INFRA CANAL BASAL IMPLANT (BOI) PLACEMENT ( Below Inferior Alveolar Nerve )

Placement of CRESTAL Implants in the atropied distal mandible is difficult.
Few procedures for enlarging the bone volume increase the risks of the overall treatment and they reduce therby the predictability and the acceptance.. Cases of severe atropy in distal mandible cannot be solved by using crestal Implants with a reasonable chances of success.
                      So, treating the atropied mandible through use of BASAL IMPLANTS are available.They require special techniques which are briefly discussed here with clinical photos which was done by us.

When the vertical bone height is 3-4mm above the mandibular nerve canal, there is indication for placement of INFRA CANAL BASAL IMPLANT (BOI) PLACEMENT.
 It is the done by placing the Base Plates below the Mandibular Nerve.

INDICATIONS: 

• Severe atropy, when the mandible has a vertically reduced bone height of 3 - 4 mm above the Inferior alveolar nerve where crestal implants are not applicable.

• Patient not willing for removable conventional dentures and wanting for fixed teeth replacement.

TECHNIQUE:

•  The full thickness flap is prepared on centre of the alveolar crest. 
• The most distal implant must be placed in the area of 2nd molar.
• First osteotomy with a hard metal cutter( horizontal cutter) at sufficient speed is made. This cut should reach the bundle of nerve and vessels.
• The more distal the implant position is chosen, the more likelly the nerve located favourably.
• The second osteotomy is done vertically from the vestibular side. The vertical cutter 1.6mm diameter or 1.9mmd is used
• This cut almost reaches the area of mandibular nerve: the safety distance can only be 1mm or less.
• Typical Implant for this procedure are basal implants with a base plate diameter of 9mm or 10 mm or Implants with two base plates of 7-10 mm each.
• It is necessary to choose implants with a long vertical part, as vertical bone growth along the implant must be expected.

The slots created for osteotomy will heal quickly and in some cases new woven bone generation inside the mandible will occur.

ADVANTAGES: 

• Patient acceptance to go in for fixed teeth replacement rather than the conventional prosthesis.
• Can be immediately loaded with prosthesis.
• Safe and effective.
• Design is simple, single piece Implant.
• Maintainence is simple. 
• Due to thin and polished nature of the vertical implant parts, no peri implant infections can possibly develop.
• No need for bone transplant or augmentation procedures.
• Bone remains in its original shape and height. 
• No need to localize or dislocate the nerve.

                                              CASE PRESENTATION: 1

                                                           DURING OSTEOTOMY

                                 

                                           DURING BOI IMPLANT PLACEMENT

                                            CASE PRESENTATION - 2 

                                                                      PRE OP OPG

POST OP OPG

                                                            FOR FURTHER DETAILS:
                                                                         VISIT US AT:                                            

                                 http://www.drmurugavel.in/                                                                                           
                                                 http://www.acdeimplants.org/

CORTICALIZATION WITH KOS IMPLANTS

Compression screw Implants (KOS)  are not considered to be Basal Implants. 

In conical Implants high insertion torques concentrate on the flat or rounded  apex area, whereas pressure distributes evenly over the whole vertical Implant area in conical implants and not in the apex of the Implants.

This pressure distribution is EFFECTIVE.

Furthermore spongeous bone becomes condensed whenever compression screw implants are inserted.

The process of condensing is described as CORTICALIZATION.

During this corticalization, the flow through the osteons is cut off, osteons are destroyed and compressed and they can no longer be the source of osteonal remodelling but only the target of osteons travelling from unaffected bone areas.

Since this takes more time( depending on the distance from the point of the initiation of a secondary osteon to the Implant surface), the time-span for carrying out prosthetical work on KOS Implants is increased.

Nevrthless, Immediate splinting( and therby loading) is still the safest way of handling KOS and BCS Implants.

DIFFERENCE BETWEEN SINGLE PIECE IMPLANTS & TWO PIECE IMPLANTS

SINGLE PIECE IMPLANT	TWO PIECE IMPLANT
·         Implant and abutment are fused. They are manufactured as one piece.	·         Implant and abutment are separate. The abutment is either cemented or cold welded. If abutment is secured with a screw onto the implant, then it is considered to be 3 piece.
·         Design is simple, no joints, single piece.	·         Design is complex, 2 parts joint by screw.
·         Single sitting surgical procedure and very often flapless (no open surgical procedure). Implant procedures are less time consuming than that required for bridgework.	·         Very often more complex surgical procedures are necessary, spread over 2 or 3 sittings in a period of 3-6 months. ( Implant placement, healing screw placement and abutment placement.
·         A wide range of sizes and designs are available. Suits various bone types and measurements. The design even help to avoid bone augmentation and sinus lifts.	·         Limited size and designs are available thereby limiting their application.
·         Immediate Loading- ie; patient can be given crowns / bridges the very next day.	·         Delayed loading- very often a waiting period of minimum 3 months is necessary after loading the implant with prosthesis.
·         Much cost effective when compared with 2 or 3 piece implants.	·         Expensive with respective to cost of implants as well as time taken for treatment procedures.
·         From patient point of view, less complex treatment procedure, less number of sittings, crowns / bridges can be cemented on a day or two.	·         From patient point of view, more number of sittings, Crowns/ bridges cemented only after 3 months after healing phase. Expensive.
·         There is no screw loosening since there is no separate abutment-screw-implant assembly.	·         Screw loosening is very common. Being 2 piece, the relation between root portions and abutment can present many problems.
·         Maintenance is very simple. Being 1 piece, strength provided by implant is excellent and there is no separate root portion and abutment portion.	·         Maintenance is more complex. Very often screw has to be tightened at periodic intervals as there will be micro movement between implant and abutment.

FLAPLESS DENTAL IMPLANT PLACEMENT IN INDIA

Flapless Implant Placement is the Placement of Implants into the bone without soft tissue flap reflection.

ADVANTAGES OF FLAPLESS IMPLANT PLACEMENT: 

                                    When dental Implants are placed by raising the mucoperiosteal flap, there is an associated boneloss at the site.  Leaving the periosteum intact on buccal and lingual aspects of the ridge maintains a better blood supply to the site, reducing the likelihood of resorption.

Flapless technique may be considered in conjunction with either single stage or Immediate loading.

Many ADVANTAGES for both the patient and the surgeon:

• Minimally Invasive.
• Accelerated post surgical healing.
• Reduced operative time.
• Increased patient comfort and satisfaction.
• Decreased bone resorption.
• Minimized bleeding and no sutures.
• Ridge contour can be preserved.        

Missing right premolar replaced by FLAPLESS IMPLANT PLACEMENT.

                                   For more details: visit us at:
                                             http://www.drmurugavel.in/
                                           http://www.acdeimplants.org/

SCREW LOOSENING AND SCREW FRACTURE

SCREW LOOSENING AND SCREW FRACTURE:

One of the important complication in 2 piece or 3 piece Implants.

Adverse occlusal forces can result in mechanical complications of implants.
While unacceptably high incidences of mechanical failures have been reported for the 2-stage external hex screw type Implant systems.

what is Screw Loosening: 
                                    Due to improper occlusal forces, the screw connecting the Implant and Abutment get loosen. This is screw loosening.

What is Screw Fracture:
                                 After screw loosening, metal fatigue may result in screw facture or fixture fracture and causes loss of Implant.

Causes of Screw Loosening and Screw Fracture:
                      screw-joint stability involves 3 most important factors:

1.Adequate pre-load:
                            Application of correct torque to an Implant screwis translated into a pre-load that holds the components together.
Pre-load is the only force that will resist the patients functional occlusal forces inorder to keep the abutment from separating from the implant.

If the pre-load exceeded by occlusal force, the screw will loosen.

2. Fit of the Mating Implant components:
                          Improper positioning or fixation of the abutment with the Implant.

3.Screw Design:
                    There is an  Anti rotational feature of Implant abutment interface. If there is no precise anti-rotational feature, screw will loosen.  

Management of screw loosening:
              For a 2 piece or a 3 piece Implant :        
                     8 degree Morse taper, 45 degree bevel on the implant shoulder  has minimized the risk of screw loosening.   

Design of standard diameter solid screw ITI implant and material used in its fabrication has minimized fixture fracture.

Use of Single Piece Implant System:

•       Single piece implant being a single component structure has no joints or a connecting screw.
• There is no screw and hence no screw loosening or fracture.
• No crestal bone loss.
• No marginal leakage between the implant components.
• Procedure can be done flapless and can be immediately loaded.
• patient comfort.
• Mimics the natural teeth in its construction.

                                          visit us at:

                                    http://www.acdeimplants.org/