The primary function of a dental implant is to act as an abutment for a prosthetic device, similar to a natural tooth root and crown. Any success criteria, therefore, must include first and foremost support of a functional prosthesis. In addition, although clinical criteria for prosthetic success are beyond the scope of this article, patient satisfaction with the esthetic appearance of the implant restoration is necessary in clinical practice. The restoring dentist designs and fabricates a prosthesis similar to one supported by a tooth, and as such often evaluates and treats the dental implant similarly to a natural tooth. Yet, fundamental differences in the support system between these entities should be recognized. The purpose of this article is to use a few indices developed for natural teeth as an index that is specific for endosteal root-form implants. This article is also intended to update and upgrade what is purported to be implant success, implant survival, and implant failure. The Health Scale presented in this article was developed and accepted by the International Congress of Oral Implantologists Consensus Conference for Implant Success in Pisa, Italy, October 2007.
Esthetic outcomes cannot be attributed to a single parameter. Rather, as this article shows, they are the result of a number of important factors, especially in the esthetic zone. An understanding of the meaning of biologic width, of the integration of the platform-switching concept into implant treatment facilitates the preservation of a stable marginal bone level around the implant neck. This stable bone then serves to support the soft tissue, determining the long-term esthetic and functional treatment outcomes stability. The following points should be noted: (1) A prefabricated post that can be used both as a temporary post and as the definitive abutment helps to avoid a frequent replacement of secondary components, provided that the 3-dimensional position of the implant is correct. It prevents a repeated destruction of the connective-tissue attachment on the biologic width, which would carry with it the risk of bone resorption. (2) A special implant and abutment design (a ledge and integration of the biologic width/tapered shape of the post) facilitates nonsurgical lengthening and thickening of the periimplant soft tissue. This leads to the establishment of a wider and more resistant zone of connective tissue. (3) A microrough and nanorough titanium surface extending to the implant shoulder in conjunction with the platform-switching concept provides osseous integration along the entire length of the implant. A fine thread optimally distributes the masticatory forces in the region of the implant neck, avoiding further bone loss in this region.
The literature supports the use of CBCT in dental implant treatment planning particularly in regards to linear measurements, three-dimensional evaluation of alveolar ridge topography, proximity to vital anatomical structures, and fabrication of surgical guides. Areas such as CBCT-derived bone density measurements, CBCT-aided surgical navigation, and postimplant CBCT artifacts need further research. ICOI RECOMMENDATIONS: All CBCT examinations, as all other radiographic examinations, must be justified on an individualized needs basis. The benefits to the patient for each CBCT scan must outweigh the potential risks. CBCT scans should not be taken without initially obtaining thorough medical and dental histories and performing a comprehensive clinical examination. CBCT should be considered as an imaging alternative in cases where the projected implant receptor or bone augmentation site(s) are suspect, and conventional radiography may not be able to assess the true regional three-dimensional anatomical presentation. The smallest possible field of view should be used, and the entire image volume should be interpreted.
Extreme caution and adherence to a universal generic protocol are suggested for clinicians who are involved with single-tooth and short-span multiple-teeth implant replacements as related to immediate loading as defined within this text.
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