BibliograÞa

1. Jokstad A. Carr A.B. What is the effect on outcomes of time to loading of a Þxed or removable prosthetic placed on implant (s)? Int J Oral Maxillofac Implant 2007;22(suppl);19-48.

2. Esposito M. Grisuvin MG. Achille H. Coulthard P. Worthing HV. Intervention for replacing missing teeth: different time for loading dental implants. Cochrane Database of Systematic Reviews 2009, issue 1.

3. Ostman P. O Periodontology 2000 vol 47; 2008; 90-112

V.Giannelli 1, L.C.Campos1, C. Baroncini 2, G. Ghirlanda1 1 Odontoiatra Libero Professionista, Roma 2 Odontotecnico, Roma Ref.: V.Giannelli email: dott.vittoriogiannelli@gmail.com

New Protocols for New Materials (Qu-Base, Qu-Resin)- The Information Transfer on a Unique Model.

Introduction   The protocol with prosthesis implant, as the one with prosthesis on dental elements is fundamental. Companies often indicate this in order to make the most of the performance of the various materials proposed; for this purpose the concept of teamwork, in accordance with respect of the roles and dignity of each operator becomes increasingly valuable. Everyone with his necessities and point of view has to collaborate so that all the different phases can be reproducible, giving a predictable result. Only in this way the percentage of success will be closer to 100%. The majority of authors are unanimous in afÞrming that the variables represented by the imprint and the occlusal surveys which are difÞcult to control; capable of determining the failure of an implant-prosthetic protocol. In order to reduce the number of variables, two phases have been proposed: the Òunique modelÓ and the transfer of the spatial position of the abutments.   Trying to unite an ideal material for ideal implant-prosthetic rehabilitation is a complex tasks if not impossible. The research and the decennial experience allows us today to offer Òspeed & stabilityÓ to our patients needing complete rehabilitation, taking in due consideration the economic side that is of primary importance. Nowadays the Òimmediate loadingÓ can be considered a valid alternative at our disposal and not an experimentation, thanks to the numerous scientiÞc works (1) validated by systematic reviews of literature (2) that establish the lack of substantial differences between implant-prosthetic rehabilitations performed by loading the implants following traditional protocols (12-24 weeks) and following immediate loading protocols (12-24 hours). It is right to say, however, that the amount of selected cases remains small. At the present time there are no guidelines to regulate this kind of rehabilitation. The majority of authors recommend the Þxture insertion with the application of the prosthesis within a period of time that goes from the 24 to 72 hours. The Þrst objective that we set for ourselves is to obtain the major immobility of the immediately loaded implants (that is within the 72 hours since the insertion of the Þxtures) during the ÒhealingÓ period that accompanies our implants from the primary stability to the secondary. For this purpose we need a prosthesis that has predetermined mechanical characteristics although it will be a product with a limited lifetime.

Materials and methods   The case presented concerns a patient in general good health, bearer of an implant-supported prosthesis loaded to the maxillary for about 12 years, but with the presence of generalized bone loss at the mandible with variable mobility of stage one to three in different sections (Þg.1); for these reasons the patient requested the realisation of a implant-prosthetic rehabilitation at the level of the lower mandible. The strong motivation of the patient was accompanied by an equally strong need to perform a similar job as the one on the maxillary but with lower costs and in reduced times compared to the other rehabilitation. The authors decided to proceed with a rehabilitation made on six Þxtures (BluSky, Bredent) performed immediately after the tooth extractions. The detection of the abutmentÕs spatial position with transparent masks, that repeat the prosthesis to perform, leads us to have a secure relationship between their position and the opposing arch. We are talking of abutment and not transfer, because it is their position that we care about and not the implant position. This kind of information transfer leads us to be faster and more precise. The consequence is that we will be able to use the master model put in articulator with the right relationship between the arch previously recognized and veriÞed. This can be obtained through the CompoForm UV (Bredent, Germany) the previously optimized abutments, considering that the attachment to the mask / replication prosthesis will take place in centric position, activating the polymerization with the light ßashing through the transparent mask. Therefore the master model will have to be perforated in correspondence with the inserted implants, on which will be replaced the mask / replication with the abutments, controlling the exact occlusion with the antagonist in articulator. At this point it will be sufÞcient to secure them in place entering plaster from the base of the model. The correct analysis and the subsequent development of the masks / replications is fundamental as important as the information transfer of the spatial position itself. Stages of Þnalization at this point are a simple work of assembling for the construction of the Þnal product. The use of this system led us to think over time to have the certainty to always being able to take action on problems or adjustments. The most commonly used materials in the procedures of immediate loading, for the making of implant-prosthetic structures, are chromium-cobalt alloys and titanium (as well as treated as performed); these confer rigidity to the system, but lengthen the time of execution and dilate the costs signiÞcantly in addition to representing a different material to those used for the aesthetic clad. The research and the experience have made that the authors use high-performing resins with mechanical and aesthetical upper level characteristics (Qu-Base and Qu-resin, Bredent, GmBh, Senden, Germany) both for the supporting structure and the chewing part (Visio.Lign and Neo.Lign Bredent, Germany).

Materials and methods

The case presented concerns a patient in good general health, who has had an implant-supported prosthesis loaded to the maxillary for about 12 years, but is showing generalised bone loss at the mandible with variable mobility of stage one to three in different sections (fi g.1). For these reasons the patient requested an implant-prosthetic rehabilitation at lower mandible level. The patient was motivated to seek treatment similar to that in the maxillary, but this time required a lower cost option which would not take as long as the previous treatment.

The practitioners decided to proceed with a rehabilitation based on six fi xtures (BlueSky, bredent) performed immediately after the tooth extractions. The detection of the abutment‘s spatial position with transparent masks ensures a secure relationship between their position and the opposing arch. We are

referring to the abutment and not the transfer, because it is this position that is important and not the position of the implant. This kind of information transfer me-ans we can work faster with more precision. Consequently, we will be able to use the master model put on the articulator with the right relationship between the arch which has been previously recognised and verifi ed.

This can be obtained through the use of CompoForm UV (bredent, Germany) on the previously optimised abutments, considering that the attachment to the mask / replication prosthesis will take place in centric position, activating polymerisation with the light fl ashing through the transparent mask.

The master model will have to be perforated in correspondence with the inserted implants, on which the mask / replication with the abutments will be replaced, thereby controlling the exact occlusion with the antagonist in articulator. At this point it will be suffi cient to secure them in place by introducing plaster into the base of the model.

The correct analysis and the subsequent development of the masks / replications is as fundamentally important as the information transfer of the spatial posi-tion itself. At this point, the fi nalisation stages are achieved simply by assembling the components for the fi nal product construction. The use of this system over time confi rmed that we would be able to resolve problems or make adjustments easily.

The most commonly used materials in the fabrication of implant-prosthetic structures for immediate loading procedures are chromium-cobalt alloys and titani-um (treated and performed). These confer rigidity to the system, but lengthen execution time and signifi cantly dilate costs. They also present a different material to that used in the aesthetic clad. Through research and practical experience, practitioners now use high-performing resins with mechanical and aesthetical up-per level characteristics (Qu-Base and Qu- resin, bredent, GmBh, Senden, Germany) both for the supporting structure and the chewing part (visio.lign and neo.lign bredent, Germany).

Introduction

Following the correct protocol when using prosthesis implants, especially prosthesis on dental elements, is fundamental. Companies often specify this to make the most of the various proposed materials‘ performance. For this purpose the concept of teamwork, whilst respecting the individual roles and dignity of each operator, becomes increasingly valuable. Each individual must collaborate so that all the different phases can be reproducible and give a predictable result. It is only in this way that 100% success can be guaranteed. The majority of dental authors unanimously affi rm that the variables represented by the imprint and the occlusal surveys, which are diffcult to control, are capable of determining the failure of an implant-prosthetic protocol. In order to reduce the number of variables, two phases have been proposed: the “unique model” and spatial position transfer of the abutments.

Trying to unite an ideal material with an ideal implant-prosthetic rehabilitation is a complex, if not impossible task. With 10 years of experience and research we can now offer “speed & stability” to our patients who need complete rehabilitation, taking due consideration of crucial economic factors. Nowadays, we have “immediate loading” at our disposal, which can now be considered a reliable alternative, rather than an experiment. This is thanks to numerous scientifi c works (1), which have been validated by systematic reviews of literature (2), which establish the lack of substantial differences between implant-prosthetic rehabilitations performed by loading the implants following traditional protocols (12-24 weeks) and follo-wing immediate loading protocols (12-24 hours). However, it must be said that there remains only a small number of selected cases.

At this present time there are no guidelines to regulate this kind of rehabilitation. The majority of dental authors recommend fi xture insertion with the application of the prosthesis within a time period of 24 to 72 hours. The fi rst objective we set for ourselves is to obtain the major immobility of the immediately loaded implants (within the 72 hour period following fi xture insertion) during the “healing” period that accompanies our implants from the primary stabili-

ty to the secondary. For this purpose we need a prosthesis that has predetermined mechanical characteristics, despite the fact that this will be a product with a limited lifetime.