Seiten: 7-23, Sprache: Deutsch
Die Implantattherapie bei älteren Menschen bedarf einer gezielten Planung. Dabei spielt die Unterscheidung zwischen dem dritten und vierten Lebensabschnitt für die Behandlungsplanung und die anschließende zahnärztliche Betreuung eine wichtige Rolle, da diese Patientengruppen sich fundamental voneinander unterscheiden. Für Menschen des dritten Lebensabschnitts steht das gesamte Spektrum der zahnärztlichen Implantologie zur Verfügung, allerdings müssen chronische Erkrankungen, Medikation und manuelle Geschicklichkeit beachtet werden. Da dentale Implantate meist deutlich länger als 20 Jahre im Mund verbleiben, muss prospektiv die zukünftige Abnahme der biologischen, sozialen und kognitiven Funktionen bei der Planung berücksichtigt werden. Im vierten Lebensabschnitt ist das Leben von der Abhängigkeit bei den Aktivitäten des täglichen Lebens (ADL), Multimorbidität, Polypharmazie und Institutionalisierung bestimmt. Es gibt fast keine wissenschaftliche Evidenz zur Implantattherapie dieser Patientengruppe. Die wenigen vorhandenen Studien zeigen eine sehr hohe Implantatüberlebensrate und es gibt Hinweise auf verringerte akute periimplantäre Entzündungsreaktionen. Gerade Patienten in der vierten Lebensphase könnten am meisten vom funktionellen Gewinn einer implantatstabiliserten Totalprothese profitieren, wenn die muskulären Fähigkeiten zur Stabilisierung einer Prothese nachlassen. Allerdings müssen Handhabung, Nachsorge und tägliche Pflege gesichert werden, bevor mit einer solchen Therapie im Sinne des Nichtschadensgebots begonnen wird. Menschen im palliativen Kontext weisen zunehmend Implantate auf, die die Betroffenen und die Pflegenden vor große Herausforderungen stellen können. Hier müssen die Implantatprothesen rechtzeitig „rückgebaut“ werden, um Schmerzen und Infektionen zu vermeiden.
Manuskripteingang: 06.01.2021, Annahme: 19.02.2021
Schlagwörter: Implantologie, Gerodontologie, dritter Lebensabschnitt, vierter Lebensabschnitt, chirurgische Strategien, prothetische Strategien
The International Journal of Oral & Maxillofacial Implants, 5/2020
DOI: 10.11607/jomi.8045, PubMed-ID: 32991653Seiten: 1013-1020, Sprache: Englisch
Purpose: The hydrophilic implant surface (INICELL) is a chemical alteration of a sandblasted and thermally acid-etched surface that should lead to long-term osseointegration. This study investigated 3-year results after early loading of implants with a hydrophilic, moderately rough surface in occlusal contact.
Materials and Methods: This prospective case series study was conducted in subjects with partially edentulous mandibles. Implants were placed on day 21 and loaded with a provisional reconstruction after at least 21 days of healing (baseline, day 0) if their implant stability quotient (ISQ) was ≥ 70 (mean of three measurements) and were replaced by definitive porcelain-fused-to-metal prostheses at the 6-month follow-up visit. Follow-up examinations were planned 1, 3, 6, 12, and 36 months after baseline.
Results: A total of 20 implants were placed in 15 patients (mean age: 51 years, range: 32 to 67 years). After 36 months, all implants were osseointegrated, and no suppuration was recorded. Small changes of bone level were observed between 3 months and 36 months. At 36 months, the median values of the 20 implants were 0.25 (range: 0 to 0.5, SD: 0.17), 0.25 (range: 0 to 1, SD: 0.27), and 4 (range: 2 to 7.25, SD: 1.17) for the mean modified Plaque Index (mPI), mean modified Sulcus Bleeding Index (mSBI), and mean probing pocket depth, respectively. The pairwise analysis between 3 and 36 months showed an improvement in the mean mPI (P = .0126) and mean mSBI (P = .0059). After 36 months, all patients (n = 15) were fully satisfied with a mean of 9.43 (range: 8 to 10, SD: 0.678) at the visual analog scale.
Conclusion: Early functional loading of implants with a hydrophilic, moderately rough outer surface in occlusal contact 21 days after healing appears to be a safe and feasible treatment option when placed in the posterior mandible of partially edentulous patients.
Schlagwörter: delayed placement, dental implants, early loading, hydrophilic implant surface
Forum Implantologicum, 1/2020
Seiten: 22-31, Sprache: Englisch
Peri-implantitis is a biofilm-mediated inflammatory process that leads to soft- and hard-tissue breakdown. Periimplant diseases are the most frequent biologic implant complication in daily practice. Certain systemic conditions as well as detrimental habits have been demonstrated to negatively impact peri-implant tissue health and stability. In addition, several local predisposing factors were also identified to be associated with the development of periimplantitis, such as the lack of keratinized mucosa, residual cement or a micro-rough implant surface exposed to the oral cavity or the peri-implant sulcus. This clinical review paper will focus on the latter risk factor, which is often caused by poor surgical performance by the clinician during implant surgery.
Schlagwörter: Peri-implantitis, peri-implant disease, dental implant, implant infection, risk factor, surgical risk factors
The International Journal of Oral & Maxillofacial Implants, 6/2019
DOI: 10.11607/jomi.7657, PubMed-ID: 31532826Seiten: 1328-1336a, Sprache: Englisch
Purpose: There is a lack of knowledge concerning the critical buccal bone thickness required for securing favorable functional and esthetic outcomes, conditioned to the dimensional changes after implant placement. A preclinical study was therefore carried out to identify the critical buccal bone wall thickness for minimizing bone resorption during physiologic and pathologic bone remodeling.
Materials and Methods: A randomized, two-arm in vivo study in healthy beagle dogs was carried out. The first group of dogs was sacrificed 8 weeks after implant placement for histomorphometric examination of postsurgical resorption of the buccal bone wall. The second group of dogs was monitored during three ligature-induced peri-implantitis episodes and a spontaneous progression episode. Morphometric and clinical variables were defined for the study of physiologic and pathologic buccal and lingual bone loss.
Results: Seventy-two implants were placed in healed mandibular ridges of 12 beagle dogs. Two groups were defined: 36 implants were placed in sites with a thin buccal bone wall (< 1.5 mm), and 36 were placed in sites with a thick buccal bone wall (≥ 1.5 mm). No implants failed during the study period. For the great majority of the histomorphometric parameters, a critical buccal bone wall thickness of at least 1.5 mm seemed to be essential for maintaining the buccal bone wall during physiologic and pathologic bone resorption. Suppuration (+) and mucosal recession (-) were more often associated with implants placed in sites with a thin buccal bone wall.
Conclusion: A critical buccal bone wall thickness of 1.5 mm at implant placement is advised, since a thicker peri-implant buccal bone wall (≥ 1.5 mm) is exposed to significantly less physiologic and pathologic bone loss compared with a thinner buccal bone wall (< 1.5 mm).
Schlagwörter: alveolar bone, dental implants, diagnostic, implant stability, peri-implant mucositis, peri-implantitis
Forum Implantologicum, 2/2019
Seiten: 91, Sprache: Englisch
Forum Implantologicum, 2/2019
Seiten: 102-109, Sprache: Englisch
Over the past decade, the use of digital technology in implant treatment planning and static computer-assisted implant surgery (sCAIS) has revolutionized the planning and execution of guided implant surgeries. However, the predictability of achieving a high degree of accuracy when using a digital workflow and sCAIS has been a subject of debate. For sCAIS procedures to transition from clinical success in individual cases to a broadly applicable procedure, a better understanding and control of variables that affect their accuracy is essential. Recently, a research team in the Department of Oral Surgery and Stomatology at the University of Bern launched a series of in-vitro investigations to further analyze the impact and magnitude of potential variables involved in the digital treatment planning of sCAIS procedures that can have a significant effect on the accuracy of sCAIS. This article presents the rationale and summary of their findings.
Schlagwörter: Computer-assisted, implant surgery, guided surgery, surgical guides
Forum Implantologicum, 1/2019
Seiten: 3, Sprache: Englisch
Forum Implantologicum, 1/2019
Seiten: 6-21, Sprache: Englisch
Implant placement post single tooth extraction in the esthetic zone is an important and frequent indication for implant therapy. Today, the clinician can choose from four different treatment approaches for the timing of implant placement. The decision for the most appropriate treatment plan should be based on a thorough clinical and radiographic examination and well-defined selection criteria. Early implant placement after soft tissue healing is one of the treatment options available. This approach is applied by our team in the case of a thin bone wall phenotype (< 1 mm) or a missing facial bone wall at the extraction site, and sufficient bone volume available in the palato-apical area to allow good primary stability of the implant. The surgical procedures include a flapless tooth extraction, a 4-to-8 week soft tissue healing period, implant placement in the correct 3-dimensional position, a simultaneous contour augmentation on the facial aspect with the GBR technique using a 2-layer composite graft with locally harvested autologous bone chips and a low-substitution bone filler, application of a double-layer collagen membrane, and a tension-free primary wound closure. Following 8 weeks of healing, the implant site is reopened with a punch technique, and the implant can be restored with a screw-retained single crown. The rationale for this surgical approach is presented including inclusion criteria, surgical procedures, case reports and long-term documentation.
Schlagwörter: Implant placement post extraction, immediate implant placement, early implant placement, late implant placement, GBR technique, contour augmentation, 2-layer composite graft
International Journal of Periodontics & Restorative Dentistry, 4/2018
DOI: 10.11607/prd.3700, PubMed-ID: 29889921Seiten: 575-582, Sprache: Englisch
The purpose of this case series was to assess safety and feasibility of a novel resorbable collagen matrix (CMX) to enhance tissue thickness simultaneous with implant placement and guided bone regeneration (GBR) in esthetic sites over an 8-week healing period. Soft tissue thickness at implant sites and adjacent teeth was monitored with an ultrasonic device. Overall tissue contour changes were assessed by sequential digital surface model superimpositions. Periodontal parameters and patient-related outcomes revealed no significant changes. Combining a novel CMX and GBR revealed a significant soft tissue thickness increase of 1.56 mm at implant sites after 8 weeks, with no significant decrease between 4 and 8 weeks. The overall tissue contour increase was most significant at a distance of 5 mm from the mucosal margin, corresponding to a tissue increase at the implant shoulder area. No effect was observed at adjacent teeth after 8 weeks.
Forum Implantologicum, 2/2018
Seiten: 99, Sprache: Englisch