Page 15 - GP Fall Final 2017

implant placement procedures. The main bone morphiogenic protein (BMP) have Implant occlusal principles are employed
objective in surgery is to obtain rigid fixa- been indicated to be major growth factors. to maintain initial and long-term osseointe-
tion of the implant body. The tooth socket PRF is an autologous healing biomaterial gration. The provisionalization follows an
including measurements of the mesio-distal rich in growth factors and glycoproteins. implant occlusal principle (IPO) scheme
width and socket depth is evaluated. Stud- The strong fibrin architecture containing of zero contact in centric occlusion, lateral
ies have shown that implants placed into ≥ PDGF, TGFB-1, Fibronectin, Vitronectin excursions and protrusion. The incisal edge
3mm of mature bone apical to the socket and numerous other cytokines encourage is designed shorter than the corresponding
demonstrate high success rates. Anatomi- hemostasis through the migration of fi- adjacent tooth. The final definitive resto-
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cal structures located apical to the socket broblasts and endothelial cells. Platelet ration follows IPO principles with the in-
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such as the nasal cavity, maxillary sinus or concentrates have demonstrated enhanced cisal edge fabricated at the ideal length.
inferior alveolar nerve may limit the depth healing of soft and hard tissues with de-
of implant placement. creased pain. PRP/PRF can be developed Conclusion
from whole blood and standard phleboto- Implant therapy is considered the treatment
The surgical stage is initiated with a flap- my principles with an inexpensive centri- of choice for single tooth replacement. The
less atraumatic extraction with emphasis fuge and associated disposables. prolongation of treatment encourages pa-
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on expansion and support of the buccal tients to select less than ideal treatment alter-
plate. The reflection of a mucoperiosteal The restorative stage is initiated at surgical natives. Immediate implant placement with
flap compromises blood supply leading to placement based on studies that elicit stable provisionalization (IIPP) decreases the treat-
bone and soft tissue loss and is to be avoid- soft and hard tissue when the IIPP approach ment period for patients. IIPP has demon-
ed during the extraction and implant place- is employed. A fixture level impression cap- strated high success rates when rigid fixation
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ment procedure. 18-20 Complete debridement tures the angulation and position of the im- of the implant is achieved with the existence
of the socket is performed followed by plant body as well as the existing ideal gin- of the buccal plate of bone. This case report
implant placement. Several studies have gival sulcus which allows for the fabrication demonstrates an implant approach that pro-
demonstrated high success rates with flap- of the final abutment and crown during the vides stable bone levels, ideal esthetics with
less implant surgical procedures. An under- osseointegrative period. This approach reduc- less surgery, less pain and the elimination
sized osteotomy is developed with a pala- es overall treatment time by eliminating ap- of a removable partial denture transitional
tal skew engaging at least 3mm of native pointments specific to the restorative aspect. stage to rehabilitate a missing tooth.
bone apical to the socket. Implant position Moreover, it limits the amount of connections
is critical for initial fixation and long term and disconnections of component parts, thus References: Please see the online version at
success. Rigid fixation is achieved with an reducing soft tissue migration. www.nysagd.org.
undersized osteotomy preparation, engage- Disclaimer
ment of native and bony socket walls and The provisionalization aspect of IIPP pre- The author has not received financial support or im-
a torque value of greater than 35 Newton serves the existing osseous and gingival ar- plant materials in content development of this man-
centimeters. A high torque value is con- chitecture by providing instant mechanical uscript.
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sidered the most critical requirement for support to the papillae and midfacial gingi- Acknowledgements
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placement of a provisionalization. Im- val tissues. Furthermore, it maintains the The author wishes to acknowledge Caitlin Carparelli,
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plant designs that create higher torque gingival embrasure form providing comfort DA, Tatyana Lyubezhanina, DA, LeeAnn Klotz, DA,
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values are characteristic of aggressive and esthetics. The fabrication of a provi- Erin Weigand, RDH, and Judy Hathaway for their as-
thread designs, microtextured surfaces and sional restoration is to be performed prior sistance in the preparation of this paper.
lengths greater than 12mm. The implant to bone grafting. After fabrication, place- Dr. Jackson is an im-
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platform is positioned in relation to the ide- ment of a tall, thin healing collar seals the plant surgeon and re-
al midfacial gingival margin producing an internal aspect of the implant allowing for constructive dentist
emerging profile. 24,25 The implant body is to bone grafting of the site. 35,36 Patients feel that has been surgi-
be placed at least 1.5mm away from an ad- that a provisional crown is a real tooth and cally placing and re-
jacent tooth to preserve the interproximal prefer it over a removable partial denture. storing dental implants
bone peak and dental papilla. 26 for over 20 years. He
The final prosthesis provides a long-term received his Doctor of
Guided bone regeneration serves a crucial predictable solution for a missing tooth Dental Surgery degree
role in the IIPP process. The space located through the utilization of state of the art at SUNY Buffalo School of Dental Med-
between the implant and the residulal tooth biomaterials. Abutment and crown mate- icine and completed a general practice
socket referred to as the “gap” requires rials are an important factor on recession residency at St. Luke’s Memorial Hos-
management at the time of surgery. Re- and how it relates to esthetics. A zirconium pital. Dr. Jackson completed his formal
oral implantology training at New York
search has exhibited that “gap” distances abutment is a highly biocompatible materi- University College of Dentistry. Dr.
<4.2mm spontaneous fill if the buccal plate al that provides soft tissue stability biolog- Jackson is a Diplomate of the American
of bone is present without the need for pri- ically and optically. 37,38 A flat or undercon- Board of Oral Implantology/Implant
mary flap closure. The gap fills with bone toured abutment and an all-ceramic crown Dentistry (ABOI/ID) and an Honored
reminiscent of a healing socket. However, with a slightly undercontoured gingival Fellow of the American Academy of Im-
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many clinicians tend to fill gaps with auto- buccal margin creates esthetically pleasing plant Dentistry (AAID). Dr. Jackson has
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grafts, allografts, xenografts or alloplasts. restorations with soft tissue stability. This been published in peer reviewed dental
design concept is based on the horizontal journals and has presented at numerous
Platelet rich plasma (PRP) and fibrin (PRF) component of the biological width around implant conferences around the world.
concentrate platelets containing growth fac- implants where platform switching, under- He has served as faculty of the India,
tors responsible for recruitment, differenti- contoured abutments and concave crowns New York and Las Vegas Maxicourses in
ation and proliferation of cells. 28,29 Platelet have exhibited less gingival recession. 40 Oral Implantology. Currently, he serves
on the editorial board for the Journal of
derived growth factor (PDGF), transferring Oral Implantology and is the treasurer
growth factor Beta 1, 2 (TGFB1,2) and of the AAID’s Research Foundation.
www.nysagd.org l Fall 2017 l GP 14