Dr. Redemagni is lecturer in the Masters and Postgraduate Program of the University of Naple and Milan. He has a private practice in Lomazzo (CO) and in Milan, Italy. He is particularly interested in periodontology, implant surgery, prosthesis and esthetic dentistry. He is an active member of the European Academy of Esthetic Dentistry and of the European Association for Osseointegration. Member of the Accademia Italiana di Odontoiatria Protesica and the Societŕ Italiana di Osteointegrazione. Founding member and treasurer of the Italian Academy of Esthetic Dentistry.
He has authored some scientific papers and coauthored “Osteointegrazione avanzata” and “Advanced Osseointegration” Ed. RC Libri with Prof. F. Santoro and Prof. C. Maiorana; “Bone augmentation in the aesthetic area with Bio Oss and Bio Gide” Ed. Italiapress with Prof. C. Maiorana et Al. He took part in the realization of “Esthetic rehabilitation in fixed prosthodontics” Vol. 1 e Vol. 2 Ed. Quintessence International Publishing with Dr. M. Fradeani. He is a speaker at several congresses.
Implant Misura Space Bar: A simple instrument to facilitate implant distance control
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In implant surgery, a minimal distance between implants, and between implants and natural teeth, must be maintained, otherwise resorption of the interproximal bony crest with loss of the relative papilla and consequent aesthetic damage could occur.
The Implant Misura Space Bar is an instrument that could aid in the positioning of the first drill during bony drilling, thereby providing for the correct distance to ensure these requisite physiologic distances. Its use ensures a correct distance between two implants or between implants and natural teeth, without difficult calculations and intraoperative measurements using periodontal probes.
In the initial x-ray is clearly visible the periapical radiolucency on teeth 25 and 27. The two teeth has also a high mobility of grade III, so that it was decided to extract them and wait three months prior to position two implants in the same site.
Three monts after the extraction both the hard and the soft tissue are healed, and it is possible to insert the implants. It is well known that it is important to leave at least 1,5 - 2,0 mm beetwen tha root and the implant to avoid interproximal bone crest reabsorption and consequent loss of the papilla. In order to maintain this distance it is important to position the first drill at a correct distance from the root, not to close, and not to far. Because if the distance would be to far, it could occur a prosthetic problem. To calculate this distance with a conventional periodontal probe is really diffucult or impossible. Because it is necessary to maintain the position during drilling and the exact point sometimes is not so easy to be seen. Moreover, the correct distance often is a number with decimals, that made really impossible to stay in the exact position.
The first step is to choose the implant diameter, and then the corrispondent IMSB instrument. The instrument has two sides: one to space apart the implant from the natural root, the other side to space apart two implant beetwen themselves. The instrument must be placed in tight contact with the root, and then it is possible to start drilling being sure to keep the drill in contact with the instrument if 2,0 mm is the desired distance of the implant from the tooth. Or, as in this case, to use the instrument just to be sure to don't stay to close to the root, because the intention was to insert the implant in the same position in which the natural root was.
If the implants are correctly positioned, then the prostheses will appear with a natural look. The papilla beetwen the tooth 24 and the implant in 25 would appears almost natural, so much so that it is almost impossible to distinguish an implant prostheses from a prosthese on antural teeth.
The final x-ray, at one year post-op, demonstrates the correct implants position, and the interproximal bone stability consequent to a correct distance beetwen the implant and the root
ConclusionsMaintenance of a bony support around implants is of great importance for the outcome of implant treatment. Many studies pertaining to changes of the marginal bone level at the implant site have been published and different amounts of bone loss have been described. In addition to a correct three-dimensional implant insertion with a precise site development when necessary, in implant surgery it is important to maintain a minimal distance between implants (at least 3 mm) and between the implant and an adjacent tooth (1.5-2 mm). If this distance is not maintained, the interproximal bone crest could be reabsorbed, with resulting papilla loss, an undesirable aesthetic outcome, and functional damage. It is important to have an instrument capable of positioning the first drill during bone drilling, immediately providing for the correct position in which to place it so as to obtain a correct implant insertion, maintaining all the requisite minimal distances. Thus, to have the option of using a simple instrument that is able to do so without the use of devices to measure the correct position in which to drill the first osteotomy is a distinct advantage.
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