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Techniques for ideal implant placement in the mandibular first molar position
Abstract
Implant restoration of the mandibular first molar can be particularly challenging because of the heavy occlusal force exerted on this tooth. Bone quantity and quality, as well as fixture characteristics, play important roles in the long-term success of any implant. In this article, techniques for the ideal placement of an implant in the lower first molar site are discussed for both abundant and moderate bone quantity and for bone quality that is either moderately or minimally dense. Placement depth and the benefit of using a commercially pure grade 4 titanium fixture for mandibular first molar restorations are also discussed. In cases where adequate supporting bone exists, wide-diameter implants can offer an advantage by anchoring the implant into more dense bone that is concentrated toward the outer edges of the underlying bone. These implants also provide greater surface area, which reduces the amount of force directed to the underlying bone and may increase the long-term prognosis of the implant.
The immense success in achieving excellent soft tissue contours around implants placed in the esthetic zone with the PET procedures has opened up the possibility of performing it on multirooted teeth. However, the presence of two or more roots adds to the complexity of the case and special attention is needed to achieve consistent results. In this chapter, the authors share their clinical experiences and describe the step-by-step procedure of performing socket shield procedures in premolars and molars. Case selection and risk factors are explained to prevent complications and failures.
El objetivo de este estudio fue valorar el efecto de la temperatura (10ºC, 37ºC, 47ºC y 70ºC) y tiempo de exposición del hueso a la misma sobre la cicatrización ósea. Se realizó en 5 cerdos minipig y utilizamos la tibia como biomodelo, colocando un total de 40 implantes de titanio (SK, Klockner). Posteriormente, los animales fueron eutanasiados y sus muestras analizadas mediante análisis de imagen e histometría. Radiológicamente se observó que en las tibias se produce una osteolisis mayor cuanto mayor es la temperatura y es mas valorable a partir de los 22 días. Los resultados no revelaron diferencias importantes en lo recuento celular, osteolisis y vascularización. En relación al contacto óseo y osteointegración sí aparecieron diferencias significativas desde los 8 hasta 76 días que duró la experiencia se ha podido verificar que de las temperaturas comparadas en este estudio las mas perjudiciales para el hueso serían la de 70ºC, por su influencia negativa en el porcentaje de contacto óseo seguida de la temperatura de 10ºC por su retraso en la cicatrización ósea.
The ultimate goal in modern esthetic dentistry is the restoration of lost hard and soft tissues by imitating nature as closely as possible. With the increasing esthetic awareness of patients, surgical and technical developments, and dentists' enhanced skills and knowledge, optimal function and esthetics are achievable even with implant-supported restorations in molar regions. Anatomic and morphologic factors and poor bone quantity and quality might reduce success rates of dental implants in the posterior jaw. Today, there are two options to replace a single missing molar by an implant-supported crown: the single wide-diameter implant or two standard-diameter implants. These two approaches are described and their advantages and disadvantages discussed in two exemplary clinical cases.
In one case, the edentulous ridge in the area of the mandibular right first molar (FDI tooth 46) provided sufficient mesiodistal space to restore tooth 46 with a porcelain-fused-to-metal crown on two standard-diameter implants, placed in a root-analog manner. In the other case, the manibular first molars (FDI teeth 36 and 46) were replaced by porcelain-fused-to-metal crowns on wide-diameter implants.
It can be concluded that both options to replace a single molar provide more surface area and better biomechanical properties than one standard implant.
Long-term data are needed before these treatment modalities can be recommended for the private practitioner.
Various treatment options have been advocated to restore short span edentulous spaces. For a single edentulous space, some clinicians have advocated the use of a unilateral removable partial denture because this design has certain advantages for the patient, and it does not require the preparation of adjacent teeth for the fabrication of a fixed partial denture. However, potentially serious consequences associated with this design type have been reported. The unilateral partial denture can become dislodged, swallowed, or aspirated, which can result in hospitalization, perforation of the gastrointestinal tract, possibly followed by surgical intervention to retrieve the prosthesis. Although an implant-supported single tooth replacement has been widely accepted and documented as a predictable treatment alternative, few clinical cases present have been presented in which potential severe iatrogenic damage can be so easily avoided. A treatment alternative that avoids potential hazards inherent in the design of a unilateral partial denture has been presented in this article.
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