Master Thesis abstract
Rationale for the choice of implantation method
High effectiveness of the immediate loading of dental implants inserted in the bone has been proven, without any significant objections, by relevant studies and clinical trials.
Medical and technical constraints are the only, and not the most important, element influencing the choice of implantation method, since they are always confronted with patient's expectations in the context of his/her availability and financial means. Therefore, the final decision is always made by the patient and it is not always the optimal choice.
A noticeable, and according to the author, one of the most important factors determining the choice of the optimal implantation protocol is time which also significantly determines the other factors influencing this choice.
Selection of relevant literature
The available literature indicates that the scope of studies and clinical trials has been systematically broaden in recent years; the main objective of this research is the optimization of currently used medical procedures within the method of one-stage implantation protocol connected with immediate prosthetic restoration. Such optimization is possible thanks to a more detailed identification and understanding of factors influencing a long-term survival of immediately loaded implants.
A search of electronic database PubMed was undertaken using the term 'immediate loading of dental implants' using all various combinations. This was supplemented by hand-searching in peer-reviewed journals and cross-referenced with the articles accessed.
In the period of 23 years, starting from 1988 which was the first year the author of this paper took into consideration, investigators from different countries and scientific centres focused their attention on various aspects related to the presented issues, and especially on various aspects of osteointegration, micro and macro design implants in the context of implant-bone connection effectiveness, computer-guided surgery in implantology, evaluation of bone condition after inserting implants in short, medium and longer periods of time, possibilities to join different implantation protocols (e.g. immediate placement with immediate loading), use of augmentative procedures, post-implantation complications, and inclusion and exclusion criteria for patients in the increased therapeutic risk group (periodntal disease, diabetes, HIV, nicotinism, bruxism, etc.). One of the observations made by the author concerns the highst number of studies regarding the effectiveness of ILDI in an edentulous mandible.
During the review of literature, 810 research works were browsed, including:
- 259 papers concerning the abovementioned, general issues related to ILDI procedure
- 183 papers devoted to the analysis of ILDI protocols for an edentulous mandible
- 133 papers devoted to the analysis of ILDI protocols for an edentulous maxilla
- 56 papers focused on the analysis of ILDI protocol for a maxilla partially edentulous in the anterior region
- 56 papers focused on the analysis of ILDI protocol for a maxilla partially edentulous in the posterior region
- 64 papers focused on the analysis of ILDI protocol for a mandible partially edentulous in the posterior region
- 44 papers focused on the analysis of ILDI protocol for a mandible partially edentulous in the anterior region
- 79 papers devoted to the analysis of ILDI protocol for single-tooth missing in the anterior region of maxilla
- 53 papers devoted to the analysis of ILDI protocol for single-tooth missing in the posterior region of maxilla
- 49 papers devoted to the analysis of ILDI protocol for single-tooth missing in the posterior region of mandible
- 46 papers devoted to the analysis of ILDI protocol for single-tooth missing in the anterior region of mandible
- 34 papers concerning evaluation of the possibility to use computer guided surgery in implantology – these issues first appeared in literature in 2002, and the number of publications concerning this problem is continuously growing (the majority of studies were reported in the last 2-3 years)
- 61 papers concerning scientific works based on the results of clinical trials in animals (rats, monkeys, Beagle dogs, rabbits and mini-pigs)
Letters to editors, authors of reviews and unpublished articles were not analysed.
Description of the own experiment
In clinical practice the author of this paper depends on two implantation systems: Ankylos and Xive, especially on the Ankylos SynCone Concept protocol. A retrospective analysis included 13 patients with completely edentulous mandibles, who were provided with 4 implants in the anterior mandible region. In 11 patients the immediate functional loading with dental prosthesis (overdenture type) was performed on the day of procedure, during the same visit. In two cases a decision to postpone prosthetic loading was made during the surgical intervention. These patients were followed-up for the period of 6 months to 5.5 years after procedure . The implant survival rate estimated on 30th June 2011 was 98.08%. Moreover, two cases of immediate implantation with immediate functional restoration of edentulous maxilla, three cases of immediate implantation of a single tooth in the anterior region of maxilla, combined with immediate non-functional loading, and two cases of late implantation combined with immediate non-functional restoration in the posterior region of the maxilla were presented.
The Ankylos SynCone Concept has strictly established procedures of use. This refers to the specific length of inserted implants (preferred – 14 mm, and not less than 11 mm) and period between the loss of the last tooth in mandible and surgical procedure (9 months). In certain cases the author of this paper did not follow these clearly established indications and used respectively:
- Eight implants 8 mm long, in 2 patients with advanced resorption of the basal bone – class E according to Lekholm and Zarb
- Five implants 9.5 mm long in 3 patients in combination with implants of various length being in conformity with the indicated standard
- In 7 patients teeth were removed from the anterior region in the period not longer than 30 days before the implantation
- Only 4 among 13 patients met all inclusion criteria; in one patient the procedure of immediate loading was not implemented
- One implant 9.5 mm long was lost.
Conclusion: Is it possible to break down barriers?
A detailed analysis of bone level measurements and periotest value did not provide clear results that could negate or confirm the rationale for deviations from indications defined in the SynCone procedure. However, it provides an interesting research material for analysing the list of indications and exclusions, in view of establishing new therapeutic methods.