implant below crestal
bone.2.Obtaining and maintaining the soft tissue
covering over the implant for 3-6 month.3.Maintaining a non-loaded implant
小椰子树environment for 3-6 months.The Reason For Countersinking The Implant Below Crestal Bone Are-i.
To reduce and minimize the bacterial infection.
ii.To prevent the apical migration of oral
epithelium along the body of implant.iii.To reduce and minimize the risk of early
implant loading during bone remodelling.DISADVANTAGES OF 2-STAGE PROTOCOL
A cond stage surgery is necessary to uncover the implants and place a prosthetic abutment.
ADVANTAGES
A high degree of long term, clinical rigid fixation has been reported after 2-stage surgery.But during the last 15-years veral authors have reported that root form implants may Oso-integrate even though they reside above the bone and through the soft tissues during early bone remodelling. This surgical approach has been called as one-stage or non-submerged implant procedures and this eliminates the cond-stage implant uncovery surgery.
HISTORICAL BACKGROUND OF IMMEDIATE LOADING
-Since long, dentists were experimenting with
IMMEDIATE LOADING OF DENTAL IMPLANT
“A SUCCESS”- A REVIEW
Dr. Vikas Jindal
Professor, Department of Periodontics & Implantology, Himachal Dental College & Hospital,
Sundernagar (H.P)
numerous designs and materials for early implant prototypes.-In 1963 Lincow introduced root form implants for immediate occlusal load which were named as vent -plants.
-
In 1970’s Ledermann ud titanium plasma sprayed implants and immediately loaded them with mandibular overdenture.
-
In 1970’s Schroeder(1976,1978,1981)showed that the submerged technique was not a prerequisite for success of implants.-
However, success came for immediate loading in 1980’s(Schroeder and Babbush)(2).
THEN CAME THE BIG QUESTION: WHY THE NEED FOR IMMEDIATE LOADING?The answer to this was associated with lot of studies which were being carried out and was concluded that first and formost reason was Psychological then was Esthetics then Functional and last but not the least was Economics involved.(1,3,14,16)Indications
-Single tooth replacement.-Partial edentulism.-Full edentulism.
Contraindications -Bruxism -Smoking.
-Reduced bone quality & quantity.-Short length implants.
ADVANTAGES:司马光砸缸教案
-This eliminates the cond –stage implant uncovery surgery.
-As a result the tissue discomfort and healing associated with cond-stage surgery are
eliminated.
-The dentist also eliminates the surgical time for uncovery and suture removal.
-In addition the soft tissue is already mature before fabrication of final Prosthesis.
-Immediate loading of implants loads the implant with a provisional restoration at the same appointment or shortly thereafter.
DISADVANTAGES:
-High chances of failure.
北京海洋馆门票More bone loss compared to delayed loading.
Peri-implantitis due to loading.
-Post operative complications.
-Patient cooperation mandatory
Preci and strict following of protocol for implant surgery may take care of above mentioned disadvantages.
PROTOCOL FOR COMPLETELY
EDENTULOUS PATIENTS (8,11,13)
2 DIFFERENT APPROACHES ARE THERE
First approach- involves placing veral more implants than the usual treatment plan for a conventional healing period and out of them only lected implants in an arch (around 3 or more) are
only immediately loaded with a transitional prosthesis. Other implants are left submerged for delayed loading.This approach was given by Schnitman et al in 1990.This approach can be ud only in edentulous mandible where abundent bone is prent.Tarnow et al (1997)-also followed this approach.He did a study in 10 concutive completely edentulous cas over 5-years,Out of them 6 were mandibular arches and 4 were maxillary arches, 10-13 implants were ud in each arch for final prosthesis, 66 out of 69 implants integrated. Failure rate was 4% and success rate was 96%.
Second approach-This includes immediate occlusal loading of all the implants inrted. The implants are splinted together which decreas the stress on all the developing interfaces and increas the stability, retention and strength of the transitional prosthesis during the initial healing pha.
GUIDELINES FOR IMMEDIATE
LOADING(6,7,8,11)
1.The bone should be of good quality.
2.The implant should engage strong cortical
bone with initial stability.
3.The type of implant should be screw type with
rough surface.
4.Cantilever should be avoided.
5.An occlusal scheme that promotes axial
loading rather than horizontal stress must be designed.
我最敬佩的人作文500字6.Night guards in patient’s with parafunctional
habits.
FACTORS MODIFYING IMMEDIATE
鳝鱼面IMPLANT LOADING
-Surgical factors included- primary implant surgery and surgical technique being ud. -Host related factors included-quantity and quality of bone; type of wound healing
-住房补贴
Implant related factors included-implant design, surface coating and length of implant -Occlusion related factors included-quantity and quality of force;prosthetic design.
Finally the need for re-evaluation of BRANEMARK PROTOCOL was done and concluded that loading per does not impede the healing process to occur thus Prematurely loaded implants are capable of integration.
APPROACHES TO REDUCE
LOADING PERIOD
Careful patient lection, Non-functional loading of the implants, to identify an effective way to reduce micro-motion beneath the critical threshold of deleterious micro-motion.
A NEW PROTOCOL FOR IMMEDIATE FUNCTIONAL LOADING
Fabrication of a provisional restoration prior to surgery, Immediately after the last implant is placed convert a previously constructed provisional prosthesis into an immediate implant supported non-removable prosthesis, Impressions
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for the final restoration is made. Opportunity to evaluate the esthetics/phonetics and functional loading during the normal osointegration healing period. This prosthesis appears to have a splinting effect, locking the implants in place as bone heals around them.
STUDIES ON IMMEDIATE LOADED
IMPLANTS WITH FIXED
PROSTHESIS(3,17,18)
Author Patients Implants Success Rate Ericsson1688100% Chow2712398.3% Collaert2511498% Testori1510398.4% Anterior zone of mandible provided success rates of >90% but lower success rates were obrved for short implants placed in unfavourable bone morphology and distal positions. Most studies (Jaffin and Berman,Misch and Degidi) suggested that a high number of implants(8-12) are required in maxilla. OUTCOMES OF IMMEDIATE LOADING
简文帝PROTOCOLS
Primary stability of the implant was the underlying requisite for predictable results. The role of implant length on implant success was limited. Short to medium term studies suggest that treatment with fixed prosthesis in the anterior mandible is predictable irrespective of implant type, surface topography and prosthesis design.Atleast 4 implants should be placed in the edentulous anterior mandible to support a fixed prosthesis. To achieve results in extraction sites, implant placement should be restricted to sites without a history of periodontal involvement.
Finally, the marginal bone loss measured, irrespective of prosthesis design, was of the same magnitude as prented for the conventional loading approach.
SUMMARY
Immediate implant loading achieved similar success rates as tho reported in the delayed 2-stage approach. Primary implant stability is a key factor to consider before attempting immediate implant loading.
Surgery-, Host-, Implant-, and Occlusion related factors may influence the outcomes of immediate implant loading. Studies are needed to understand the possibility of immediate implant loading in patients who are diabetics, osteoporotics and smokers as well as tho who have other systemic co
mpromising dias.
Long term, prospective studies particularly in Indians are still needed to evaluate other potential determining factors on this technique.
CONCLUSION
The level of predictability and high success of current implant therapy has provided reasons to reasss the guidelines.
With the trend of shortening treatment time and reducing patient discomfort, immediate loading implants has emerged as an alternate approach.
However, meticulous lection is needed to integrate this treatment into daily practice.
Regular maintainence is the key factor to ensure long term success of immediately loaded implants.
REFERENCES
1)Akagwa Y., Ichikawa Y. et al. Interface histology of unloaded
and easily loaded partially stabilized zirconia endosous implant in Initial bone healing. J. Prosthet. Dent. 1993; 69:599-604.
2)Babush C. Dental implants- Principles and Practice” W.B.
Saunder’s Company.
3)Ericsson I. Et al. Early functional loading using Branemark
Dental Implants. Int. J. Periodontics Restorative Dent. 2002;
22:9-19.
4)Guichet D.L., Yoshinobu D. et al. Effect of splinting and
interperoximal tightness on load transfer by implant restorations. J. Prosthet Dent. 2002; 87:528-35.
5)Hobo S. et al. Osointegration and occlusal rehabilitation.
Quintesnce Publishing Company, 1989.
6)Holt R., Vernino A. et al. Effect of early exposure on the
integration of dental implants : Part 2 – Clinical findings at 6 months post loading. Int. J. Periodontics Restorative Dent.
2001; 21:407-414.
7)Hurzeler M.B., Zuhr O. et al. Distraction osteogenesis : A
treatment tool to improve baline conditions for esthetic restorations on immediately placed dental implants – A ca report. Int. J. Periodontics Restorative Dent. 2002; 22:451-461.
8)Kammeyer G., Proussaefs P. et al. Conversion of a complete
denture to a provisional implant-supported screw-retained fixed
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prosthesis for immediate-loading of a completely edentulous arch. J. Prosthet. Dent. 2002; 87:473-6.
9)Lange G.D., Tadjoedin E. et al. Fate of a the H.A. coating of
loaded implants in the Augmented sinus floor : A human ca study of retrieved implants. Int. J. Periodontics Dent. 2002;
22: 287-296.
10)Lazzara R.J., Portar S.P. et al. Prospective multicenter study
evaluating loading of osotite implants two months after placement one year results. Journal of Esthetic Dentistry, 1998;
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月亮月光光教案
11)McKinney R.V., Lemons J.E. The Dental Implant. American
Academy of Implant Prosthodontics.
12)Misch C.E. Contemporary implant dentistry. Mosby
Publishing Company.
13)Reddy S.M., Geuris W.C. et al. Mandibular growth following
implant restoration : Does Wolff’s law apply to residual ridge resorption? Int. J. Periodontics Restorative Dent. 2002; 22:315-321.
14)Rung Charassaeng K., Lozada L.J. et al. Peri-implant tissue
respon of immediately loaded, threaded, H.A. coated implants : 1 year results. J. Prosthet. Dent. 2002; 87:173-81.15)Smet E.D., Steenbenke D.V. et al. The influence of plaque
and /or excessive loading on marginal soft and hard tissue reaction around Branemark implants. A review of literature and experience. Int. J. Periodontics Restorative Dent. 2001;
21:381-393.
16)Srinivasan B., Chitnis D.P., Meshrum S.M. et al. To load
immediately or not to load that is the question. JIPS; June 2003; 3(2):31-38.
17)Testori T. et al. Healing of osotite implants under submerged
and immediate loading condition in a single patient : A ca report and interface analysis after 2 months. Int. J. Periodontics Restorative Dent. 2002; 22:345-353.
18)Testori T. et al. Immediate loading of osotite implants: A
ca report and histologic analysis after 4 months of occlusal loading. Int. J. Periodontics Restorative Dent. 2001; 21:451-459.
19)Trisi P., Rebaudi A. et al. Progressive bone adaptation of
titanium implants during and after orthodontic load in humans.
Int. J. Periodontics Restorative Dent. 2002; 22:31-43.
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