EDI - European Association of Dental Implantologists

32
EDI
EDI News
Immediate loading
vs. time-efficient treatment
Competition increased as other manufacturers
emerged. Much was made of the effectiveness of different
surface types in the ensuing campaigns. These
were designed to reach not only the dentists responsible
for treatment decisions, but marketing efforts were
also targeted directly at the patients. Today, the controversy
has largely abated. Surfaces treated by sandblasting
and high-temperature etching have become
something of a standard. Their use can be considered
the state of the art in the quest for osseointegration.
Any newly developed surfaces will have to stand the
test of time, which is not going to be easy given the
very high success rates already on record.
Competing manufacturers, but also implantologists,
have instead embarked on a race for shorter
healing periods and ways of offering patients the
benefits of immediate restoration. Extensive debates
about these issues are a relatively new phenomenon,
having started only five to seven years ago. Once
again, however, they are based on the efforts and
experience of dentists such as Dr Ledermann, who successfully
used a bar design for the immediate restoration
of implants 30 years ago. Some of the original
techniques have fallen into oblivion, either because
the system components available at the time would
not allow the spectrum of indications to be increased
or because the available implants did not have the
properties required for immediate restoration.
Furthermore, any expectations of immediately
restoring all implants have turned out to be over -
enthusiastic and are clearly being reconsidered today.
Reduced healing periods of six to eight weeks often do
not justify the extra effort that is required for immediate
restoration. Even temporary restorations can offer
good patient comfort today. Current scientific evidence
on the subject was summarized at the 1 st European
Consensus Conference of the BDIZ EDI in 2006.
Challenges in the maxillary
posterior segment
Continuous progress has been made over the past
25 years with regard to treatment options. The first
implants were placed in the maxillary anterior segment
(using the Tübingen implants for immediate
placement) or to support a bar in the mandible
(using titanium implants). These original indications
were followed by maxillary restorations supported by
implants, whose insertion was guided by the principle
of utilizing existing bone. Prosthetic handling
became extremely difficult when implants were
inserted in the tuberosity region. Some fellow den-
TPS-coated IMZ implant afflicted with peri-implantitis. A large bone defect is present
on the lingual aspect.
Polarized-light micrograph of an
osseointegrated implant. Note the
structure of collagen fibers.
Tübingen implant replacing tooth 12.
The radiograph was obtained three
years after prosthetic restoration.
tists lost faith in their manual skills. As augmentation
procedures became established, the era when only
the available bone was utilized gave way to a new era
of bone enhancement for implant placement.
Especially in the maxillary posterior region, sinus
floor elevation and augmentation have become an
established procedure recognized by the scientific community.
Surgical access is established by lateral fenestration
and elevation of the Schneiderian membrane.
Most authors have used essentially the same approach.
However, very different materials have been used for
sinus filling. Ancillary measures to support wound heal-