27: Minimally Invasive Implant Esthetics

Chapter 27 Minimally Invasive Implant Esthetics

Relevance of Minimally Invasive Implant Stabilization to Esthetic Dentistry

All cosmetic principles are based on the tooth setup. With dentures, because of the loss of bone, the teeth must be placed close to the residual ridge to create a stable prosthesis. This often means they cannot be placed in an esthetic position. If, however, these dentures are supported and stabilized with implants, then the teeth can be placed in a more ideal position to achieve the desired esthetic look. Not only is the smile improved, but the lower third of the face is redeveloped from the extreme collapse of the vertical dimension. This approach contributes to the esthetics of the teeth that create the desired smile and facial proportions.

Brief History of the Clinical Development of Minimally Invasive Implant Stabilization

Implants have been in active use for 40 to 45 years. Initially the people who needed the implants the most did not have adequate bone to support the implants available at the time. The typical implants were made of titanium alloy. To use these implants, patients had to undergo very invasive grafting procedures that were only occasionally successful. The implants then evolved into mini-implants, which were not really different from the previous implants as they were still made of titanium and had the same shape. Early attachments were only good if the implants were placed parallel to each other. In most cases this eliminated maxillary treatment because it is almost impossible to place all the implants parallel owing to the anatomic realities. If it was necessary to use attachments that allowed the path of insertion to be altered when implants were not parallel. Thus, due to the superior position of the attachments the bar created, the implants were exposed to increased detrimental lateral forces of mastication. The denture that was supported by a bar (implant supported and implant retained) was exposed to the same forces as any fixed restoration. The bar essentially negated the ability to use a smaller implant because the surface area was lacking for this fixed application. When regular-sized implants were used in a bar-retained overdenture, bone loss would occur after only a few years, primarily because the lateral forces transmitted to the implants were not addressed. The development of an attachment that could alter the path of insertion on divergent implants and minimize lateral forces without a bar was the solution to the overdenture challenge. This new over denture technique produced a tissue-supported, implant-retained prosthesis that reduced the forces enough to make the smaller implants a predictable option.

The ERA® attachment (Sterngold Dental, Attleboro, Massachusetts, Figure 27-1) has been available for many years and was miniaturized and adapted to these smaller implants. The ERA®mini implant (an ERA abutment incorporated onto a 2.2 or 3.25 mm diameter implant) enables the clinician to place implants in areas that are too atrophic for traditional implants. Thus making it possible to treat many more patients in whom the remaining bone width is insufficient to support conventional implants without extensive bone grafting. The ERA®mini implant’s ability to alter the path of insertion and negate the need for a bar in the maxilla, has opened the door to these smaller implants in the maxilla where minimal bone is present, often without additional bone grafting. The success rate of the ERA®mini implants is equal to that of the larger implants in the over denture application primarily due the ability of the ERA® attachment to alter the path of insertion which significantly reduces forces placed on the implant. The ERA® supported denture, whether on conventional or smaller ERA®mini implants, creates a tissue-supported implant-retained prosthesis. Patients who were not eligible for the treatment previously can now proceed with a less invasive and significantly more economical technique. Once a stabilizing platform has been achieved (implant support) and the teeth can be replaced on a denture, the limitations previously caused by a lack of stabilization for the dentures no longer apply.

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Jan 3, 2015 | Posted by in Esthetic Dentristry | Comments Off on 27: Minimally Invasive Implant Esthetics
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