Page 13 - CEREC Q3|2013

quarter 4 | 2013 | cerecdoctors.com | 11
 No meaningful data are
available about immediate or
early loading of edentulous
maxillae with implant-
supported overdentures.
 The use of immediate or
early loading of fixed implant-
supported prosthesis in the
maxilla is not supported by
sufficient data to consider this
treatment modality as routine;
although preliminary results
seem to be encouraging.
 On average, the maxilla
requires more implants than
the mandible for proper
prosthetic rehabilitation.
 Case reports and studies
indicate that once immediately
loaded implants integrate, they
appear to have longitudinal
bone loss and soft-tissue
stability comparable to those of
conventionally loaded implants.
 Limited data suggests
that immediate restoration of
implants in the esthetic zone
might facilitate and stabilize
gingival architecture more
than a staged approach, and
there is no evidence to suggest
that deleterious gingival
complications can be directly
attributed to immediate
restoration or loading protocols
(this statement should not
be confused with failures
associated with temporary
cement and cement sepsis of
immediate restorations in a
surgical site).
One should also appreciate
that the primary cause of soft-
tissue failure on immediate
loading is cement sepsis and,
therefore, one should employ
screw-retained prosthetics
when possible.
 Decontamination of peri-
implantitis-affected implants
may be achieved most easily
and effectively by applying
gauze soaked alternately in
chlorhexidine and saline.
 Based on the published
literature, it is not possible to
distinguish between subtypes
of systemic diseases such
as diabetes type 1 and 2,
or primary and secondary
osteoporosis. The supposition
that subjects with diabetes
tend to have higher failure
rates is equivocal. The
density of peripheral bone, as
currently used for the diagnosis
of osteoporosis, showed only a
weak association with the risk
of implant failure in two case-
control studies.
For bisphosphonate
therapy and implant surgery,
the duration, route and the
dosage of the medication,
as well as the type of
bisphosphonate, are reported
to play an important role in
potential bisphosphonate-
related osteonecrosis of the
jaws. A systematic review of
implants placed before and
after radiotherapy reported
failure rates up to 12.6% for
a follow-up period of 12 years.
For this reason, in my
practice, history of radio-
therapy is a contraindication
to implant treatment.
Osteoradionecrosis following
implant placement has been
reported in the literature
and a recent systematic
review found no beneficial
effect of hyperbaric oxygen
therapy.
 There is an increased
risk of peri-implantitis in
smokers compared with non-
smokers. The combination of a
history of treated periodontitis
and smoking increases the risk
of implant failure and peri-
implant bone loss.
 The absence of a metal
framework in overdentures,
the presence of a cantilever
extension greater than
15 mm, bruxism, the length
of the reconstruction,
and a history of repeated
complications are all
associated with increased
mechanical/technical
complications.
 The type of retention,
the presence of angled
abutments, the crown-
implant ratio and the number
of implants supporting an
FPD were not associated
with increased mechanical/
technical complications.
 Among the leading
authorities in implant
surgery: flapless surgery
technique should normally
be reserved for skilled and
experienced implant
surgeons who utilize
comprehensive 3-D planning.
A systematic review of the
literature suggests that
implant survival using flapless
technique appeared to be
efficacious and clinically
effective; however the
duration of the studies are
too short-term.
 In the day and age of
companies creating implant
clones, cross-compatible
“generic” abutments, screws
and prosthetics, one should
take extreme caution when
mixing components. Although
the manufactures may claim
cross-compatibility, one
should note that the stringent
requirements that go into
the design and engineering of
threaded components cannot
be replicated identically,
and thus pose a great risk
for mechanical and technical
failure.
 Do not try to beat the
system: trying to place implants
the “cheapest” way will
only get you “cheap” results
that are subject to scrutiny.
Generally speaking, even in the
best of hands, implants have a
95 percent success rate. When
failures occur, you want to
ensure that the treatment and
hardware provided were of the
highest quality and standards as
seen from the eyes of another
colleague.
 Guided surgery is simple
but very sophisticated, and
should not be mistaken as the
easy way of doing implant
surgery. Once understood,
the clinician becomes a
master of the art of 3-D
implantology and has the
opportunity to obtain optimal
results with predictability.
 Image guidance alone is
not comparative to the use of
computer-generated surgical
guides in implant placement.
Far too many clinicians use
CBCT for planning purposes
only and ultimately place
implants with freehand
technique. This often results
in less than optimal outcomes.
Computer-generated surgical
guides will someday be the
standard of care set forth by
legal precedence.
 It would behoove a clinician
to learn more about non-
resorbable PTFE membrane
for grafting extraction sites
as it offers both predictability
and esthetic results with
relationship to soft-tissue
preservation. Use of PTFE
bypasses the need to make
releasing incisions and
displacement of keratinized
tissue often associated with
obtaining primary closure
in socket grafting.