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Savransky Philip Z.
MD, Professor, scientific consultant at Humana Dental GbmH + 972 52 222 9900
Simahov Roman V.
Assistant Department of Maxillofacial Surgery Medical University, Omsk State Medical Academy, Russia,
Omsk. +79136281271 Grishin Petr O.
PhD, Associate Professor, Department of Oral and Maxillofacial Surgery Kazan State Medical University,
Russia, Kazan. +79274093860 Bersanov Ruslan U.
MD, Head of the Department of General Dentistry of the Medical Institute of the Chechen State University,
Russia Grozny +7 967 777 8887 Haykin Maxim B.
PhD, assistant of the Department of Oral and Maxillofacial Surgery, Samara State Medical University, the head physician of the city of Samara GBUZ CO dental poliklinikil, Russia, Samara, + 7 9608177777
Kushnir Evgeny N.
PhD, Assistant of the Department of Prosthetic Dentistry ON Medical University Ukraine, Odessa, +38
0,634,991,605
IMMEDIATE LOADING OF DENTAL IMPLANTS. POSSIBILITIES OF THE MODERN MODIFIED IMPLANTATION SYSTEM HUMANA DENTAL.
Abstract.
The article presents a detailed analysis of the literature data and our own clinical observations using the method of immediate loading after the dental implantation .Indicate advantages and deficiency of this method. Noted demans for the quality and description of implants. Universal implant system Humana Dental, meets all the requirements, allows for one-step implantation, followed by immediate loading. Also provides specific recommendations to be followed when planning and carrying out this method, which will make it possible to obtain positive and lasting results on the basis of clinical experience.
Keywords: implants, immediate loading, single-stage implants, osseointegration
The question of aesthetics in dental practice is one of the most urgent problems. First of all, this refers to the medical tactics after extraction of teeth in the frontal sections. In the opinion of a number of authors, under certain conditions, immediate implantation can be performed followed by immediate loading [1, p.515;
2, p.189]. However, it is believed that to achieve osseointegration of the implants, they should not be subjected to premature loading [3, p.936]. Theoretically, immediate functional prosthetics based on a single implant may inhibit its osseointegration and increase the risk of implant loss due to micro-mobility. At the same time, immediate or early nonfunctional pros-thetics is associated with a high osteointegration rate
for single implants. [4, p.23] The results of the study presented [5, p. 451; 6, p.1823] confirm the efficacy of immediate functional prosthetics based on implants. Some authors associate the formation of a connective tissue layer between the implant and the bone with immediate functional load [7, p.489; 8, p.367]. According to other data, such a load does not prevent the formation of bone tissue around the implants (9, p.289; 10, p.247; 11, p.89; 12, p.20). At the same time, it was found that in some cases the contact area of the implant surface with bone was higher precisely with immediate functional load, in comparison with the delayed loading on the implant.
Ul
An important moment for carrying out an immediate load is primary stabilization, which has a great influence on the process of osseointegration. From a practical point of view, this shortens the duration of treatment and eliminates a number of inconveniences (wearing a temporary prosthesis).
A high degree of surface roughness, the presence of hemispherical pores with a depth of 1.5-4 mm and its purity, contribute to obtaining the maximum number of contacts between the bone bed and the intraosseous part of the implant (13, p.522; 14, p.64; 15, p.721). According to a number of authors, the reliability of early or immediate loading of implants also depends on the state and volume of bone tissue in various areas of the
upper and lower jaw, on occlusion, the type of prosthesis, and on the method of fixing the prosthesis (16, p.76; 17, p.537; 18, p.591).
In a further study of osseointegration, it was found that the reason for rejection of the implant was not premature loading (as Professor Branemark believed), but the implant mobility caused by this load (19, p.92). This assumption made it possible to draw an important theoretical conclusion: it is possible to subject the implant to a load immediately after its introduction into bone tissue, provided that the amplitude of its oscillations does not exceed a certain level (about 50-150 microns) and at the same time it achieves normal osse-ointegration (Figure 1).
Fig. 1
Our clinical experience and the analysis of long-term results have shown that this type of implantation can be predictable no less than delayed implantation, subject to certain planning and immediate implantation procedures, and the use of an appropriate implant system. To this implant system there are certain requirements. First of all, the implantation system must ensure a reliable initial stabilization of the implant. This is achieved due to the design and geometry of the implant (cone shape, resembling the root of the tooth, aggressive self-tapping double thread, micro thread on the neck, internal conical connection and adherence to the principle of platform switching, which allows to preserve bone tissue and mucosa gum after implant placement). One of the characteristics that play an important role in the process of osseointegration is a certain microstructure and surface purity. Without exaggeration, we can say that all of these characteristics are provided
by the implantation system of the company Humana Dental (Germany), primarily an implant with a conical Vega connection, which is confirmed by the clinical results of using this implant.
Based on clinical experience, in order to achieve positive results when carrying out an immediate load, the following recommendations should be used:
-to increase the number of implants subjected to immediate loading: the load on several implants is less dangerous than for single implants, because if we prosthetic the entire jaw, the implants stabilize each other; -use longer implants and install them as deep as possible in the cortical bone; - to apply implants with a rough, absolutely clean surface, with a clear microstructure, as well as implants not of cylindrical, but of a conical shape with thread; - If possible, place implants that are mounted on one bone ridge, not in a straight line, but in a polyline to better distribute the pressure in Fig.2
ir I ML > 1i %
Fig. 2
If it is a question of a single implant, it is necessary to take into account that the main load when chewing falls on the posterior region of the jaw and there the risk of rejection will be the highest;
- It is necessary to avoid occlusal contact during the first months (temporary prosthesis without functional contact);
Due to the fact that the bone is soft on the upper jaw than on the lower jaw, a smaller diameter hole should be drilled than the diameter of the implant itself in order to compact the bone during implant insertion. Bone compaction increases the strength of primary mechanical contact. This effect can be achieved by using osteotomes.
Do not load the implant, if at its introduction, failed to reach an opposing force of at least 35 N /
Clinical
cm2. Measurement of this force is an empirical tool to make sure that we have achieved sufficient retention of the implant.
In this case, the reaction force should exceed 20 N / cm2. Both these values are measured when implants are inserted using a special key equipped with a tor-siometer or motor.
All of the above principles are applicable for interventions in all areas of the dental system. As clinical experience has shown, it is precisely with the prosthesis of the entire jaw that the method of immediate loading is less risky, since the implants stabilize each other, the danger of oscillations exceeding the threshold of 150 microns is in this case lower.
case 1.
ft
I
VM
In our clinic the patient at the age of 36 turned to complain about mobility of the lower anterior teeth. A survey of a large mobility of the lower incisors was found, which did not allow to keep them. After the extraction and the appropriate preparation of the well in their place, we installed implants with a screw force of
more than 35 N / cm2, and the abutments were strengthened on them. Then, a temporary bridge was made. Three months later, the temporary prosthesis was replaced by a permanent one.
Ul
/ J
Clinical case 2. Use of Implant Reval with Immediate Load.
The patient complained of a lack of teeth of the lower jaw, a difficult chewing of food, an aesthetic defect, with the aim of prosthetics. After the consultation, a treatment plan was proposed that includes: removal of all roots of the destroyed teeth of the lower jaw, one-stage implantation with direct prosthetics and a final prosthesis "All on 6". Under infiltration anesthesia, the
roots of the lower jaw teeth were removed, followed by implantation with Humana Dental Reval implants. A temporary prosthesis was made for the lower jaw. After 2.5 months after the spent radiography, a final prosthesis was performed.
The implantation operation, the temporary prosthesis made on the image.
Radiography 2.5 months after implantation
Conclusion
Analysis of literature data and own clinical studies has shown that, under certain conditions, the method of immediate loading can be used quite successfully. At the same time, the universal implant system Humana Dental is available in the arsenal of the implantologist, allowing one-stage implantation with immediate immediate loading, which shortens the time of the surgical interventions, accelerates the rehabilitation time already in the early stages of treatment and gives a good aesthetic result.
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