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The intraoral welder was invented by Dr. Pierluigi Mondani during the early 70's to weld titanium needle implants to a titanium bar in patient's mouth and to load them immediately by means of resin prosthesis. The clinical use documented dates back to 1972. Over the years, many practical applications have been added to the initial one, which have expanded the use of this device. In this scientific work, main applications are described. The aim of the work was to trace the historical process of intra-oral welding according to Mondani and describe the main practical applications. Intra-oral welding is a process introduced by dr. Pier Luigi Mondani of Genova (Italy) which allows to firmly conjoin titanium implants of any shape by means of a titanium bar or also directly between them in the mouth during surgery. The immediate stabilization achieved by intraoral welding increases implants success rate, allows immediate loading even in situations of bone atrophy, saves implants that are running into failure, re-evaluates fractured implants, allows to stabilize submerged implants postponing prosthesis management, allows to achieve efficient rehabilitation protocols to deal with difficult cases. The 40-years' experience with intra-oral welding described in this article, confirms the ease of use and efficiency in providing immediate stabilization of titanium implants of all types.
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JOURNAL OF BIOLOGICAL REGULATORS & HOMEOSTATIC AGENTS
0393-974X (2016)
Copyright © by BIOLIFE, s.a.s.
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Unauthorized reproduction may result in nancial and other penalties
DISCLOSURE: ALL AUTHORS REPORT NO CONFLICTS OF
INTEREST RELEVANT TO THIS ARTICLE.
233(S)
Vol. 31, no. 2 (S1), 233-239 (2017)
Mailing address:
Dott. Luca Dal Carlo,
Studio Dentistico Dott. Luca Dal Carlo,
San Marco 924,
30124 Venezia, Italy
Tel.: 0039 041 5227465
e-mail: lucadalcarlo@yahoo.it
The intraoral welder was invented by Dr. Pierluigi Mondani during the early 70’s to weld titanium
needle implants to a titanium bar in patient’s mouth and to load them immediately by means of resin
prosthesis. The clinical use documented dates back to 1972. Over the years, many practical applications
have been added to the initial one, which have expanded the use of this device. In this scientic work,
main applications are described. The aim of the work was to trace the historical process of intra-
oral welding according to Mondani and describe the main practical applications. Intra-oral welding
is a process introduced by dr. Pier Luigi Mondani of Genova (Italy) which allows to rmly conjoin
titanium implants of any shape by means of a titanium bar or also directly between them in the mouth
during surgery. The immediate stabilization achieved by intraoral welding increases implants success
rate, allows immediate loading even in situations of bone atrophy, saves implants that are running into
failure, re-evaluates fractured implants, allows to stabilize submerged implants postponing prosthesis
management, allows to achieve efcient rehabilitation protocols to deal with difcult cases. The 40-years’
experience with intra-oral welding described in this article, conrms the ease of use and efciency in
providing immediate stabilization of titanium implants of all types.
MONDANI INTRAORAL WELDING:
HISTORICAL PROCESS AND MAIN PRACTICAL APPLICATIONS
L. DAL CARLO1, M. E. PASQUALINI2, P. M. MONDANI3,
F. ROSSI4, E. MOGLIONI5 and M. SHULMAN6
1Private practice in Venice, Italy; 2Practice in Milan, Italy; 3Private practice in Genoa, Italy
4Private practice in Busto Arsizio, Italy; 5Private practice in Rome, Italy; 6Private practice in
Cliffside Park, NJ USA
when Dr. Pier Luigi Mondani, a dentist of Genoa
(Italy), presented his intraoral welder, created in
collaboration with the University of Modena (Fig.
1). It was nally possible to rmly conjoin implants
together in a single structure, without any play
between the parts put in solidarization. Mondani
brought his invention to the GISI congress, the
main event in Italy, held in Bologna twice a year by
Prof. Giordano Muratori. He published the technical
description only later, in 1982 (5).
Mondani strove to create this device to put
titanium needle implants into immediate contention,
enabling the needle technique to become a repeatable
technique and therefore, scientically reliable (6-9).
The fact that immediate solidarization increases
the success rate of immediately loaded implants is
accepted in the international literature (1-3).
The rst insights proven by clinical series, were
described by Ugo Pasqualini in 1972. He published
the following, describing his experience: “In our
experience, even in light of quite a few puzzling
exceptions, we can prudently recommend to block
implants on each other or to other natural elements
as early as possible, noting that immediate prosthesis
(performed according to the rules of gnathology)
helps to decrease the number of failures” (4).
The most important innovation in the eld of
implants solidarization occurred during the 70’s,
Key words: intra-oral welding, titanium implants, retention, Mondani
234 (S1) L. DAL CARLO ET AL.
2. Join new implants to already osseointegrated implants
3. Stabilize other implants
Additional uses
4. Connect already osseointegrated implants
5. Join endosseous and iuxtaosseous implants
6. Join teeth and implants with appropriate connectors
7. Rebuild abutments of inadequate length
8. Rebuild fractured implants
9. Connect new implants to fractured implants
10. Join implants between the submucosa
1. Join endosseous implants during intervention
This is the main use of intra-oral welding proceedings.
The immediate solidarization of the implants positively
affects their stability, promoting bony inclusion without
interposed connective tissue. Immediate loading of the
implant structure causes bone apposition that follows
trajectories lead by force.
Immediate solidarization by welding can be made
between two or more implants, to allow immediate load
and to protect implants from the expansive action of the
tongue during swallowing (18, 19). A surgical protocol for
the superior arch was published in 2005 and 2015, with
exhaustive indications about prosthesis management (20,
21). In Fig. 3, you can see a full-arch inferior jaw implant
structure with prosthesis including the bar. Recent studies
have demonstrated that the presence of the bar does not
create inammatory problems (22, 23).
One of the advantages of this method of solidarization
is that emerging and submerged implants of different
shape can be welded together, allowing to freely choose
the suitable implant. This aspect frees the dentist from a
single implant factory, facilitating treatment of difcult
cases in which a single type of implant does not t
anatomical ridge variations.
Normally, when the plan is to maintain the welded bar
also in the nal phase, one-piece implants are used. When
the plan is to eliminate the welded bar before building
the nal prosthesis, you can either use one-piece implant
planning to mill them as if they were natural teeth, or
use submerged implants to postpone and manage the
prosthetic stages at will.
In general, the choice of keeping the bar depends on
the difculty of the clinical case. The bar gives strength
to the structure not only when there is poor bone depth,
The needle implant solution is particularly suited to
thin bone crests and the exploitation of very small
recesses in the context of the alveolar process,
utilizing the principle of bicorticalism. This proves
particularly suitable to ridges containing rareed
cancellous bone (10-17).
Numerous colleagues soon began to think about
how to apply this technique of intra-oral welding to
other forms of implants. Several applications were
identied.
MATERIALS AND METHODS
The welding procedure according to Mondani is
performed immediately after the placement of the titanium
implants.
The “intraoral welder” unit comes with an energy
accumulator, a potentiometer and a clamp. This device
emits a very intense electric charge, but for such a short
period (4 sec) that with proper material, the heat released
does not propagate over the areas adjacent to the point at
which the gripper is applied. As a safety precaution, the
welding should be carried out under continuous cooling
with cold water.
A fundamental requirement is that the two pieces of
titanium to be welded are in contact with each other and
contact the spouts of the clamp, so that there is a uid
passage of energy. It is possible to weld two or more
implants between themselves directly or by means of a
titanium bar.
By welding the bar, a single structure is created, formed
by implants and bar, without solution of continuity. This
produces a single body, known as implant structure. The
solidarization can also be achieved by means of several
titanium wires.
To try to reduce the internal volume of the bar to a
minimum, you can mold it before performing the welding,
in order to ensure that it overhangs the ridge occlusal
surface (Fig. 2).
In general, the intraoral welder can be used to join any
titanium implant type. Specically, we list below its most
common uses, dividing them in two categories: main and
additional.
Main uses
1. Join endosseous implants during intervention
(S1) 235
Journal of Biological Regulators & Homeostatic Agents
suitable to immediate loading (Fig. 4) (31). In particular
cases, the welding is also used to solder an implant to an
adjacent tooth (32).
RESULTS
The analysis of the statistical studies performed
by our research group lead us to suggest the use
of intraoral welding as a standard aid when you
want to load implants immediately. The choice of
whether to keep it in the nal prosthesis or remove
it before completing it depends on the evaluation
of the biomechanical requirements of the implant
structure in the context in which it is inserted. Some
rehabilitation protocols long tested by our research
group have given very encouraging statistical results.
In particular, as noted above, a study of 193 screw
and blade implants used in cases of higher atrophy
with Auriga technique gave results of complete
success (30) and a study of 351 thin cylindrical
titanium implants inserted in the posterior atrophic
mandible gave results of 99% at 5 years and 95.8%
at 10 years (8). It must be underlined that the correct
use of the intra-oral welding implies an adequate
learning curve.
DISCUSSION
The solidarization of the implants is a solution
whose effectiveness is now universally accepted
by the world literature (1-3). In Italy and in Latin
but also when the implants are inserted in a tilting manner
so as not to damage deep anatomical structures, such as
the mental foramen. A study on the rules of keeping or
eliminating the bar has been recently published (24). The
presence of welded bar allows you to mitigate the effect
of negative factors, extending the possibility of treatment
even in difcult cases (25).
The welding of a titanium bar can be used to join
implants at the end of surgery, which is then removed
before performing the denitive prosthesis.
After osseointegration is reached under load, the bar is
removed. The subsequent prosthetic steps are facilitated by
the fact that soft tissues are already healed and stabilized
around the circumference of the stumps (Fig. 4) (26).
Connecting submerged implants by intra-oral welding
is described in literature since 1998 (27-29).
2. Connect new endosseous implants to already
osseointegrated endosseous implants
This type of management of the clinical case can be
programmed in the therapeutic plan [Auriga technique,
(30)] or may arise from the fact that included implants
placed years before are already exploited.
3. Stabilize other implants to prevent or correct stability
problems
In situations where, due to the need for immediate
loading and scarceness of bone offered by the “receptor”
site, the inserted implant does not guarantee stability per
se. A needle implant can be soldered to the main implant to
provide immediate stability, making this implant structure
Fig. 1. a): drawing of the intra-oral welding machine; b); different types of clamps t to different situations. Flat edges
are suitable to buccal-palatal welding, chamfer edges to mesio-distal welding between teeth.
236 (S1)
Fig. 2. a): a titanium bar has been curved and then welded to the abutments of two titanium screw implants; b): the
zirconia x prosthesis including the bar; c): due to bar shaping, no volume augmentation has been necessary; d): X-ray.
The bar is inside the prosthesis.
Fig. 3. a): panoramic X-ray taken at end of intervention in which 10 one-piece implants were intraorally
welded after insertion in the inferior jaw. Immediate load by means of provisional prosthesis was applied
immediately after; b): view of the gums after healing; c): nal prosthesis.
L. DAL CARLO ET AL.
(S1) 237
Journal of Biological Regulators & Homeostatic Agents
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... L'aiguille doit être insérée dans un sens divergent de celui de l'implant principal en respectant l'intégrité des dents adjacentes et poussée profondément jusqu'à atteindre et heurter la corticale profonde. Une fois la profondeur d'impact cortical atteinte à l'aide de la soudeuse intra-orale Mondani, celle-ci doit être soudée à l'implant au niveau de l'émergence ostéo-muqueuse pour former un moignon prothétique unique (16)(17)(18). ...
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The authors present an implant prosthesis procedure that uses screws on one-piece implants connected with a titanium pin at their abutment level and one supporter titanium bar in order to guarantee immediate stabilization. These can be implanted and fitted with customized temporary crowns in a single surgical procedure, restoring function and aesthetics and consenting recovery of the bone deficit with reduced healing times and limited patient discomfort. One-piece wide-diameter titanium screw implants with thread measurements of 2.1 and 2.6 mm (smaller diameter) up to diameter of 4.5 mm with one abutment of 2.0 and 2.5 mm respectively, were positioned and splinted by intraoral welding. One-piece titanium implants were used together with a pin (needle) titanium implant as supporting structure to achieve deep stabilization. The Scialom-like pin has a diameter of 1.2 mm and it is long enough to reach deep cortical bone that is “bicorticalism”. The One-piece implant is tightly connected to the needle implant by means of Mondani intra-oral welding technique. In severely atrophic anterior maxilla, the use of this method allows the immediate loading of a fixed resin prosthesis soon after surgery. These implants yielded satisfactory functional and aesthetic outcome in bone-deficient upper anterior sectors, without invasive regenerative procedures. The low invasiveness of this approach also consents rapid healing, reduced biological burden and greater patient benefit.
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Necessary to take into account the effect of occlusal and non-axial loading in orthopedic treatment and rehabilitation of patients with edentulous jaws with implant-supported structures. Immediate stabilization, which achieved by intraoral welding, increases the posebility of success of implant osseointegration, and using immediate loading even in cases of bone atrophy for allows implants to be stabilized. The presented review of scientific literature on the use of laser welding in dentistry, the features of the application and the practical feasibility of immediate loading when splinting implants using intraoral welding. Many authors have investigated the use and effect of the parameters of a pulsed solid-state Nd:YAG laser for Ti and dental alloys. Scientists have proven the safety and effectiveness of using a dental Nd:YAG laser for welding metals directly in the oral cavity. The main risk for immediate loading implants is bone overload in the implants area during the first postoperative weeks, which can lead to their disintegration. Splinting prevent micro-displacement, distributes forces across multiple implants and shows highly effective immediate loading protocols. The expediency of immediate loading and the use of implant splinting with the intraoral welding prevents possible implant tilt and overload. The problem of using the method of immediate loading of implants with intraoral welding in dental orthopedic treatment has not been finally solved, and the well-known developments of the authors require further research and improvement.
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Prediction and prevention of premature birth is a significant problem of modern obstetrics. The use of ultrasound cervicometry and the index of placental angiogenesis for the prediction of premature birth is promising. The aim of the study was to investigate the effectiveness of cerclage, pessary, intravaginal progesterone or their combinations in the prevention of premature birth. A total of 292 pregnant women were examined. They were divided into several groups according to the results of the detection of cervical length and the level of the ratio between placental growth factor (PlGF) and fms-like tyrosine kinase (sFlt-1). Group I included women with a negative screening’ resuls. Other groups included women with a «short» cervix and disturbed placental angiogenesis. In group II, women with cervical cerlage were observed. In group III — used a pessary; Group IV — vaginal progesterone; V — cobined use of cerclage and pessary; and in VI — use of cerclage and vaginal progesterone. The pregnancy was completed at term in 159 patients, and 133 women had preterm delivery. Among patients who had positive miscarriage screening results, the use of preventive measures or combinations resulted in fairly equal results. However, the use of progesterone and cervical cerclage has shown the best efficacy. Some limitations in this study were the small sample size and the lack of information on the use of anticoagulants, disaggregants and tocolytics in the examined women.
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Dr. Luca Dal Carlo developed the “Auriga Protocol” for general dentists and specialists. The Auriga technique is indicated for implant rehabilitation in edentulous patients. The purpose of the Auriga technique is to facilitate treatment from the partially or completely edentulous state to a full-arch fixed implantsupported restoration. There is no down time when the patient has a removable prosthesis. Through all phases of the Auriga treatment technique, the patient has fixed teeth. The Auriga protocol can also eliminate costly and complicated sinus augmentation procedures. Auriga protocol can be used for lower jaw rehabilitations as well. This technique was presented for the first time in 2007 at the seventh AISI International Implant Congress in Bologna, Italy, and has been improved upon throughout the years. Ten-year statistics for 14 full-arch cases with 121 implants and 193 prosthetic teeth, completed by the authors of this article, confirm the validity and reliability of this procedure.
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Aim of the work: the aim of this work is to describe proceedings and advantages of the author’s technique of immediate retention of the submerged implants, which are joined together by welding together the implants abutments with a titanium bar. Materials and methods: the procedure, based on using submerged implants, provisional titanium abutments, welding machine and titanium bar, is here described.The provisional abutments are screwed inside the submerged implants soon after positioning and, soon after the sutures have been done, the implants are joined together by welding on them a titanium bar. After soft tissues healing and implants osseointegration, the titanium bar will be removed and the prosthetic passages will be done. Results: this technique allows to get a perfect soft tissues conditioning just in one surgical session, improving prosthetic outcome and patient’s compliance.This technique can be use for immediate loading as well. Conclusions: the author has been using this technique during over 12 years, in 106 clinical cases. So it’s been possible to verify its validity. Moreover, there’s no difference of success rate and of bone level in relation with the traditional technique with whom submerged implants are normally used.
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Aim of the work. Implant's immobility alter insertion in bone tissue is necessary to reach the osseointegration in oral implantology, independently from loading times and the implant being submerged or not. The purpose of this work is to make professionals aware of the importance of the destabilizing action of the tongue. by proposing some solutions to improve the therapeutic safety. Materials and methods. From the analysis of the tongue functions and from clinical considerations obtained by the author's survey, it emerges that, during the oro-pharyngeal phase of swallowing, the tongue pushes with a oressure that may bring the implant to failure. Results and conclusions. Some ways to prevent the problems, deriving from the tongue's action ore: to use submerged implants, to sold the non-submerged implants together, to protect the implants with a temporary prosthesis and to apply the immediate loading.
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Aim of the work. The aim of this study was to compare the efficacy of submerged implants in a same case report to draw useful directions for immediate loading. Materials and methods. Four screw implants were positioned in the left lower emi-arch of the same patient. Three were submerged screw implants, one was non-submerged. At the end of surgery the implants were soldered together with a titanium wire through an endoral welding machine. Two days after, a temporary prosthesis was cemented on the four implants. Three and a half months after surgery the titanium wire was removed, the final abutments cemented and the fixed prostheses fabricated. Results and conclusions. By analyzing treatment clinical aspects, two of the three submerged implants turned out to be more suitable for immediate loading than the third.
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Aim of the work This article describes the “Auriga” technique devised by Dr. Luca Dal Carlo for the management of critical situations in implant dentistry and allowing the placement of an immediate fixed prosthesis without any intermediate stages. This technique is particularly indicated in maxillary sinus pneumatization and severe atrophy of the posterior area of the upper jaw. mat erial s and methods The technique is based on the use of submerged screw implants, one-piece screw implants and the Mondani intraoral welding machine. If necessary, implants of a different shape can be used. During the first surgical step submerged implants are placed in the tuber maxillae. During the second surgical step, 4-6 months after the first one, periodontally compromised teeth and implants are extracted, and new implants are inserted in the extraction sockets and connected, through a bar welded in mouth, to those in the tuber maxillae. Immediate load ensues, by means of a provisional fixed prosthesis. result s and concl usions Intraoral welding according to Mondani allows new implant prosthodontic solutions, using both submerged and one-piece implants in order to achieve the best rehabilitation. The Auriga technique proved to be safe, as it starts with the placement of implants in the place of the upper posterior teeth and then, after a few months, additional implants are placed in the front area with immediate stability owing to the welding to those already osseointegrated. The advantage is that no removable prosthesis is required. Moreover it is possible to plan and manage over time the immediate loading of full arches. This procedure enhances patient compliance.
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Introduction Contusive trauma or malocclusion-related periodontal disease can severely compromise the upper anterior teeth, leading to labial bone resorption and ultimately loss of function and unsightly root exposure. To resolve these issues, we propose the replacement of compromised teeth using one-piece, immediate-load, post-extraction implants. These can be implanted and fitted with customised temporary crowns in a single surgical procedure, restoring function and aesthetics and allowing recovery of the bone deficit with reduced healing times and limited patient discomfort. This study aims to assess the one-piece, immediate-load, post-extraction implants in labial bone-deficient upper jaws. Materials and methods One-piece, wide diameter, titanium screw implants with thread measurements of 3.5 mm and 4.5 mm, with an abutment of 2.5 mm, were positioned and splinted by intraoral welding. Results These implants yielded satisfactory functional and aesthetic outcomes in bone-deficient upper anterior sectors, without invasive regenerative procedures. Conclusion The low invasiveness of the approach used in this research study consents rapid healing, reduced biological burden and greater patient benefit.
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The edentulous maxilla can be reconstructed by one-piece implants welded together intraorally and immediately loaded with a provisional restoration. The technique described must follow a strict surgical and prosthodontic protocol which includes using a number of implants as close as possible to the number of teeth to be replaced, achieving primary stability by engaging both cortical plates (bicorticalism), immediate splinting of the implants utilizing intraoral welding, and immediate insertion of a fixed provisional prosthesis with satisfactory occlusion.
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ABSTRACT Introduction: The titanium needle implants received great enthusiasm at the time of presentation, but have recently received negative publicity due to unusual technique and because it requires a specific instrument to be used, such as the intra-oral welding instrument. Materials and methods: A total of 351 implants were placed during a17 year period (1996- 2012) in the posterior inferior sector and welded to a titanium bar using the intra-oral welder. The implants were inserted in atrophic ridges of the D3-D4 bone and were all loaded immediately with a temporary prosthesis. Results: Overall success of the implants investigated during the years 1996-2012 was 97.1% (341/351); five year success rate was 99% (296/299); ten year success rate was 95.8 % (138/144). Progressive thickening of the bone around the implants was observed. Conclusions: Titanium needle implants can be used with immediate loading in the posterior atrophic sector, especially in elderly people, in the zone below the maxillary sinus, in the upper front area. They also give stability to other implants. In all cases, intra-oral welding is necessary and requires specific clinical training. Needle implants are not suitable for deep and wide ridges containing dense spongy bone.
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The aim of the present study is a comparative evaluation of inflammatory infiltrate, microvessel density, vascular endothelial growth factor, nitric oxide synthase, and proliferative activity in soft tissues below intraorally welded titanium bars. Twenty-two patients participated in this study. All patients carried immediately loaded one-stage titanium implants splinted with intraorally welded titanium bars. Each patient underwent two gingival biopsies, a control biopsy harvested from an area of mucosa 5 mm away from the titanium bar and a test biopsy from the mucosa below the titanium bar, which were histologically and immunohistochemically processed. No fractures or radiographically detectable alterations of the welded frameworks were present. In all the cases examined, the average of the modified plaque index was 1, no suppuration or bleeding on probing was present, and probing depth was < or =3 mm. However, the immunohistochemical analysis revealed some differences. The inflammatory infiltrate was mostly present in test sites and its extension was much larger than in control sites. Statistically significant differences were found in microvessel density and Ki-67 expression among control and test groups (P <0.0001). The high intensity of vascular endothelial growth factor, nitric oxide synthase 1, and nitric oxide synthase 3 expression were mainly detected in the test group, whereas the low intensities were mostly expressed in controls, with statistically significant differences (P <0.0001). In the present study, the immunohistochemical analysis shows that the tissues below the titanium bars underwent a higher rate of inflammatory and reparative processes. However, further long-term studies, where clinical and immunohistochemical data are collected in parallel, should be conducted for a better understanding of the expression pattern of inflammation markers.