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A COMPARISON OF THREE DIFFERENT IMPLANT …

A COMPARISON OF THREE DIFFERENTIMPLANT SYSTEMS IN THE SAME PATIENTLESTER DU PREEZ1, KURT-W B TOW1, WILFRIED BENNINGHOFF2 The study was designed to compare THREE DIFFERENT implantsystems in the same host and under similar conditions, for theirmedium longevity and functionality in the anterior region ofthe mandible. Various intraoral endosseous IMPLANT systemshave been introduced over the years to equip practitioners inhelping to restore partially- and fully edentulous jaws tofunctionality. To date there are many DIFFERENT implant1 Department of Maxillo-Facial and Oral Surgery, University of Pretoria, South Africa2 Department of Prosthetics and Dental Mechanics, University of Pretoria, South AfricaCorresponding address:Prof Kurt-W B towDepartment of Maxillo-Facial and Oral SurgeryFaculty of Health Science, PO Box 1266,Pretoria 0001, South Africaemail: available on the market. A number of these arebased on the design of the Br nemark submergibleendosseous IMPLANT .

A COMPARISON OF THREE DIFFERENT IMPLANT SYSTEMS IN THE SAME PATIENT LESTER DU PREEZ1, KURT-W BÜTOW1, WILFRIED BENNINGHOFF2 The study was designed to compare three different implant

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Transcription of A COMPARISON OF THREE DIFFERENT IMPLANT …

1 A COMPARISON OF THREE DIFFERENTIMPLANT SYSTEMS IN THE SAME PATIENTLESTER DU PREEZ1, KURT-W B TOW1, WILFRIED BENNINGHOFF2 The study was designed to compare THREE DIFFERENT implantsystems in the same host and under similar conditions, for theirmedium longevity and functionality in the anterior region ofthe mandible. Various intraoral endosseous IMPLANT systemshave been introduced over the years to equip practitioners inhelping to restore partially- and fully edentulous jaws tofunctionality. To date there are many DIFFERENT implant1 Department of Maxillo-Facial and Oral Surgery, University of Pretoria, South Africa2 Department of Prosthetics and Dental Mechanics, University of Pretoria, South AfricaCorresponding address:Prof Kurt-W B towDepartment of Maxillo-Facial and Oral SurgeryFaculty of Health Science, PO Box 1266,Pretoria 0001, South Africaemail: available on the market. A number of these arebased on the design of the Br nemark submergibleendosseous IMPLANT .

2 The major differences among the variousimplants are found in their design, whether screw type or non-screw type, and the material used to coat them. Thesematerials include titanium (plasma sprayed/pure/alloy),ceramics and hydroxyapatite. Most of the implants are two-stage submergible units comprising an endosseous elementand a transmucosal unit onto which a superstructure can befitted. These implants require two surgical procedures forplacement - one for the initial endosseous placement and asecond surgical procedure for the exposure of the implantand fitting of the superstructure. The success of thesenumerous systems has been reported in the literature byvarious authors1-3. Recently, some authors have reported on theAbstract Objectives. The goal of this study was designed to test THREE DIFFERENT IMPLANT design systems in the same patient,under similar conditions, for their longevity and functionality.

3 Various intraoral endosseous IMPLANT systems have beenintroduced over the years to equip practitioners in helping to restore partially- and fully edentulous jaws tofunctionality. To date many DIFFERENT makes of IMPLANT systems are available on the market. Many of these are basedon the Br nemark submergible endosseous IMPLANT . The various implants come in DIFFERENT designs and coatings. Thecoating materials include hydroxyapatite, ceramics or titanium (plasma sprayed/pure/alloy). Most of the implants aretwo-stage submergible units, requiring two surgical procedures for placement. Recently there has been a movetowards single stage implants with the added advantage of one surgical procedure for the patient. The question as towhich IMPLANT system is the better one, is still open to speculation. Materials and methods. Six titanium implants , THREE pairs of DIFFERENT design, were placed in the mandibles of 14patients and evaluated over one to five years.

4 The six implants included: two cylindrical units (GMI, Southern implants ),two Br nemark-like implants (IBS, Southern implants ), and two compression implants (OCSI [LIBB], Southern implants ).The cylindrical and Br nemark-like units are two-stage IMPLANT components while the OCSI (LIBB) units are single-stageunits. All the implants were manufactured from the exactly the same grade IV titanium and supplied by SouthernImplants of South Africa (Pty) Ltd. Results. The retention rate of the implants over the observation period was , comparing favourably with theretention rate as published in the literature. success of the study proves the hypothesis, that DIFFERENT designs of IMPLANT systems have no bearingon the longevity or functional success of the units used, and lends credence to the assumption that the design of theimplant does not influence its Significance. DIFFERENT designs of IMPLANT systems have no bearing on the longevity or functional success ofthe units used, and lends credence to the assumption that the design of the IMPLANT does not influence its functionalityin the anterior words:dental IMPLANT , IMPLANT designs, edentulous mandible, survival 46 INTERNATIONAL DENTISTRY SAVOL.

5 9, NO. 3 CLINICAL osseointegrated compression screw IMPLANT (OCSI) as anotheraddition to the field of implants4,5. This system differs from theBr nemark (Nobel Biocare) and the Br nemark-like (SouthernImplants) systems in that it is placed directly as a one-stageprocedure and requires no flap surgery. These implants employthe principle that bone should be compressed upon insertion,providing both stability and rigidity. The authors reporting ontheir experience with the OCSI implants , claim that failurerates are similar to those of the Br nemark submergibleimplant systems 4,5. A comprehensive search of the health science literature onintra-oral implants revealed no reported studies that testeddifferent implants systems in the human host. Tillmanns et ,7reported on peri- IMPLANT breakdown of THREE DIFFERENT dentalimplants placed in Beagle dogs. The implants tested were:hydroxyapatite coated, titanium plasma-sprayed and titaniumalloy units.

6 The authors concluded that all implants wereequally susceptible to peri-implantitis. d'Hoedt et four DIFFERENT endosseous IMPLANT systems indifferent patients. The type of implants compared were:T bingen (Frialit , Friedrichsfeld Ltd) of aluminium oxideceramic; TPS (Straumann Ltd), titanium plasma sprayed, selftapping screw; IMZ (Friedrichsfeld Ltd) an intramobile cylinderused both as titanium plasma sprayed and hydroxyapatiteceramic coated units; Br nemark (Austenal-Dental Ltd, NobelBiocare) of pure titanium and ITI (Straumann Ltd) titaniumplasma sprayed system. This study assessed the survival time ofthese DIFFERENT implants over various time periods and thefollow up results for the DIFFERENT systems varied in differentpatients. The implants utilised were two cylindrical units (GMI,Southern implants ), two compression implants (single stageOCSI [LIBB], Southern implants ) and two Br nemark-likeimplants (IBS, Southern implants ).

7 No definitive conclusionswere drawn from the data because of major differences indistribution within the question of which IMPLANT system is the best to use intrying to restore edentulous cases to functionality, is still opento speculation. The working hypothesis was formulated asfollows: the DIFFERENT designs of IMPLANT systems have nobearing on the longevity or functional success of the and MethodsPatient selectionSelection criteria included: completely edentulous patients,reasonable to good general health with no anaestheticcomplications, bone height in the mandibular anterior regionthat would accommodate placement of 13 to 18 mm lengthimplants, bone width that would accommodate implants mm in diameter, no history of previous radiation therapyfor malignancies in the head and neck region. Patients wererandomly drawn from the Pre-prosthodontic Surgical completely edentulous patients, two males and tenfemales, aged between 33 and 73 years (mean, 53 years),were included in the study.

8 Treatment was performed in allcases by the same surgeon, assistant surgeon considerationsThe Research Ethics Committee approved the study. All thepatients signed an informed consent document beforeparticipating in the ProcedureSix implants , two non-submergible and four submergible units,were placed between the mental foramina of the implants were all grade IV titanium units. The cases weredone under general anaesthesia. A free gingival graft wastransplanted onto the anterior lower jaw in 10 cases at leasttwo months prior to placement of the implants . In two casessufficient keratinised epithelium was present. The cylindrical(GMI) and Br nemark-like units were placed in two stages. Thefirst components were placed into the bone and allowed toheal for four months. Thereafter, the transmucosal ball headabutments (GMI and IBS) were placed as a second procedureunder local anaesthesia.

9 The OCSI (LIBB) ball head units wereplaced at the same time as the first procedure of the two stageimplants as a single stage final procedure. The implants wereplaced in a 3:2:1 permutation, hence with every sixth patientthe same IMPLANT placement position was surgical procedure for the four two-stage submergibleimplants had a crestal incision, raising a full thicknessmucoperiostium flap, exposing the bone and followed by0No mobility1 Slight mobility with firm pressure2 Mobility with minimal pressureTable 1: Mobility00 to 3 mm1>3 to 5 mm2>5 mmTable 2: Probing depth10baseline value10 to 3 mm2> 3 mmTable 3: Bone height, average of mesial and distalsitesINTERNATIONAL DENTISTRY SAVOL. 9, NO. 347 CLINICALnew upper and lower acrylic resin denture was constructed onthe ball abutment. Fabrication of the denture usually requiredthree treatment sessions, after which follow-up care withrelieving of pressure spots was performed.

10 In all the cases, aconventional denture in the maxilla opposed the overdenturein the mandible. Patients were seen after one week, fourweeks, THREE months, six months and subsequently every yearfor the duration of their follow up of the IMPLANT units under copious water mucosal incisions were sutured using resorbable materialsand allowed to heal until the second stage procedure THREE tofour months later. The two non-submergible implants OCSI(LIBB) were placed without any gingival incisions directly intothe bone using tactile guidance. The alveolar process wasflattened when indicated for the submergible received antibiotics (Amoxicillin 500mg), from the dayof operation THREE times daily, for five days postoperatively andwere requested to rinse with a chlorhexidine solutionfour times per day for five ProcedureThe Department of Prosthetics and Dental Mechanics did theprosthetic rehabilitation.


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