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Articles of Interest
Here are a selection of articles written by Dr M K
Vasant, which were published in professional dental journals.
THE
ITALIAN-SWISS MATCH
AESTHETIC IMPLANT PLACEMENT AT EASTMAN DENTAL
HOSPITAL
Prof D Buser of University of Berne, Switzerland
and
Prof M Tonetti of Eastman Dental Institute,
London
Dentistry 21 March 2002 |
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by Dr M
K Vasant MBE
MGDS RCS (Eng), MGDS RCS (Edin), FFGDP (UK),
FDS RCS (Edin)
Despite having spent a week at the University
of Berne some six weeks earlier, I could not
resist an opportunity to hear two world-class
speakers. Travelling to central London on
a Saturday morning is a much more pleasant
experience not to mention more relaxed and
readily available parking slots. No wonder
the main lecture room at the Eastman Dental
Institute was filled to the capacity. |
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| Prof Buser gave the history of implantology
and highlighted in particular the efforts of the
International Team for Oral Implantology (ITI) who
have collaborated with Straumann over the years
to continue to refine the implant systems and the
aesthetics in particular. The ITI group consists
of not only dentists, oral and maxillo-facial surgeons,
prosthodontists, periodontists, anatomists and histologists,
but also, constructors, metallurgists, dental technicians
and other experts. Some years ago, this innovative
team had introduced to the profession the unique
non-submerged ITI dental implant system. This concept
of a one-stage implant, so seemingly at odds with
the convention in the 70s led by the Branemark group,
is now becoming the standard for the new implant
designs. |
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| Prof
Tonetti and Prof Buser |
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The aim today was to recap on various techniques in differing
situations such as, aspects of bone augmentation, handling
of atrophied maxillae, osteotome technique for sinus lift
procedures and to give the attendees a glimpse of things
to come.
With most systems available today, with due care and attention,
osseointegration is to be taken granted in virtually all
cases. Machined surface, on which the earlier systems
were based, was improvised by the ITI with a Titanium
Plasma Spray (TPS) surface. Over the years, this has served
us very well and is still available today. The issue still
remained to reduce the healing times and facilitate early
or immediate loading. There is ample literature to support
that a roughened surface achieves both these. This basis
of evolution of the new Sand blasted, Large grit, Acid-etched
(SLA) surface. It has been suggested that the osteoblasts
cannot resist the smell of titanium and are lured to surface
in small groups. Rumour has it that the SLA surface sends
them in absolute frenzy! Clinically this means that in
many cases healing times can be reduced to six weeks.
| Prof
Buser posing for question |
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Evidence is also emerging that, unlike
the commonly held belief in some quarters, that
the loss of crestal bone up to the first thread,
is not an inevitable outcome. The loss of bone seems
to be related to greater bacterial load where there
is a microgap present under the gingivae- a feature
of some implant systems. The seamless tulip design
of the ITI system seems to prevent this problem. |
Prof Buser went on to show how the (relatively) new plus
system improves the aesthetics in anterior sites. He also
warned against deep placement of implants, which will
have negative effect not only on periodontal health but
also on crown root ratio. Ideally, the level of the implant
shoulder should be 2mm below the level of the adjacent
CEJ. Where the bone height does not allow this possibility,
it is prudent to augment the bone with or without the
use of a collagen membrane (Biogide Gieslich) depending
on the clinical situation.
| Discussions
continued in the refectory |
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Many bone augmentation techniques have been introduced
to reduce the morbidity in patients. The techniques involve
the nasal spine, maxillary tuberosity, chin and other
intra-oral sites as donor areas. To complement the bone
augmentation, there is a range plastic surgery procedures
to ensure that the ideal gingival architecture, volume
and aesthetics is attained. In this context, he pointed
out that to bulk the tissues up (where necessary), small
connective tissue grafts are simple to carry out with
low morbidity and have a very high success rate.
He then went on to describe the lateral window technique
for sinus lift procedures (Summers technique). In his
opinion this is still the most controlled and reliable
technique. However, recently many new instruments have
been introduced. These include the standardised osteotomes
to match implant sizes in order to enable one to carry
out sinus lifts from within the osteotomy sites. In selected
cases, these new gadgets bring this sort of procedure
within the reach of an average implantologist. In many
cases this will also obviate the need for a more invasive
technique and obviously reduce morbidity. He reminded
us that you need about 5 mm of bone to get primary stability
if osteotome technique was used.
One of the problems that is common to all the systems
in use today is the compromised cervical contour which
is circular as opposed to scalloped cervical contour of
a natural tooth. For the manufacturers, technically, this
issue has not been an easy one to solve. To the best of
my knowledge, to date this issue has not yet been addressed.
Thankfully, ITI seem to have come up with an answer. There
is now for the very first time, a scalloped implant which
is being tested at the University of Berne. The latter
mimics the natural tooth form in every way. Whether or
not this will address lack of interdental papillae on
adjacent multiple implants remains to be seen. The latter
problem has also eluded all implant systems thus far.
To add further refinement to the system and enhance the
aesthetics of the supra structure, ITI Straumann have
also brought out an Inceram coping. This is the ultimate
in aesthetics and welcome addition for the prosthodontists.
Prof Tonetti who was Prof Buser’s contemporary at
Harvard spoke on the new partnership between local practitioners
and the Eastman, which is to be announced in due course.
This will give an opportunity to local practitioners to
participate in the treatment of their implant patients
at the Eastman Dental Institute. This will be based on
a similar system that has proven successful in Switzerland.
These are exciting times for dentists. Watch the space!
We acknowledge our thanks to Ian Braby and Seema Sharma
of Straumann and the Eastman Dental Institute for giving
so many of us an opportunity to listen to speakers of
this calibre.
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