Journal of Oral Implantology October 2012 - (Page 611)

CASE REPORT Fixed Rehabilitation of Severely Atrophic Jaws Using Immediately Loaded Basal Disk Implants After In Situ Bone Activation Guillaume Odin, MD, PhD1 Carl E Misch, DDS, MDS2 Itzak Binderman, DDS, MDS3 Gerard Scortecci, DDS, PhD4* Rehabilitation of severely atrophic jaws is facilitated when basal disk implants are used after activation of the future bony implant bed with a purpose-designed instrument (Osteotensor) 45 to 90 days before implant surgery. Fabrication of a highly rigid, screw-secured fixed prosthesis that acts as an external orthopedic fixator permits immediate functional loading. This protocol also represents a second chance for patients who have experienced complete implant loss and/or bone graft failure. Key Words: disk implant, atrophic jaw, bone activation, immediate loading protocol INTRODUCTION mplant placement in severely atrophic jaws (Figure 1) is especially challenging because of the poor quality and quantity of the future implant bed.1 Calvarial or iliac bone grafts, mental nerve displacement, and sinus lift procedures are often used to overcome the initially unfavorable anatomical and mechanical conditions.2 Despite acceptable success rates, these approaches involve unpredictable degrees of morbidity at the donor and/or recipient sites.3 Furthermore, patients are sometimes reluctant to undergo such procedures. This article describes an approach based on osteogenic activation of the future implant bed and full-flap surgery for basal implant installation. Using a novel flapless procedure, a series of microcracks are created in the bone by a purpose-designed 1 ´ Institut Universitaire de la Face et du Cou, Departement de Chirurgie maxillo-faciale, Nice, France. 2 Misch Implant Institute, Birmingham, Mich. 3 School of Dental Medicine, Department of Bio-Engineering, Tel Aviv University, Tel Aviv, Israel. 4 Private practice, Nice, France. * Corresponding author, e-mail: scortecci@wanadoo.fr DOI: 10.1563/AAID-JOI-D-10-00163 I bone matrix Osteotensor 45 to 90 days before implant surgery. The cascade of biological responses includes recruitment of stem cells, both locally and at a distance, that participate in bone remodeling. Once the density of the recipient bone site is judged acceptable, the implants are installed and immediately loaded with a rigid, passive-fit, screw-secured prosthesis serving as an external fixator. MATERIALS METHODS AND Rationale for bone activation Just as mechanical microtrauma of the periosteum induces subsequent repair,4 surgical trauma of the cortical bone results in a burst of localized hard tissue remodeling.5–7 The microcracks caused by penetration of the Osteotensor (Victory, Nice, France) induce the release of bone matrix growth factors (bone morphogenetic protein and insulinlike growth factor I, II, and beta)8 that have a range of biologic properties. Osteoinductive proteins from the bone matrix recruit stem cells at a distance from the microcracks that participate in the bone remodeling process.7 Complex interactions have Journal of Oral Implantology 611

Table of Contents for the Digital Edition of Journal of Oral Implantology October 2012

Should the Implant Fit the Patient or Should the Patient Fit the Implant?
Histologic and Biomechanical Evaluation of Alumina-Blasted/Acid-Etched and Resorbable Blasting Media Surfaces
Impact of Dental and Zygomatic Implants on Stress Distribution in Maxillary Defects: A 3-Dimensional Finite Element Analysis Study
Precision of Implant Placement With Stereolithographic Templates: A Pilot In Vitro Study
An Evaluation of Biocompatibility of Indigenously Produced Pure Titanium: An Experimental Study in Rabbits
Relationship Between Smoking and Bleeding on Probing
Stress Analysis in Platform-Switching Implants: A 3-Dimensional Finite Element Study
Acrylic Resin Polymerization in Direct Contact to the Abutment and the Temperature at Bone-Implant Interface: A Pilot In Vitro Study
Clinical Application of Stereolithographic Surgical Guide With a Handpiece Guidance Apparatus: A Case Report
Fixed Rehabilitation of Severely Atrophic Jaws Using Immediately Loaded Basal Disk Implants After In Situ Bone Activation
A Functional Open-Tray Impression Technique for Implant-Retained Overdenture Prostheses
Use of Plasma Rich in Growth Factor for Schneiderian Membrane Management During Maxillary Sinus Augmentation Procedure
A Technique to Facilitate the Fabrication of Provisional Restorations for ITI Solid Abutments
Influence of Etiologic Factors in Peri-Implantitis: Literature Review and Case Report
Simplistic Partially Limiting Surgical Guide for Flapless Implant Placement: A Case Report
Types of Implant Surgical Guides in Dentistry: A Review
Rehabilitation of Atrophic Posterior Maxilla With Zygomatic Implants: Review

Journal of Oral Implantology October 2012