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

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.

Prof Tonetti and Prof Buser

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.

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

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

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

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