Endosseous Implants Question And Answers

Endosseous Implants Question And Answers

Discuss the immediate loading and Progressive Loading of Endosseous Implants

Answer

 Immediate loading Endosseous Implants Definition
The prosthesis is attached to the implant within 24 hours of the implant being placed.

Early loading Endosseous Implants Definition
The prosthesis is attached to the implant within days/weeks of the implant being placed.

Read And Learn More: Fixed Partial Denture Short Essay Question And Answers

Delayed Loading Endosseous Implants Definition
The prosthesis is attached to the implant after a healing period of 3–6 months.

Conventional or delayed loading protocol

Was initially proposed by Brånemark where a waiting period is essential for the implant to osseointegrate and the prosthesis is fabricated after the delayed waiting time after complete integration.

Advantages of the Delayed Protocol

• It can be used on weaker bones in both quality and quantity. The procedure provides sufficient time for the bone to heal and implant to integrate
• The stimulatory forces of bone metabolism aid in improving bone density and enhance osseointegration
• Improved bone architecture and bone-forming factors around the implant are achieved better with a delayed loading protocol
• Extensively documented data available on its success
• Increased predictability of osseointegration.

The prosthodontic loading time in delayed protocol varies with the type of bone, jaw, and span of the restoration. The maxilla has increased waiting time than the mandible because of the lesser quality of bone. The universal waiting period for different bone types is listed below:

Disadvantages of progressive loading

• Time taken to fabricate the restoration. It can vary between 3 and 6 months depending on the type of bone and prosthesis
• Patient psychology can be affected due to the delay in the implant loading.

The advancement in implant surfaces and improved understanding of bone science, prosthesis, and occlusion have led to the development of improved implantology protocol of immediate loading which reduces the limitations of delayed implant loading.

Immediate Loading of Endosseous Implants

Immediate loading is loading the implant immediately. This occlusal loading can be with a provisional restoration or with a definitive prosthesis. The type of loading and prosthesis depends on the clinical situation.

Endosseous Implants Indications

• Adequate bone quality and dimensions
• Psychology needs patients who dislike temporary removable partial dentures either due to prosthesis movement or due to its supporting mechanism.

Endosseous Implants Contraindications

• Inadequate bone architecture, poor bone quality, and density (Type 4 bone)
• Parafunctional habits
• Poor systemic health
• Inadequate bone height (≥12 mm) and bone width ≥5 mm
• Inability to achieve an adequate AP spread
• Contraindication factors associated with generalized implantology procedures.

Advantages of Immediate Loading Endosseous Implants

• Minimize the requirement of angle abutments since the implants can be placed in the same position as the extracted tooth or in extraction sites
• Immediate restoration improves patient satisfaction and psychology
• Osseointegration is more favorable when implants are placed immediately following an extraction
• The recession of tissue, bony receptors, and the crystal bone are preserved better with immediate loading of implants
• Stage 2 surgery of conventional protocol is eliminated
• Countersinking of implants done in delayed protocol is avoided which reduces the chance of crystal bone loss
• Splinting of implants aids in early healing and improves biomechanical advantages
• The primary healing time of bone and tissues is reduced coupled with implant surgical healing in immediate loading.

Disadvantages of immediate loading

• If the primary stability of the implant is reduced it affects the success rate of a procedure
• The micro-movements of implants increase the chances of bone microfracture
• Parafunctional habits like tongue thrusting can disturb the implant site and can cause crystal bone loss eventually leading to failure
• Entrapment of impression or surgical material can interfere in the healing process.

Factors that influence the Immediate-Loading Protocol

Surface area
The implant surface area is enhanced with an increase in the number, dimension, design, and surface area of implants.

Nonaxial forces
The nonaxial forces are less endured by the supporting structures and it can enhance bone resorption in immediately loaded implants. The possibility of nonaxial forces is observed significantly in parafunction, cantilever, and inappropriate crown/implant ratio.

Occlusal consideration – Implant-protected occlusal scheme reduces the damaging forces transmitted to the implants.

Implant position
The mandible is divided into three segments and maxilla into four segments.
The three mandible segments are bilateral canine region, canine, and two posterior segments on either side.

In the maxilla, there are four segments midline to canine on either side or posterior bilateral space present behind canine to molar on either side. An implant is also necessitated in the midline to improve the supporting mechanism.

Immediate loading protocol for different kinds of prosthesis designs

Single Tooth Replacements

• Ideal soft tissue, bone, and implant conditions
• Threaded- or screw-type implant design with the highest pitch and depth that increases the implant surface area
• Implant-protected occlusal scheme
• Definitive cement is used for luting the restoration.

Partially Edentulous Area (missing 2 or more teeth)

• Each missing tooth has to be preferentially restored with one implant
• The maximum dimension of the implant that can be accommodated with minimum dimension is 10 × 3.75 mm
• Threaded- or screw-type implant design with the highest pitch and depth that increases the implant surface area
• No cantilever load
• Implant-supported occlusal scheme.

Fixed prosthodontics in completely edentulous situations

• Necessitates minimum of 8 implants in maxilla and 5 in mandible
• Maximum implant dimension that can be accommodated should be used with a of 3.75 mm in width and 10 mm in length
• Threaded- or screw-type implant design with the highest pitch and depth that increases the implant surface area
• No cantilevers
• Implant-supported occlusal scheme.

Overdenture

• Adequate residual bone height is essential
• Interarch space should be a minimum of 12 mm
• A minimum of four implants are to be placed between two mental foramen and widely distributed in the maxilla (two bilateral canine and molar regions)
• Implants have to be splinted with a bar for force distribution
• An acrylic denture with a metal framework engaging the bar will be more ideal prosthesis.

Endosseous Implants Conclusion

The immediate loading of implants has become more of a standardized protocol of acceptance. The choice between immediate- and delayed-loading protocol depends on the clinical situation.