Daniel van Steenberghe*, M.D., D.D.S., Ph.D., Dr.h.c., H.F.R.C.S. (Irl), Marc Quirynen, D.D.S., Ph.D., Periodontol.
Department of Periodontology, Catholic University Leuven, Belgium.
*Holder of the P-I Brånemark Chair in Osseointegration.
Abstract:
Amputations, such as edentulism have been successfully treated with socket
prostheses, called dentures in oral health care. In some instances , the socket
is so reduced, the jaw bone so resorbed, that the retention of the socket
prosthesis/denture becomes insufficient.
In some instances patients refuse the prosthesis and are only satisfied if it
becomes boneanchored, integral part of their body picture.
Since the clinical introduction of osseointegrating implants in 1965 by P-I
Brånemark, oral rehabilitation has been revolutionized. Today some 5 million
people have been treated by means of endosseous implants which achieve more or
less predictably an intimate bone apposition. This has also led to developments
in other fields in medicine related to rehabilitation : orthopedics, hand
surgery, plastic surgery, oto-rhino-laryngology etc. None of them ever used the
term “implantology” which seems so popular among some dentists and which
confuses patients.
The increased endeavours to achieve optimal results, not only from a surgical
but also from a prosthetic viewpoint, has led to the increasing cooperation
between periodontologists/oral surgeons and the restorative team of
dentists/prosthodontists/dental technicians. Without falling into the trap of
cosmetics, the opposite of health care, one must admit that this improved
cooperation was often appreciated by patients.
Today softwares are available, such as the fully three-dimensional planning
software developed in the mid-nineties in Leuven and now recently commercially
available, which allows a meticulous planning and interaction between all team
partners
through internet. If on the other hand one person feels he/she is capable to do
everything, or in countries with a less developed health system, this planning
software still favors better planning and eventual distant experts inputs. It
definitely broadens the field of applications, such as when minimal bone volume
remains available.
A key issue is to transfer the planning to the surgical field. This was tried
out by navigation, but we felt after some two years that this was not realistic
in a moving patient. Therefore we opted for surgical drill guides. Ex vivo
experiments demonstrated the high precision of the transfer and allowed to
develop a system to prefabricate an individualized final prosthesis. The role of
Matts Andersson and his collaborators should be acknowledged in this context.
The precision of the placement of implants was such that a fixed prosthesis
could be installed on top of it, dealing with the minute deviations by means of
expanding abutments. Today one can even op for a flapless approach, where the
drill guide is fixed to the jaw bone by means of pins. It is up to the team to
decide whether an immediate or early or delayed loading is preferred, depending
on patients’ general and local jaw bone characteristics. If immediate loading is
considered, the prosthesis can be installed at the end of the surgical procedure
or the patient can be sent to the dentist’s office. In the latter case, healing
abutments are mandatory since the gums quickly cover up the inserted implants.
One should be aware that, although surgical guides based on preoperative
planning software can help professionals not surgically trained to perform
surgery, the key issue remains to be able to deal with eventual complications,
especially during blind surgery.