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Samdar Sami Abdulkareem
Freelancer in Erbil (Kurdistan, Iraq)
Full-arch rehabilitation with monophasic post-extraction implants with immediate loading
CLINICAL CASE - NSI DENTAL ACADEMY
Samdar Sami Abdulkareem
AIM OF THE WORK
In this case, we wanted to highlight the need and the numerous advantages in carrying out a complete rehabilitation of the upper arch in edentulous and post-extraction sites, taking advantage of the unique peculiarities of monophasic implants, particularly suitable for immediate loading.
In the rehabilitation of partially and totally edentulous patients, the use of monophasic implants is today increasingly indicated, given their ease of use and effectiveness. These implants allow an easy achievement of the ideal primary stability for immediate loading in an atraumatic and minimally invasive way. The goal is to obtain maximum implant stabilization through bicorticalism, avoiding invasive and painful surgical practices. This objective is achieved simply using a single drill, a unique feature of “basal” and “compression” implants.
The one-stage implants of various shapes, diameters, and dimensions have characteristics allowing the achievement of primary stability in the medulla, thanks to their particular self-threading, which determines an important self-condensation of the cancellous bone, compacting it and simultaneously cutting it without ischemic it.
In addition, the intrinsic activity of the one-stage implant coils creates and maintains an internal blood supply of the site both during the crossing of the spongiform and whether it is to incise and thread lateral cortical during the achievement of bicorticalism.
Thanks to these unique characteristics, the monophasic implant, also defined as “emergent”, is a reliable solution with practically guaranteed long-term and immediate success rates.
The literature from the 1960s to today has amply documented that the insertion of “monobloc” implants in post-extraction sites, both immediate and not, guarantees success rates between 90 and 100%. In these cases, moreover, high aesthetic results can be obtained, as the positioning of the implant takes place without incisions, using the same site of the avulsion; however, the simultaneous creation of a new path in “new bone” is essential.
Often the search for ideal conditions of “healthy bone” for a good load can involve particular inclinations of the monolithic fixture, which can subsequently be corrected simply by bending the abutment or preparing it as a typical element but using tungsten burs. Therefore, achieving maximum primary stability is very important, having as a priority, where possible, the engagement of a lateral or apical cortical structure that guarantees the immediate discharge of the masticatory forces and the subsequent guarantee of success of the case.
These actions, facilitated and easily obtainable thanks to the implant’s particular shapes and spiral profiles, give the possibility in a simple, safe, and intuitive way to obtain maximum primary stability, an essential basis for immediate successful loading.
By applying these principles and these characteristics, we obtain incredibly intimate contact between the bone and the implant, which will immediately favor the osseointegration process, effectively eliminating possible micro-movements of the implant that could compromise its immediate and long-term success. Particular attention must be paid immediately and subsequently to balancing the provisional and the definitive, particularly on the projection of the masticatory and occlusal loads and related individual functional releases, precisely to avoid destabilizing micro-traumas that could lead to non-integration.
The use of monophasic truncated conical implants with machined surfaces called “basal”, or conical ones with sandblasted and etched surfaces called “compressive” allow to reach excellent values of primary stability in the different bone classifications, stemming possible high peri-implantitis, thanks also to the predisposition tissue healing of the cervical area, also given the absence of prosthetic components and micro gaps.
The “emerging” neck profile has always been safe and easy to keep sanitized by the patient, who manages to maintain excellent aesthetic results over time, in the complete absence of peri-implantitis even in cases where patients are less attentive to oral hygiene.
The case treated concerns a 63-year-old diabetic male patient with significant periodontal disease, who came to our observation to solve partial edentulism and a substantial aesthetic-functional deficit.
Clinical examination reveals a lack of 12-21 and 16-17, compromised elements, and significant mobility (fig. 1). On radiographic examination (fig. 2), apical resentments and poor bone quality are revealed; good basal bone availability is appreciated. Therefore, it was decided together with the patient to perform an immediate post-extraction implant treatment of all elements, plus add four implants in the posterior area.
The operation involved the atraumatic extraction of practically all the elements because periodontal disease and widely compromised. Consequently, before using drills and implant insertion, a general cleaning was carried out by applying local washes with topical antibiotics. Once a “clean” operating field was created, a minimally invasive site was created in the front group with a single lance drill with a diameter of 2 mm, with a cutting profile up to 29 mm.
The goal was to probe the bone quality by searching for those 13/15 mm and the relative cortex to anchor the apex and compact the medulla with the tapping part of the implant.
Given the excellent response and bone quality, we proceeded with the insertion of the NSI basal implants with a machined surface with a diameter of 3.6 and a length of 23-26 mm (fig. 3), creating a bicorticalism by orienting the entrance of the drill slightly inclined vestibule-palatal.
The implant has a progressive wide pitch spiral, with a conical core in the first part to become cylindrical for the remaining 8/9 mm of the 23-26 total. In the posterior parts of the arch in the tuber area, it was preferred to proceed with the insertion of 2 + 2 Maxifix Compressive implants diameter 3.7×10 and diameter 3.7×12, always using the same drill and always maintaining an inclination that aimed to seek space and stability. This was necessary given the low density of the upper bone, about D3, but by exploiting the particular self-threading of the Maxifix Compressive implants, it was possible to obtain remarkable primary stability around 50/60 Ncm.
In the same session, an impression was taken with the particular NSI disposable prosthetic kit, making it possible to immediately apply a provisional, made in pre-shaping and immediately relined on standard caps of the NSI disposable sterile prosthetic kit.
Once the margins of the resin artifact have been perfectly finished, we proceeded carefully to immediately take the impression for the definitive future, to then balance the chewing of the provisional by eliminating the contacts in occlusion with the antagonist teeth.
Following a healing period of ten days, in which the soft tissue healing process was completed (fig. 4), the temporary prosthetic elements with a definitive metal-ceramic arch were replaced. In the one-month check-up, the excellent healing and maturation of the soft tissues and the general stability of the arch can be appreciated.