LM Implant Misura MR – Easy implant positioning in the edentulous mandible

13 Jun 2018 - 5376

LM Implant Misura MR instruments help position the first spiral drill at a correct distance from the pillar i.e. implant or natural element adjacent to the implant and respect the bone healing process.

This results in correct amount of bone between the implant and the tooth or between two adjacent implants, so that the interproximal bone crest could remain stable over time. If the bone ridge 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 mm of bone ridge will remain outside 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, due to the severe periodontal reabsorption around them.

Fig. 12

Once raised a flap, the bone ridge showed a minimum presence of the residual alveolar sockets, and a knife edged 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 bur mounted on a straight hand-piece. Now, the bone thickness is large enough to host some implants with a correct amount of bone around them.

Fig. 14

In order to better exploit all the available space, the first osteotomy is done as close as possible to the mental foramen on both sides of the mandible. Remembering not to damage the anterior loop of the nerve, as it sometimes is there.

Fig. 15

Once the first osteotomy is carried out 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 tight contact with it and the drill. Now, maintenance of a bony support around implants is of great importance for the outcome of an implant treatment.

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.

It is possible to start drilling aware that 3 mm of bone crest will remain between the two implants, and that this ridge will have all the possibility to remain stable and healthy over time. Logically, the implant diameter and consequently the dedicated instrument must be chosen before starting with the second osteotomy.

Fig. 16

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

Fig. 17

The day after the surgery, a hybrid prosthesis was delivered to the patient, giving him the possibility to immediately have a normal social life, 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 each other in order to preserve and maintain the inter proximal bone ridge as well as it would be possible.

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).

Thus, having a simple instrument available, that is able to do so without the use of  complicated 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.