BONE & MAXILLARY SINUS RESPONSE FOLLOWING IMMEDIATE LOADING WITH BASAL IMPLANTS
(a post meant for my dentist friends)
A colleague of mine forwarded the message on a concern raised by a fellow implantologist on smooth surface implants. Please find the same below:
“Just because it’s polished implant collar doesn’t mean peri-implantitis isn’t possible. It can and will still happen if there is still cement around those restorations and if it is difficult to clean. Is that restoration hard to clean? It looks like you will still get bone remodeling which may open spaces under the restoration. So the argument that smooth surface implants cannot be afflicted by peri implantitis does not hold.”
And here is the reply I gave him:
“I personally have scores of cases (full mouth as well as segments) where bone has grown around the smooth implant shafts… how is that possible if their argument was true? Here are the Xray and CBCT images of a case of 3 segments which we completed last year. The 65 yrs old male patient presented with advanced periodontitis and acute bone loss… you can see distinct bone growth around the implants after 1 year when the patient reported to us for the final prosthesis. We also adopt different measures to prevent accumulation of the luting cement around the implants to ensure that we are able to give a hygienic prosthesis.”
Please note that the CBCT images indicate collection in the maxillary sinuses owing to intraoperative bleeding into the sinus…it resolved completely and the patient is absolutely free of sinus issues now. Only smooth surface implants are to be used in the vicinity of the sinuses as the rough surface implants are more prone to peri implantitis. The bacterial colonization will certainly trigger sinusitis and related complications. As Maxillofacial Surgeons, we routinely place smooth surface screws into and around the maxillary sinuses after trauma and orthognathic surgical procedures… and all of them take up well without creating any kind of untoward effects in the long run.
From the conventional two stage & 2 piece implantology viewpoint, this case is sacrilege all over!
1) Immediate loading done in acute periodontitis case…. that too below the maxillary sinus
2) Implants perforating and sticking into the sinus floor
3) Implants contacting each other inside the sinus (the fact is that when we take a 3D view, we will see that the implant apices are away from each other)
4) Implant perforating the upper canine roots bilaterally (we have byepassed the canine root palatally – can be seen only from the 3D imaging)
5) No bone augmentation – sinus lift carried out. It will take at least 1 year for rehabilitation of this case using conventional implants… after sinus lifts.
It is high time that teachers of implantology accepted the fact which Prof Ihde highlighted in his lecture recently: “Half of what you are taught in medical school will be wrong in 10 years’ time. And the trouble is none of your teachers know which half.” This was a statement made by Prof Sydney Burwell – former dean of Harvard medical school.