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Weigl toronto 30-05-2012_print-out

  1. 1. Key Factors Affecting the Long-term Success of Short ImplantsPaul Weigl
  2. 2. strategy to get successprocess optimization & implant design Hiroshi Sugimoto Boden Sea Uttwill
  3. 3. Key Factors Affecting the Long-term Success of Short Implants consequence residual therapyindication vertical bone < 10 mm long crowns esthetic: removable denture Ø > 5.0 mm; splintingosseo- primary stability small special threadintegrationprocess loading protocoll delayed loading non functional occlusion high load: bone Ø > 5.0 mm long cantilver splintingosseo- high load: implantintegrationfinished Ø = 3.5 mm fatique of implant Ø > 5.0 mm single molar > 5 years components splinting crown
  4. 4. Key Factors Affecting the Long-term Success of Short Implantsindication vertical bone < 10 mm
  5. 5. Key Factors Affecting the Long-term Success of Short Implantsindication vertical bone < 10 mm
  6. 6. Key Factors Affecting the Long-term Success of Short Implants consequence residual therapyindication vertical bone < 10 mm long crowns esthetic: removable denture
  7. 7. Key Factors Affecting the Long-term Success of Short Implants consequence residual therapyindication vertical bone < 10 mm long crowns esthetic: removable dentureosseo- primary stability smallintegrationprocess shortening
  8. 8. Key Factors Affecting the Long-term Success of Short Implantssurgical protocol: increased use of underdimensional preparation to improve the primary stability
  9. 9. Key Factors Affecting the Long-term Success of Short Implantssurgical protocol:lateral bone condensation
  10. 10. Key Factors Affecting the Long-term Success of Short Implantssurgical protocol:vertical bone condensation
  11. 11. Key Factors Affecting the Long-term Success of Short Implants consequence residual therapyindication vertical bone < 10 mm long crowns esthetic: removable denture Ø > 5.0 mm; splintingosseo- primary stability small special threadintegrationprocess shortening
  12. 12. Key Factors Affecting the Long-term Success of Short Implantsimplant selection Tapered core with progressive threads Ø > 5.0 mm; splinting special thread 1985: 2005: Ankylos NobelActive
  13. 13. Key Factors Affecting the Long-term Success of Short Implants consequence residual therapyindication vertical bone < 10 mm long crowns esthetic: removable denture Ø > 5.0 mm; splintingosseo- primary stability small special threadintegrationprocess
  14. 14. Key Factors Affecting the Long-term Success of Short ImplantsFelice P, Checchi V, Pistilli R, Scarano A, Pellegrino G, Esposito M.Bone augmentation versus 5-mm dental implants in posterior atrophic jaws.Four-month post-loading results from a randomised controlled clinical trial.Eur J Oral Implantol. 2009 Winter;2(4):267-81. L = 5.0 mm Ø = 6.00 mm
  15. 15. Key Factors Affecting the Long-term Success of Short ImplantsEsposito M, Pellegrino G, Pistilli R, Felice P.Rehabilitation of posterior atrophic edentulous jaws: prostheses supported by 5mm short implants or by longer implants in augmented bone? One-year resultsfrom a pilot randomised clinical trial.Eur J Oral Implantol. 2011 Spring;4(1):21-30.Prosthetic procedures:Four months after placement, provisional screw-retained crowns or reinforcedacrylic restorations rigidly joining the implants. (npatient = 30)Four months after delivery of provisional prosthetis , definitive metal-ceramicrestorations rigidly joining the implants. (npatient = 30)Results:There were no statistically significant differences in failures or complications.
  16. 16. Key Factors Affecting the Long-term Success of Short ImplantsEsposito M, Pellegrino G, Pistilli R, Felice P.Rehabilitation of posterior atrophic edentulous jaws: prostheses supported by 5mm short implants or by longer implants in augmented bone? One-year resultsfrom a pilot randomised clinical trial.Eur J Oral Implantol. 2011 Spring;4(1):21-30.The problem is that it may be only half of patients thathave bone widths of at least 8 mm as confirmed by thepresent recruitment data: 27 patients had to beexcluded due to insufficient bone width.
  17. 17. Key Factors Affecting the Long-term Success of Short Implants consequence residual therapyindication vertical bone < 10 mm long crowns esthetic: removable denture Ø > 5.0 mm; splintingosseo- primary stability small special threadintegrationprocess loading protocoll delayed loading
  18. 18. Key Factors Affecting the Long-term Success of Short Implantsneed of high anchoring qualityof the implant bone interface
  19. 19. crestal bone resorption
  20. 20. Cochran DL, Nummikoski PV, Schoolfield JD, Jones AA, Oates TW. A prospective multicenter 5- year radiographic evaluation of crestal bone levels over time in 596 dental implants placed in 192 patients. J Periodontol. 2009bone May;80(5):725-33. source: info-CD of Straumann AG
  21. 21. Cochran DL, Nummikoski PV,Schoolfield JD, Jones AA,Oates TW.A prospective multicenter 5-year radiographic evaluationof crestal bone levels overtime in 596 dental implantsplaced in 192 patients.J Periodontol. 2009May;80(5):725-33.
  22. 22. Astrand P, Ahlqvist J, Gunne J, Nilson H.Implant treatment of patients with edentulous jaws: a 20-year follow-up.Clin Implant Dent Relat Res. 2008 Dec;10(4):207-17. Epub 2008 Apr 1.
  23. 23. reasons for crestal bone loss surgery periimplant soft tissue biomechanics• overheating • immunology • overload• pressure • oral hygiene • un loaded• flap surgery • cement excess • ????• membrane • gap formation• augmentation • ???• re-entry surgery• thin bone lamina• ????
  24. 24. overheating pressure flap surgery membrane thin bone lamina second stage surgery augmentation ???????? immunology oral hygiene unloaded cement excess gap formation overloadone broken chain link = reason forcrestal bone loss
  25. 25. mutifactorial determinants of crestal bone lossc1 c2 c3 c4 c5 c6 c7 c8 c9 c10 c11 c12 c13 c14 c15 c16 c17 c18 c19 c20 c21 c22 c23 c24 c25 c26 c27 c28 c29 c30 c31 c32 c33related to: surgery soft tissue load other issues unknown issues
  26. 26. factors of load distribution at implant-bone interface 1st time-slot: 2nd time-slot:insertion until 3 3 months until 40 month years
  27. 27. factors of load distribution at implant-bone interface 1st time-slot: 2nd time-slot: insertion until 3 3 months until 40 month years Berglundh T, Abrahamsson I, Lang NP, Lindhe J.2 hours after De novo alveolar insertion bone formation adjacent to endosseous implants. A model study in the dog. Clin Oral Impl Res, 14, 2003, 251–262
  28. 28. factors of load distribution at implant-bone interface 1st time-slot: 2nd time-slot:insertion until 3 3 months until 40 month years
  29. 29. load distribution during transmucosal healing period reduced by stepFload Fload solutions: - minimal invasive surgeryair air - minimal invasive prosthetics - platform switching - sealed conical connection titan titan bone bone
  30. 30. Fig. 1. Three dimensional finite element models.Maeda, Yoshinobu, Miura, Jiro,Taki, Ikuro & Sogo, MotofumiBiomechanical analysis onplatform switching: is there anybiomechanical rationale?.Clinical Oral ImplantsResearch 18 (5), 581-584. platform switching
  31. 31. Romanos G. et al.:J Periodontol. 2003; 74(10) 1483-90.
  32. 32. mutifactorial determinants of crestal bone lossc1 c2 c3 c4 c5 c6 c7 c8 c9 c10 c11 c12 c13 c14 c15 c16 c17 c18 c19 c20 c21 c22 c23 c24 c25 c26 c27 c28 c29 c30 c31 c32 c33related to: surgery soft tissue load other issues unknown issues
  33. 33. mutifactorial determinants of crestal bone lossc1 c2 c3 c4 c5 c6 c7 c8 c9 c10 c11 c12 c13 c14 c15 c16 c17 c18 c19 c20 c21 c22 c23 c24 c25 c26 c27 c28 c29 c30 c31 c32 c33related to: to implant system not to implant system unknown issues
  34. 34. Becker J, Ferrari D, Herten M, Kirsch A, Schaer A, Schwarz F.Influence of platform switching on crestal bone changes at non-submergedtitanium implants: a histomorphometrical study in dogs.J Clin Periodontol. 2007 Dec;34(12):1089-96. Epub 2007 Oct 22MATERIAL & METHODS:One-stage insertion of sand-blasted and acid-etched screw-type implants with eithermatching (CAM) or smaller-diameter healing abutments (CPS) were randomly assigned tothe lower jaws of nine beagle dogs. The animals were killed after 7, 14, and 28 days ofnon-submerged healing. Dissected blocks were processed for histomorphometricalanalysis. Measurements were made between the implant shoulder (IS) and:--the apicalextension of the long junctional epithelium (aJE), --themost coronal level of bone in contact with the implant (CLB), and --the level of the alveolarbone crest (BC)
  35. 35. Fig. 1. (a) Platform-switching was created by connecting wide-diameter (5.0 mm) test implants with smaller- diameter healing abutments (4.0 mm), resulting in a circumferential horizontal mismatch of 0.5 mm. In particular, the circumferential plateau revealed an outer bevelled (45°) part of 0.3 mm, and an inner horizontal part of 0.2 mm. (b) Commercially available wide-diameter implants (5.0 mm) with matching wide- body healing abutments served as control. Both types of implants had an identical design, exhibiting a machined-neck size of 0.4 mm.Becker, Jürgen, Ferrari, Daniel, Herten, Monika, Kirsch, Axel, Schaer, Alex & Schwarz, FrankInfluence of platform switching on crestal bone changes at non-submerged titanium implants: a histomorphometrical study in dogs.Journal of Clinical Periodontology 34 (12), 1089-1096.
  36. 36. Fig. 2. (a) Both CPS and CAM implants were inserted in such a way that the implant shoulder (IS) exceededthe alveolar crest for 0.4 mm (ID). Accordingly, in both groups, the machined neck was located at the bonecrest level. Particular care was taken to preserve a residual thickness of the alveolar bone crest of at least 1mm at both buccal and lingual aspects of each implant site. (b) The implants were left to heal in a non-submerged position.Becker, Jürgen, Ferrari, Daniel, Herten, Monika, Kirsch, Axel, Schaer, Alex & Schwarz, FrankInfluence of platform switching on crestal bone changes at non-submerged titanium implants: a histomorphometrical study in dogs.Journal of Clinical Periodontology 34 (12), 1089-1096.
  37. 37. Fig. 3. Representative histological views (Masson Goldner stain) of crestal bone changes at CAM implants(original magnification × 40). The junctional epithelium commonly proliferated along the machinedsupracrestal titanium surface of CAM implants. (a) 7 days (buccal site), (b) 14 days (lingual site), and (c) 28days (buccal site). Landmarks for histomorphometrical analysis: IS, implant shoulder; aJE, the apical extensionof the long junctional epithelium; CLB, the most coronal level of bone in contact with the implant; BC, thelevel of the alveolar bone crest.Becker, Jürgen, Ferrari, Daniel, Herten, Monika, Kirsch, Axel, Schaer, Alex & Schwarz, FrankInfluence of platform switching on crestal bone changes at non-submerged titanium implants: a histomorphometrical study in dogs.Journal of Clinical Periodontology 34 (12), 1089-1096.
  38. 38. Fig. 4. Representative histological views (Masson Goldner stain) of crestal bone changes at CPS implants(original magnification × 40). The circumferential horizontal mismatch of 0.5 mm was able to prevent theapical down-growth of the barrier epithelium over an observation period of 28 days. (a) 7 days (buccal site),(b) 14 days (lingual site), and (c) 28 days (lingual site). Landmarks for histomorphometrical analysis: IS,implant shoulder; aJE, the apical extension of the long junctional epithelium; CLB, the most coronal level ofbone in contact with the implant; BC, the level of the alveolar bone crest.Becker, Jürgen, Ferrari, Daniel, Herten, Monika, Kirsch, Axel, Schaer, Alex & Schwarz, FrankInfluence of platform switching on crestal bone changes at non-submerged titanium implants: a histomorphometrical study in dogs.Journal of Clinical Periodontology 34 (12), 1089-1096.
  39. 39. Becker J, Ferrari D, Herten M, Kirsch A, Schaer A, Schwarz F.Influence of platform switching on crestal bone changes at non-submerged titaniumimplants: a histomorphometrical study in dogs.J Clin Periodontol. 2007 Dec;34(12):1089-96. Epub 2007 Oct 22Results:At 7, 14, and 28 days, the mean IS-aJE values weresignificantly the lowest at CPS implants. However, after 28days of healing, both groups revealed significantlyincreased mean IS-BC values at the buccal aspect of thealveolar bone. The difference in IS-CLB and IS-BCbetween groups was not significant.
  40. 40. overheating pressure flap surgery membrane thin bone lamina second stage surgery augmentation ???????? immunology oral hygiene unloaded cement excess gap formation overloadone broken chain link = reason forcrestal bone loss
  41. 41. High resolution X-ray device: 1 µm Fload0N 50N 100N
  42. 42. Fload clearance fit without connecting screw
  43. 43. Fload clearance fit with connecting screw
  44. 44. Micro-CTload: 0N load: 100N (30°) Zipprich, H; Weigl, P
  45. 45. Amazon river delta
  46. 46. Amazon river delta
  47. 47. High resolution X-ray device: 1 µm 50N
  48. 48. Dynamic load: F0N – 200N - 0N30° to implantaxis Zipprich, H; Weigl, P
  49. 49. free download of x-ray videos:www.kgu.de/zzmk/werkstoffkunde
  50. 50. Zipprich, H; Weigl, P
  51. 51. Zipprich, H; Weigl, P
  52. 52. Zipprich, H; Weigl, P
  53. 53. Zipprich, H; Weigl, P
  54. 54. Zipprich, H; Weigl, P
  55. 55. Zipprich, H; Weigl, P
  56. 56. Zipprich, H; Weigl, P
  57. 57. Influence of the Size of the Microgap on CrestalBone Changes Around Titanium Implants. AHistometric Evaluation of Unloaded Non-Submerged Implants in the Canine Mandible Hermann et. al., 2001 JP A B C D E F gap without micromovement gap with micromovement
  58. 58. gap without micromovementA B C gap with micromovementD E F
  59. 59. force transfer from abutment to implant (virtual one piece implant)
  60. 60. force transfer from abutment to implant (virtual one piece implant)
  61. 61. Zipprich, H; Weigl, P
  62. 62. Zipprich, H; Weigl,
  63. 63. Zipprich, H; Weigl,
  64. 64. Zipprich, H; Weigl,
  65. 65. Zipprich, H; Weigl,
  66. 66. Zipprich, H; Weigl,
  67. 67. Zipprich, H; Weigl,
  68. 68. bacterial seal under cyclic load Miatke, S; Zipprich, H; Weigl, P
  69. 69. bacterial seal under cyclic load System Astra Tech Astra Tech Friadent Friadent ITI ITI Medentis Nobel Osstem Co. Prototyp Osseo Osseo Ankylos Ankylos Straumann Straumann Templant Biocare Ltd. GS II Elliptic speed speed C/X plus Bone Level Tissue ICX Nobel Cone Profile ZirDesign Level Active BiAbutment Standard Plus SolidPrüfkörper Abutment 1 2 3 4 125 5 Miatke, S; Zipprich, H; Weigl, P
  70. 70. mutifactorial determinants of crestal bone lossc1 c2 c3 c4 c5 c6 c7 c8 c9 c10 c11 c12 c13 c14 c15 c16 c17 c18 c19 c20 c21 c22 c23 c24 c25 c26 c27 c28 c29 c30 c31 c32 c33related to: to implant system not to implant system unknown issues
  71. 71. solutions: - minimal invasive surgery - minimal invasive prosthetics - platform switching - sealed conical connectionW. Cohen
  72. 72. lengthImpl = 9.5 mmOwn results: single posterior crowns 158 single crown restorations with Ankylos implant
  73. 73. Key Factors Affecting the Long-term Success of Short Implantsneed of high anchoring qualityof the implant bone interface
  74. 74. factors of load distribution at implant-bone interface 1st time-slot: 2nd time-slot: insertion 12 weeks after insertion until 3 3 months until 40 month years Berglundh T, Abrahamsson I, Lang NP, Lindhe J.2 hours after De novo alveolar insertion bone formation adjacent to endosseous implants. A model study in the dog. Clin Oral Impl Res, 14, 2003, 251–262
  75. 75. factors of load distribution at implant-bone interface 1st time-slot: 2nd time-slot: insertion until 3 3 months until 40 month years Berglundh T, Abrahamsson I, Lang NP, Lindhe J.2 hours after De novo alveolar insertion bone formation adjacent to endosseous implants. A model study in the dog. Clin Oral Impl Res, 14, 2003, 251–262
  76. 76. factors of load distribution at implant-bone interfaceRik Huiskes, Ronald Ruimerman, G. Harry vanLenthe and Jan D. JanssenEffects of mechanical forces on maintenance andadaptation of form in trabecular boneNature 405, 704-706 (2000)Ruimerman R, Hilbers P, van Rietbergen B, HuiskesR.A theoretical framework for strain-relatedtrabecular bone maintenance and adaptation.J Biomech. 2005 Apr; 38(4): 931-41
  77. 77. factors of load distribution at implant-bone interfaceRik Huiskes, Ronald Ruimerman, G. Harry vanLenthe and Jan D. JanssenEffects of mechanical forces on maintenance andadaptation of form in trabecular boneNature 405, 704-706 (2000)Ruimerman R, Hilbers P, van Rietbergen B, HuiskesR.A theoretical framework for strain-relatedtrabecular bone maintenance and adaptation.J Biomech. 2005 Apr; 38(4): 931-41
  78. 78. factors of load distribution at implant-bone interface Akagawa Y, Sato Y, Teixeira ER, Shindoi N, Wadamoto M. A mimic osseointegrated implant model for three-dimensional finite element analysis. J Oral Rehabil 30(1):41-45 (2003).
  79. 79. factors of load distribution at implant-bone interface Fv Fv
  80. 80. factors of load distribution at implant-bone interface von Mises stress distribution around the implant in mimic model (MM) and control model (CM). B: buccal, L: lingual, M: mesial, D: distal.
  81. 81. Key Factors Affecting the Long-term Success of Short ImplantsBerglundh T, Abrahamsson I, Lang NP, Rik Huiskes, Ronald Ruimerman, G. Harry van Lenthe and Jan D.Lindhe J. De novo alveolar bone formation Janssenadjacent to endosseous implants. A model Effects of mechanical forces on maintenance and adaptation of form instudy in the dog. trabecular boneClin Oral Impl Res, 14, 2003, 251–262 Nature 405, 704-706 (2000)
  82. 82. Key Factors Affecting the Long-term Success of Short Implants Fload Fload Implant Implant l = 14.0 mm l = 8.0 mm
  83. 83. Key Factors Affecting the Long-term Success of Short ImplantsGabet Y, Kohavi D, Voide R, Mueller TL, Müller R, Bab I.Endosseous implant anchorage is critically dependent on mechanostructuraldeterminants of peri-implant bone trabeculae.J Bone Miner Res. 2010 Mar;25(3):575-83.
  84. 84. Key Factors Affecting the Long-term Success of Short Implants consequence residual therapyindication vertical bone < 10 mm long crowns esthetic: removable denture Ø > 5.0 mm; splintingosseo- primary stability small special threadintegrationprocess loading protocoll delayed loading non functional occlusion 6 weeks
  85. 85. Key Factors Affecting the Long-term Success of Short ImplantsImplants (total): 406 Upper jaw: 151 Lower jaw: 255Failures: 7 Upper jaw: 2 (1/1/0) Lower jaw: 5 (5/0/0)Successrate: 98,3%
  86. 86. Key Factors Affecting the Long-term Success of Short Implants progressive prospective clinical trial, n= 131 implants, upper jaw bone loading 6 weeks 6 weeks 6 weeks } } } 0 -0,62 -0,76 -0,5periotest values -1,51 second stage surgery second stage surgery -1 -2,02 -1,95 -2,01 -1,5 second stage surgery -2 -2,5 bone type A bone type B bone type C n = 51 n = 77 n=2
  87. 87. Key Factors Affecting the Long-term Success of Short Implants Romanos G. et al.: Bone-implant interface around titanium implants under different loading conditions. J Periodontol. 2003;10, 1483-1490 without withbone loading progressive bone loading
  88. 88. Key Factors Affecting the Long-term Success of Short ImplantsCorrente G, Abundo R, des Ambrois AB, Savio L, Perelli M.;Short porous implants in the posterior maxilla: a 3-year report of a prospectivestudy.Int J Periodontics Restorative Dent. 2009 Feb;29(1):23-9.Single crowns in the posterior maxilla:19 implants: 5 mm length29 implants: 7 mm lengthcumulative survival rate: 97,2 %
  89. 89. Key Factors Affecting the Long-term Success of Short ImplantsTelleman G, Raghoebar GM, Vissink A, den Hartog L, Huddleston Slater JJ,Meijer HJ.A systematic review of the prognosis of short (<10 mm) dental implants placedin the partially edentulous patient.J Clin Periodontol. 2011 Jul;38(7):667-76. Epub 2011 May 12Conclusion:There is fair evidence that short (<10 mm) implants can beplaced successfully in the partially edentulous patient,although with a tendency towards an increasing survivalrate per implant length. (year 1980 - 2009)
  90. 90. Key Factors Affecting the Long-term Success of Short Implants consequence residual therapyindication vertical bone < 10 mm long crowns esthetic: removable denture Ø > 5.0 mm; splintingosseo- primary stability small special threadintegrationprocess loading protocoll delayed loading non functional occlusion high load: bone long cantilverosseo-integrationfinished
  91. 91. Key Factors Affecting the Long-term Success of Short Implants short implant long cantilever
  92. 92. Key Factors Affecting the Long-term Success of Short Implantsbruxism:long suprastructures not recommended
  93. 93. Key Factors Affecting the Long-term Success of Short Implants consequence residual therapyindication vertical bone < 10 mm long crowns esthetic: removable denture Ø > 5.0 mm; splintingosseo- primary stability small special threadintegrationprocess loading protocoll delayed loading non functional occlusion high load: bone Ø > 5.0 mm long cantilver splintingosseo-integrationfinished sourve: www.bicon.com
  94. 94. Key Factors Affecting the Long-term Success of Short ImplantsEsposito M, Pellegrino G, Pistilli R, Felice P.Rehabilitation of posterior atrophic edentulous jaws: prostheses supported by 5mm short implants or by longer implants in augmented bone? One-year resultsfrom a pilot randomised clinical trial.Eur J Oral Implantol. 2011 Spring;4(1):21-30.Results:Patients with short implants lost on average 1 mmof peri-implant bone and patients with longerimplants lost 1.2 mm. This difference wasstatistically significant.
  95. 95. Key Factors Affecting the Long-term Success of Short Implants consequence residual therapyindication vertical bone < 10 mm long crowns esthetic: removable denture Ø > 5.0 mm; splintingosseo- primary stability small special threadintegrationprocess loading protocoll delayed loading non functional occlusion high load: bone Ø > 5.0 mm long cantilver splintingosseo- high load: implantintegrationfinished fatique of implant components
  96. 96. Key Factors Affecting the Long-term Success of Short ImplantsBlanes RJ.To what extent does the crown-implant ratio affect the survival andcomplications of implant-supported reconstructions? A systematic review.Clin Oral Implants Res. 2009 Sep;20 Suppl 4:67-72.
  97. 97. Key Factors Affecting the Long-term Success of Short Implants consequence residual therapyindication vertical bone < 10 mm long crowns esthetic: removable denture Ø > 5.0 mm; splintingosseo- primary stability small special threadintegrationprocess loading protocoll delayed loading non functional occlusion high load: bone Ø > 5.0 mm long cantilver splintingosseo- high load: implantintegrationfinished fatique of implant Ø > 5.0 mm components splinting
  98. 98. Key Factors Affecting the Long-term Success of Short Implantsown research Zipprich; Ratka; Weigl Ø > 5.0 mm splinting
  99. 99. Key Factors Affecting the Long-term Success of Short Implants Ø > 5.0 mm splinting
  100. 100. Key Factors Affecting the Long-term Success of Short Implants consequence residual therapyindication vertical bone < 10 mm long crowns esthetic: removable denture Ø > 5.0 mm; splintingosseo- primary stability small special threadintegrationprocess loading protocoll delayed loading non functional occlusion high load: bone Ø > 5.0 mm long cantilver splintingosseo- high load: implantintegrationfinished Ø = 3.5 mm fatique of implant Ø > 5.0 mm single molar components splinting crown
  101. 101. Key Factors Affecting the Long-term Success of Short Implantsown research Ø = 3.5 mm single molar crown
  102. 102. Key Factors Affecting the Long-term Success of Short Implantsown research Zipprich; Ratka; Weigl Ø = 3.5 mm single molar crown
  103. 103. inserting an abutment with a morse taper connection
  104. 104. free choice of rotation position of an abutment without an index
  105. 105. pressing of the morse taper into the implant
  106. 106. press fit of the abutment without an index
  107. 107. Key Factors Affecting the Long-term Success of Short Implantshigh mechanicalstrength ofimplant-abutment joint: single pieceimplant long, steepcone connection Ø = 3.5 mm single molar crown
  108. 108. Key Factors Affecting the Long-term Success of Short Implantshigh mechanicalstrength ofimplant-abutment joint: single pieceimplant long, steepcone connection Ø = 3.5 mm single molar crown
  109. 109. Key Factors Affecting the Long-term Success of Short Implantshigh mechanicalstrength ofimplant-abutment joint: single pieceimplant long, steepcone connection Ø = 3.5 mm single molar crown
  110. 110. Key Factors Affecting the Long-term Success of Short Implantshigh mechanicalstrength ofimplant-abutment joint: single pieceimplant short coneconnection Ø = 3.5 mm single molar crown
  111. 111. Key Factors Affecting the Long-term Success of Short Implantsproper conical abutment connection 11° 5.8° 5,8° 15° Wide retaining screw Narrow retaining screw Wide retaining screw Wide retaining screwNo anti-rotational capability Antirotational feature No antirotational capability Index mandatory Index mandatory Index not mandatory Index mandatory very short cone Astra Ankylos Nobel Active Bone Level
  112. 112. Key Factors Affecting the Long-term Success of Short Implants precise adjustment of occlusion Ø = 3.5 mm single molar crown
  113. 113. Key Factors Affecting the Long-term Success of Short Implantsno special prosthetics on short implants Ø = 3.5 mm 5 years single molar crown
  114. 114. Key Factors Affecting the Long-term Success of Short Implants Volls t. Zens iert 1,01Anteil der Vers orgungen ohne Komplik ationen 1,00 0,99 0,98 0,97 0,96 0,95 0,94 0,93 Einz elk rone Einzelkronen 0,92 vverblockte Einzelkronen erbloc k te Einz elk rone vImplantatbrücken erbloc k t mit Implantaten 0,91 vVerbundbrücken erbloc k t mit Zähnen und Implantaten 0,90 0 1 2 3 4 5 6 7 8 9 10 11 12 13 Zeit (J ahre)
  115. 115. Key Factors Affecting the Long-term Success of Short Implantsown research 8 mm n=131 9.5 mm n=364 1 implant loss 4 implant lossesfrequency frequency period of risk (months) period of risk (months)
  116. 116. Key Factors Affecting the Long-term Success of Short Implantsown research 8 mm n=131 9.5 mm n=364bone loss (mm) bone loss (mm) period of risk (years) period of risk (years)
  117. 117. Key Factors Affecting the Long-term Success of Short Implants own research 8 mm n=131bone loss (mm) n.s. implant diameter
  118. 118. Key Factors Affecting the Long-term Success of Short Implantsown research 8 mm n=131 category of crown-implant length ratio:bone loss (mm) 0: 0,95 – 1,05 1: 1,05 – 1,15 2: 1,15 – 1,25 3: 1,25 – 1,35 4: 1,35 - 1,45 5: 1,45 – 1,55 6: 1,55 – 1,65 7: 1,65 – 1,75 8: 1,75 – 1,85 9: 1,85 – 1,95 category of crown-implant length ratio 10: 1,95 - 2,05
  119. 119. Key Factors Affecting the Long-term Success of Short Implants consequence residual therapyindication vertical bone < 10 mm long crowns esthetic: removable denture Ø > 5.0 mm; splintingosseo- primary stability small special threadintegrationprocess loading protocoll delayed loading non functional occlusion high load: bone Ø > 5.0 mm long cantilver splintingosseo- high load: implantintegrationfinished Ø = 3.5 mm fatique of implant Ø > 5.0 mm single molar > 5 years components splinting crown
  120. 120. Key Factors Affecting the Long-term Success of Short ImplantsFazit:After finished oseointerationshort implants can anchor thesame kind of prostheticsuprastructures than conventionallong implants
  121. 121. Thank You for Your Attention

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