Implant Tribune U.S. No. 5, 2013
ICOI Spring Symposium set for Las Vegas / Blade implants in treatment of thin ridges / Scenes from CDA in Anaheim / Industry
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IMPLANT TRIBUNE
The World’s Dental Implant Newspaper · U.S. Edition
may 2013 — Vol. 8, No. 5
www.dental-tribune.com
ICOI Spring Symposium
set for Las Vegas
Blade
implants in
treatment
of thin
ridges
Indications and techniques
By Luca Dal Carlo, DDS,
Marco E. Pasqualini, DDS,
Michele Nardone, Medical Officer,
Ministry of Health, Rome, Italy, and
Prof. Leonard I. Linkow, DDS
The ICOI’s Spring Symposium will take place at the Bellagio Hotel in Las Vegas from May 16–18. Photo/www.sxc.hu
Group’s annual event heads
to the Bellagio Hotel for a sixth time
The conception of the endosseous
blade implant arose from the intuitions of Prof. Leonard I. Linkow and
R. Roberts; its development and diffusion, however, must be attributed
to Linkow, who presented it in 1967
and published on the subject in 1968,
thereby making it possible to treat
the problem of edentulism in tens of
thousands of patients from that time
to this day.1,2
Given the thinness of the blade,
this implant can be used in any alveolar crest, but it is particularly useful in the thinnest, where the use of
root-form implants is difficult and
needs bone regeneration procedures.
When the ridge is thin, it permits tricortical anchorage,3 i.e., the implant
is stabilized by press-fit in both the
internal and external bone cortex, as
well as the deep cortex. This condition
” See BLADES, page C16
AD
By Craig Johnson
ICOI Executive Director
T
hat old bromide, “nothing succeeds like success,” is very appropriate when it comes to the ICOI
and its devotion to Las Vegas and
the Bellagio Hotel. The International Congress of Oral Implantologists (ICOI) will return to the Bellagio for the sixth time as it
hosts the spring implant symposium from
May 16–18.
Dr. Michael Pikos is the scientific
chair for the three-day conference of
dental implant continuing education
opportunities. The theme for this spring
symposium will be “The Maxilla: Single
Tooth to Full-Arch Reconstruction.”
Attendees will be exposed to a group
of experienced private practice and
academic-based clinicians who will
share their wealth of knowledge in
a friendly and scientific environment.
The general session will commence at
1 p.m. on Thursday, May 16, and conclude
on Saturday, May 18, at 6:30 p.m.
Main podium speakers, in order of
their appearance, are Dr. Jaime L. Lozada,
Dr. Giuseppe Cardaropoli, Dr. Joseph Kan,
Dr. Michael Sonick, Dr. Randolph R. Resnik,
Dr. Natalie Wong, Dr. Marc L. Nevins, Dr. Ernesto Lee, Lee Culp, CDT, Dr. Michael Pikos,
Dr. Kevin Murphy, Dr. Abdelsalam Elaskary, Dr. George F. Priest, Dr. Alvaro J. Ordonez, Dr. Tara Aghaloo, Dr. Craig M. Misch,
Dr. Howard Chasolen, Dr. Aldo Leopardi,
Dr. Georgios Romanos, Dr. Paulo Malo,
Dr. Carl E. Misch and Arthur W. Curley, Esq.
The ICOI designates the scientific program for 20 C.E. credits.
The general session will be preceded by
several pre-symposium workshops that
will take place on Thursday morning.
” See ICOI, page C4
[2] =>
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industry
Implant Tribune U.S. Edition | May 2013
[3] =>
[4] =>
C4
“ ICOI, Page C1
The lineup of the four-hour presymposium workshops held by the sponsors of this symposium will feature the
following:
• Dr. Miguel Stanley will present a course
on treatment planning titled “Practice
Building Through Simplified Advanced
Techniques,” sponsored by MIS.
• Dr. David Wong’s course, sponsored by
DENTSPLY Implants, will cover “Successful
Socket Grafting and Ridge Augmentation:
Maximizing Predictability in Everyday
Implant Situations.”
• Dr. Michael Toffler will educate delegates on “Transcrestal Sinus Floor Elevation: Redefining Limitations,” in a course
sponsored by Hiossen.
• Dr. Carl Misch will discuss “Prosthetic
Complications” because of screw loosening, porcelain fracture and residual
cement. His course is sponsored by the
Misch International Implant Institute.
AD
From Page 1
• Dr. Randolph Resnick’s four-hour
course will discuss “Medical/Dental Emergencies and Complications in Implant
Dentistry.” The course is sponsored by
Salvin Dental Specialties.
• Dr. Michael Pikos will hold a hands-on
course dealing with “Extraction Site Management for Implant Reconstruction,”
sponsored by Osteogenics Biomedical.
• Barb Herzog will deal with “Changes
in Latitude, Changes in Attitude: Keeping Pace with How New Technologies Effect Your Financial Arrangements.” This
course is sponsored by Springstone Patient
Financing.
• ZEST Anchors will sponsor Drs. Ara
Nazarian and Paresh Patel’s workshop,
which features narrow-diameter implants,
in a lecture on “Utilizing the Next Generation of Narrow-Diameter Overdenture
Implants to Expand Your Practice Revenue
Opportunities.”
In addition to the program for the doctors, the ADIA will present a 2½-day pro-
gram for team members. On Thursday,
May 16, the auxiliary program will feature
the following main podium speakers:
Teresa Duncan, Carla Frey, Michelle Kratt
and Yva Khalil.
On Friday, the auxiliaries will hear lectures from Dr. Mitra Sadrameli, Dr. Avi
Schetritt, Dr. Jin Kim, Dr. John Olsen, Dr.
Ira Langstein, Dr. Thomas Ford and Dr.
Justin Moody. The ADIA program will conclude on Saturday with four certification
programs held simultaneously for dental
hygienists, dental assistants, practice management coordinators and implant coordinators. This 2½-day program is applicable
for 18 C.E. credits.
With more than 12,000 members worldwide, the ICOI is the largest professional
dental implant organization and provides
vast dental implant continuing education opportunities by sponsoring or cosponsoring many meetings each year.
For more information on this symposium or about the ICOI, visit www.icoi.org.
Implant Tribune U.S. Edition | May 2013
IMPLANT TRIBUNE
Publisher & Chairman
Torsten Oemus t.oemus@dental-tribune.com
Chief Operating Officer
Eric Seid e.seid@dental-tribune.com
Group Editor
Robin Goodman r.goodman@dental-tribune.com
Managing Editor Implant Tribune
Sierra Rendon s.rendon@dental-tribune.com
Managing Editor Show Dailies
Kristine Colker k.colker@dental-tribune.com
Managing Editor
Fred Michmershuizen
f.michmershuizen@dental-tribune.com
Managing Editor
Robert Selleck, r.selleck@dental-tribune.com
Product/Account Manager
Humberto Estrada h.estrada@dental-tribune.com
Product/Account Manager
Charles Serra c.serra@dental-tribune.com
Marketing director
Anna Wlodarczyk-Kataoka
a.wlodarczyk@dental-tribune.com
Education Director
Christiane Ferret c.ferret@dtstudyclub.com
Tribune America, LLC
116 West 23rd Street, Suite 500
New York, NY 10011
Phone (212) 244-7181
Fax (212) 244-7185
Published by Tribune America
© 2013 Tribune America, LLC
All rights reserved.
Tribune America strives to maintain the utmost accuracy in its news and clinical reports. If you find a
factual error or content that requires clarification,
please contact Managing Editor Sierra Rendon at
s.rendon@dental-tribune.com.
Tribune America cannot assume responsibility for
the validity of product claims or for typographical
errors. The publisher also does not assume responsibility for product names or statements made by
advertisers. Opinions expressed by authors are their
own and may not reflect those of Tribune America.
Editorial Board
Dr. Pankaj Singh
Dr. Bernard Touati
Dr. Jack T. Krauser
Dr. Andre Saadoun
Dr. Gary Henkel
Dr. Doug Deporter
Dr. Michael Norton
Dr. Ken Serota
Dr. Axel Zoellner
Dr. Glen Liddelow
Dr. Marius Steigmann
Corrections
Implant Tribune strives to maintain the
utmost accuracy in its news and clinical
reports. If you find a factual error or
content that requires clarification, please
report the details to Managing Editor
Sierra Rendon at s.rendon@dental-tribune
.com.
Tell us what you think!
Do you have general comments or criticism
you would like to share? Is there a particular
topic you would like to see articles about in
Implant Tribune? Let us know by e-mailing
feedback@dentaltribune. com. We look
forward to hearing from you! If you would
like to make any change to your subscription
(name, address or to opt out) please send us
an e-mail at database@dental-tribune.com
and be sure to include which publication
you are referring to. Also, please note that
subscription changes can take up to six
weeks to process.
[5] =>
[6] =>
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Events
XXXXX
Implant Tribune U.S. Edition | May 2013
Scenes from CDA in Anaheim
Implant companies bring newest products to share at Southern California show
The Glidewell
staff at CDA
Presents in
Anaheim
stands ready
to help
attendees
pick out
technology
that will help
their practice.
Straumann’s Brent
Reilly and Tim
Graham speak with
Dr. Cuong Nguyen,
right, on April 11
about the company’s
implant options at
the CDA Presents in
Anaheim.
AD
Emiko Ota and Yukari Aritake at the Osada
booth.
Hiossen’s Derrick Lee shows attendees the
company’s CAS Kit at the company’s booth.
Photos by
Sierra Rendon
Managing Editor
[7] =>
Implant Tribune U.S. Edition | April 2013
industry
B5
[8] =>
C8
industry
Implant Tribune U.S. Edition | May 2013
ENTSPLY offers
D
the SmartFix
restorative solution
DENTSPLY Implants introduces SmartFix,
available for ANKYLOS and XiVE implant
systems. Photos/Provided by DENTSPLY Implants
DENTSPLY Implants is pleased to introduce SmartFix™, available for ANKYLOS®
and XiVE® implant systems.
According to DENTSPLY, SmartFix is an
effective and time-saving implant-prosthetic technique for immediate, screw-retained restoration in the upper and lower
jaw.
The SmartFix Concept allows for res-
AD
SmartFix seating.
torations on angled implants using either a 15- or 30-degree angled ANKYLOS
Balance Base or XiVE MP abutment. These
two-piece abutments provide the optimal
design freedom for the superstructure in
terms of height and diameter, the company said. The abutment components are
pre-mounted in a short, flexible seating
instrument for easier handling and placement of the abutment into the implant.
For more information, visit www.
dentsplyimplants.com or call DENTSPLY
Implants’ customer service at (800) 5313481.
Nobel Biocare
approves
re-elections,
dividends
At its annual general meeting in
March, Nobel Biocare endorsed all
the proposals put forward by the
board of directors, including the approval of a gross dividend. In addition, all board members who stood
again were re-elected, the international provider of restorative and esthetic dental solutions has reported.
Daniela
Bosshardt-Hengartner,
Raymund Breu, Edgar Fluri, Michel
Orsinger, Juha Räisänen, Oern Stuge,
Rolf Watter and Georg Watzek were
re-elected as board members for
a one-year term. Franz Maier was
elected as a new member.
KPMG, Zurich, was confirmed as
auditor for the current financial year.
Nobel Biocare announced that the
next meeting will be held in March
2014.
[9] =>
Dentsply Implants
[10] =>
B10
industry
GNYDM
Implant Tribune U.S. Edition | May 2013
[11] =>
industry
Implant Tribune U.S. Edition | May 2013
C11
BIOMET 3i, 3M ESPE collaborate to create
digital solutions that simplify restorations
BIOMET 3i has announced a new collaboration with 3M ESPE that utilizes the
BIOMET 3i patented BellaTek® Encode®
Impression System with the 3MTM True
Definition Scanner to create customized
abutments using intraoral impressions,
resulting in simplified esthetic restorations.
Utilizing these combined technologies,
clinicians are able to make a digital impression of a healing abutment with the
use of the 3M True Definition Scanner,
which will scan embedded codes on the
occlusal surface of the abutment, the surrounding soft tissue and adjacent dentition. These codes provide the necessary
information to design and mill the definitive abutment. The process is handled
supragingivally by utilizing the BellaTek
Encode Impression System, so no removal of the healing abutment is required to
create the scan.
Greater patient satisfaction may also
occur as intraoral scanning eliminates
the need for impression-taking material; some patients find this is a more
comfortable experience, according to the
company. Patients should also recognize
fordability, the company says.
“We are pleased to offer the broadest range of digital solutions, which will
lead to esthetic outcomes for patients,”
said Bart Doedens, president of BIOMET
3i. “This new step forward in impression
making offers a win-win experience for
clinicians, laboratories and patients.”
“This new collaboration is a very important step to digitize implant treatment, and we are happy to add BIOMET
3i as a new trusted connection with the
3M True Definition Scanner,” said Dave
Frezee, business director, 3M Digital Oral
Care, 3M ESPE. “Dentists now have the option to use the 3M True Definition Scanner for the complete implant workflow.”
About BIOMET 3i
The 3M True Definition Scanner.
(Photo/Provided by 3M ESPE)
time savings as the process is shorter
than the typical procedure.
The new 3M True Definition Scanner is
designed for accuracy, flexibility and af-
BIOMET 3i LLC is a leading manufacturer
of dental implants, abutments and related products. Since its inception in 1987,
BIOMET 3i has been on the forefront in
developing, manufacturing and distributing oral reconstructive products, including dental implant components and
bone- and tissue-regenerative materials.
The company also provides educational
programs and seminars for dental professionals around the world. BIOMET 3i
is based in Palm Beach Gardens, Fla., with
operations throughout North America,
Latin America, Europe and Asia-Pacific.
For more information about BIOMET 3i,
visit www.biomet3i.com or contact the
company at (800) 342-5454; outside the
United States, dial (561) 776-6700.
About 3M ESPE
3M ESPE manufactures and markets
more than 2‚000 products and services
designed to help dental professionals
improve patients’ oral health. 3M Health
Care‚ one of 3M’s six major business segments‚ provides innovative products
and services to help clinicians improve
the practice and delivery of patient care
in medical‚ oral care‚ drug delivery and
health-information markets. For more information on the complete 3M ESPE line
of dental products, visit www.3MESPE.
com or call the 3M ESPE technical hotline
at (800) 634-2249. Products are available
for purchase through authorized 3M
ESPE distributors. 3M and ESPE are trademarks of 3M or 3M Deutschland GmbH.
AD
[12] =>
industry
C12
Implant Tribune U.S. Edition | May 2013
New Implant Direct online
store with ‘all-in-1’ shopping
By Implant Direct staff
Implant Direct, the company that revolutionized the implant industry by creating the value-priced segment in 2006,
introduces a new online store that will
dramatically simplify how implants and
auxiliary items are ordered.
Available at www.implantdirect.com,
the new online store introduces visitors
to the latest products, resources and
events with an ever-changing homepage
display (Fig. 1). Visual selection charts
lead clinicians or office staff through the
implant selection process, first by identifying the implant system (Fig. 2) and
then the correct diameter and prosthetic
platform (Fig. 3).
Once on the implant product page,
the compatible components, abutments,
instruments, biologics and literature
are just a click away. There’s no need to
jump through different product categories or pages — with “all-in-1 shopping,”
everything can be found all in one spot.
The simply smarter system even identifies the related items.
In addition, Implant Direct’s new online store allows visitors to:
• watch related 3-D graphic videos
without interrupting shopping
• easily switch between different product images or zoom-in for a close-up
view
• compare the features and benefits between different products of interest
• move to different categories when
desired via the global, top navigation bar
• find attachments, international products and education opportunities easily
in new, dedicated sections
• look for products quickly with improved search capabilities and new advanced search option
• quickly preview cart contents
• keep track of potential future purchases with a wish list
• manage their account and view all
recent activity easily from the account
dashboard
This new online store, with advanced
technological capabilities, represents
the latest progression in the web-based
business strategy Implant Direct was
originally founded upon. The company
has long strived to augment the service
and support available to dental professionals from the customer service and
field teams with online assistance, such
as an extensive library of 3-D graphic
videos detailing technical procedures
and product features.
Implant Direct’s implant systems offer surgical and prosthetic compatibility
with premium-priced systems as well
as significant design improvements for
enhanced clinical performance. Implant
Direct offers a non-negotiable list price
for each item in its broad product range.
All-in-1 packaging includes components
such as cover screw, healing collar, trans-
Fig. 1: Implant Direct’s new online
store at www.implantdirect.com.
Photos/Provided by Implant Direct
fer and final or temporary abutment
with the implant for added value.
About Implant Direct
Implant Direct is a joint venture between
implantology pioneer Dr. Gerald Niznick
and Sybron Dental Specialties (SDS). The
venture combines SDS’ 100-year history
of providing service, quality and innovation to dental professionals, the expansive expertise of its Fortune 500 parent
company, Danaher Corporation and
Niznick’s 33-year history of innovation
in the implant industry, with more than
30 patents including the internal, conical connection in 1986 — a cornerstone
of modern dental design.
Today, Implant Direct continues those
traditions through its commitment to
provide high-quality products at valueadded prices with simplified surgical
procedures and versatile prosthetic options. The company releases numerous
new product lines and line extensions
each year while also continually improving its existing product designs, manufacturing processes and online support.
Fig. 2: Implant System
Selection. Shown here:
Legacy System with
Dr. Niznick’s orginal,
internal conical connection
interface.
Fig. 3: Implant Diameter
Selection. Shown here:
Legacy3 implants packaged
on a carrier that is transfer
and final abutment.
Fig. 4: Implant Product Page
with all-in-1 shopping.
[13] =>
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[14] =>
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C14
Implant Tribune U.S. Edition | May 2013
Implant position
in the esthetic zone
Establishing a treatment plan is paramount
By Siamak Abai, DDS, MMedSc
Since the advent of modern root form
osseointegrated implant dentistry in
1952, clinicians have strived for improvements in implant positioning in the esthetic zone to achieve predictable restorative and esthetic results.
Years of clinical experience in congruence with controlled clinical studies have helped establish parameters as
a guide for these results. Establishing a
treatment plan and clinical protocol prior to implant placement is paramount.
Treatment planning traditionally begins with comprehensive medical and
dental evaluations, articulated diagnostic casts, radiographs, cone-beam computed tomography (CBCT) scans and
a diagnostic wax-up. Patient demands
must be taken into consideration prior to
surgery, and pre-surgical mockups may
be necessary to convey the information
to the patient.
The advancement of CBCT technology
has led dentistry into a new realm of
dimensional accuracy. In combination
with the use of a surgical or guided stent,
proper 3-D positioning of an implant has
led to more accurate clinical results.
The importance of the implant position can be manifested in the four
dimensionally sensitive positioning
criteria: mesiodistal, labiolingual and
apico-coronal location, as well as implant angulation.1 The ultimate goal is
not only to avoid sensitive structures,
but to respect the established biological
principles to achieve esthetic results.
Mesiodistal criteria
Correct implant position in a mesiodistal
orientation allows the clinician to avoid
damaging adjacent critical structures. A
minimum distance of 1.5 mm between
implant and existing dentition prevents
damage to the adjacent teeth and provides proper osseointegration and gingival contours.2–4 (Fig. 1a)
Distances of less than 3 mm between
two adjacent implants leads to increased
bone loss and can reduce the height of
the inter-implant bone crest. A distance
of more than 3 mm between two adjacent implants preserves the bone, giving
a better chance of proper interproximal
papillary height (Fig. 1b).
Labiolingual criteria
An implant placed too far labially can
cause bone dehiscence and gingival recession while an implant placed too far
lingually can cause prosthetic difficulties. A thickness of 1.8 mm of labial bone
is critical in maintaining an implant
soft-tissue profile.5 (Fig. 2)
Labially oriented implants compromise the subgingival emergence profile
development, creating long crowns and
misalignment of the collar with respect
to the adjacent teeth.6
Apico-coronal criteria
Peri-implant crestal bone stability plays
a critical role in the presence of interdental papilla.7 Implants placed too shallow
may reveal the metal collar of the implant through the gingiva. Countersinking implants below the level of the crestal bone may give prosthetic advantages
but can lead to crestal bone loss.
The ideal solution would be the placement of an implant equicrestal or subcrestal to the ridge. However, the existing
microgap at the implant abutment junction leads to bone resorption because of
peri-implant inflammation.8 It is suggested an implant collar be located 2 mm
apical to the CEJ of an adjacent tooth if no
gingival recession is present.9 (Fig. 3)
Fig. 1a: Minimum distance of 1.5 mm
between implant and existing dentition.
Photos/Provided by Glidewell Laboratories
Fig. 1b: Minimum distance of 3 mm between
two adjacent implants.
Fig. 5a: Inclusive Tapered Implant
at placement.
Fig. 5b: Inclusive custom healing abutment
in place.
Implant angulation
Implant angulation is particularly important in treatment planning for screwretained restorations. Implants angled too
far labially compromise the placement
of the restorative screw while implants
angled too far lingually can result in unhygienic and unesthetic prosthetic design.
For every millimeter of lingual inclination, the implant should be placed an additional millimeter apically to create an
optimal emergence profile.10 In general,
implant angulation should mimic angulation of adjacent teeth (Fig. 4). Furthermore, maxillary anterior regions require
a subtle palatal angulation to increase
labial soft-tissue bulk.11
Inclusive Tooth Replacement
Solution
Fig. 2: Proper labiolingual placement with
1.8 mm thickness of labial bone.
Fig. 5c: Contoured soft-tissue sulcus after
healing.
Fig. 3: Lateral view of implant placed with
the collar at the level of crestal bone with
adjacent teeth CEJ 2 mm coronal to the collar
of the implant.
The Inclusive® Tooth Replacement Solution was developed by Glidewell Laboratories as a complete, prosthetically
driven method of restoring missing
dentition. The solution is composed of
treatment planning, implant placement,
patient-specific temporization and the
definitive restoration (Figs. 5a–5f).
When utilizing the comprehensive
range of Inclusive Digital Treatment
Planning services, the clinician has absolute and precise control of each step.
The clinician has control of the four dimensions of implant placement in the
esthetic zone, creating a consistently predictable result.
To read the full article, go to www.
inclusivemagazine.com. References are
available from the publisher.
Fig. 5d: Screw-retained IPS e.max® crown
(Ivoclar Vivadent; Amherst, N.Y.) in place.
Fig. 5e: PA to verify seating of crown.
Fig. 4: Proper implant angulation with screw
access in the cingulum area.
Fig. 5f: Buccal view of final restoration at
delivery.
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[16] =>
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clinical
Implant Tribune U.S. Edition | May 2013
“ BLADES, Page 1C
represents the optimum to allow immediate loading with a functional provisional prosthesis.
Blade implants are made of titanium.
Osseointegration of titanium implants
has been confirmed by numerous histological studies, completed with any
implant shape. Histological studies on
blade implants demonstrate their osseointegration and thickening of bone tissue
around their surface consequent to
load.9,17,18,19 Figure 1 allows you to appreciate the bone thickening around the neck
and body of a blade implant, which represents bone reaction accrued during 11
years of functional work.
Due to the fact that bone response is
the same, you can build fixed prosthetic
bridges supported by screw and blade
implants. Figure 2 has been taken immediately after positioning a screw implant and a blade implant in the superior
posterior area, in order to build a threeelements bridge. The blade is leaning on
the cortical of the maxillary sinus, engaging it in some points.
Blades allow:
• the possibility of making the most of
even the narrowest alveolar crests;
• adaptability to the majority of anatomical conformations;
• valorization of existing tissue and obviation of bone expansion and regeneration procedures;
• mechanical correction of parallelism
issues during implant surgery;
• versatility in adaptation to the deep
anatomical structures possible by modifying the implant;
• the presence of numerous stabilizing
contacts with deep cortical layer;
• the possibility of inserting a part of
the implant below the intact cortex (as
compared to EDE technique);
• adequate management of attached
gingiva during implant surgery; and
• simple surgical technique performed
with standard instruments.
conceived during the 1970s by Roberts
and Linkow. The technique involves tracing the implant housing mesial to the implant positioning site, so that the blade is
gradually rotated distally until it reaches
the distal border of the post housing
(Fig. 4). In this way almost all of the implant is placed beneath the intact bone
and soft tissues. The presence of intact
superficial bone tissue posterior to the
abutment can be seen upon radiographical examination.
Reliability
Fig. 1: Photo at seven years and radiograph at 11 years of submerged blade implant positioned
in zone 1.2 in 1993. Photos/Provided by Luca Dal Carlo, DDS.
Fig. 2: Blade implant and screw implant inserted in the superior posterior area. Blade’s shoulder
has been positioned deep inside the bone. The blade engages in some points the cortical bone
of the maxillary sinus.
Shape modifications
The blade implant can be modified to perfectly suit the deep bone anatomy (Fig.
1), and the body can be curved to follow
the anatomical profile. If the abutment
needs to be angled, this can be achieved
mechanically, up to a maximum of 20 degrees, before the implant is positioned4,5
using two pairs of steel pliers, thereby
resolving beforehand any problems that
could arise because of incongruous abutment positioning (Fig. 3).
Fig. 3: Blade implant inserted in zone 3.5, where the bone ridge was narrower than posteriorly.
Notice how the blade’s abutment has been bent to solve parallelism problem, before deep insertion of the implant in the bone.
Immediate loading
During the years, several authors have
proposed variations on the original technique, which fit to certain situations. The
technique known as Endosseous Distal
Extension (E.D.E.) is particularly useful
for treatment of lower posterior sectors
featuring scarce bone density.
Used since 1993, E.D.E. was first published in 2001.7-8 The type of blade implant to use is ramus blade, which was
Conclusions
The blade implant is a valid therapeutic
device useful for treating cases with particular anatomical features, such as narrow bone crest and scarce spongy bone in
the lower distal sector.
It can be used, due to the numerous
forms available, not only in the upper
and lower posterior sectors, but also to
provide deep anchorage in posterior and
anterior (esthetic) sectors alike.
It is therefore a treatment of choice in
cases where the outcomes of alternative
procedures are less predictable and the
procedures themselves are more likely
to compromise the integrity of the local bone tissue. Because they induce the
same bony reaction, blade implants can
be used in combination with other implant types (Fig. 5).
Furthermore, this method offers excellent response of the surrounding soft
tissues. To prevent failure, practitioners
would be wise to bear in mind that blade
implants are not indicated in wide alveolar crests or in areas where bone density
is insufficient and the implant cannot engage the deep cortical layer.
It is very important that clinicians who
want to learn the blade implant technique
carefully follow training courses held by
expert fellows, who can teach you how
to practice this technique while avoiding
some of the mistakes that have caused
unfair bad press in the past.
Theoretical and practical courses are
organized in New Jersey and Jamaica by
Atlantic Dental Implant Seminars (www.
adiseminars.com), under supervision of
Linkow, the blade implants inventor.
References available upon request from
the publisher.
The blade implant can be immediately
loaded if adequate stability has been
achieved. Anchoring the implant through
two cortical layers and in contact with the
deeper cortex should confer best stability.
Static and dynamic occlusion should
be meticulously checked upon fitting of
both temporary and permanent crowns.6
Variations
Numerous articles have attested to the
long-term stability of this type of implant
and document the histological confirmation of its osteointegration, without connective tissue interposition at the bone/
implant interface.9-22
This kind of procedure is characterized
by excellent soft-tissue response.
About the author
Luca Dal Carlo, DDS, graduated from the University of Padua (Italy) in 1988. He is the founder of the
New Italian Group for
Studies in Implantolo-
Fig. 4: Schematic representation of the E.D.E. technique.
gy (NuovoGISI). He has
lectured
Fig. 5: Combination of different
implant types in the same
clinical case.
throughout
the world for dental
schools, dental societies
and
specialty
groups and has authored more than 50
articles and chapters in
professional
journals
and textbooks. Dal Carlo maintains a private
practice in Venice, Italy. He may be reached at
lucadalcarlo@yahoo.it.
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