Provisional implants: surgical and prosthetic aspects.

Although numerous technological advances have improved the ability of implant practitioners to successfully reconstruct dental implants, providing patients with teeth during the immediate postsurgical period has remained problematic. One solution has been the development of temporary implants. Such provisional implants eliminate the need for a tissue-borne prosthesis that may interfere with the healing of the submerged conventional implants and/or grafting material. This article describes the methodology for placing immediate provisional implants. Three alternative approaches to fabrication of the temporary prosthesis are discussed, and the results of 12 cases are reviewed.

Mandibular smooth staple implant: a case report.

This article reviews the development of staple bone plates for mandibular reconstruction over the past 25 years. A case study utilizing the Smooth Staple Implant System in a severely resorbed mandible is presented. Benefits of this system include reduction of the surgical operating and reconstruction time, elimination of the need to harvest a bone graft, the ability to create a functional prosthesis within 24 to 48 hours of the implant surgery, and increased cost-effectiveness.

The use of a new allograft material for osseous reconstruction associated with dental implants.

This article introduces the use of a new bone graft material. The material is a human collagen allograft resorbable matrix impregnated with demineralized freeze-dried bone granules. This material is harvested from the same donor. A series of three cases of extractions with immediate implant placement accompanied by osseous defects were used to demonstrate the use of this material. Bone cores were harvested at Stage II uncovering of the implants. The histologic and clinical results are reviewed.

Transpositioning and repositioning the inferior alveolar and mental nerves in conjunction with endosteal implant reconstruction.

Without the benefit of the computed tomographic scan with three-dimensional reformatted imaging, this procedure would be difficult if not impossible to carry out. The end-point results would not be as valid. It is also not indicated to place any type of granular allograft and/or any one of the alloplast materials in this area, as it could prove to irritate the exposed neurovascular bundle. I have also found that, in most instances, the residual bone from the osteotomy site is not sufficient to replace at the termination of the procedure. However, if it is sufficient, then it would be necessary to thin down the medial aspect of the cortical plate in repositioning it, as it would then prevent excessive pressure or crushing of the nerve against the surface of the implant(s). Procedures such as onlay or saddle grafting can be offered to the patient as an alternative to these nerve procedures. However, a second surgical site is then required as well as, in some cases, staging of the procedure, thus increasing treatment time and the number of procedures for the patient. Lastly, adequate soft tissue coverage over the graft is often difficult, if not impossible to achieve.

Five-year statistical and clinical observations with the IMZ two-stage osteointegrated implant system.

This study evaluated patients who were reconstructed with the IMZ system, which consists of a cylindrical implant with an intramobile element for stress relief. It is placed through a two-stage surgical procedure resulting in osteointegration. During a 5-year period, 1,059 implants were placed in 322 patients. Twenty-one implants were lost to follow-up. A total of 28 implants failed over the 5-year period, of which 9 had not integrated at stage 2 surgery. Of the remaining implants, 19 failed primarily for periodontal and prosthetic reasons. The life table method was used for statistical analysis. The 5-year survival rate of all IMZ implants was 95%. Seventy-five percent of the implants were placed to restore partial edentulism, with a survival rate of 96%. The survival rate for totally edentulous patients was also 96%. Forty-four percent of the implants were placed in the maxilla, with a survival rate of 92%. The survival rate in the mandible was 99%. Sixty-six percent of the implants were placed in women, with a survival rate of 94%. The survival rate in men was 98%. Major factors that positively influenced long-term survival were use of the longest and largest-diameter implants appropriate for the clinical situation.

Presurgical evaluation for dental implants using a reformatting program of computed tomography: maxilla/mandible shape pattern analysis (MSPA).

A new analysis technique that provides a shape pattern of the maxilla or mandible is described. This technique uses a software program of computed tomography multiplanar reformation (CT/MPR). The successive cross-sectional images obtained by the CT/MPR are numbered, and the height and width of the maxilla and mandible at each of these cross-sectional images at specified levels are measured. The measured height and width are plotted against the number of the cross-section. This technique, termed maxilla/mandible shape pattern analysis (MSPA), creates an easy profile of the shape of the maxilla and mandible, and it enhances treatment planning for the placement of dental implants.

Titanium plasma-sprayed (TPS) screw implants for the reconstruction of the edentulous mandible.

The Titanium Plasma-Sprayed Swiss Screw Implant System is described, with a discussion of preoperative patient evaluation, and implantation and prosthetic techniques. The results in 484 patients in whom these implants were placed in four countries are summarized.

Titanium plasma spray screw implant system for reconstruction of the edentulous mandible.

The most difficult and complicated group of dental patients to restore to function are those with completely edentulous mandibles. The TPS screw implant system is a predictable, cost-effective means by which patients can be restored in an outpatient setting. The TPS screw system has demonstrated a 94 per cent rate of success in 484 patients with 1739 implants from four countries.

ITI endosteal hollow cylinder implant systems.

The endosteal hollow cylinder implant systems have been in clinical use for over 10 years. These systems incorporate advanced sophisticated biomaterials and bioengineering design concepts such as the titanium plasma spray (TPS) surface coating as well as the cylindric shape. This shape has now introduced the third dimension to dental implantology. In previous systems, such as the blade-vent, only height and width were present. Therefore, these previous systems could not be used as single-tooth replacements; also, they were not able to withstand lateral forces or torquing. In a series of cases reported from Switzerland, Sweden, Germany, and the United States, 580 hollow cylinder implants were placed for up to 10 years with an overall rate of success of 95.3 per cent.

Endosteal blade-vent implants.

At this writing, endosteal blade-vent implants have been used in clinical cases for over 17 years. At the last writing in the Dental Clinics of North America, we had just passed the 10-year mark. Many new systems for preprosthetic reconstructive surgery have gained the attention of the existing implantology community; and new systems have stimulated significant new levels of implant activity in the profession in general. Even with long-term research and clinical documentation with such modalities as the Brannemark, Swiss screw, and hollow cylinders, the blade-vent implant remains in the armamentarium of members of the profession active in implantology. Even with advances in design, no implant system can be placed in the extremely narrow or even knife-edge ridges still encountered in a significant percentage of patients, unless the practitioner is knowledgeable and skillful with (the narrow 1.2 mm buccolingual width of) this implant. I predict that the endosteal blade-vent implant will continue to hold a valued place in the implant field.

Reconstruction of the edentulous mandible.

Three techniques, the subperiosteal mandibular bone plate, the mandibular staple bone plate and the titanium plasma screw implant system, used in the reconstruction of the edentulous mandible, are reviewed. The surgical and prosthetic techniques for each type of implant are described. A first attempt at gathering statistics on the results obtained with these implants is reported.