Secondary Logo

Journal Logo

Basic and Clinical Research

Aesthetics in Oral Implantology: Biological, Clinical, Surgical, and Prosthetic Aspects

Sammartino, Gilberto MD, DDS*; Marenzi, Gaetano DMD, PhD; di Lauro, Alessandro Espedito DMD, PhD; Paolantoni, Guerino DMD§

Author Information
doi: 10.1097/ID.0b013e3180327821
  • Free

Abstract

When Brånemark introduced the osseointegration concept, he established some requisites for correct dental implantology1 without considering the aesthetic aspects. Today, in clinical practice, many patients consider the aesthetic final result to be the most important aspect of an oral rehabilitation. To ensure aesthetics in implant treatment means the rigorous respect of many biological and biomechanical concepts. Many factors were identified by several authors to influence a satisfactory aesthetic final result in oral implantology.2–5 Some of these are individual: gingival morphology and plane orientation, periodontal biotype, upper and lower lip position in relaxed smile, occlusion, and adequate interdental and interocclusal space. Others are surgical: soft tissue and/or bone regeneration, no incision or flaps elevation technique, and correct implant position and placement. Others are strictly prosthetic: morphology and proportion of the crown, the use of prosthetic-guided soft tissue, and prosthetic components. An accurate clinical evaluation of the patient can lead the surgeon to identify the surgical options able to ensure a better preservation or recreation of natural alveolar ridge anatomy. After tooth extraction, the alveolar bone resorption may not only leave an aesthetic problem for the fabrication of conventional or implant-supported prostheses but can also make a correct placement of an endosseous implant difficult or even impossible.6 Resorption of the buccal wall of the extraction socket may lead to significant disadvantages, especially in the anterior part of the maxilla.7–9 A buccal concavity in the alveolar process or an implant placed more lingually than the neighboring teeth can result in poor aesthetics.10 The examination of the clinical parameters should influence the presurgical implant plan, including a predictable bone and soft tissues healing. Placement of an implant immediately after tooth extraction may help to maintain the bone crest and lead to an ideal implant position from a prosthetic point of view.11,12 This technique has proven to be a successfully predictable treatment modality11–23 according to the criteria proposed by Roos et al.24 The advantages include reduction in morbidity and treatment time, preservation of residual ridge width and height, and an optimal aesthetic result. Immediate 1-stage post-extraction implants have better opportunities for osseointegration because of the healing potential of the fresh extraction site.25 Recent preliminary studies have reported high success rates following the provisional restoration of a single endosseous implant placed immediately following tooth extraction in the maxillary anterior area. The temporary restoration was identified as a valid technique for preserving the gingival architecture and existing osseous.15 The aim of the present study was to evaluate the clinical and aesthetic results given by a surgical approach characterized by no incision or flap elevation. The cases were evaluated 24 months after the definitive prosthetic treatment.

Materials and Methods

Patients

The study population consisted of 55 patients (33 men, 22 women), ranging in age from 19 to 57 years. All patients were given oral and written information regarding the study, and their written informed consents were obtained. All patients required tooth extraction and replacement with an immediately placed implant. The patients were selected according to specific inclusion and exclusion criteria.

Inclusion criteria were as follows:

  1. Age 18 years or older.
  2. Indication for tooth (maxillary incisor, canine, or premolar) extraction due to prosthetic reasons (root fractures, nonrestorable carious lesions, residual roots, trauma), periodontal compromise, or endodontic failures.
  3. The absence of pathologies that would contraindicate bone healing.
  4. The presence of stable soft tissue conditions.
  5. No presence of dehiscences or fenestrations in the extraction sites, or the loss of labial bony plate following tooth removal and/or implant osteotomy as ascertained by bone sounding technique.15
  6. Adequate apical bone volume to achieve primary implant stability following immediate implant placement (at least 4 mm beyond the root apex).
  7. No smokers.
  8. A correct and stable occlusion.
  9. No parafunctional habits (e.g., bruxism).

Exclusion criteria were as follows:

  1. No consent for inclusion into the study.
  2. Poor oral hygiene with no possibility of improvement.
  3. Poor interest and cooperation.
  4. Chronic or acute systemic pathologies that might affect the surgical procedure (uncontrolled diabetes, hemorrhagic diatheses, immunodeficiency, cardiac ischemia, hypertension) or the subsequent prosthodontic treatment and required follow-ups.
  5. Presence of active infection around the failing tooth.
  6. Existence of nontreated generalized progressive periodontitis.
  7. Pathologic changes at the receptor site (cysts, tumors, osteomyelitis).
  8. Medical history of alcohol or drug dependency.
  9. Psychological problems.
  10. Irradiation in the implant area.
  11. Patient still growing.
  12. Pregnant or nursing woman.
  13. Peri-implant horizontal bone defects exceeding 4 mm.

Treatment Techniques

A total of 87 implants (53 Institute Straumann implants and 34 Friadent implants) (Tables 1 and 2) were placed immediately after tooth extraction in 55 patients according to the standard surgical procedure by the same expert surgeons between the time of the first immediate implant placement on February 2001 and the last definitive prosthetic treatment on June 2004. In the immediate implantation, to preserve the papillae of the adjacent teeth and prevent recession of gingival margins, no flaps or incisions were designed to achieve primary closure. The primary stability of the fixtures was confirmed prior to completion of the surgery. The temporary restoration was placed 2 months later. The definitive restoration was placed 4 months after the surgical time.

Table 1
Table 1:
Dimensions of the Friadent Immediate Post-extraction Implants Placed
Table 2
Table 2:
Dimensions of the Institute Straumann Immediate Post-extraction Implants Placed

Amoxicillin (1 g) was administrated 1 hour prior to surgery. For the penicillin-allergic patients (8.7%), 0.5 g Erythrocin (Abbott Laboratories, Abbott Park, IL) was the drug of choice. Chlorhexidine rinses were used prior the surgery, and the patients were instructed to rinse twice daily for 2 minutes with a 0.1% chlorhexidine solution during the first 4 weeks following surgery. An antibiotic prophylaxis (amoxicillin 1 g, 2 tablets/day) and antiinflammatory agent (naprossene 550 mg, 2 tablets/day) was prescribed for 10 days postsurgery. Oral hygiene instruction was given and reinforced at each visit; at the same time, professional hygiene measures were done around each experimental fixture using teflon curettes, rubber points, and prophylaxis paste.

Clinical and Radiographic Evaluations

Tomograms and periapical radiographs were evaluated for mesiodistal width (interradicular distance), residual bone beyond the apex, socket width, and root angulation. An individual bite registration film holder was fabricated for each patient, ensuring in this way that all radiographs had the same position. Periapical radiographs were taken at the preoperative phase, immediately postoperatively, and at 3, 6, 18, and 24 months after implant placement. Marginal bone loss from the implant placement to the radiological examination time was calculated by subtracting from 2 subsequent periapical radiographs the distance between the implant shoulder (implant-healing screw junction) and the most coronal part of the alveolar crest. During the prescription follow-up, both the plaque and gingival indices were examined.

Surgical and Prosthetic Protocols

After administering local anesthetic, the teeth were luxated with an elevator, and carefully removed avoiding fracture of the buccal and palatal bone walls. The socket was debrided. Implant receptor sites were prepared by sequential standard drills, internally and externally irrigated, reduced low speed, without incision or flaps elevation. The osteotomies were realized using the bony walls as guides and taking advantage by the maximum use of bone apical to extraction sockets (at least 4 mm). The distance between the gingival margin and bone was measured with a millimetric standard periodontal probe. Implant placement in the prepared site was made 1-mm apical to the height of the most coronal wall of the bony housing. The implant dimensions were chosen according to the extraction socket. Prior to placement, the mean depth and buccolingual and mesiodistal widths of the alveolus amounted to 8.0 (range 4.5–12.5), 7.8 (range 4.0–12.5), and 6.4 mm (range 3.5–10.0), respectively. Primary implant stability was achieved, and after placement, the healing screw was immediately applied. The presence of a gap from the implant surface to the surrounding marginal bone walls was noted and measured with a graded periodontal probe placed perpendicular to the long axis of the implant. No grafting materials and/or barrier membranes were used to treat the peri-implant defects not exceeding 2 mm. This was in accordance with the observation reported by other authors,16,27 who obtained spontaneous bone healing of these defects with primary flap closure. Cases that showed gaps larger than 2 mm were excluded from this study. The longest (15 mm) and widest (5.5 mm) were placed where possible to achieve an optimal primary stability, a normal emergence profile, and the maximal vertical bone preservation in the maxillary incisors, canine, and premolar regions. No sutures were made to achieve primary closure. After 2 months from the surgical procedure, the patients had a temporary nonfunctional restoration. After 4 months, they were restored with functional ceramometal crowns.

Assessment of Success

The implants were deemed successful if they fulfilled Roos et al’s24 criteria under function. All implants restored were tested for mobility, presence of gingival inflammation, and patient discomfort. Radiographic examination was utilized to ascertain the presence of peri-implant translucencies or absence of progressive bone loss >0.2 mm annually.

Results

All treated patients had returned for the scheduled appointments up to the 24-month follow-up. A total of 87 implants were evaluated that included 18 central incisors, 16 lateral incisor, 13 canines, 22 first premolars, and 18 second maxillary premolars (Table 3). Single implants were placed in 69.1% of the patients, 18.3% had 2 implants, and 12.6% had 3 or more fixtures.

Table 3
Table 3:
Location and Reason for Failure of the Tooth Replaced With Immediate Anterior Single Implant

Apart from 3 lost implants, none of the patients suffered postoperative complications, and the implant success rate was 96.6%. Forty days after the time of surgery, 1 fixture (13 mm in length and 4.5 mm of diameter), placed in the first premolar region, was lost. No infection or negative mucosal response was present. The patient presented to the department showing a mobility of the healing abutment. A periapical radiograph showed bone loss around the fixture. It was decided to remove the fixture. At the reopening, the loss of all the buccal bone wall was evident. We have justified this failure because of the postoperative thinness of the buccal wall. In another 2 patients, the implants were mobile at the abutment connection stage (4 months from the surgical procedure).

Just after implant placement, 54 of a total 87 sites (62.0%) around implants were found to have horizontal defects. Table 4 presents the location of postoperative infrabony defects. All implants had uneventful healing times and the aesthetic outcomes of the temporary rehabilitation 2 months after surgery. No screw loosening of the temporary abutment was observed, and no complications were noted after the definitive restoration placements.

Table 4
Table 4:
Location, Type, and Dimension of Bone Defect Around Immediate Post-extraction Implant

The peri-implant soft tissues anatomy was considered clinically acceptable in all patients, with no need for additional mucogingival surgery.

The same examiner always recorded clinical parameters. Plaque Index scores of 0 and 1 were observed throughout the study. No significant differences in the Plaque Index score among the 4 time intervals (2, 4,1 8, and 24 months), implanting that good oral hygiene had been maintained by the patient.

Discussion

In this study, in 41.4% of the implantations, the reason for tooth extraction was unsuccessful endodontic treatment; the implants replacing residual roots represented 23.0%. In 17.3% of the implantations, the reason for tooth loss was advanced periodontitis. Of implants, 9.3% replaced a tooth failed by a trauma, and nonrestorable carious lesions procured only 9.2% of the cases (Table 4). Because the number of subjects observed in the present study was small and the length of the follow-up period was short, conclusions should be drawn with caution. Results of this seem to demonstrate a positive effect of a surgical procedure without flap elevation on soft tissues healing around implants placed in post-extraction sockets. A success rate of 96.6% as found in this study is comparable to results reported in other studies of immediate post-extraction implant placement.25 Immediate post-extraction implantology has the advantage to offer the possibility for placing the implant in a optimal position (i.e., in the same position and inclination as the natural tooth) from a prosthetic point of view, avoiding post-extraction bone resorption.26 This technique helps the clinician to maintain the presurgical gingival architecture and is able to ensure better opportunities for osseointegration because of the healing potential of the fresh extraction site.17 It is our opinion that the healing potential of the fresh socket is able to promote both hard and soft peri-implant tissue. A correct relation of the immediately placed fixture with gingivae ensures not only the preservation of its morphology but gives the possibility to improve adaptation of the soft tissues to the crown favoring a satisfactory aesthetic final result.

A possible complication of this method is the presence of bone defects between the coronal aspect of the implant body and surrounding socket wall.27–29 Our treated cases presented 4 or 3 wall defects in relation to the size and morphology of the socket. This was present especially in premolar implantation sites rather than the incisor/canine areas. This study is evidence that the presence, after inserting the implant, of horizontal gaps of 2 mm or less is a clinical situation that does not need any guided bone regeneration technique.12 Our experience suggests to avoid this surgical technique in aesthetic areas when the fixture dimensions are not able to reduce the bone defect within 2 mm. The role of the implant surface in bone defect healing appears to be very important, but it was not within the scope of this study. Some authors30 question the need for primary closure in immediate implantation. In this study, as protocol, we did not use sutures; and in all cases, we had good aesthetic results. We believe optimal aesthetic result is connected to the bone quality and dimensions of the buccal wall. Resorption of this may produce a buccal concavity in the alveolar process that usually produces a compromised aesthetic situation.7–9 The thickness of the buccal aspect of the alveolar process after implant placement, immediate or not, is the real important prognostic factor. In this study, during the implant site preparation, the burs were positioned in contact with the palatal socket walls with the end to reduce the surgical trauma to the buccal wall and its vascularization. The implants were normally placed along the palatal wall of the extraction socket in the incisor and canine areas, and centrally in the socket in the premolar areas (Figs. 1–5). Our opinion is that the surgical respect of the buccal socket wall is the most important factor for obtaining a satisfactory aesthetic result. The idea of inserting the fixtures without flap elevation is an attempt to have a major respect of the buccal wall and its periosteal membrane minimizing soft tissue trauma. Another aspect that the clinician must take into account, imagining the final aesthetic result, is the gingival morphology and thickness (Figs. 6 and 7). Several authors31,32 reported facial gingival recession after definitive prosthesis placement. Preoperative clinical examination must note gingival anatomy and architecture, and the presence of inflammation/edema or recessions in the implantation sites. These factors can reduce the possibility of predicable aesthetic results. We believe a very thin and festooned biotype of gingival tissue is not a good prognostic element for immediate implant placement in the anterior maxilla. Conversely, the available temporary components made by the industries ensure the respect of the soft tissues and its correct modulation. The temporary rehabilitation reduces the dead space between the soft tissue coverage and bone, reduces the chances of infection, and enhances the maturation and modeling process.33 The temporary dentures cannot cause pressure on the soft tissues (Fig. 8).

Fig. 1.Fig. 2.Fig. 3.Fig. 4.Fig. 5.
Fig. 1.Fig. 2.Fig. 3.Fig. 4.Fig. 5.:
Clinical view of the failing maxillary left central incisor. Preoperative periapical radiograph. Intraoral view of preparation of the implant receptor site with sequential standard drills without incision or flap elevation after atraumatic extraction of the tooth. Clinical view of the implant placed in the fresh socket. The application of the healing abutment. No suture was made to achieve primary closure. Immediate postoperative periapical radiograph of the implant.
Fig. 6.Fig. 7.
Fig. 6.Fig. 7.:
Buccal view of soft tissues healing after 2 months from surgical time. Occlusal view of soft tissues healing after 2 months from surgical time.
Fig. 8.Fig. 9.Fig. 10.Fig. 11.
Fig. 8.Fig. 9.Fig. 10.Fig. 11.:
Clinical view of the temporary restoration. Clinical view of the final casting. Clinical view of the final restoration. Periapical radiograph after 24 months from surgical time.

In this study, the occlusal height of the acrylic resin temporary crowns was shortened about 2 mm to prevent the load transmission directly to the implant. The use of a fixed provisional restoration can help to control the occlusal forces that are applied to the healing bone-to-implant interface within a physiologic range.33 This is a very satisfactory solution for the patient and prevents excessive stress to the fixture (Figs. 9–11).

Conclusions

Within the limits of this study, the preliminary results have confirmed that immediate implantation in fresh extraction sites of the anterior maxilla, even without the incision or flap reflection, is a surgical procedure that appears to foster a well-preserved gingival architecture contributing to a satisfactory aesthetic final result.

Disclosure

The authors claim to have no financial interest in any company or any of the products mentioned in this article.

References

1. Brånemark PI, Hansson BO, Adell R. Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year period. Scand J Plast Reconstr Surg Suppl. 1977;16:1-132.
2. Belzer UC, Bernard JP, Buser D. Implant-supported restorations in anterior region: Prosthetic consideration. Pract Periodontics Aesthet Dent. 1996;8:875-883.
3. Belzer UC, Bernard JP, Hess D, et al. Aesthetic implant restoration in partially edentulous patients: A critical appraisal. Periodontol 2000. 1998;17:132-150.
4. Belzer UC, Bernard JP, Buser D. Implant-placement in aesthetic zone. In Lindhe J, Karring T, Lang NP, eds. Clinical Periodontology and Implant Dentistry. 4th ed. London: Blackwell Munksgaard; 2003:915-944.
5. Kois JC. Predictable single tooth peri-implant aesthetics: Five diagnostic keys. Compend Contin Educ Dent. 2001;22:199-206.
6. Zitzmann NU, et al. Immediate or delayed immediate implantation versus late implantation when using the principles of guided bone regeneration. Acta Med Dent Helv. 1996;1:221-227.
7. Carlsson GE, Persson G. Morphologic changes of the mandible after extraction and wearing of dentures. A longitudinal, clinical, and x-ray cephalometric study covering 5 years. Odontol Revy. 1967;18:27-54.
8. Atwood D. Post-extraction changes in adult mandible as illustrated by microradiograph of midsagittal section and serial cephalometric roentgenograms. J Prosthet Dent. 1963;13:810-816.
9. Ulm C, Solar T, Blahout R. et al. Reduction of the compact and cancellous bone substance of the edentulous mandible caused by resorption. Oral Surg Oral Med Oral Pathol. 1992;74:131-136.
10. Brånemark P, Zarb GA, Albrektsson T. Tissue-Integrated Prostheses: Osseointegration in Clinical Dentistry. Chicago, IL: Quintessence; 1985:199-204.
11. Schulte W, Kleineikenscheidt H, Linder K, et al. The Tubingen immediate implant in clinical studies [in German]. Dtsch Zahnarztl Z. 1978;5:348-359.
12. Cornelini R, Scarano A, Covani U, et al. Immediate one-stage postextraction implant: A human clinical and histologic case report. Int J Oral Maxillofac Implants. 2000;15:432-437.
13. Balshi TJ, Wolfinger GJ. Immediate placement and implant loading for expedited patient care: A case report. Int J Oral Maxillofac Implants. 2002;17:587-592.
14. Cooper LF, Rahman A, Moriarty J, et al. Immediate mandibular rehabilitation with endosseous implant: Simultaneous extraction, implant placement, and loading. Int J Oral Maxillofac Implants. 2002;17:517-525.
15. Kan JYK, Rungcharassaeng K, Lozada J. Immediate placement and provisionalization of maxillary anterior single implants: 1 year prospective study. Int J Oral Maxillofac Implants. 2003;18:31-39.
16. Rosenquist B, Grenthe B. Immediate placement of implants into extraction sockets: Implant survival. Int J Oral Maxillofac Implants. 1996;11:205-209.
17. Barzilay I, Graser GN, Iranpour B, et al. Immediate implantation of pure titanium implants into extraction sockets of Macaca fascicularis. Part II: Histologic observations. Int J Oral Maxillofac Implants. 1996;11:489-497.
18. Fugazzotto PA. Implant placement in maxillary first premolar fresh extraction sockets: Description of technique and report of preliminary results. J Periodontol. 2002;73:669-674.
19. Block MS, Kent JN. Placement of endosseous implant into tooth extraction sites. J Oral Maxillofac Surg. 1991;49:1269-1276.
20. Tolman D, Keller E. Endosseous implant placement immediately following dental extraction and alveoloplasty: Preliminary report with 6 year follow up. Int J Oral Maxillofac Implants. 1991;6: 24-28.
21. Gomez-Roman G, Schulte W. Immediate post-extraction implant placement with root analog stepped implants: Surgical procedure and statistical outcome after 6 years. Int J Oral Maxillofacial Implants. 2001;16:503-513.
22. Garber DA, Salama MA, Salama H. Immediate total tooth replacement. Compend Contin Educ Dent. 2001;22:210-216.
23. Gomez-Roman G, Schulte W, d’Hoedt B, et al. The Frialit-2 implant system: Five-year clinical experience in single-tooth and immediately post-extraction applications. Int J Oral Maxillofac Implants. 1997;12:299-309.
24. Roos J, Sennerby L, Lekholm U, et al. A qualitative and quantitative method for evaluating implant success: A 5 year retrospective analysis of the Brånemark implant. Int J Oral Maxillofac Implants. 1997;12:504-514.
25. Grunder U. Retrospective case series analysis of the factors determining immediate implant placement. Compend Contin Educ Dent. 2000;21:805-811.
26. Lazzara RJ. Immediate implant placement into extraction sites: Surgical and restorative advantages. Int J Periodontics Restorative Dent. 1989;9:332-343.
27. Schropp L, Kostopoulos L, Wenzel A. Bone healing following immediate versus delayed placement of titanium implants into extraction sockets: a prospective clinical study. Int J Oral Maxillofac Implants. 2003;18:189-199.
28. Wilson TG, Schenk R, Buser D, et al. Implant placed in immediate extraction sites: A report of histologic and histometric analysis of human biopsies. Int J Oral Maxillofac Implants. 1998;13:333-341.
29. Paolantonio M, Dolci M, Scarano A, et al. Immediate implantation in fresh extraction sockets. A controlled clinical and histological study in man. J Periodontol. 2001;72:1560-1571.
30. Schwartz-Arad D, Chaushu G. Placement of implant into fresh extraction sites: 4 to 7 years retrospective evaluation of 95 immediate implants. J Periodontol. 1997;68:1110-1116.
31. Bengazi F, Wennstrom JL, Lekholm U. Recession of the soft tissue margin at oral implants. A 2-year longitudinal prospective study. Clin Oral Implants Res. 1996;7:303-310.
32. Oates TW, West J, Jones J, et al. Long-term changes in soft tissue height on the facial surface of dental implants. Implant Dent. 2002;11:272-279.
33. Lorenzoni M, Pertl C, Zhang K, et al. Immediate loading of single tooth implants in the anterior maxilla. Preliminary result after one year. Clin Oral Implants Res. 2003;14:180-187.

Abstract Translations

GERMAN / DEUTSCH

AUTOR(EN): Gilberto Sammartino, MD, DDS*, Gaetano Marenzi, DMD, PhD**, Alessandro Espedito di Lauro DMD PhD***, Guerino Paolantoni DMD****. *A.O. Professor, Universität von Neapel “Federico II”. Medizinische Fakultät. Abteilung für Odontostomatologie und Gesichts- und Kieferheilkunde. Neapel, Italien. **Oralchirurg, Universität von Neapel “Federico II”. Medizinische Fakultät. Abteilung für Odontostomatologie und Gesichts- und Kieferheilkunde. Neapel, Italien. ***Assistenzprofessor, Universität von Neapel “Federico II”. Medizinische Fakultät. Abteilung für Odontostomatologie und Gesichts- und Kieferheilkunde. Neapel, Italien. ****Privat praktizierender Arzt, Neapel, Italien. Schriftverkehr: Gilberto Sammartino, MD, DDS, Dip. di Scienze Odontostomatologiche e Maxillo-Facciali, Facoltà di Medicina e Chirurgia dell’Università degli studi di Napoli “Federico II”, Via Pansini 5, 80125 Neapel, Italien. Telefon: +39-081/7462654, e-Mail:[email protected]

Ásthetik in der Oralimplantologie: biologische, klinische, chirurgische und prothetische Aspekte

ZUSAMMENFASSUNG:Zielsetzungen: Diese Studie zielte darauf ab, eine korrekte klinische, chirurgische und prothetische und auf ein vorhersagbar gutes ästhetisches Ergebnis abzielende Vorgehensweise bei der Einsetzung Knochengewebsintegrierender Implantate zu erfassen, die zum Zweck des Ersatzes fehlender Zähne im vorderen Oberkiefer eingesetzt werden. Die sofort in die Extraktionshöhlen vorgenommene Einpflanzung von Implantaten ohne zusätzliche Einschnitte und Lappenanhebungen stellt eine der chirurgischen Behandlungsoptionen dar, um die Heilungschancen und regenerativen Möglichkeiten der frischen Pfanne zu verbessern. Materialien und Methoden: 55 Patienten, davon 33 Männer und 22 Frauen im Alter von 19 bis 57 Jahren (mit 29 als durchschnittlichem Alter) wurden zur Teilnahme an dieser Studie ausgewählt. Keiner der Patienten rauchte oder knirschte mit den Zähnen. Bei allen lagen stabile Weichgewebsbedingungen vor, der Zahnreihenschluss war bei allen weitestgehend zufrieden stellend und keiner wies krankhafte Veränderungen auf, die eine Knochenheilung beeinträchtigen könnten. Die Patienten wurden mit Implantaten zweier verschiedener Hersteller behandelt, zum ersten vom Institut Straumann, Walderburg, Schweiz, und zum zweiten von Friadent, Mannheim, Deutschland). 87 Implantate wurden sofort nach Entfernen des jeweiligen versagenden Zahns implantiert. 3 Monate nach Implantatsetzung wurde die vorübergehende Prothetik angebracht und 4 Monate nach dem chirurgischen Eingriff folgte die abschließende Wiederherstellung. Die Patienten wurden klinisch und röntgentechnisch bei Implantatsetzung sowie 2, 4, 18 und 24 Monate nach Implantierung untersucht. Ergebnisse: Nach 24 Monaten musste nur bei drei Implantaten ein Fehlschlagen festgestellt werden, wobei zwei dieser Implantate männlichen Patienten eingesetzt worden waren und eines bei einer Patientin. Keines der versagenden Implantate konnte eine Knochengewebsintegration erzielen. Die vor der abschließenden Wiederherstellung ermittelte Gesamterfolgsquote lag bei 96,6% mit einer Versagensrate der Implantate von 3,4%. Schlussfolgerungen: Die sofortige Platzierung von Implantaten in die frischen Extraktionshöhlen des vorderen Oberkiefers ohne zusätzliche Einschnitte oder Lappenanhebungen stellen eine chirurgische Option dar, die unter Erhalt der vor der Operation bestehenden Zahnfleisch- und Knochenbedingungen eine optimale Gewebsheilung im das Implantat umlagernden Gewebe garantieren kann. Für ein vorhersagbar gutes ästhetisches Ergebnis scheinen die Höhe und Dicke der wangenseitigen Knochenwand, die nach der sofortigen Anbringung der Deckprothese verbleiben, die wichtigste Rolle zu spielen.

SCHLÜSSELWÖRTER: Ásthetik im Zahnfleischbereich, Zahnextraktion, sofortige Implantatsetzung, vorübergehende Wiederherstellungslösung

SPANISH / ESPAÑOL

AUTOR(ES): Gilberto Sammartino, MD, DDS*, Gaetano Marenzi, DMD, PhD**, Alessandro Espedito di Lauro, DMD, PhD***, Guerino Paolantoni, DMD****. *Profesor Asociado, Universidad de Nápoles “Federico II”, Facultad de Medicina, Departamento de Ciencias Odontoestomatológicas y Maxilofaciales, Nápoles, Italia. **Cirujano Oral, Universidad de Nápoles “Federico II”, Facultad de Medicina, Departamento de Ciencias Odontoestomatológicas y Maxilofaciales, Nápoles, Italia. ***Profesor Asistente, Universidad de Nápoles “Federico II”, Facultad de Medicina, Departamento de Ciencias Odontoestomatológicas y Maxilofaciales, Nápoles, Italia. ****Práctica Privada, Nápoles, Italia. Correspondencia a:Gilberto Sammartino, MD, DDS, Dip. di Scienze Odontostomatologiche e Maxillo-Facciali, Facoltà di Medicina e Chirurgia dell’Università degli studi di Napoli “Federico II”, Via Pansini 5, 80125 Napoli, Italy. Teléfono: +39-081/7462654, Correo electrónico:[email protected]

La estética en la implantología oral: aspectos biológicos, clínicos, quirúrgicos y prostéticos

ABSTRACTO:Objetivos: El objetivo de este estudio fue identificar una atención clínica, quirúrgica y prostética correcta de los implantes endoóseos para reemplazar dientes que faltan en la maxila anterior para lograr resultados estéticos pronosticables. La colocación de los implantes inmediatos a la post-extracción sin incisiones o elevación de las aletas es una de las opciones de tratamiento quirúrgico capaces de mejorar el potencial regenerativo y de curación de la cavidad fresca. Materiales y métodos: Se seleccionaron para el estudio cincuenta y cinco pacientes (33 hombres, 22 mujeres), con edades desde los 19 a los 57 (edad media de 29) años. Todos los pacientes no eran fumadores, sin bruxismo, presentaban tejidos suaves estables, una oclusión aceptable y la ausencia de patologías que pudieran contraindicar la curación del hueso. Los pacientes fueron tratados con implantes hechos por 2 fabricantes (Institute Straumann, Walderburg, Suiza y Friadent, Mannheim, Alemania). Ochenta y siete implantes fueron colocados inmediatamente después de la extracción de cada diente fallado. La restauración temporal se colocó tres meses después de la colocación del implante y la restauración final se colocó 4 meses después del procedimiento quirúrgico. Los pacientes fueron evaluados clínicamente y radiográficamente en el momento de la colocación del implante y a los 2, 4, 18 y 24 meses posteriores a la colocación. Resultados: A los 24 meses solamente se habían perdido tres implantes (2 en pacientes masculinos y 1 en una paciente femenina). Todos los implantes fallados no lograron la oseointegración. La tasa general de éxito fue del 96.6% con una tasa de falla del implante del 3.4%, todos antes de la restauración. Conclusiones: La colocación inmediata en las cavidades de extracción frescas de la maxila anterior sin incisiones o elevación de la aleta es una opción quirúrgica que puede asegurar una curación ideal de los tejidos periimplante para proteger los aspectos gingivales y del hueso previo a la cirugía. Para lograr un resultado estético pronosticable, el aspecto más importante parece ser la altura y el espesor de la pared del hueso bucal que queda luego de la colocación inmediata del aparato.

PALABRAS CLAVES: estética gingival, extracción de dientes, colocación inmediata del implante, restauración temporal

PORTUGUESE / PORTUGUÊS

AUTOR(ES): Gilberto Sammartino Médico, Cirurgião-Dentista*, Gaetano Marenzi Doutor em Medicina, PhD**, Alessandro Espedito di Lauro Doutor em Medicina, PhD***, Guerino Paolantoni Doutor em Medicina****. *Professor Associado, Universidade de Nápoles “Federico II”. Faculdade de Medicina. Departamento de Ciência Odontostomatológica e Maxilo-Facial. Náoles, Itália. **Cirurgião Oral, Universidade de Nápoles “Federico II”. Faculdade de Medicina. Departamento de Ciência Odontostomatológica e Maxilo-Facial. Nápoles, Itália. ***Professor Assistente, Universidade de Nápoles “Federico II”. Faculdade de Medicina. Departamento de Ciência Odontostomatológica e Maxilo-Facial. Náoles, Itália. ****Clínica particular, Nápoles, Itália. Correspondência:Gilberto Sammartino, MD, DDS, Dip. di Scienze Odontostomatologiche e Maxillo-Facciali, Facoltà di Medicina e Chirurgia dell’Università degli studi di Napoli “Federico II”, Via Pansini 5, 80125 Napoli, Italy. Telefone: +39-081/7462654, e-Mail:[email protected]

Estética em implantologia oral: Aspectos biológicos, clínicos, cirúrgicos e protéticos

RESUMO:Objetivos: O objetivo deste estudo era identificar um tratamento clínico, cirúrgico e protético correta de implantes endósseos substituindo dentes ausentes na maxila anterior alcançando resultados estéticos previsíveis. A colocação de implantes de pós-extração imediata sem incisões ou elevação do retalho é uma das opções de tratamento cirúrgico capazes de melhorar a cura e os potenciais regenerativos do alvéolo fresco. Materiais e Métodos: Cinqüenta e cinco pacientes (33 homens, 22 mulheres), compreendendo em idade de 19 a 57 (idade média 29) anos, foram selecionados para este estudo. Todos os pacientes eram não-fumantes, não-bruxistas, apresentavam condições de tecido mole estáveis, uma oclusão aceitável e a ausência de patologias que contra-indicassem a curta do osso. Os pacientes foram tratados com implantes feitos por 2 fabricantes (Institute Straumann, Walderburg, Suíça e Friadent, Mannheim, Alemanha). 87 implantes foram colocados imediatamente depois que cada dente deficiente for removido. A restauração temporária foi colocada três meses após a colocação do implante e a restauração final foi colocada 4 meses a partir do procedimento cirúrgico. Os pacientes foram avaliados clínica e radiograficamente na colocação do implante e em 2, 4, 18 e 24 meses pós inserção. Resultados: Em 24 meses apenas três implantes foram perdidos (2 em pacientes masculinos;1 em paciente feminino). Todos esses implantes fracassados deixaram de alcançar a osseointegração. A taxa de sucesso geral foi de 96.6% com taxa de fracasso do implante de 3.4%, tudo antes da restauração. Conclusões: A colocação imediata nos alvéolos de extração frescos da maxila anterior sem incisões ou elevação do retalho é uma opção cirúrgica que pode assegurar a cura ideal de tecidos de periimplante, preservando os aspectos gengivais e ósseos pré-cirúrgicos. Para um resultado estético previsível o aspecto mais importante parece ser a altura e espessura da parede do osso bucal que permanecem após a imediata colocação do aparelho.

PALAVRAS-CHAVE: estética gengival, extração de dentes, colocação imediata de implantes, restauração temporária

RUSSIAN / SYMBOL

Symbol
Symbol

АВТОРЫ: Гилбeрто Саммартино (Gilberto Sammartino) доктор мeдицины, доктор стоматологии*, Гаeтано Марeнзи (Gaetano Marenzi) доктор стоматологии, доктор философии**, Алeссандро Eспeдито ди Лауро (Alessandro Espedito di Lauro) доктор стоматологии, доктор философии***, Гуeрино Паолантони (Guerino Paolantoni) доктор стоматологии****. *Адъюнкт-профeсссор унивeрситeта Нeаполя “Federico II”. Мeдицинский факультeт. Кафeдра одонтостоматологии и изучeния чeлюсти и лица. Нeаполь, Италия. **|R+ирург-стоматолог, унивeрситeт Нeаполя “Federico II”. Мeдицинский факультeт. Кафeдра одонтостоматологии и изучeния чeлюсти и лица. Нeаполь, Италия. ***Доцeнт унивeрситeта Нeаполя “Federico II”. Мeдицинский факультeт. Кафeдра одонтостоматологии и изучeния чeлюсти и лица. Нeаполь, Италия. ****Врач, занимающийся частной практикой, Нeаполь, Италия. Адрeс для коррeспондeнции: Gilberto Sammartino, MD, DDS, Dip. di Scienze Odontostomatologiche e Maxillo-Facciali, Facoltà di Medicina e Chirurgia dell’Università degli studi di Napoli “Federico II”, Via Pansini 5, 80125 Napoli, Italy. Тeлeфон: +39-081/7462654, Адрeс эл. почты: gilberto.[email protected]

Эстeтика в стоматологичeской имплантологии: биологичeский, клиничeский, xирургичeский и простeтичeский аспeкты

АННОТАЦИЯ:Цeли: цeль данного исслeдования – установить правильноe клиничeскоe, xирургичeскоe и простeтичeскоe примeнeниe костныx имплантатов, замeняющиx отсутствующиe зубы в пeрeднeй части чeлюсти с достижeниeм прeдсказуeмого эстeтичeского рeзультата. Установкаимплантата сразу послe удалeния зуба бeз разрeза и поднятия лоскута являeтся одним из вариантов xирургичeского лeчeния, с помощью которого можно улучшить заживлeниe и восстановлeниe функции образовавшeйся зубной лунки. Матeриалы и мeтоды: для данного исслeдования были отобраны пятьдeсят пять пациeнтов (33 мужчины, 22 жeнщины), в возрастe от 19 до 57 лeт (срeдний возраст – 29 лeт). Всe пациeнты нe курят, у ниx отсутствуeт одонтопризис, имeют стабильноe состояниe мягкиx тканeй, нормальный прикус и отсутствиe патологий, являющиxся противопоказаниeм для лeчeния кости. Пациeнтам были установлeны имплантаты, выполнeнныe 2 изготовитeлями (институтом Straumann, Вальдeрбург, Швeйцария и компаниeй Friadent, Мангeйм, Гeрмания). 87 имплантатов было установлeно сразу послe удалeния больного зуба. Врeмeнноe восстановлeниe было выполнeно чeрeз три мeсяца послe установки имплантата, и окончатeльноe восстановлeниe было выполнeно чeрeз 4 мeсяца послe xирургичeского вмeшатeльства. Была провeдeна клиничeская и радиологичeская оцeнка состояния участков, на которыx пациeнтам были установлeны имплантаты, чeрeз 2, 4, 18 и 24 мeсяца послe установки. Рeзультаты: чeрeз 24 мeсяца только три имплантата были утрачeны (2 у мужчин; 1 у жeнщины). Всe эти имплантаты нe прижились к кости. Общий показатeль успeшности составил 96,6% при показатeлe нeудачной установки имплантата 3,4%; всe данныe приводятся до восстановлeния. Выводы: установка имплантата на пeрeднeй части чeлюсти в зубную лунку сразу послe удалeния зуба бeз надрeза или поднятия лоскута являeтся способом xирургичeского лeчeния, который можeт обeспeчить идeальноe заживлeниe тканeй вокруг имплантата, соxраняя такоe жe состояниe дeсeн и кости, как до xирургичeского вмeшатeльства. Хто касаeтся прeдсказуeмости эстeтичeского рeзультата, наиболee важным аспeктом прeдставляeтся высота и толщина стeнки щeчной кости, которая остаeтся послe нeпосрeдствeнной установки имплантата.

КЛЮХEВЫE СЛОВА: эстeтика дeсны, удалeниe зуба, нeмeдлeнная установка имплантата, врeмeнноe восстановлeниe

JAPANESE / SYMBOL

Symbol
Symbol
Figure
Figure

CHINESE / SYMBOL

Symbol
Symbol
Figure
Figure

KOREAN / SYMBOL

Symbol
Symbol
Figure
Figure
Keywords:

gingival aesthetics; tooth extraction; immediate implant placement; temporary restoration

© 2007 Lippincott Williams & Wilkins, Inc.