Oral Implantology - Science topic

I am a consultant Maxillofacial Surgeon

following 15y at UCL Maxillofacial I am back at OMFS Uni Thessaloniki as clinical prof

The adherence is related

1. to material characteristics, roughness, hardness, acid etching

2. host biology compromise (immunosuppresants, steroids,

chemotherapy, uncontrolled diabetes

3. Blood dyscrasias

Lawrence Newman and Colin Hopper approached craniofacial implant characteristics with acquired and congenital defects

Please have a look at the following link:

I attached main articles that show the surgical techniques related to increasing the amount of keratinized tissue around the implants by using free gingival graft. The other two articles show the the importance of increasing soft tissue thickness and the amount of keratinized tissue surrounding the implant.

Increasing soft tissue thickness and the amount of keratinized tissue surrounding the implant have recently raised an attention in Implant dentistry. Soft tissue thickness has a significant influence on marginal bone stability around implants. Linkevicius et al found that if the tissue thickness is less than 2 mm up to 1.45 mm of crestal bone loss might be anticipated, which can be avoided by increasing the tissue thickness to more than 2.5 mm. Thick vs thin biotype, represents thicker bony architecture with rich blood supply and vasculature and more resistance to bone loss at the time of inflammation.

Systematic reviews have shown that inadequate keratinized tissue around dental implants is related to more plaque accumulation, tissue inflammation, marginal soft tissue recession, and attachment loss.

OVER THE PAST 30+ YEARS we have observed that Branemark system implants placed in your patients will stay static in spacial position as the cranium continues to develop and grow.  Infact, this growth continues through out  adult life as well.  it is especially relevant in the maxilla which continues to grow downward and forward.

In agreement with the other comments, implant removal should be done quickly with either intra-oral approach by lateral window or functional endoscopic sinus surgery

(FESS). The attached paper might be of your interest.

Dear Dr!!!!

The prognosis of implants placed simultaneously with sinus augmentation is well established and documented.You can go to our first publications in 1998-1999 and later on 2006 in JOMI showing data of 731 sinuses with more than 2000 implants placed simultaneously regardless of the residual bone height ..It was shown again by Testori and Del Fabro in their publications.The only factor is achieving primary implant stability. 

For any implant t osseointegrate successfully, we have to look at various parameters. Proper case selection, diagnosis and treatment planning is the key to success. Good implant system, pre-surgical and surgical protocols are to be practiced in order to achieve success.

this one is a good read :

I would say that if you can convert the bacteria in the pocket from an unhealthy bacterial mix to a healthy bacterial mix, the inflammatory reaction will take care of itself.

Hello Dr Gustavo,

The two responses are different. Peri-implantitis is severe and causes destruction of tissues around implants (very dificult to control eventually). 

Please go thru these when you get time:

Regards

Thank you.

An interesting  question about  a historic  approach . However,in my view,cross arch stabilisation is very much  yesterday's game.

There can be very little ,if any, justification now  for removing 62-73% of sound tooth tissue (Edelhof and sorenson 2002) for multiple preparations to provide one path of insertion for such prostheses.

The concept was founded on the   now discredited  idea that distributing  occlusal load across multiple teeth to provide rigidity  stopped periodontal disease.

Most of  have  not believed that for over forty years (Axelsson and Lindhe). Double abutting as a concept  can contain the seeds of  later failure due to pulpal or structural problems .Splinting teeth  for cross arch stabilisation also makes it more difficult for the average person to keep things clean -hence later failure.

Just ask yourself-"would I have that  destruction done to your own remaining sound teeth if you were missing those teeth"