Abstrakt pracy dyplomowej:
Orthodontic and Prosthetic Used implants- Similarities and Differences of Design and Treatment Protocol.
Dental implants are the main prosthetic device applied in modern dentistry for the thorough and partial restoration as well as for a single tooth complementation. For many years dental implants were used only for the reconstruction of the oral system in terms of retainer for the prosthodontic reconstruction. In 80-ties there was a new type and application of dental implants, the -so called- orthodontic implants. The dental world adopted the term “mini-implants” to describe all type of implants with a diameter less then 3mm. These implants have become widely used for the treatment of orthodontic defects. Their application shortened the treatment and was effective in the treatment of the orthodontic defected which had been not successfully treated by traditional methods. The relatively atraumatic insertion as well the fact, that mini implants can be loaded shortly after their implementation using their thorough capacity to move the teeth were some of the factors leading to their wide application. On the other hand conventional dental implants implants are still used as anchorage in orthodontic treatment. The design and special surface characteristics of these dental implants allow a stable, long-term osseointegration. For this reason a very precise implementation exactly in the place where the final prosthetic restoration will be applied is required.
Both conventional dental implants and orthodontic mini-implants can be successfully used for orthodontic treatments. However, there is a variety of individual characteristics and treatment options between the two groups. Our hypothesis is that the application of orthodontic mini-implants offers advantages both in clinical/practical and financial point of view. An additional hypothesis is that orthodontic mini-implants can be widely used, because of their minimal invasive insertion.
Aim of this paper is to research and analyze the several implant systems available in the dental industry for orthodontic treatment. Furthermore, a literature research should focus to in-vivo and in-vitro studies and critically analyze the results of the of the application of the various systems in the field of orthodontics. Specially the advantages and disadvantages of the different systems -both for clinicians and patients- should be presented.
The article presents the different applications of prosthetic and orthodontic implants in the treatment of orthodontic ceses . All methods listed in this work show high success rate. Application of prosthetic implants as retaining and reconstructive elements may be later used as the base for the final prosthetic restoration with crown or partial dentures. The disadvantage of this method is the fact that before the implants can be used first the process of osseointegration must take place. According to Branemark the standard osseointegration protocol is 3 months for mandible and 6 months for maxilla. When reviewing the implant studies all of them presented a osseointegration period before loading for orthodontic indication. The healing period described in the several trials varied from 2 months to a maximum of 12 months, presenting an average waiting time of 4 to 6 months (13,35,36,37).Trisi et al. (13) evaluated titanium implants with a length of 5 or 7mm and with a diameter of 3.3mm. Although the healing period varied from 2-12 months the gold standard for orthodontic implants is the 2 months healing time, while the factor “bone density at the time of implant insertion must always be considered. The implant success varies from 72.2%- 100% (13,35,42). Final inserted, dental implants are relatively larger in size then orthodontic implants and mini-screws. This could be in some cases from disadvantage as they are difficult to insert in limited access areas. Frequently, a laboratory work is required. Additionaly, in cases where the osseointegrated prosthetic implants need to be removed, a very traumatic surgical procedure is required (38,35). It is often difficult for patients to keep the adequate oral hygiene, since prosthetic implants are mostly placed in posterior areas and the access for mouth hygiene is not easy (38). The other aspect is the high cost of implants which is higher than the cost of micro-implants. The age of a patient is also a limiting factor as prosthetic implants can be applied after the bone growth has been completed. They must not be used in children which are the big group of orthodontic patients. The presence of all teeth disqualifies this method as it does not allow implant insertion. As opposed to prosthetic implants, orthodontic implants and mini-implants (mini-screws) may be applied only as retaining elements and they can not be used for prosthetic reconstructions. Mini-implants (screws)have some advantages over prosthetic implants. Some researchers present the possibility of immediate force loading (39,41) whereas others suggest loading 2 weeks after insertion (38,40). This advantage shortens the treatment period and the comfort and acceptance of a patient (41). An essential advantage of orthodontic mini-implants is there widely application, since their small size allows an insertion in almost every difficult anatomical situation. Their insertion does not require a complex surgical procedure and the cost is relatively low for the patient (39, 40). Finally, what is also important they are easily, non-traumatically removed what is for big advantage for the patients (40).
Summarizing the findings and analysis of the literature for implant application in the treatment of orthodontic patients, we can resent following results:
- Dental implants
When dental implants are used for orthodontic treatment, following advantages can be pointed out: a) they are proved to be a perfect solution for partially edentulous or single tooth missing cases; b) they can be used as basis for the future, final restoration. On the other hand, these kind of implants require: a) a sufficient bone in the region of insertion and b) the completion of osseointegration before orthodontic forces can be applied and finally c) implantation can not be run prior to the natural completion of a patient's growth.
- Mini- and orthodontic implants
Compared the dental implants, mini-implants and orthodontic implants show following advantages: a) they are easy to use; b) can be immediate loaded; c) their insertion is minimal invasive; d) they are relatively cheaper; e) can be inserted in anatomical compromised regions; f) the treatment time in general is shorten and finally g) they can be applied prior to the natural completion of a patient’s growth.
This category of implants for orthodontic treatments can not be used for the final restoration.
The use of both dental implants and mini-implants, permit a proper orthodontic treatment, but on the basis of this paper mini-implants and orthodontic implants allow a minimal invasive treatment option and offer better and more possibilities both for clinicians and patient