Dental Implant Options in Atrophic Jaws

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1 Dental Implant Options in Atrophic Jaws Orthopedic Application Jay B. Reznick, D.M.D., M.D. Diplomate, American Board of Oral and Maxillofacial Surgery Tarzana, CA Endopore Dental Implant System Screw-Type Dental Implant Developed at the University of Toronto, 1983: Professors Douglas Deporter - Periodontics Robert Pilliar - Biomaterials Philip Watson - Prosthodontics The Endopore Dental Implant Endopore Dental Implant Design Rationale: Reliable implant fixation by 3-D 3 bone ingrowth into a porous surfaced region formed by a sintering process. 1

2 Endopore Dental Implant System Necessary Requirements for Bone Ingrowth Biocompatible materials Pore size > 50µm; µm preferred Atraumatic placement Limited relative movement at implant- tissue interface during healing (<50µm) Research Dental Implant Surface Geometries Currently-Used Designs Only the Branemark System has more long-term, prospective clinical research Feb 2003: 52 Publications Threaded screw: Press-fit cylinder: Stepped cylinder: (press fit) Truncated cone: (press fit) -Machined -Ti plasma-sprayed sprayed -Acid-etched/grit-blasted -Ti plasma-sprayed sprayed -HA plasma-sprayed sprayed -Ti plasma-sprayed sprayed -HA plasma-sprayed sprayed -Sintered porous-surface surface Machined Surface Surface Features: Roughness (1-3 µm) Machining lines (0.1 µm m width) Pits, gouges, transfer particles (nm-µm) m) Plasma-Sprayed Surface Surface Features: Roughness (up to 20µm) Irregular depressions Isolated pores (<10 vol%) Some undercuts Protrusion, sharp asperities 2

3 Acid-etch Surface Surface Features: Roughness (1µm) Etch pits, dimple-like like depression (1µm) Regular pattern/texture Sintered Porous Surface Surface Features: 3-D D interconnected porosity (avg=100µm) 35 vol% porosity Uniform distribution Fine striations (thermal etching-nm) nm) Sinter necks Titanium Alloy Features Titanium Alloy (Ti-6Al 6Al-4V) High fatigue strength (>600 MPa) Excellent corrosion resistance Biocompatible (extensive use in load- bearing dental and orthopedic implants) Ti-alloy core Porous surface- 0.3 mm SCR (smooth coronal region): 1 or 2 mm Implant core Neck Ti-Alloy Particle Neck Neck Ti-Alloy Particle 3

4 Histology Surface Areas of Endopore Implants Implant model* Estimated Surface Area (mm²) 4.1 mm x 7 mm long mm x 9 mm long mm x 12 mm long mm x 9 mm long ( mini( mini ) mm x 7 mm long (wide body) mm x 5 mm long ( wide body) 455 *compared to a 4.0 x 12 mm long threaded implant of Branemark 248 design, i.e. machined finish Crown-Root Ratio Multi-Center Studies of the Endopore Dental Implant Overall Clinical Results Maxilla versus Mandible 4

5 Location and Success Rate of Implants Placed by the U.S. Study Group Success Rate by Length Distribution by the U.S. Study Group Implant Failures Ten-Year Results of a Prospective Study Using Porous-Surfaced Dental Implants and a Mandibular Overdenture. Deporter D, Watson P, Pharoah M, Todescan R, and Tomlinson G. Clinical Implant Dentistry and Related Research. 4(4), Deporter,, et al Results Prospective analysis 52 Fully edentulous patients (mean age = 56) Each received 3 short implants (7 10 mm) and a mandibular overdenture 2-Stage surgical protocol Clinical Evaluation and standardized radiographs at: Baseline, 3 months, 6 months, 7 years and 10 years. 9 patients lost from study (6 died, 1 lost to f/u,, 2 failure of all 3 implants) 92.7% survival at 10 years (145/156) Implants that failed were 9 or 10mm in length (9/ 89) Only two 7 or 8 mm implants failed (2/67) Alveolar crest resorbed to machined collar- to-porous surface junction by 3 years 0.03 mm/year years

6 Mean Bone Loss Time of Bone Loss Baseline 1 year 1 2 yr 2 3 yr 3 4 yr 4 5 yr 5 7 yr 7 10 yr Mean Annual 2 10 yr Sample Mean (mm) Lower Limit (mm) Upper Limit (mm) Endopore Dental Implants 5, 7, 9, 12 mm lengths Design Features- External Hex Tapered, truncated cone shape Coronal 1mm or 2mm with machined surface Remainder porous surfaced 3.5 (mini), 4.1 (regular) and 5.0 mm (wide) diameters 5,7,9,12 mm length External hex of 0.7 mm (industry standard compatible) on RD Design Features - Internal Connection Tapered, truncated cone shape 5,7,9,12 mm length 4.1 and 5.0 mm diameters 4.8 mm abutment platform diameter to use the same prosthetic components Transgingival collar of 1.8 or 2.8 mm remainder porous surfaced 6

7 Endopore Features & Benefits Tapered, truncated cone shape Coronal 1 mm or 2mm with machined surface Remainder porous surfaced Uniform stress distribution Predictable and minimal crestal bone loss 3-dimensional interlocking interface with bone Increases the surface area Endopore Surgical Kit 5,7, 9, 12, mm length External Hex of 0.7 mm (regular) Internal Connection (ITI compatible) Greater surgical options with shorter implants Shorter healing periods Extensive prosthetic options 2.3mm (#6) Round Bur Step # 1 After selecting the final implant location with a placement guide the site can be marked with a 2.3 mm round bur at 1800 to 2000 rpm. The pilot drill is indexed with markings to correspond to the various implant lengths. Pilot Drill Step # 2 Use the pilot drill to the appropriate depth at a speed of rpm with copious sterile saline irrigation. 7

8 Step #3 Paralleling Pin Step # 4 A paralleling pin is used to determine the appropriate alignment with adjacent teeth, opposing occlusion or other implants. To prevent swallowing a suture can be passed through the pin. When the final depth is reached with the pilot drill, the site is expanded with the appropriate sized implant bur at a drill speed of 1000 rpm with constant irrigation. Implant Burs Sharp burs are critical to avoid overheating of bone and bur chatter, therefore it is recommended to change burs after approximately 10 uses, depending on bone quality. Trial Fit Gauge Step # 5 Endopore Product Packaging Generously irrigate the osteotomy with sterile saline to remove any bone chips or residue before checking the site with the appropriate trial fit gauge. The shoulder of the cone-shaped portion of the gauge should be flush or just below the crestal bone. 8

9 Step # 6 The implant is aseptically removed from the sterile package and delivered directly to the site using the attached delivery tool. The implant is pressed into the prepared site with manual pressure and the delivery tool is disconnected from the implant using a gentle rocking motion. Step # 7 The implant is driven to its final position with several firm taps with the punch and mallet, resulting in a snug fit of the implant into crestal bone. The smooth coronal portion must be fully submerged in bone. Step # 8 With finger pressure only, use the 0.05 hex driver to ensure that the cover screw is tightly threaded onto the implant. Step # 9 Flap margins are repositioned and soft tissue is sutured tension-free. Step # 6 Endopore Surgical Technique Internal Connection The Endopore IC is aseptically removed from the sterile package and delivered directly to the site using the attached delivery tool. The implant is pressed into the prepared site with manual pressure and the delivery tool is disconnected from the implant using a gentle rocking motion. 9

10 0.5mm smooth coronal region Step # 7 The implant is driven to its final position with several firm taps with the punch and mallet, resulting in a snug fit of the implant into crestal bone. The 0.5 mm smooth coronal region should be flush with the crest of the ridge. Step # 8 With finger pressure only, use the 0.05 hex driver to ensure that the cover screw is tightly threaded onto the implant. Step # 9 Flap margins are repositioned around the transgingival collar and the soft tissue is sutured tension-free. Post Operative Follow Up Implant Loading The minimum initial healing period after implant placement is weeks in the anterior mandible and weeks in the maxilla and posterior mandible. This time period is dependent on bone quality. Following the initial healing period the cover screw is removed and the clinician can proceed with the final prosthetic protocol. Indirect Sinus Lift Surgical Technique 10

11 Trial Fit Gauge 11

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