Dr. Cutnei from Brazil asks us:
At our practice when we are working with a one stage dental implant
system, we notice some limitations in the esthetic zone.
Specifically, when working with ITI Straumann dental implants in anterior region of mandible, where we all know we have a very nonkeratinized and thin mucoso in the lingual section of anterior mandible, we are always confronted with a thin and tearable and non attached mucosa in the lingual aspect of dental implant. This situation could predispose the patient for bone loss in the area. What should I do? Should I move to a 2 Stage implant process in the anterior of mandible and make a bucal flap instead of crestal flap? Thanks for any help.
I had similar problems it thos cases I decided to do connective tissue graft with the implant placement it gave me nice gingival height
this is my question that had been posted few days latter!
I too was having a problmn in tne anterior region with that implant. It is ok for the back part of the mouth, NOT THE FRONT. You mught look at rhe PerioSeal implant. I started using just for the front, but now I use it in all areas.It is easy to use and gives GREAT esthetics. Look at perioseal.com
JBH
To answer your question without pitching another implant system, JBH, yes a two-stage implant system would be better. I use a system that allows me to bury the implant and maintain greater tissue height and thickness. Also with 3.25-4mm platforms you should be able to place the implant in the proper position without compromising esthetics. By the way, using gingival grafting in order to make up for the short coming of the implant system doesn’t make sense because there are several implants which give me great esthetics in the anterior.
I still use ITI in the posterior but not all the time, just when it is requested.
I use 2 other traditional 2 stage implants in the anterior. I found the ITI implants work as well as any other implant I have used but I have had questionablr esthetics.
ITI has a two stage implant, it is the same as the one stage implant. You can place the implant subgingival. With a one stage or two stage implant bone will remodel based on your placement. If you need to submerge a single stage implant in the anterior then you should. Changing to a two stage implant will not change biologic width considerations. You also have to consider the micro-gap at the implant to abutment connection. I am not saying that ITI has the perfect solution for all anterior cases but when people say you can’t use ITI in the anterior they are accurate.
I meant to say inaccurate.
I have a personnal friend who is a Professor at the University of Sao Paulo Brazil, dept of Prosthodontics.In the last 8 years, he has restored 4,000 cases using the Ankylos system from Dentsply. Once you get to know and understand this system, you will dramatically reduce or eliminate crestal bone loss/ He has several cases where he has bone growing over the shoulder of the implant, thanks to the platform switching, no microgap, no micromovement. Let me know if you need to contact him.
to James – from a dental implant patient ,please can you provide the name and contact info for the Professor at the University of Sao Paulo in Brazil that you mentioned on your comments. I believe he may can help me with my present situation.
Dr. Cutnei
Straumann can be used with success in the anterior region with proper placement aided by an instrument I developed. A depth gauge with a 1.8mm collar to simulate the platform. With the use of this gauge after the 2.2 drill you can then determine if the platform will be subgingival enough for esthetics. If not modify the ridge and then drill deeper before enlarging the osteotomy. You may visit my website at http://www.drillstops.com to view the product. This is not intended for promotion but a sharing of a new product which can greatly improve implant placement.
Emil Verban