Oral implantology :: Original multitape - implant concept

I have been involved in dental implantology for 42 years. I have specialized in a number of Western European countries such as Italy, France, Switzerland and Germany, as well as in the USA and Israel. In the meantime, I protected a patent for a subperiosteal implant and wrote a book summarizing this experience. Drawing from both the foreign experience in this dental medical discipline and my own, I came to understand that a universal implant system does not exist, ie. only in very rare cases, where the available bone in the patient is sufficient and of good quality, can you manage the case with a single implant system.

Daily practice is full of a great variety of anatomical and physiological features even in a single patient in different parts of his jaw, which is a prerequisite for the implantologist to have at least 3 implant systems, one of which the subperiosteal, in order to be able to combine with them to rehabilitate this patient. The alternative is complex augmentative surgical techniques such as sinus lifting, bone auto grafting, guided tissue regeneration or surgical techniques such as bone distraction, nerve transposition, etc., which are expensive, slow, and not guaranteed to be successful.

Considering all this, I came to understand the approach in such cases, which I called "multi-type - implant concept", which means using at least 3 implant systems, one of which is subperiosteal. I also call this concept "as much as where", ie. I create as many fixed prosthetic supports as I need and wherever I need them. In practice, this is achieved with at least 3 implant systems, one of which is subperiosteal.

The concept does not conflict with the possibility, if necessary, of making bone grafting in certain sections of the jaw with a view to placing a particular type of implant, which, in this case, would be in the interest of the patient, as well as the possibility of certain anatomophysiological peculiarities, that the case should be treated with one type of implants.

Considering the above, let us return to the concept "as much as where". It is clear that we are not always able to place as many implants as we need and where we need them, using one implantation method, having one implant system, or having several but similar in type. There is a need to use several implantation methods and the availability of several types of implant systems in order to be able to carry out the concept and to improvise in case of accident in practice but ultimately to finish the treat of the patient.

Класификация на Kenedy за дефектите на зъбните редици



Types and degrees of atrophy of the alveolar bone of the mandible. According to these types and grades, which are determined by the scanner, the planning and placement of one or the other type of implants is undertaken, or the bone grafting method is chosen to create the conditions for this.

 

Classification of Lekholm and Zarb of bone types according to bone density.
• Type 1 (D1) - compact homogeneous bone with almost complete absence of spongous substance. The entire bone is a compact plate.
• Type 2 (D2) - cortical plate 2 mm thick. and dense spongiosis.
• Тype 3 (D3) - 1 mm thick cortical plate. and medium density spongiosis.
• Type 4 (D4) - cortical plate less than 1 mm thick. and low-density spongiosis.

As it becomes clear, implant treatment planning we make according to the Kenedy classification and the Lekholm and Zarb classification, drawing on the amount and quality of bone from the scanner.
Initially, when there were no scanners, we used a primitive but clever way (see the pictures below).
 



1 = We make a jaw print. Then on a model of gypsum, we cut a segment in which we will implant.
2 - The resulting segment
3 - In the mouth of the patient with a dental probe and a rubber stopper from an endodontic file we prick the mucosa every 2 mm. and plot the result on that segment, marking points that we then connect. We obtained the height, thickness and configuration of the bone.
4 - On this picture we take into account the length and thickness of the implant that we will put.
Subsequently, the manufacturing companies offered transparent celluloid plates with isometric X-ray images, which we directly impose on the x-ray photos and automatically received the required size of the future implant.
Here...

Most often, the magnification of the X-ray image is 1.25


Modern computer tomographs / scanners / give a three-dimensional image of incisions of the jaw every 2 mm, which greatly facilitates the work of the implantologist.


Some do it directly with the software.

 Implant treatment planning, as well as its practical implementation, is not an easy task.  It have to do only trained specialists.
The diverse design of dental implants is the result of many years of empirical and scientific research. There are currently 4 types of dental implant forms / see introductory article / In order to satisfy the concept of "as much as where" the implantologists must know at least 3 of them in order to be able to improvise in the clinic. Otherwise, he or she must can do complex bone plastic surgery to deal with a single implant system in a given clinical case.
I will illustrate „The concept“ with tracking a clinical case.


This is how looks the jaw scanner, of a 45-year-old woman, ballet dancer, a passionate smoker.

I had her treatment 11 years ago when she was 34. In the Dentistry faculty, the professors offered partial dentures.
She categorically did not want to wear removable prostheses and it was only natural that implant treatment would be required.



The scaner slices shown show a very thin alveolar bone where, after cutting the sharp tips, I put MTI implants whose diameter was 1.8 mm could be inserted.
In the area of section No. 18, sections No. 35 and 39 corresponding to 36.37 and 46 teeth, respectively, I placed implants T.B.R.

Orthopantomography after implantation. The upper jaw is orthopedically completed and the lower jaw is a temporary bridge. In the area of 26-st tooth I put a subperiosteal implant.
Here are the stages of orthopedic treatment with metal ceramics.
 




Bridge of metal ceramics in "disassembled" form. In principle, entire arcs we cast into parts. After that we solder the parts. My idea is to use  "Ancora" joints and then glue the individual parts with ionomer cement.
 


The bridge in an assembled look - different view. After about 4 years, the patient lost 14.15 and 17 teeth.

The "Adapta" Bridge, with its heavy accumulation of nicotine deposits and tartar. I put out theese teeth. After the extraction and waiting for about 3 months, I placed in this section a 2-head SPI. Then I prosthetically restored  the upper jaw with a metal ceramic bridge.


This is what orthopantomography looks like after implantation. The lower jaw has long been prosthesis with the metal ceramic bridge we showed above.

This is what the metal ceramic bridge looks like in the patient's mouth.


This is what the treatment looks like in its final form

 I took the photos from my lectures for the training courses, which I led, and from my book "Subperiosteal implants ..."

Contact pfhristov@yahoo.comfor more details
 

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