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Dental Implant in Case of Deficient Maintenance at Alveolar

Author: ShiQuanGui
Tutor: MaWeiDong
School: Dalian Medical University
Course: Clinical Stomatology
Keywords: alveolar maintaining level dental implant bone morphogenetic protein
CLC: R783
Type: Master's thesis
Year: 2010
Downloads: 152
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Abstract

Background:Bone maintenance involving two different contents reveals the properties of volume(dimension) and density.Whatever the placement in bone presents inadequate volume or low density may potentially compromise the outcome of implant and osteointegration.The definition on bone of deficient maintaining level makes two ways for evaluation in clinic.The placement in bone of deficient volume presents the first dilemma to implant.Usually ideal distance from implant to naturally adjacent tooth needs 1.5-2.0mm.Buccal or labial edge of implant needs 2.0mm lingual to the desired emergence position. Ideally vertical volume of bone surrounding implant needs at least 10mm.Ideal apical position from desired emergence profile needs over 2.0mm,while necessary space between two implants needs 3.0-4.0mm.The volume under the needed dimension is defined deficient volume at the site for implant.On another way,there needs an assessing for dimension of maxillary sinus.Normally, the distance from the floor of maxillary sinus to crest of alveolar being over 12.0mm means adequate volume for implant. Vertical height from the floor to the ridge being 8.0-12.0mm means slight type of deficient volume,needing press-urization to the sinus to elevate approximate 4.0mm at the site for implant. The distance of vertical height being 5.0-8.0mm means middle type of deficient volume,needing surgery aid for elevation of maxillary sinus, mostly maxillary augmentation technology being used in the bone of this type.Implant may be simultaneously placed because mechanical stability may be produced by residual volume of alveolar.The distance of vertical height being under 5.0mm implies severe type of deficient volume,needing surgery aid for elevating the volume of the vertical height,for example,the utilization of maxillary sinus augmentation or simultaneously associated with elevation of alveolar.Implant may be placed after approximate 6 months of surgery to elevate the alveolar because the volume of residual alveolar is too inadequate to stabilize the implant initially.Secondarily, density of bone is divided into 4 classes-Ⅰ、Ⅱ、Ⅲand IVclass.Usually class II-III of bone may contribute to implant obtaining mechanical stability,while class IV of bone frequently needed to be improved for implant at the site,especially at which the higher function is needed. Utilization of mechanical methods and osteoblast factors may potentially promote the density.The research on use of BMP-Ⅰ/BMP-Ⅱfor promo-tion of density is focused so far.However, the surgical juncture needs to be determined.Whatever volume or density needs to be improved, all surgical ways to promote the condition of bone should commence as early as possible,although sometime the surgical aid commence at the time while placing implant, and sometime the surgical aid use as a manipulating method to redeem the bone loss post-implant. For example,immediate bone graft simultaneous extraction of tooth prefers to bone graft delayed. On the whole,sufficient volume and density as the materialized fundament offers implant initially mechanical stability and subsequently biological stability: osteointegration.Following consideration of function and esthetics for implant, promoting of volume and density by surgical or other ways have become to more and more implantologists’adoption for deficient main-taining level of bone.Objective:This clinical study is to investigate office setup, surgical ways, skills and attention highlights to procedures and clinical effects in case of deficient maintaining level at alveolar.Subsequent evidence for deficient alveolar to implant produced from tying to identify available manipulation for reconstruction of deficient maintenance through statistics.Methods:By surgical ways (i.e. pressurization, split of alveolar and so on) or/and associated with bone graft,osteoblast factors such as BMP-Ⅰ/BMP-Ⅱfor variously different degree of deficient maintaining level at alveolar to improve the condition of bone at implant site partially or completely and simultaneously or subsequently placed implants(BEGO, BLB). Results:With relative surgical and other manipulation or treatment,36 cases involving in 107 implants obtained satisfaction after 60 months while the various manipulation for deficient maintaining level at alveolar to improve the condition of bone. The another had been extracted due to periimplantitis after 18 months of implant. The bone surrounding implants absorbed 0-2.7mm,and 1.2mm on average.Conclusion:The key way to achieve long-term success of functional loading and esthetics in case of deficient maintenance at alveolar in implant therapy,is of primarily correct diagnosis and office setup following strict Evidence-Based Medicine. Performing reconstruction of deficient alveolar with surgical and/or other manipulation in accordance with different bone type and features of topography is the next task for success to implant Autograft associated with Bio-Oss and BMP, autograft associated with Bio-Oss or HA,pressurization and split of bone are available for deficient alveolar to be reconstructed.Autogenous bone,Bio-Oss and BMP-Ⅱare important material factors for successful reconstruction.

Dental Implant in Case of Deficient Maintenance at Alveolar

Abstract

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