PDF: Evaluation of the Success of Strategic Implant Placement for Immediate Loading Prosthesis in Edentulous Cases

The purpose of the article is to compare and evaluate the efficacy of strategic implant® placement followed by immediate loading in regard to primary stability, quality of bone and survival and success of implants.

Dental implants currently commercially available are two piece (conventional implant, abutment and body are separate identity) or single piece (mono implant, where the abutment and body is in continuity) being surface treated of various designs, roughness and materials or smooth/machined polished implants. 

The loading protocols followed are either the delayed or immediate loading following various principles, school of thoughts and methodology. 

In immediate loading, we have non-functional or functional loading depending upon the strategic sites and bone (cancellous or cortical/basal) engaged. Interestingly, we have different school of thoughts in implantology; Swiss, French, German and Italian school of thought. 

Swiss, following the delayed loading; i.e. fabricating the supra structure and prosthesis after a sufficient healing of fixture being engaged in alveolar/cancellous bone of the jaws and the Italian protocols where fixture is engaged in the cortical/basal bone and thus making it possible to immediately provide the prosthesis and fabricate the fixture in function . 

Here the screw design single piece rough or polished implants/fixtures were placed. 

Pasqualini et al., Ihde et al., have published their work on immediate functional loading implantology with various designs like blade implants, vent implants, screw implants, diskos/boi lateral/basal implants. 

In conventional/alveolar implantology “All on Four” is the most preferred method for immediate functional loading in atrophic jaws where the implants are placed between inter-mental foramen of lower jaw and in premaxilla region but having cantilever extension. 

Salama et al., proposed a prerequisite for immediate functional loading which emphasizes on avoidance or reduction of cantilever, high density bone at implant site, implant design that increases mechanical retention, rough implant surface to increase primary stability, bi-cortical implant placement for increased stability, avoidance or reduction of distal cantilevers and protected occlusal scheme against overloading. 

A technique in which the implant supported restoration is placed within 48 hours of implant insertion and a distinction was made between the immediate restoration for aesthetic purpose–out of occlusal contacts and true immediate loading. 

The demand and need of the population are to have an ideal solution for the replacement of lost tooth/teeth with minimal expenses, least traumatic, flapless, painless, quick to restore and rehabilitate with minimal time consumed/spent. Prof. 

Stefan Ihde with all his past experience and knowledge of bone and basal implantology redefined strategic implantology®. 

The principles of orthopedic and traumatology follow the principles of the concept of strategic implantology® that involve that if implants are initially stable but have not yet undergone biologic osseointegration, this clinical situation is similar to the surgical stabilization of mobile bone fragments by osteosynthesisplates in orthopedic surgery. 

Here the smooth surface screws are used, and bi-cortical anchorage is done. Non-parallel screws are used to enhance macro anchorage. 

Rigid splinting is done by fracture plates, similar to prosthesis/bridge in dental implantology. 

Stable anchorage areas for cortical engagement, infection–free cortical bone, resorption free bone areas like buttresses being low in metabolism, thin mucosal penetration, smooth surface thus virtually no peri-implantitis, an abutment preferably single piece, bending zone, avoidance of cantilever, cross arch splinting, splinting within 72 hours, before the bone remodeling starts. 

More the atrophy, the greater one has to splint. The strategic implant® is non-homogenous, designed following the concept of strategic implantology. 

They are smooth or polished surface like osteosynthesis plates used in traumatology. 

Self-tapping with self-cutting threads for maximum bone to implant contact and increased insertion torque. 

For retrievability, single piece multiunit mono implants are there. Body of the implants is thin but strong enough to sustain occlusal loading. 

They are bendable in order to bring the abutment to a desired prosthetic plane after engaging the buttress. 

Also, the desired cortical bone is mandatory to sustain occlusal function. Almost all the implants are designed to be placed flapless minimizing regional acceleratory phenomenon and most atraumatic to patient. 

Force transmission at apical threads engaged at the intended cortices and buttress, negligible influence at the unstable crestal cortical of which all conventional implantology is been based on its support. 

This study is an attempt to focus on the efficacy of strategic implant®, following immediate loading protocol as well as to compare and evaluate the efficacy of strategic implant placement followed by immediate loading in regard to primary stability, quality of bone and survival and success of implants. 

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