The Use Of Tilted Implant In Extreme Case Of Failed .
SCIENTIFIC ARCHIVES OF DENTAL SCIENCESVolume 3 Issue 5 May 2020Case ReportThe Use of Tilted Implant in Extreme Case of Failed Implants: Surgical ProcedureAngelo Cardarelli1* and Arun K Garg21Adjunct Professor, Department of Dentistry, IRCCS San Raffale Hospital Milan, Dean Professor Gherlone, Italy2DMD Former Professor of Surgery Divison of Oral and Maxillofacial Surgery, Department of Surgery, University of Miami School ofMedicine*Corresponding Author: Angelo Cardarelli, Adjunct Professor, Department of Dentistry, IRCCS San Raffale Hospital Milan, Italy.Received: March 10, 2020; Published: April 07, 2020AbstractMaxillary sinus often can have a severe limitations for conventional implants treatment .Resorption of bone and the expansion ofmaxillary sinus reduce in many cases the amount of bone available both in thickness and height .The aim of this work is to present analternative technique to maxillary sinus lift procedure to reduce the invasivity and to do immediate loading at the same time.Keywords: Tilted Implant; Maxillary Sinus; Immediate Loading; Minimal Invasive ApproachIntroductionFrom an aesthetic point of view, the wrong implant placementcan cause the bad prosthetic work. Since aesthetics is a primaryrequirement, this mistake can be prevented through propersurgery planning.Therefore, the clinical examination is not limited, the studyof the models on the articulator, the diagnostic wax-up, theradiographic images (OPT, cone beam) and the use of any surgicalguides are important. Until recently, removing an implant meantheavy bone loss and the need for bone grafting procedures.Recently the development of a new tools can facilitate implantremoval through conservative and simple procedures. The aim ofthis article is to describe an extreme case about wrong placementFigure 2: Wrong implants placement.implants with severe periimplantitis and bone loss in the right siteof maxilla [1-3] (Figure 1-5).Figure 1: Initial clinical situation to show thewrong placement implants.Figure 3: Occlusal view of initial situation.Citation: Angelo Cardarelli and Arun K. Garg. “The Use of Tilted Implant in Extreme Case of Failed Implants: Surgical Procedure”. Scientific Archives OfDental Sciences 2.5 (2020): 01-06.
The Use of Tilted Implant in Extreme Case of Failed Implants: Surgical Procedure02Figure 4: Initial X RAY.Figure 5: TAC cone beam view.Figure 6: TAC cone beam.Figure 7: Removal implants with dedicateddevice to preserve the bone.So, using a tilted implant it was possible to avoid the sinus liftprocedure and also to do immediate loading at the same time usingonly basal bone.Case ReportIn this case it is described a woman patient of 68 years, ingood health, with a negative history, not a smoker. The clinical andradiographic examination (OPT and Cone Beam) shows a seriousperiimplantitis around the implants in right site of maxilla witha wrong placement and a not correct prosthetic rehabilitation(Figure 6-8). So, it was decided to remove the implants and at sametime to place two implants with immediate loading using tiltedimplant to avoid maxillary sinus.Vertical bone insufficiency in the maxillary posterior teeth isa common clinical situation. At present, the bone insufficiency inFigure 8: Unscrewed implants.the maxillary posterior teeth is mainly overcome by bone graftingthrough maxillary sinus floor ,tiltedimplantation can better avoid bone grafting, reduce complications,Citation: Angelo Cardarelli and Arun K. Garg. “The Use of Tilted Implant in Extreme Case of Failed Implants: Surgical Procedure”. Scientific Archives OfDental Sciences 2.5 (2020): 01-06.
The Use of Tilted Implant in Extreme Case of Failed Implants: Surgical Procedureshorten the treatment cycle, reduce the treatment cost for patients,and gradually be promoted in clinical settings.The term tilted implants refers to implants placed at an angleof normally 30 degrees or more with respect to axially or verticallypositioned implants. According to many authors, the use of tiltedimplants in the posterior maxillary sector offers advantages overaxial implants.03diameter and 16 mm of length with 30 degree extreme abutment(AB IMPLANT Israel). Then is placed an anterior implant with 3,75of diameter and 11,5 of length with straight extreme abutment(AB IMPLANT Israel). After the sutures is screwed a temporaryrehabilitation waiting for the Osseointegration in next 4 months(Figure 9-21).The placement of tilted implants offers both surgical andprosthodontic benefits. In effect, the combination of tilted and axialimplants allows the use of longer implants, thereby increasing theosseointegration surface; improves primary stability by anchoringin more than one cortical layer; avoids cantilever extremities byplacing the implants more distal and with better load distributionover the dental arch [4-6].Surgical and prosthetic proceduresOne hour before the operation, 1g of amoxicillin is given tothe patient, to be taken twice a day for the following 6 days.Surgical procedures are started under local anesthesia, 20 mg/mLaptocaine with 1: 80,000 adrenaline. So, the implants are removedwith dedicated device then a palatal incision is made from the areaof the first right molar after the extraction to the lateral incisorwith two mucoperiosteal incisions to research the anterior wallof maxillary sinus. The distal osteotomy has tangential to theanterior wall of the maxillary sinus; this inclination is necessaryto achieve an emergence of the implant platform at the level of theFigure 10: Failed implants.first moar, so for this reason is positioned an implant with 3,75 ofFigure 9: Occlusal view after implants removal.Figure 11: Failed implants with not correctprosthetic rehabilitation.Citation: Angelo Cardarelli and Arun K. Garg. “The Use of Tilted Implant in Extreme Case of Failed Implants: Surgical Procedure”. Scientific Archives OfDental Sciences 2.5 (2020): 01-06.
The Use of Tilted Implant in Extreme Case of Failed Implants: Surgical Procedure04Figure 15: Implants placement with extreme abutments.Figure 12: Bone skeletrization with palatal flap approach toincrease also the soft tissue around the implants.Figure 13: Surgical view after implants removal it's possible tosee the preservation of the bone using a dedicated device.Figure 14: Distal osteotomy tangential to theanterior wall of the maxillary sinus.Figure 16: Occlusal view after implants placement.Figure 17: gbr to cover the bone dehiscence.Citation: Angelo Cardarelli and Arun K. Garg. “The Use of Tilted Implant in Extreme Case of Failed Implants: Surgical Procedure”. Scientific Archives OfDental Sciences 2.5 (2020): 01-06.
The Use of Tilted Implant in Extreme Case of Failed Implants: Surgical Procedure05Figure 21: Post op x-rayConclusionIndependently of the cause, when an implant is not wellpositioned, prosthetic rehabilitation may not be adequate from amechanical, functional and aesthetic point of view.Figure 18: Sutures with healing caps.In this case presented here, was necessary to remove theimplants and to do a new surgical and prosthetic plan in the patientwith severe loss of bone. The goal of this technique is the use ofthe basal bone of patient to increase a long term success of ourimplants rehabilitation. So, this surgical approach represent a validand predictable therapeutic alternative to the bone augmentationand regeneration [7-9].Prosthetic rehabilitation of the edentulous maxilla includesthe placement of tilted implants as a relatively recent option. Theadvantages of tilted implants are: the use of longer implants, therebyFigure 19: Temporary rehabilitation screwed.increasing the contact (osseointegration) surface; improvedprimary stability by anchoring in more than one cortical layer; theavoidance of cantilever extremities by placing the implants moredistal and with better load distribution over the dental arch; andavoidance of the use of bone grafts and sinus lift procedures - withthe resulting reduction in morbidity.The marginal bone loss observed with the tilted and axialimplants likewise proved very similar. It thus can be deducedthat tilted implants exhibit the same evolutive behavior as axialimplants.Bibliography1.Del Fabbro M., et al. “Systematic review of survival rates forimmediately loaded dental implants”. International Journal ofPeriodontics and Restorative Dentistry 26.3 (2006): 249-263.Figure 20: Immediate loading without occlusal contacts.Citation: Angelo Cardarelli and Arun K. Garg. “The Use of Tilted Implant in Extreme Case of Failed Implants: Surgical Procedure”. Scientific Archives OfDental Sciences 2.5 (2020): 01-06.
The Use of Tilted Implant in Extreme Case of Failed Implants: Surgical Procedure2.3.4.5.6.7.8.9.Malo P., et al. “All-on-Four” immediate function concept withBrånemark system implants for completely edentulous mandibles: A retrospective clinical study”. Clinical Implant Dentistry and Related Research 5.1 (2003): 2-9.Malo P., et al. “All-on-4 immediate function concept withBrånemark system implants for completely edentulous maxillae: A 1-year retrospective clinical study”. Clinical ImplantDentistry and Related Research 7.1 (2005): S88-S94.Duyck J., et al. “Magnitude and distribution of occlusal forces on oral implants supporting fixed prostheses: An in vivostudy”. Clinical Oral Implants Research 11.5 (2000): 465-475.Aparicio C., et al. “Tilted implants as an alternative to maxillary sinus grafting”. Clinical Implant Dentistry and Related Research 3.1 (2001): 39-49.Krekmanov L., et al. “Tilting of posterior mandibular and maxillary implants of improbe prosthesis support”. InternationalJournal of Oral and Maxillofacial Implants 15.3 (2000): 405414.Maló P., et al. “A pilot study of complete edentulous rehabilitation with immediate function using a new implant design:Case series”. Clinical Implant Dentistry and Related Research8.4 (2006): 223-232.Stegaroiu R., et al. “Influence of super- structure materials onstrain around an implant under 2 loading conditions: A technical investigation”. International Journal of Oral and Maxillofacial Implants 19.5 (2004): 735-742.Tealdo T., et al. “Immediate function with fixed implant-supported maxillary dentures: A 12-month pilot study”. Journal ofProsthetic Dentistry 99 (2008): 351-360.Volume 2 Issue 5 May 2020 All rights are reserved by Angelo Cardarelli and ArunK. Garg.Citation: Angelo Cardarelli and Arun K. Garg. “The Use of Tilted Implant in Extreme Case of Failed Implants: Surgical Procedure”. Scientific Archives OfDental Sciences 2.5 (2020): 01-06.06
The term tilted implants refers to implants placed at an angle of normally 30 degrees or more with respect to axially or vertically positioned implants. According to many authors, the use of tilted implants in the posterior maxillary sector offers advantages over axial implants. The placement of
May 02, 2018 · D. Program Evaluation ͟The organization has provided a description of the framework for how each program will be evaluated. The framework should include all the elements below: ͟The evaluation methods are cost-effective for the organization ͟Quantitative and qualitative data is being collected (at Basics tier, data collection must have begun)
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(SD 0.67) for tilted implants, with no significant correlation between implant angulation and bone loss. A significant correlation between implant angulation and annual bone loss was obtained for tilted implants only (r 0.52, p .004).Using Albrektsson criteria, the success rate was 89.6% (26 out of
Chính Văn.- Còn đức Thế tôn thì tuệ giác cực kỳ trong sạch 8: hiện hành bất nhị 9, đạt đến vô tướng 10, đứng vào chỗ đứng của các đức Thế tôn 11, thể hiện tính bình đẳng của các Ngài, đến chỗ không còn chướng ngại 12, giáo pháp không thể khuynh đảo, tâm thức không bị cản trở, cái được
9. Straumann PURE Ceramic Implant Monotype 35. 9.1 Design 37. 10. Surgical procedure for Straumann PURE Ceramic Implant Monotype 38. 10.1 Preoperative planning 38 10.2 Basic implant bed preparation 42 10.3 Fine implant bed preparation 45 10.4 Implant insertion 46. 11. Prosthetic procedure for Straumann PURE Ceramic Implant Monotype 49
