Dental Asia Mar/Apr 2016 - page 66

is close to 96 per cent. Thanks
to well-established implant
placement protocols, with a
few differences according to
the implant system used, predictability
of the result under optimum tissue
conditions is quite significant. It is very
different when these conditions do not
meet the recognised standards in terms
of volume and quality for reproducibility
in implantology.
Thin ridges, for instance, which are
frequent occurrences, will require a
long and costly process for patients
because they entail bone augmentation
or possibly support tissue grafts. In this
case, would there be aminimally invasive
alternative that can be performedwithout
One line of thinking is to stop the
systematic practice of implantology
as subtractive at the tissue level, but
rather to transfer these volumes and
thereby ensure a minimally invasive
procedure. This implies reviewing
all the biomechanical principles of
implantology, not only in terms of
implant structure and design but also in
relation to peri-implant tissue.
The general surgical principle of modern
implantology since Brånemark has been
bone preparation (osteotomy) as close
as possible to the dimensions of the
implant that will be placed. This principle
is still widely prevalent. However, soft
tissue management has evolved and the
trend over the past few years has been to
manage soft tissue from the first surgical
With the arrival of self-tapping conical
implants, a new techniquewas developed,
which enables lateral and vertical bone
compressing, condensing or expanding.
In addition, in 1994, Summers, practising
Case 1
The patient presented with a fracture
of tooth #16 (Figure 3) and periapical
cysts. With the patient’s consent, the
decision was made to performextraction,
debridement, socket decontamination
and immed i a t e p l a c emen t o f a
non-submerged implant (implant +
healing screw) using Summers’ method
(crestal sinus lift). The patient was on
standard pre-medicationwith amoxicillin
and corticosteroids.
Tooth #16 was carefully extracted by
radicular separation to avoid bone
fracture especially in the vestibule, where
the cortical bone is very thin. The lamina
his crestal sinus lift technique with
careful choice of conical taps, was the first
to demonstrate the capacity of cancellous
bone to be modelled (Figure 1).
The following clinical cases will show that
it is possible for implant placement to be
minimally invasive and precise, and that
the use of biomaterials can be avoided
simply by exploiting the biomechanical
properties of bone tissue and its capacity
to regenerate.
Respecting guided regeneration
principles (implementation of
physical barriers to isolate the
epithelial and connective tissue
cells from the operating site)
enables regeneration of the
different tissues. These principles
are as follows (Figure 2):
– Primary closure of the surgical
site to enable undisturbed and
uninterrupted healing;
– Completion of the best possible
angiogenesis to provide the
required vascularisation and
undifferentiated mesenchymal
– Creation and maintenance of a
space to facilitate bone formation
inside this space; and
– Stabilisation of the surgical site
to induce blood clot formation and
facilitate healing;
Thanks to the careful choice of
healingscrewor implant abutment/
temporary crown pair, these two
entities with different regeneration
potentials can be hermetically
sealed, thereby avoiding cell
competition, which contributes to
the growth of epithelial cells that
develop more rapidly.
Fig. 1: Original
sketch of
Fig. 3: Pre-operative
view: Fractured and
infected tooth #16.
Fig. 4:
Osteo Safe®
in use.
Fig. 2: 1 and 2: Bone expansion through the
septum with the use of osteotomes;
3 and 4: Choice of healing screw that enables
primary closure of the soft tissue.
Dr. Gilles Chaumanet, MSc
The bone expansion technique
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