Protected: Correct implant position in the edentulous mandible

9 Apr 2018

LM Implant Misura MR instruments help positioning the first spiral drill at a correct distance from the pillar i.e. implant or natural element adjacent to the implant and respecting the bone biology.

This results in correct amount of bone between the implant and the tooth or betwheen two adjacent implants, so that the interproximal bone crest could remain stable over time. If the bone crest will remain stable, also the papilla will be consequently correct for dimension and shape, improving or maintaining the physiologic and esthetic aspects of the clinical case. Once the biology is respected and the case is spaced correctly, a long lasting esthetic result will be established.

The instruments are available in different diameters, and every instrument corresponds to an implant diameter size. The instruments are color-coded and each instrument has a larger tip for insertion of adjacent implants
and a smaller tip for spacing an implant from a natural element. Markings on the tip facilitate checking bucco-lingual bone thickness, in order to easily control if at least 2,0 mm of bone crest will remain outside to the implant border.

Choose the right instrument size based on the implant diameter.

Implant Misura MR brochure

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Fig. 1

LM Implant Misura MR 3.0-5.0 product code LM 400-401 ES

Fig. 2

LM Implant Misura MR 3.1-5.3 product code LM 402-403 ES

Fig. 3

LM Implant Misura MR 3.3-5.6 product code LM 404-405 ES

Fig. 4

LM Implant Misura MR 3.4-5.8 product code LM 406-407 ES

Fig. 5

LM Implant Misura MR 3.7-6.3 product code LM 408-409 ES

Fig. 6
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Fig. 11

The teeth were extracted easily, thanks to the severe periodontal reabsorption around them.

Fig. 12

Once raised a flap, the bone crest showed a minimum presence of the residual alveolar sockets, and a knive edge profile, that make it difficult to manage the surgery, and to insert the implants with a proper amount of bone around them.

Fig. 13

To allow a correct implant insertion, the bone profile has been regularized and flattened by the use of a big rounded bar mounted on a straight hand- peace. Now, the bone thickness is large enough to host some implants with a correct amount of bone around them.

Fig. 14

In order to utilize in the best way all the available space, the first osteotomy is done as close as possible to the mental foramen in the both side of the mandible. Remembering to not damage the anterior loop of the nerve whenever it would be present.

Fig. 15

Once executed the first osteotomy with the first drill, a pin with same diameter of the drill is inserted inside the osteotomy, and then the large tip of the Implant Misura Space Bar is placed in tigth contact with it and the drill. Now, the Maintenance 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. It is possible to start drilling aware that 3,00 mm of bone crest will remain betwheen the two implants, and that this crest will have all the possibility to remain stable and healthy over time. Logically, the implant diameter and consequently the dedicated instrument must be choosen before starting with the second osteotomy.

Fig. 16

The distal implants are correctly spaced betwheen them, so much so that it is possible to utilize the remaining central space as we prefer to optimize the implant insertion, the bone physiology, and the prosthetic result.

Fig. 17

The day after the surgery a hybrid prostheses was delivered to the patient, giving him the possibility to immediately have a normal social live, and a good comfort.

Fig. 18

The final X-ray at 1-year post-op shows the nice implant insertion with a stable and correct amount of bone between all of them.

 

Conclusions

Full arch immediate load is well documented in the literature, and the success results are very interesting. Many factors compete to obtain these results. Among these it is really important to place the implants at a correct distance between them to preserve and maintain the inter proximal bone crest as well as it would be possible. Maintenance 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.

Bibliography

  1. Saadoun AP, LeGall M, Touati B: “Selection and ideal tridimensional implant position for soft tissue aesthetics.” Pract Periodont Aesthet Dent 1999;11(9):1063-107

  2. Salama H, Salama M, Garber D, Adar P: “The interproximal height of bone: a guidepost to predictable aesthetic strategies and soft tissue contours in anterior tooth replacement.” Pract Periodont Aesthet Dent 1998;10(9):1131-1141

  3. Tarnow DP, Cho SC, Wallace SS : « The effect of inter-implant distance on the height of inter-implant bone crest » J Periodontol 2000;71:546-549

  4. Cardarapoli G, Wennstr Öm JL, Lekholm U: “Peri-implant bone alterations in relation to inter-unit distances. A 3 year retrospective study.” Clin Oral Impl Res 2003;14:430-436

  5. Grunder U, Gracis S, Capelli M: “Influence of the 3-D bone-to- implant relationship on esthetics.” Int J Periodont Rest Dent 2005;25(2):113-9

  6. Schnitman P, Wohrle PS, Rubenstein JE, Da silva JD, Wang NH: Ten years results for Brånemark implants immediately loaded with fixed prostheses at implant placement. INT J ORAL MAXILLOFAC IMPLANTS 12:495, 1997.