Edentulous
The Evolution of Implant Therapy for the Edentulous Patient
Frank M.A. Vidjak, DDS, MSEd
Frank M.A. Vidjak, DDS, MSEd, is an associate professor
of clinical dentistry at the University of Southern California School
of Dentistry.
Copyright 2003 Journal of the California Dental Association.
Few developments have had the positive effect on the clinical practice
of dentistry that endosteal dental implant development has had. The scope
of treatment that can be provided to a patient has been significantly
broadened. Treatment plans once focused solely on the presence or absence
of natural dentition. Therefore, traditional fixed or removable prosthodontics
or combinations thereof were the only options. However, if overall patient
satisfaction is assessed, the group of individuals with the highest propensity
for a compromise in function, comfort, and/or self-esteem are the edentulous
patients.1 The mandibular arch would often be the source of
many post-treatment complications due to the nature of the anatomy of
the area and the physiology of the bone.
The patient "A.K." presents today with stable anterior sextants. However, with her past history of periodontal disease and retreatment, it is conceivable that the future may require considerations for the loss of the remaining teeth. This article will focus on the cylindrical or root-form implant as related to the edentulous patient and the treatment of the mandibular arch.
A significant amount of information has been published on creating treatment modalities to improve the quality of life of the edentulous patient. Per-Ingvar Brånemark deservedly receives most of the credit for providing a predictable treatment protocol. The original protocol, as described by Brånemark and colleagues,2 required a two-stage surgical protocol: the surgical placement and surgical uncovering of an implant. The suggested healing period of three months for the mandible and six months for the maxilla was followed religiously. It was assumed that the healing period provided a time of nonfunction to ensure that osseointegration of the implants would occur. The restorative goal was usually the placement of a fixed implant-supported mandibular prosthesis, formerly referred to as a hybrid prosthesis. Many authors have published studies that duplicated and validated the use of this treatment modality endorsed by the dental profession.3-6
Though clinically very successful, the criteria for success were challenged and research began for scientific evidence to support them. One of the issues being reviewed in recent years has been the need for the healing period following implant placement. Recent clinical and scientific reports describe a one-stage surgical protocol followed by the immediate utilization of the implants, particularly when treating the anterior mandible.7-10 The reported success showed a trend that could be comparable to the two-stage protocol. This pattern appears to be occurring for patients treated with fixed implant-supported mandibular prostheses or implant-retained mandibular overdentures.11,12 The advantages of immediately loading implants are that it allows for the immediate improvement in the patient’s functional ability and self-confidence while dramatically reducing treatment time. Proper clinical assessment of bone density and implant stability becomes even more important when implants are immediately loaded since the usual period of healing (nonfunction) has been eliminated.
Clearly, the way in which dentists utilize dental implants is evolving. When patients present psychological, emotional, and anatomical concerns about the loss of the natural dentition or the wearing of removable prosthetic appliances, the concept of immediate loading of dental implants has the potential for being a viable addition to treatment modalities. Clinical judgment plays an even more critical role due to the subjective nature of the decision-making process when immediately loaded implants are concerned. Continued research in this area on combining surgery and prosthesis design will be critical for dentistry to be able to include immediate placement and immediate loading of osseointegrated implants into routine treatment planning.
References
1. Koper A, Human factors in prosthodontic treatment. J Prosth Dent 30(4):678-9, 1973.
2. Brånemark P-I, Hansson BO, et al, Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year period. Scand J Plast Reconstr Surg 16(Suppl):1-132, 1977
3. Adell R, Lekholm U, et al, A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. Int J of Oral Surg 6:387-416, 1981.
4. Adell R, Eriksson B, et al, A long-term follow-up study of osseointegrated implants in the treatment of the totally edentulous jaws. Int J Oral Maxillofac Implants 5:347-59, 1990.
5. Arvidson K, Bystedt H, et al, A 3-year clinical study of Astra dental implants in the treatment of edentulous mandibles. Int J Maxillofac Implants 7:321-9, 1992.
6. Albrektsson T, On long-term maintenance of the osseointegrated response. Australian Pros J 7:15-24, 1993.
7. Ericsson I, Randow K, et al, Some clinical and radiographical features of submerged and non-submerged titanium implants. Clin Oral Implants Res 5:185-9, 1994.
8. Ericsson I, Randkow K, et al, Some clinical and radiographical features of submerged and non-submerged titanium implants. A 5-year follow-up study. Clin Oral Implants Res 8:422-6, 1997.
9. Tarnow DP, Emtiaz S, Classi A, Immediate loading of threaded implants at stage 1 surgery in edentulous arches: Ten consecutive case reports with 1- to 5-year data. Int J Oral Maxillofac Implants 12:319-24, 1997.
10. Schnitman PA, Wohrle PS, Rubenstein JE, Ten-year results for Brånemark implants immediately loaded with fixed prostheses at implant placement. Int J Oral Maxillofac Implants 12:495-503, 1997.
11. Chiapasco M, Gatti C, et al, Implant-retained mandibular overdentures with immediate loading: A retrospective multicenter study on 226 consecutive cases. Clin Oral Impl Res 8:48-57, 1997.
12. Gatti C, Haefliger W, Chiapasco M, Implant-retained mandibular overdentures with immediate loading: A prospective study of ITI implants. Int J Oral Maxillofac Implants 15:383-8, 2000
To request a printed copy of this article, please contact/Frank Vidjak, DDS, Ph SOUTH, 436 N. Roxbury Drive, Beverly Hills, CA 90210-5019.
