Jan Lindhe. Clinical Periodontology
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IMPLANTS IN THE LOAD CARRYING PART OF THE DENTITION • 977
Ellegaard, B., Baelum, V. & Karring, T. (1997a). Implant therapy
in periodontally compromised patients.
Clinical Oral Implants
Research 8,
180-188.
Ellegaard, B., Kolsen-Petersen, J. & Baelum, V. (1997b). Implant
therapy involving maxillary sinus lift in periodontally com-
promised patients.
Clinical Oral Implants Research
8, 305-315.
Ellen, R.P. (1998). Microbial colonization of the peri-implant
environment and its relevance to long-term success of
osseointegrated implants.
International journal of Prosthodon
tics
11, 433-441.
Engel, E., Gomez-Roman, G. & Axmann-Krcmar, D. (2001). Ef-
fect of occlusal wear on bone loss and periotest values of
dental
implants.
International Journal of Prosthodontics
14, 444-450.
Engquist, B, Astrand, P., Dahlgren, S., Engquist, E., Feldman, H.
& Grondahl, K. (2002). Marginal bone reaction to oral im-
plants: a prospective comparative study of Astra Tech and
Branemark System implants.
Clinical Oral Implants Research
13, 30-37.
Ericsson, I., Nilson, H., Nilner, K. & Randow, K. (2000). Immedi-
ate functional loading of Branemark single tooth implants. An
18 months' clinical pilot follow-up study.
Clinical Oral Im
plants
Research
11, 26-33.
Ganeles, J., Rosenberg, M.M., Holt, R.L. & Reichman, L.H.
(2001).
Immediate loading of implants with fixed restorations
in the
completely edentulous mandible: Report of 27 patients
from a
private practice.
International Journal of Oral and Max
illofacial
Implants
16, 418-426.
Gatti, C., Haefliger, W. & Chiapasco, M. (2000). Implant-retained
mandibular overdentures with immediate loading: a pro-
spective study of TTI implants.
International Journal of Oral and
Maxillofacial Implants
15, 383-388.
Glantz, P.O. & Nilner, K. (1998). Biomechanical aspects of pros-
thetic implant-borne reconstructions.
Periodontology 2000
17,
119-124.
Gomez-Roman, G., Kruppenbacher, M., Weber, H. & Schulte, W.
(
2001). Immediate postextraction implant placement with
root-
analog stepped implants: Surgical procedure and statis
tical
outcome after 6 years.
International Journal of Oral and
Maxillofacial Implants
16, 503-513.
Good acre, C.J., Kan, J.I.K. & Rungcharassaeng, K. (1999). Clinical
complications of osseointegrated implants.
Journal of Prosthetic
Dentistry
81, 537-552.
Gotfredsen, K., Berglundh, T. & Lindhe, J. (2001a). Bone reactions
adjacent to titanium implants subjected to static load. A study
in
the dog (I).
Clinical Oral Implants Research
12, 1-8.
Gotfredsen, K., Berglundh, T. & Lindhe, J. (2001b). Bone reac-
tions adjacent to titanium implants with different surface
characteristics subjected to static load. A study in the dog (11).
Clinical Oral Implants Research
12, 196-201.
Gotfredsen, K., Berglundh, T. & Lindhe, J. (2001c). Bone reactions
adjacent to titanium implants subjected to static load of dif-
ferent duration. A study in the dog (III).
Clinical Oral Implants
Research
12, 552-558.
Gross, M. & Laufer, B.Z. (1997). Splinting osseointegrated im-
plants and natural teeth in rehabilitation of partially edentu-
lous patients. Part I: Laboratory and clinical studies.
Journal
of
Oral Rehabilitation
24, 863-870.
Gunne, J., Astrand, P., Lindh, T., Borg, K. & Olsson, M. (1999).
Tooth-implant and implant supported fixed partial dentures:
A 10-year report.
International Journal of Prosthodontics
12,
216-
221.
Gunne, J., Rangert, B., Glantz, P-O. & Svensson, A. (1997). Func-
tional load on freestanding and connected implants in three-
unit mandibular prostheses opposing complete dentures: An
in
vivo study
International Journal
of
Oral and Maxillofacial
Implants
12, 335-341.
Haas, R., Polak, C., Fiirhauser, R., Mailath-Pokorny G., Dort-
budak, O. & Watzek, G. (2002). A long-term follow-up of 76
Branemark single-tooth implants.
Clinical Oral Implants Re-
search
13, 38-43.
Hebei, K.S. & Gajjar, R.C. (1997). Cement-retained versus screw-
retained implant restorations: achieving optimal occlusion
and
esthetics in implant dentistry.
Journal of Prosthetic Den
tistry 77,
28-35.
Hermann, J.S., Buser, D., Schenk, R.K., Higginbottom, F.L. &
Cochran, D.L. (2000). Biologic width around titanium im-
plants. A physiologically formed and stable dimension over
time.
Clinical Oral Implants Research
11,
1-11.
Hermann, J.S., Buser, D., Schenk, R.K., Schoolfield, J.D. & Co-
chran, D.L. (2001a). Biologic width around one- and two-
piece
titanium implants. A histometric evaluation of un
loaded
nonsubmerged and submerged implants in the canine
mandible.
Clinical Oral Implants Research
12, 559-571.
Hermann, J.S., Cochran, D.L., Nummikoski, P.V. & Buser, D.
(
1997). Crestal bone changes around titanium implants. A
radiographic evaluation of unloaded nonsubmerged and
submerged implants in the canine mandible.
Journal of Perio-
don tology
68,
1117-1130.
Hermann, T.S., Schoolfield, J.D., Nummikoski, P.V., Buser, D.,
Schenk, R.K & Cochran, D.L. (2001b). Crestal bone changes
around titanium implants: A methodological study compar
ing
linear radiographic with histometric measurements.
In-
ternational Journal of Oral and Maxillofacial Implants
16,475-485.
Hosny, M., Duyck, J., van Steenberghe, D. & Naert, I. (2000).
Within-subject comparison between connected and noncon-
nected tooth-to-implant fixed partial prostheses: Up to 14-
year
follow-up study.
International
Journal of Prosthodontics
13,
340-
346.
Hultin, M., Gustafsson, A. & Klinge, B. (2000). Long-term evalu-
ation of osseointegrated dental implants in the treatment of
partially edentulous patients.
Jou
r
nal of Clinical Periodontology
27, 128-133.
Isidor, F. (1999). Occlusal loading in implant dentistry. In: Lang,
N.P., Karring, T. & Lindhe, J., eds.
Proceedings of the 3rd Euro-
pean Workshop on Periodontology.
Berlin: Quintessence, pp.
358-
375.
Jemt, T., Heath, M.R., Johns, R.B., McNamara, D.C., van Steen-
berghe, D. & Watson, R.M. (1996). A 5-year prospective mul-
ticenter follow-up report on overdentures supported by
osseointegrated implants.
International Journal of Oral and
Maxillofacial Implants
11, 291-298.
Johnson, R.H. & Persson, G.R. (2001). A3-year prospective study
of a single-tooth implant – Prosthodontic complications.
In-
ternational Journal of Prosthodontics
14, 183-189.
Keith, S.E., Miller, B.H., Woody, R.D. & Higginbottom, F.L.
(1999).
Marginal discrepancy of screw-retained and cemented
metal-
ceramic crowns on implant abutments.
International
Journal of
Oral and Maxillofacial Implants
14, 369-378.
Keller, W., Bragger, U. & Mombelli, A. (1998). Peri-implant mi-
croflora of implants with cemented and screw retained su-
prastructures.
Clinical Oral Implants Research 9,
209-217.
Kiener, P, Oetterli, M., Mericske, E. & Mericske-Stern, R. (2001).
Effectiveness of maxillary overdentures supported by im-
plants: maintenance and prosthetic complications.
Interna-
tional Journal of Prosthodontics
14, 133-140.
Lang, N.P, Wilson, T. & Corbet, E.F. (2000). Biological complica-
tions with dental implants: their prevention, diagnosis and
treatment.
Clinical Oral Implants Research
11(suppl. I), 146-155.
Lekholm, U., Gunne, J., Henry, P, Higuchi, K., Linden, U.,
Bergstrom, C. & van Steenberghe, D. (1999). Survival of the
Branemark implant in partially edentulous jaws: a 10-year
prospective multicenter study
International Journal of Oral and
Maxillofacial Implants
14, 639-645.
Leonhardt, A., Grondahl, K., Bergstrom, C. & Lekholm, U.
(2002).
Long-term follow-up of osseointegrated titanium im
plants
using clinical, radiographic and microbiological pa
rameters.
Clinical Oral Implants Research
13, 127-132.
Lindh, T., Back, T., Nystrom, E. & Gunne, J. (2001). Implant
versus tooth-implant supported prostheses in the posterior
maxilla: a 2-year report.
Clinical Oral Implants Research
12,
441-449.
Lindh, T., Gunne, J., Tillberg, A. & Molin, M. (1998). A meta-
978 • CHAPTER
41
analysis of implants in partial edentulism.
Clinical Oral Im-
plants Research 9,
80-90.
Lindhe, J. & Berglundh, T. (1998). The interface between the
mucosa and the implant.
Periodontology 2000
17, 47-53.
Lindqvist, L.W., Carlsson, G.E. & Jemt, T. (1996). A prospective
15-year follow-up study of mandibular fixed prostheses sup-
ported by osseointegrated implants. Clinical results and mar
-
ginal bone loss.
Clinical Oral Implants Research 7,
329-336.
Lundgren, D. & Laurell, L. (1994). Biomechanical aspects of fixed
bridgework supported by natural teeth and endosseous im-
plants.
Periodontology 2000 4,
23-40.
Melsen, B. & Lang, N.P. (2001). Biological reactions of alveolar
bone to orthodontic loading of oral implants.
Clinical Oral
Implants Research
12, 144-152.
Mengel, R., Schroder, T. & Flores-de-Jacoby, L. (2001). Osseoin
-
tegrated implants in patients treated for generalized chronic
periodontitis and generalized aggressive periodontitis: 3- and
5-year results of a prospective long-term study.
Journal
of
Periodontology 72,
977-989.
Mericske-Stern, R. (1998). Treatment outcomes with implant-
supported overdentures: clinical considerations.
Journal
of
Prosthetic Dentistry 79,
66-73.
Merz, B.R., Hunenbart, S. & Belser, U.C. (2000). Mechanics of the
connection between implant and abutment – an 8y morse
taper compared to a butt joint connection.
International Journal
of Oral and Maxillofacial Implants
15, 519-526.
Morneburg, T.R. & Proschel, P.A. (2002). Measurement of masti
-
catory forces and implant loads: A methodological clinical
study.
International Journal
of
Prosthodontics
15, 20-27.
Naert, I.E., Duyck, J.A.J., Hosny, M.M.F., Quirynen, M. & van
Steenberghe, D. (2001b). Freestanding and tooth-implant con
-
nected prostheses in the treatment of partially edentulous
patients. Part II: An up to 15-years radiographic evaluation.
Clinical Oral Implants Research
12, 245-251.
Naert, I.E., Duyck, J.A.J., Hosny M.M.F. & van Steenberghe, D.
(
2001a). Freestanding and tooth-implant connected prosthe-
ses in the treatment of partially edentulous patients. Part I:
An up to 15-years clinical evaluation.
Clinical Oral Implants
Research
12, 237-244.
Oetterli, M., Kiener, P. & Mericske-Stern, R. (2001). A longitudi-
nal study on mandibular implants supporting an overden-
ture: The influence of retention mechanism and anatomic-
prosthetic variables on periimplant parameters.
International
Journal
of
Prosthodontics
14, 536-542.
Olsson, M., Gunne, J., Astrand, P. & Borg, K. (1995). Bridges
supported by free standing implants vs. bridges supported
by tooth and implants. A five-year prospective study.
Clinical
Oral Implants Research 6,
114-121.
O'Mahony, A.M., Williams, J.L. & Spencer, P. (2001). Anisotropic
elasticity of cortical and cancellous bone in the posterior
mandible increases peri-implant stress and strain under
oblique loading.
Clinical Oral Implants Research
12, 648-657.
Quirynen, M., De Soete, M. & van Steenberghe, D. (2002). Infec
-
tious risks for oral implants: a review of the literature.
Clinical
Oral Implants Research
13, 1-19.
Quirynen, M., Peeters, W., Naert, I., Coucke, W. & van Steenber
-
ghe, D. (2001). Peri-implant health around screw-shaped
cop.
titanium machined implants in partially edentulous patients
with or without ongoing periodontitis.
Clinical Oral Implants
Research
12, 589-594.
Rangert, B., Sullivan, R.M. & Jemt, T.M. (1997). Load factor
control for implants in the posterior partially edentulous
segment.
International Journal
of
Oral and Maxillofacial Implants
12, 360-370.
Roccuzzo, M., Bunino, M., Prioglio, E & Bianchi, S.D. (2001).
Early loading of sandblasted and acid-etched (SLA) implants:
a
prospective split-mouth comparative study
Clinical Oral
Implants Research
12, 572-578.
Romanos, G.E., Toll, C.G., Siar, C.H., Swaminathan, D. & Ong,
A.H. (2002). Histologic and histomorphometric evaluation of
peri-implant bone subjected to immediate loading: An experi-
mental study with
macaca fascicularis. International Journal of
Oral and Maxillofacial Implants
17, 44-51.
Romeo, E., Chiapasco, M., Ghisolfi, M. & Vogel, G. (2002). Long
-
term clinical effectiveness of oral implants in the treatment of
partial edentulism. Seven-year life table analysis of a prospec-
tive study with ITI® Dental Implant System used for single-
tooth restorations.
Clinical Oral Implants Research
13, 133-143.
Schwarz, M.S. (2000). Mechanical complications of dental im-
plants.
Clinical Oral Implants Research
11 (suppl. I), 261-264.
Schwartz-Arad, D. & Dolev, E. (2000). The challenge of en-
dosseous implants placed in the posterior partially edentu-
lous maxilla: a clinical report.
International Journal
of
Oral and
Maxillofacial Implants
15, 261-264.
Sheets, C.G. & Earthman, J.C. (1993). Natural tooth intrusion and
reversal in implant-assisted prosthesis: evidence of and a
hypothesis for the occurrence.
Journal
of
Prosthetic Dentistry
70,
513-522.
Simion, M., Jovanovic, S.A., Tinti, C. & Parma Benfenati, S.
(
2001). Long-term evaluation of osseointegrated implants in-
serted at the time of or after vertical ridge augmentation. A
retrospective study on 123 implants with 1-5 year follow-up.
Clinical Oral Implants Research
12, 35-45.
Sutter, F., Weber, H.P., Sorensen, J. & Belser, U.C. (1993). The new
restorative concept of the ITI Dental Implant System: Design
and engineering.
International Journal
of
Periodontics and Re-
storative Dentistry
13, 409-431.
Szmukler-Moncler, S., Piatelli, J.A., Favero, J.H. & Dubruille, J.H.
(2000). Considerations preliminary to the application of early
and immediate loading protocols in dental implantology.
Clinical Oral Implants Research
11, 12-25.
Tangerud, T., Gromningsseter, A.G. & Taylor, A. (2002). Fixed
partial dentures supported by natural teeth and Branemark
System implants: A 3-year report.
International Journal
of
Oral
and Maxillofacial Implants
17, 212-219.
Tarnow, D.P., Emtiaz, S. & Classi, A. (1997). Immediate loading
of threaded implants at stage 1 surgery in edentulous arches:
ten consecutive case reports with 1- to 5-year data.
Interna-
tional Journal
of
Oral and Maxillofacial Implants
12, 319-324.
Taylor, T.D. (1998). Prosthodontic problems and limitations as-
sociated with osseointegration.
Journal of Prosthetic Dentistry
79,
74-78.
Taylor, T.D., Belser, U.C. & Mericske-Stern, R. (2000). Prostho-
dontic considerations.
Clinical Oral Implants Research
11
(
suppl. 1), 101-107.
ten Bruggenkate, C.M., Asikainen, P., Foitzik, C., Krekeler, G. &
Sutter F. (1998). Short (6 mm) non-submerged dental im-
plants: results of a multicenter clinical trial of 1-7 years.
Inlerrrrrtional Journal of Oral and Maxillofacial Implants
13, 791
-
798.
Van Steenberghe, D., Quirynen, M. & Wallace, S.S. (1999). Sur-
vival and success rates with oral endosseous implants. In:
Lang, N.P., Karring, T. & Lindhe, J., eds.
Proceedings of the 3rd
European Workshop on Periodontology.
Berlin: Quintessence,
pp.
242-254.
von Arx, T., Cochran, D.L., Hermann, J., Schenk, R.K., Higgin-
bottom, F. & Buser, D. (2001a). Lateral ridge augmentation
and implant placement: An experimental study evaluating
implant osseointegration in different augmentation materials
in the canine mandible.
International Journal
of
Oral and Max-
illofacial Implants
16, 343-354.
von Arx, T., Cochran, D.L., Hermann, J.S., Schenk, R.K. & Buser,
D. (2001b). Lateral ridge augmentation using different bone
fillers and barrier membrane application. A histologic and
histomorphometric pilot study in the canine mandible.
Clini-
cal Oral Implants Research
12, 260-269.
Weber, H.P., Crohin, C.C. & Fiorellini, J.P. (2000). A 5-year pro-
spective clinical and radiographic study of non-submerged
dental implants.
Clinical Oral Implants Research
11, 144-153.
Wie, H. (1995). Registration of localization, occlusion and oc-
cluding materials for failing screw joints in the Branemark
implant system.
Clinical Oral Implants Research 6,
47-63.
Wiskott, A.H.W. & Belser, U.C. (1999). Lack of integration of
IMPLANTS IN THE LOAD CARRYING PART OF THE DENTITION • 979
smooth titanium surfaces: a working hypothesis based on
strains generated in the surrounding bone.
Clinical Oral Im-
plants Research
10, 429-444.
Wiskott, A.H.W., Perriard, J, Scherrer, S.S., Dieth, S. & Belser, U.C.
(2002). In vivo wear of three types of veneering materials
using implant-supported restorations. A method evaluation.
European Journal of Oral Sciences
110, 61-67.
Wismeijer, D., van Waas, M.A.J., Mulder J., Vermeeren I.J.F. &
Kalk, W. (1999). Clinical and radiological results of patients
treated with three treatment modalities for overdentures on
implants of the ITI dental implant system. A randomised
controlled clinical trial.
Clinical Oral Implants Research
10,
297-306.
Wright, P.S., Glantz, P-O., Randow, K. & Watson, R.M. (2002).
The effects of fixed and removable implant-stabilised pros-
theses on posterior mandibular residual ridge resorption.
Clinical Oral Implants Research
13, 1169-174.
Wyatt, C.L. & Zarb, G.A. (1998). Treatment outcomes of patients
with implant-supported fixed partial prostheses.
International
Journal of Oral and Maxillofacial Implants 13,
204-211.
Wyatt, C.L. & Zarb, G.A. (2002). Bone level changes proximal to
oral implants supporting fixed partial prostheses.
Clinical
Oral Implants Research
13, 162-168.
Zarb, G.A. & Schmitt, A. (1995). Implant prosthodontic treat-
ment options for the edentulous patient.
Journal of Oral Reha-
bilitation
22, 661-671.
Zitzmann, N.U. & Marinello, C.P. (1999). Treatment plan for
restoring the edentulous maxilla with implant supported
restorations: removable overdenture versus fixed partial den-
ture design.
Journal of Prosthetic Dentistry
82, 188-196.
Zitzmann, N.U. & Marinello, C.P. (2002). Areview of clinical and
technical considerations for fixed and removable implant
prostheses in the edentulous mandible.
International Journal
of Prosthodontics
15, 65-67.
Zitzmann, N.U., Scharer, P. & Marinello, C.P. (2001). Long-term
results of implants treated with guided bone regeneration: A
5-year prospective study.
International Journal of Oral and Max-
illofacial Implants
16, 355-366.
ACKNOWLEDGEMENTS
The authors wish to acknowledge and thank Drs Viviana Coto-
Hunziker, Stephan Dieth, Thierry Doumas, German Gallucci,
Robin Jaquet, Nikolaos Perakis and Valerie Wouters (all of them
clinicians at School of Dental Medicine, University of Geneva,
and involved in the treatment of some of the patients presented
in this chapter) for their contributions. We would also like to
thank the laboratory technicians and ceramists Michel Bertossa,
Cedric Bertsch, Pierre Martini, Roger Renevey, Alwin Schonen-
berger and Gerard Verdel, for their expertise and meticulous
execution of the implant suprastructures presented in this chap
-
ter. Furthermore, our gratitude is extended to Dr Pascal Magne
(Senior Lecturer, University of Geneva) for his competent assis-
tance in development of the schematic illustrations.
CHAPTER
42
Rehabilitation by Means of
Implants: Case Reports
CHRISTOPH H. F. HAMMERLE, TORD BERGLUNDH, JAN LINDHE AND INGVAR ERICSSON
Patient 1
Implants used to restore function in the
mandible
Patient 2
Fixed restorations on implants and teeth
Patient 3
Implants used to restore function in the
maxilla
Patient 5
Implants used to solve restorative problems
occurring during maintenance therapy
Patient 6
Implants used to solve problems associated
with accidental root fractures of important
abutment teeth
Patient 4
Implants used in a cross-arch bridge
restoration
PATIENT
1
IMPLANTS
USED TO RESTORE
FUNCTION
IN
THE
MANDIBLE
The 56-year-old woman sought help to solve her peri
-
odontal and esthetic problems. She was systemically
healthy and in good physical condition. She had been
a smoker since age 18.
Initial examination
The patient presented with a full denture in the max
-
illa and a cross-arch fixed porcelain-fused-to-metal
restoration in the mandible (Fig. 42-1a-d). The initial
examination included inspection of the oral mucosa
and the periodontal tissues (pocket depths, furcation
involvements, radiographs), vitality testing, caries di
-
agnosis and evaluation of the restoration (Table 42-1).
This examination revealed the presence of hard and
soft supragingival and subgingival deposits through
-
out the dentition (plaque score 75%), severe inflamma
-
tion (Bleeding on probing - BoP - 84%) and advanced
destruction of the periodontal tissues at several teeth.
At various locations the restoration showed subgingi
-
vally located, overcontoured and ill-fitting margins.
Initial prognosis
Teeth 33, 43, 44 and 45 could be maintained; teeth 41,
42, 46 and 47 were questionable due to periodontal
and endodontic problems; number 37 could not be
maintained.
Treatment planning
In order to achieve a situation that allowed for proper
self-performed plaque removal by the patient, it
seemed reasonable to remove the plaque retention
factors brought about by the ill-fitting cross-arch
bridge. The loss of tooth 37 called for the placement of
dental implants to make possible the placement of a
new cross-arch bridge. Evaluation of the remaining
teeth or roots as abutments for the new bridge was
postponed until the existing bridge had been re-
moved.
The patient was informed regarding her status,
problems specific to her situation, and the etiology of
oral and especially periodontal diseases, as is com-
monly done for patients with periodontitis. The treat
-
ment plan as well as possible treatment alternatives
REHABILITATION BY MEANS OF IMPLANTS: CASE REPORTS • 981
Fig. 42-1. (a-c) Clinical pictures of patient 1 at initial examination. (d) Radiographs of patient 1 at initial
examination.
were also thoroughly discussed with the patient. In
particular, the requirements for a successful long-term
result of the therapy were emphasized: excellent per-
sonal plaque removal, proper healing of the periodon-
tal tissues and optimal tissue integration of the im-
plants. Finally, the importance of continuous suppor
-
tive care to prevent the recurrence of periodontal and
peri-implant disease was explicitly addressed.
Treatment
No precautions due to systemic conditions were nec-
essary.
Initial therapy (cause
related)
A program training the patient in proper oral hygiene
measures was initiated. The cross-arch fixed bridge
was removed and replaced by an acrylic temporary
restoration. Tooth 37 was extracted. All remaining
roots were carefully scaled and planed under local
anesthesia. After completion of this treatment phase,
the patient was enrolled in a maintenance care pro-
gram with appointments scheduled every 3 months.
Corrective therapy and implantation
A re-examination after 4 months revealed that only
minor reductions in pocket depth had occurred and
that BoP was only slightly reduced (68%) (Table 42-2).
Hence, flap surgery was performed to allow for im-
proved removal of plaque and calculus from all root
surfaces. During this surgical intervention, teeth 41,
42 and 47 were removed due to advanced periodontal
destruction. The furcation of tooth 46 was eliminated
by hemisection, and the mesial root was extracted. In
order to replace the strategically important abutments
in the third quadrant, two implants of the IT
I
't
Dental
982 • CHAPTER 42
Table 42-1. Initial examination, periodontal diagnosis and prognosis
Clinical periodontal examination
Diagnosis
Prognosis
Pocket depth
Furcation
involvement
n
3
N
v
O
r-F
r-F
,
ft.
v
O_
O
rF
a
1
°
v
Q
O
5
rF
rF
N
o
3
x
N
.
o
5
N
.
O
O!
cr
m
N
O
0)
Tooth
m
b d 1
47 8 6 5 8
b,l x
x
46 6
4 6 7
b,l x x
45 7 3 6 7
x x
44 6
3
6
6
x x
43 6 3 8 6
x x
42 5 4 6 3
x x
41 5 3 4 5
x x
33 5 3 5 5
x x
37 8 6 4 8
b,l x
x
Table 42-2. Re-evaluation after 4 months
Clinical periodontal examination
Pocket depth
Furcation
involvement
Tooth
m
b d
47 8 6 5 8
b,l
46 4 3 3 6
b,l
45 4 2 4 5
44 4 2 5 4
43 4 2 3 6
42 4 3 5 3
41 3 2 4 4
33 5 2 5 5
Fig. 42-2. Occlusal view of the abutment teeth and the
two implants in patient 1 prior to insertion of the fixed
bridges.
Table 33-3. Periodontal findings and prognosis at
completion of active therapy
Clinical periodontal examination
Prognosis
Pocket depth
c
o
3
v
5
Tooth
m
b d
46 4 4 4 3
x
45 5 2 3 2
x
44 3 2 3 4
x
43 3 2 3 3
x
33 3 2 2 2
x
134 3 2 3 4
x
136 3 1 2 3
x
Implant System were placed in regions 34 (hollow
cylinder 8 mm. long) and 36 (hollow screw
8
mm long).
Restorative therapy
After the periodontal and peri-implant tissues were
given sufficient time to heal properly (Fig. 42-2), three
porcelain-fused-to-metal fixed bridges were made
and inserted. One bridge was purely implant borne
(
I34-x-I36), and two bridges were purely tooth borne
(
33-xxxx-43, 44-45-x-46). Concomitantly, a new maxil
-
lary full denture was manufactured.
Maintenance therapy
During the 5 documented years of maintenance care,
supportive therapy consisted of recall appointments
REHABILITATION BY MEANS OF IMPLANTS: CASE REPORTS • 983
Fig. 42-3. (a-c) Clinical pictures of patient 1, 5 years following completion of active therapy. (d) Radiographs of pa
tient 1, 5 years following completion of active therapy.
with the dental hygienist every 3-4 months, including
standard procedures for periodontal patients with im
-
plants and fixed reconstructions. In addition, tooth 44
lost its vitality and was given root canal therapy. The
alignment of the front teeth of the maxillary full den
-
ture was readjusted for esthetic reasons. No additional
incidents arose calling for therapeutic interventions.
The situation 5 years after completion of active ther
-
apy is shown in Fig. 42-3a-d and Table 42-3 (plaque
score 7%, BoP 15%). Based on the clinical and radio
-
graphic findings as well as on the excellent plaque
control performed by the patient, all teeth and im-
plants were given a good prognosis.
Concluding remarks
This case illustrates how the loss of strategically im
-
portant abutments can be compensated by the place
-
ment of dental implants, thus allowing treatment with
fixed bridgework. In addition, proper attention to
personal and professional plaque removal will main-
tain a successful treatment outcome of combined peri
-
odontal, prosthetic and implant therapy for pro-
longed periods of time also in patients who are sus-
ceptible to diseases caused by plaque infections.
9
8
4 ' CHAPTER 42
Fig. 42-4. (a-c) Clinical pictures of patient 2 at initial examination. (d) Radiographs of patient 2 at initial examina
tion.
PATIENT 2
FIXED RESTORATIONS ON
IMPLANTS AND TEETH
The posterior teeth in the maxilla had been lost due to
periodontal disease. The patient was suffering from
hypertension but was otherwise in good physical con-
dition.
The 35-year-old woman complained about the esthet-
Initial examination
ics and function of the removable partial denture
(RPD) in the maxilla. She had been wearing this pros- The patient presented with a removable partial den-
thesis for 4 years but had been unable to adapt to it.
ture in the maxilla (Fig. 42-4a-d). The cast denture
REHABILITATION BY MEANS OF IMPLANTS: CASE REPORTS • 985
Table 42-4. Initial examination, periodontal diagnosis and prognosis
Tooth m b d I
13 4 3 3 4
x x
12 3 2 2 3
x x
11 3 2 2 3
x x
21 3 2 3 2
x
x
22 3 2 3 3
x x
23 4 2 2 4
x x
47 3 3 3 3 b
x
x
46 7 2 6 2 I
x
x
45 3 2 5 2
x x
44 3 2 4 2
x
x
43 4 2 4 2
x
x
42 3 2 5 2
x x
41 4 2 3 3
x
x
31 5 4 3 2
x x
32 4 2 3 2
x x
33 2 2 4 2
x
x
34 4 2 5 3
x
x
35 6 3 5 3
x x
36 6 2 6 4
b,1
x x
37 5 3 5 4
b,1
x x
replaced teeth 17, 16, 15, 14 and 24, 25, 26, 27 and was
anchored to the canines by clasps. The initial exami
-
nation included inspection of the oral mucosa and the
periodontal tissues (pocket depths, furcation involve
-
ments, radiographs), vitality testing and caries diag
-
nosis (Table 42-4). This examination revealed the pres
-
ence of hard and soft deposits both supragingivally
and subgingivally throughout the dentition (plaque
score 48%). Gingival inflammation was moderate
exept where the RPD was in contact with the marginal
periodontium (BoP 532); there it was severe. Destruc
tion of the periodontal tissues was mild to moderate
throughout the dentition.
Initial prognosis
All teeth in the maxilla and mandible except for teeth
36, 37 and 47 could be maintained; 36, 37 and 47 were
questionable due to deep pockets with angular bone
defects and furcation involvements.
Treatment planning
Before any form of prosthetic treatment could be con
sidered, the periodontal disease had to be treated
and
further disease development prevented. Based on
the
premise of successful periodontal therapy, the
treat
ment plan foresaw placement of dental
implants in
regions 14 and 24, allowing the
restoration of two
premolar units bilaterally, i.e.
pursuing the concept of
a shortened dental arch.
The patient was informed regarding her status,
problems specific to her situation, and the etiology of
oral and especially periodontal diseases, as is com-
monly done for patients with periodontitis. The treat
-
ment plan as well as possible treatment options in-
volving removable partial dentures or elevation of the
sinus floors for the placement of additional implants
were also thoroughly discussed with the patient. In
particular the conditions for a successful long-term
result of the therapy were explained, including: excel
-
lent personal plaque removal, proper healing of the
periodontal tissues and optimal tissue integration of
the implants. Finally, the importance of continuous
986 • CHAPTER
42
Fig. 42-5. (a-b) Clinical pictures of patient 2,
4
1
/2
years following completion of active therapy. (c) Radiographs of
patient 2, 4½ years following completion of active therapy
supportive care to prevent periodontal and peri-im-
plant diseases was explicitly addressed.
Treatment
No precautions for standard dental and oral surgical
interventions were necessary due to the systemic con
-
dition of the patient.
Initial therapy (cause related)
The patient was enrolled in a program training her to
perform proper oral hygiene procedures. In order to
test the functional and esthetic feasibility of a short-
ened dental arch, the existing removable partial den-
ture was altered, i.e. the molars were removed from
the denture. Hard and soft deposits were removed
from all tooth surfaces and the exposed root surfaces
were carefully scaled and planed under local anesthe
-
sia. After completion of this treatment, the patient was
enrolled in a maintenance care program with appoint
-
ments scheduled every 3 months.
Corrective therapy and implantation
A re-examination performed after 3 months revealed
that the inflammatory processes were resolved
(
plaque 9%, BoP 12%). Marked recession of the mar-
ginal gingiva had occurred and the probing depths
were reduced. No periodontal surgical intervention
was necessary. Two implants of the ITI
®
Dental Im-
plant System were placed in regions 14 (hollow screw
6
mm long) and 24 (hollow screw 6 mm long).
Restorative therapy
After 4 months, two porcelain-fused-to-metal fixed
bridges were inserted. Both bridges (13-I14-x and 23-
I24-x) were seated on mixed support, i.e. one natural
tooth abutment, one implant abutment.
Maintenance therapy
During the
4
1
/2
documented years after completion of
active therapy, supportive care consisted of recall ap-
pointments with the dental hygienist every 3-4
months. No therapeutic interventions apart from
regular recall activities were necessary. The situation
4
1
/2
years after completion of active therapy is shown
in
Fig. 42-5a-c and Table 42-5 (plaque 14%, BoP 19%).
Based on the clinical and radiographic findings as well
as on the plaque control performed by the patient, all
teeth and implants were given a good prognosis.