Evaluation of Ultratooth® Immediate Load lmplant
Hessam Nowzari, D.D.S., Ph.D.
Director, Advanced Periodontics
Diplomat American Board of Periodontology
Associate Professor, Clinical Dentistry
School of Dentistry
University of Southern California
School of Dentistry
University of Southern California
Los Angeles, CA 90089-0641
Fax: 213-7408414 Tel: 213-7408081
November 4, 1997
Hard and soft tissue-integrated dental implants have been used in the treatment of fully and partially edentulous patients.1-4 A two stage technique of endosseous dental implant insertion was recommended by Branemark,1 in which the implant was covered with soft tissues at the time of insertion. A one stage technique was described by Schroeder et al.,5 in which the implant extended above the osseous crest and the soft tissues at the time of insertion. In both techniques, the healing time required prior to implant direct load was empirically estimated at 3 to 6 months. A stress-free healing period was proposed for implant osseointegration to occur.
More recently, there have been reports in the literature where implants have been loaded immediately after their insertion.6.7 The success rates reported were comparable to the success rates in other studies where implants were not loaded Immediately. In these studies the implants were located in the anterior part of the mandible and multiple implants were splinted before loading.
The Sargon® Immediate Load Implant is an apically expandable quintapodal root-form dental implant, designed to be loaded immediately with a provisional fixed restoration in normal occlusion. After surgical insertion, the implant is expanded apically by the hand tightening of a center screw within its central channel, exerting a compressive force on the walls of the recipient site, thus increasing the primary mechanical stability of the implant at the time of insertion. The net result of this process is the ability to immediately load the implant. To my knowledge the Sargon® Immediate Load Implant is the only system that can be loaded immediately after extraction of the tooth, without being splinted.
Following tooth extraction, insertion point of the implant is marked and using the 2 mm diameter tri-spade drill 5 mm of osteotomy is performed within the lingual wall of the extraction site. Osteotomy site is gradually enlarged with the trispade guide and final drills, and threaded to the length of the selected implant. At this time, a 3.8 mm wide screw-type root-form dental implant manufactured from Titanium alloy (90% Ti, 6% AI, 4% V) is inserted and expansion mechanism activated to expand the implant into the walls of the surgical site. Implant has a 1 mm high external hex that features a beveled base for abutment fit. Immediately after implant placement, restorative abutment is Installed and implant loaded in normal occlusion with provisional fixed restoration. Patient is instructed to use the immediately restored implant normally. The same restorative abutment is used for the final restoration.
In our clinics and laboratories, we have been studying the clinical, histological, immunological, and microbiological features of Sargon® Immediate Load Implant.
Clinically, implants have been asymptomatic from the day of the insertion and thereafter during the functional loading. Immunological examinations of crevicular fluid obtained from the implant sites confirm the clinical observations. It is reasonable to assume that the apical expansion and mechanical stability of the implant, immediate installation of the fix provisional, and no need for suturing, positively influence the soft tissue adaptation and enhancement during the healing period.5.8 Peri-implant probing depths and the formation of a biologic seal of soft tissue around implant indicate true adhesion of the epithelium to the implant with underlying bone support.5,9
The microorganisms studied around Sargon® system using Polymerase Chain Reaction (PCR), Culture, and Phase Contrast Microscopy, include the pathogens: A. actinomycatemcomitans, Prevotella intermedia, Porphyromonas gingivalis, Bacteroides forsythus, Campylobacter rectus, Fusobacterium species, Peptostreptococcus micros, Capnocytophaga species, l3-hemolytic Streptococcus species, Staphylococcus species, Mitsuokella dentalis, Enterobacterjaceae species, Pseudomonadaceae species, and Candida Species.10-14 These microorganisms interfere with peri-implant tissue healing.15.16
Our results show lack of survivability of these bacteria around the pert-implant site. Absence of pathogen examined suggest that these organisms can not evade antimicrobial host cells and mediators by residing on the implant or in the peri-implant site. The PCR method of bacterial detection, used in our laboratories, offers a very specific yet powerful detection method for fastidious organisms or organisms which exist at low level and not detectable by conventional culture methods. The phase-contrast microscopy method of bacterial detection has been consistently negative for spirochetes as well.
Absence of bleeding may be a clinically useful indicator of pert-implant stability. Bleeding on probing may be used to identify pert-implant inflammation or degradation of connective tissues. Most likely, in the absence of mechanical injury, bleeding on probing reflects the presence of pathogens.1 7 Absence of bleeding indicate that the Sargon® implant represent an effective way to achieve pert-implant soft and hard tissue stability.
In conclusion, our results indicate that the Sargon® tooth replacement system seems to be the most advanced treatment modality available at the present time. Treatment with Sargon® Immediate Load Implant constitutes valuable treatment modality in optimizing the potential for healing.
1. Branemark P-1, Brein U, Adell R, Hansson BO, Lindstrom J, Oisson A. Intraosseous anchorage of dental prostheses: I. Experimental studies. Scand J Plast Reconstr Surg 3:81-100, 1969.
2. Adell R, Lekholm U, Rockier B, Branemark P-I: A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. Int J Oral Surg 10:387-416, 1981.
3. Jemt T. Lekholm U, Adell R: Osseointegrated implants in the treatment of partially edentulous patients: a preliminary study on 876 consecutively placed fixtures. Int J Oral Maxillofac Implants 4:211-217, 1989.
4. Adell R, Eriksson B, Lekholm U, Branemark P-1, Jemt T: A long-term followup study of osseointegrated implants in the treatment of the totally edentulous jaw. Int J Oral Maxillofac Implants 5:347-359, 1990.
5. Schroeder A, Zypen E, Stich H, Sutter F: The reactions of bone, connective tissue, and epithelium to endosteal implants with titanium-sprayed surfaces. J Maxillofac Surg 9:15-25, 1981.
6. Schnitman PA, Wohrle PS, Rubenstein JE, DaSilva JD, Wand NH: Ten year results for Branemark implants immediately loaded with fixed prostheses at implant placement. Int J Oral Maxillofac Implants 12:495-503, 1997.
7. Chiapasco M, Gatti C, Ross! E, Haefliger W, Markwalder TH: Implant retained mandibular overdentures with immediate loading: A retrospective multicenter study on 226 consecutive cases. Clin Oral Impl Res 8:48-57, 1997.
B. Goodman S, Aspenberg P: Effects of mechanical stimulation on the differentiation of hard tissues. Biomaterials 2:37-47, 1993.
9. Quirynen M, van Steenberghe D, Jacobs R, Schotte A, Darius P: The reliability of pocket probing around screw-type implants. Clin Oral Impl Res 2:186-192, 1991.
10. Slots J: Selective medium for isolation of Actinobacillus
actinomycetemcomitans. J Clin Microbiol 15:606-609, 1982.
11. Slots J: Rapid identification of important periodontal microorganisms by cultivation. Oral Microbiol immunol 1:49-55, 1986.
12. Boom R, Sol CJA, Sallmans MMM, Jansen CL, Wertheim-van Dillen PME, van der Noordaa J: Rapid and simple method for purification of nucleic acids. J Clin Microbiol 28:495-503, 1990.
13. Parra B, Slots J: Detection of human viruses in periodontal pockets using polymerase chain reaction. Oral Microbiol Immunol 5:289-293, 1996.
14. Ashimoto A, Chen C, Bakker I, Slots J: Polymerase chain reaction detection of 8 putative periodontal pathogens in subgingival plaque of gingivits and advanced periodontitis lesions. Oral Microbiol Immunol 11:266-273, 1996.
15. Mombelli A, Van Oosten MAC, Schurch E, Lang NP: The microblota associated with successfull or failing osseointegrated titanium implants. Oral Microbiol immunol 2:145-151 1987.
16. Rams TE, Link CC: Microbiology of failing dental implants in humans: electron microscopic observations. J Oral Implantol 11:93-100, 1983.
17. Nowzari H, Smith MacDonald E, Flynn J, London RM, Morrison JL, Slots J: The dynamics of microbial colonization of barrier membranes in guided periodontal tissue regeneration. J Periodontol 67:694-702, 1996.