Immediate Implantation and Immediate Loading in All Its Parts
Failing dentition is a very common condition and there is a great need for a wider variety of solutions to treat this diverse group of patients. It represents a global health care burden, and will continue to do so for the forseeable future.
In historical development of implant treatment, recommended consolidation time until loading of implants is a constantly decreasing parameter depends on the perspective of what dental implants can capable of and the technological progress of dental implants even dynamics of bone metabolism is invariable. Immediate loading is a pioneer concept which changed the rules of implant praxis that seems like a good solution to edentulous waiting period after conventional implantation.
Immediate implantation and immediate loading procedure could be analysed as follows with different cases categorized as missing dentition.
CASE 1 SUMMARY
#1 Case 1 Preop. intraoral photo
#2 Case 2 Preop. CBCT image of anterior mandibula
#3 Case 1 After extractions very thin alveolar bone can be seen
Patient: A 68 years old male patient, applied to our clinic with pain in chewing function after a bicycle accident.
Challenge: Because of the trauma, Miller class 3 luxation observed at the bridge which supports the 10 years old denture in the mandible (pic.1). Advanced bone loss observed at posterior mandible.
Treatment: After CBCT examination, extraction of mandibular teeth and immediate implantation and immediate loading were planned for All-on-four Implant therapy because of the inadequate bone height at posterior mandible (pic.2).
All on four concept is a well designed, minimally invasive dental implant treatment with a fixed full-arch restoration for high patient satisfaction. Avoiding expensive and prolonged grafting procedures with all on four treatment concept, patients that meet the criteria for immediate loading can also benefit from an immediate implant supported acyrlic restoration, as a provisional prothesis is screwed onto the implants right after surgery. Final solutions include both fixed and fixed-removable protheses.
Especially with such patients suffering from moderate to severe bone resorption, finding adequate bone to place implants is a challenge. There are financial considerations too, as placing enough implants to restore a whole jaw could be cost prohibitive for many patients. All on four system could be a good treatment option for these patients to compensate edentoulism.
#4 Case 1 A thick bone plane formed with piezosurgery
#5 Case 1 implants are in place
#6 Case 1 Implant retained immediate temporary denture
Extraction was done and mucoperiostal flap elevated (pic.3). Thin ridge at anterior mandible was cut and taken out with piezosurgery to gain suitable and plain bone surface for implantation (pic.4). Then 4.1-13 mm and 3.7-13mm Mode Level Implants were placed with the insertion torque of 35 N and more (pic.5). By tilting the two posterior implants, the bone-to-implant contact is enhenced, providing optimized bone support even with minimum bone volume. Additionally, tilting the implants also helps avoid vital structures, N. Alveolaris inf. in this particular case and resuts in a better distribution of implants along the alveolar crest which optimizes load distribution and allows for a final prothesis with up to 12 teeth (pic.6).
Mode Multiunit abutments fixed to implants (pic.7) and an overdenture which have prepared before operation adapted and fixed by chairside by means of high implant insertion torque so the patient have benefit from immediat loading (pic.8 and 9).
#7 Case 1 Fixed denture in place
#8 Case 1 Preop. OPG
#9 Case 1postop. OPG after surgery
CASE 2 SUMMARY
Immediate implantation and immediate loading could be achieved in many variations.
Patient: A 55 years old male patient with no systemic disorder, complaining about luxated maxillary teeth and nonadaptive old partial denture applied to our clinic for fixed solution (pic.10).
Challenge: Inadequate bone width and dehiscences around teeth.
Treatment: After panaromic x-ray examination extraction of maxillary teeth and immediate implantation and immediate loading were planned (pic.11).
Extraction was done and mucoperiostal flap elevated. Then 4.1-10 mm for site 17 and 16; 3.7-13mm for site 14; 3.7-10 mm for site 12; 3.7-13mm for site 22, 24 and 26; 3.3-13 mm for site 27 Mode Rapid Implants were placed respectively with the insertion torque of 35 N and more.(pic.12). An overdenture which have prepared before, adapted and fixed with Mode Multiiunit abutments by chairside (pic.13 and 14 ).
#1 Case 2 Preop. View
#2 Case 2 Preop. OPG
#3 Case 2 postop. intraoral view
#4 Case 2. After open tray impression provisional denture adapted to implants
#5 Case 2. post op OPG
CASE 3 SUMMARY
Missing of single tooth is also major study field of immediate implantation and loading.
Patient: A 32 years old female patient applied to our clinic with vertical fracture at teeth no:24 and searching a solution convenient to her esthetic expectations. After panaromic x-ray examination extraction of teeth no:24 and immediate implantation and immediate loading were planned(pic.15).
Challenge: Limited bone height, ovoid extractio socket and low bone density.
Treatment: Conservative extraction without flep elevation was done and gingival integrity was preserved (pic.16). After osteotomy 3.7-13 mm Mode Rapid implant was placed with the insertion torque of 35 N and more (pic.17). A provisional crown was prepared by chairside with flowable composite resin to preserve emergency profile and to cover the grafted area (pic.18 and 19).
#1 Case 3 Preop. OPG
#2 Case 3 Preop. intraoral photo
#3 Case 3. After extraction dental implant in place and socket grafted
#4 Case 3 .screw retained immediate provisional crown
#5 Case 3. post op OPG
Result:
Maintaining the function and esthetics of the patients during the dental implant treatment could be achieved by immediate implantation and immediate loading in proper cases. Patients that meet the criteria for immediate loading can benefit from an immediate implant supported restoration and can avoid expensive and prolonged grafting procedures. Mode Implant System offers successfull and reliable solutions at immediate implantation and immediate loading procedure with specific design, technology and wide range of prosthetic part alternatives simplfy dental professionals work load even in hard to manage cases.