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A technique for using endosteal blade implants
Implant dentures
A technique
for
using
endosteal
blade
Ronald 1. Rosenthal, Uniuersity of Kentucky,
D.D.S.* College
of
Dentistry,
Lexington,
implants
Ky.
M
any patients with an edentulous space and no distal abutment may require distal-extension removable partial dentures. However, advances in design and technique of blade-type endosteal implants may permit the substitution of a fixed partial denture for the removable partial denture. This restoration provides the patient with increased comfort and function. This article presents a technique for the use of the endosteal blade implant as an abutment for short-span fixed partial dentures. METHODS
AND
MATERIALS
Adequate records of past health and dental treatment and a physical examination must be completed for the patient. From this information, a decision can be made as to whether or not the patient can receive the implant without undue stress and strain and without endangering his health. Several endosteal blade implants are selected for placement at the site. Prior to the surgical procedure, celluloid templates of the blades are used in selection of blades which might fit the site. Having several blades available at surgery will give more latitude in blade selection. Many times the exposed bone will not have the same size and shape as imagined during palpation or while viewing the radiographs. The template is superimposed over the radiograph of the site to receive the implant (Fig. 1). In this way, an implant can be selected that will fit within the bone without undesirable impingement on anatomic structures, such as the maxillary sinus or the inferior alveolar canal. Radiographs of the site of the implant should be made using a paralleling technique to accurately determine the height of the bone. The selection of blades should be done some time prior to the surgical procedure. Once the implants have been selected. they are assembled with the rest of the necessary instrumentation. The required instruments include : ( 1) a No. 669 or No. 700 X-L tapered fissure bur (friction-grip), (2) a scalpel, (3) silk suture material (000 with atraumatic needle), (4) rubber dam material (medium weight), (5) rubber-base or reversible hydrocolloid impression material, (6) instruments for inserting the blade into the *Assistant
Professor,
Department
of Oral
Diagnosis
and
Oral
Medicine.
97
.I I’tosthet. Dent. Julv. 1’):4
98
Rosenthal
Fig.
1. A template of the implant
is superimposed
cww the radiograph
of the surgical site.
Fig. 2. Instruments for placing endosteal blade implants include (from left to right) : two blade implants of different shapes; the implant-seating instrument with three interchangeable heads: the multipurpose seating instrument; the removal instrument; and the surgical mallet. Fig.
3. The
bone, (7) (Fig. 2).
incision
is made
custom-fitted
lingual
to the ridge
impression
crest
trays, and
(broken
(8)
line).
the previously
selected
implants
TECHNIQUE An incision is made approximately 2 mm. lingual to the crest of the ridge so that, when the tissues arc repositioned, the opening in the bone will be covered with the periosteum (Fig. 3). The incision is made through the periosteum to the bone, and it should be several millimeters lon,Ter than the blade of the implant. The soft tissue is reflected buccally. Using copious amounts of water from both the high-speed handpiece and a water syringe, a channel is made mesiodistally in the crest of the bone with the high-speed bur (Fig. 4). The depth of the channel should be greater than that to which the blade will be placed so as to decrease the amount of tapping necessary to force the blade to place (Fig. 5) . The sides of the channel must be parallel to the long axis of the roots of the teeth, which will act as additional retainers for the fixed partial denture. To avoid burning, the bone is cut carefully by advancing the bur very slowly. The sterilized blade implant is placed in the channel. The implant will probably not go completely to place on the first try, and it will then be necessary to widen
Volume Number
32 I
Technique
for endosteal
Fig. 4. A channel is made in the bone for placement of the implant. Fig. 5. A diagram indicates the parts of a blade implant. Fig. 6. A notch is cut into the soft tissue so that the edges of the incision
blade
implants
99
can be repositioned
for suturing.
Fig. 7. The implant is seated and the flap sutured in the patient’s Fig. 8. The sutures are removed five days after surgery.
mouth.
or deepen the channel. The blade should seat into the bone so that the shoulder or superior edge of the blade is almost level with the crest of the bone. A radiograph is made to determine the distance of the implant from important anatomic structures. If necessary, the blade may be shortened or the implant replaced with one of different size or shape. Then, the implant is tapped further into the bone so that the shoulder of the blade is approximately 2 mm. below the crest of the residual ridge, allowing bone to fill in over the shoulder of the implant. Once the implant has been placed and there is sufficient clearance between the post and the opposing teeth (the post height may have to be reduced by grinding), a notch is cut in the mucoperiosteal flap at the site of the neck of the implant (Fig. 6). When the flap is repositioned, periosteum will cover the channel in the bone, tending to assure bony fill-in and allow coaptation of the flaps without c.ompression of the soft tissue against the neck of the implant. Then the soft tissues are sutured (Fig. 7)) and the other retainers are prepared. The teeth are prepared parallel to the implant post, and impressions are made. Normal retraction techniques are used for the abutment retainers. A small piece of rubber dam material approximately 1 cm. in diameter is placed over the post of the implant and carried down to the level of the soft tissue around the neck of the
Fig. 9. The fixed partial denture is cemented while in the mouth. Fig. 10. A radiograph shows the location of the blade implant.
post. This prevents the impression material from being forced subgingivally around the post. Impressions, face-bow mountings, and centric relation records are made. and the fixed partial denture is completed. The patient returns five to seven days following surgery for suture removal (Fig. 8). If the tissues have healed normally, the fixed partial denture may be placed at this time. However, it may be necessary to allow additional time to eliminate inflammation in the tissue. The fixed partial denture is constructed in such a manner as to allorv the patient to clean the area around the post as well as the abutment teeth. The pontic should touch the soft tissue in one spot on the buccal side of the ridge, and there should for use of floss and other home-care be complete access to gingival embrasures devices. Prior to cementation, a piece of rubber dam material is placed over the implant and around the post to prevent cement from being forced subgingivally around the neck of the implant. Once the cement has hardened and the excess has been removed, the rubber dam is removed (Figs. 9 and 10). The occlusion should bt: positions are adjusted so that deflective occlusal contacts in centric or eccentric eliminated. The patient must be instructed in proper home-care procedures to maintain healthy gingival tissues. SUMMARY A for a of the partial
technique for insertion of an endosteal blade implant and its use as a retainer fixed partial denture have been described. Careful planning for the location implant, good surgical procedures, and attention to proper detail in fixed denture construction are essential to success of blade implants.
UNIVERSITY COLLEGE LEXINGTON,
OF
OF KENTUCKV DENTISTRY
KY.
40506
A technique
for
using
endosteal
blade
Ronald 1. Rosenthal, Uniuersity of Kentucky,
D.D.S.* College
of
Dentistry,
Lexington,
implants
Ky.
M
any patients with an edentulous space and no distal abutment may require distal-extension removable partial dentures. However, advances in design and technique of blade-type endosteal implants may permit the substitution of a fixed partial denture for the removable partial denture. This restoration provides the patient with increased comfort and function. This article presents a technique for the use of the endosteal blade implant as an abutment for short-span fixed partial dentures. METHODS
AND
MATERIALS
Adequate records of past health and dental treatment and a physical examination must be completed for the patient. From this information, a decision can be made as to whether or not the patient can receive the implant without undue stress and strain and without endangering his health. Several endosteal blade implants are selected for placement at the site. Prior to the surgical procedure, celluloid templates of the blades are used in selection of blades which might fit the site. Having several blades available at surgery will give more latitude in blade selection. Many times the exposed bone will not have the same size and shape as imagined during palpation or while viewing the radiographs. The template is superimposed over the radiograph of the site to receive the implant (Fig. 1). In this way, an implant can be selected that will fit within the bone without undesirable impingement on anatomic structures, such as the maxillary sinus or the inferior alveolar canal. Radiographs of the site of the implant should be made using a paralleling technique to accurately determine the height of the bone. The selection of blades should be done some time prior to the surgical procedure. Once the implants have been selected. they are assembled with the rest of the necessary instrumentation. The required instruments include : ( 1) a No. 669 or No. 700 X-L tapered fissure bur (friction-grip), (2) a scalpel, (3) silk suture material (000 with atraumatic needle), (4) rubber dam material (medium weight), (5) rubber-base or reversible hydrocolloid impression material, (6) instruments for inserting the blade into the *Assistant
Professor,
Department
of Oral
Diagnosis
and
Oral
Medicine.
97
.I I’tosthet. Dent. Julv. 1’):4
98
Rosenthal
Fig.
1. A template of the implant
is superimposed
cww the radiograph
of the surgical site.
Fig. 2. Instruments for placing endosteal blade implants include (from left to right) : two blade implants of different shapes; the implant-seating instrument with three interchangeable heads: the multipurpose seating instrument; the removal instrument; and the surgical mallet. Fig.
3. The
bone, (7) (Fig. 2).
incision
is made
custom-fitted
lingual
to the ridge
impression
crest
trays, and
(broken
(8)
line).
the previously
selected
implants
TECHNIQUE An incision is made approximately 2 mm. lingual to the crest of the ridge so that, when the tissues arc repositioned, the opening in the bone will be covered with the periosteum (Fig. 3). The incision is made through the periosteum to the bone, and it should be several millimeters lon,Ter than the blade of the implant. The soft tissue is reflected buccally. Using copious amounts of water from both the high-speed handpiece and a water syringe, a channel is made mesiodistally in the crest of the bone with the high-speed bur (Fig. 4). The depth of the channel should be greater than that to which the blade will be placed so as to decrease the amount of tapping necessary to force the blade to place (Fig. 5) . The sides of the channel must be parallel to the long axis of the roots of the teeth, which will act as additional retainers for the fixed partial denture. To avoid burning, the bone is cut carefully by advancing the bur very slowly. The sterilized blade implant is placed in the channel. The implant will probably not go completely to place on the first try, and it will then be necessary to widen
Volume Number
32 I
Technique
for endosteal
Fig. 4. A channel is made in the bone for placement of the implant. Fig. 5. A diagram indicates the parts of a blade implant. Fig. 6. A notch is cut into the soft tissue so that the edges of the incision
blade
implants
99
can be repositioned
for suturing.
Fig. 7. The implant is seated and the flap sutured in the patient’s Fig. 8. The sutures are removed five days after surgery.
mouth.
or deepen the channel. The blade should seat into the bone so that the shoulder or superior edge of the blade is almost level with the crest of the bone. A radiograph is made to determine the distance of the implant from important anatomic structures. If necessary, the blade may be shortened or the implant replaced with one of different size or shape. Then, the implant is tapped further into the bone so that the shoulder of the blade is approximately 2 mm. below the crest of the residual ridge, allowing bone to fill in over the shoulder of the implant. Once the implant has been placed and there is sufficient clearance between the post and the opposing teeth (the post height may have to be reduced by grinding), a notch is cut in the mucoperiosteal flap at the site of the neck of the implant (Fig. 6). When the flap is repositioned, periosteum will cover the channel in the bone, tending to assure bony fill-in and allow coaptation of the flaps without c.ompression of the soft tissue against the neck of the implant. Then the soft tissues are sutured (Fig. 7)) and the other retainers are prepared. The teeth are prepared parallel to the implant post, and impressions are made. Normal retraction techniques are used for the abutment retainers. A small piece of rubber dam material approximately 1 cm. in diameter is placed over the post of the implant and carried down to the level of the soft tissue around the neck of the
Fig. 9. The fixed partial denture is cemented while in the mouth. Fig. 10. A radiograph shows the location of the blade implant.
post. This prevents the impression material from being forced subgingivally around the post. Impressions, face-bow mountings, and centric relation records are made. and the fixed partial denture is completed. The patient returns five to seven days following surgery for suture removal (Fig. 8). If the tissues have healed normally, the fixed partial denture may be placed at this time. However, it may be necessary to allow additional time to eliminate inflammation in the tissue. The fixed partial denture is constructed in such a manner as to allorv the patient to clean the area around the post as well as the abutment teeth. The pontic should touch the soft tissue in one spot on the buccal side of the ridge, and there should for use of floss and other home-care be complete access to gingival embrasures devices. Prior to cementation, a piece of rubber dam material is placed over the implant and around the post to prevent cement from being forced subgingivally around the neck of the implant. Once the cement has hardened and the excess has been removed, the rubber dam is removed (Figs. 9 and 10). The occlusion should bt: positions are adjusted so that deflective occlusal contacts in centric or eccentric eliminated. The patient must be instructed in proper home-care procedures to maintain healthy gingival tissues. SUMMARY A for a of the partial
technique for insertion of an endosteal blade implant and its use as a retainer fixed partial denture have been described. Careful planning for the location implant, good surgical procedures, and attention to proper detail in fixed denture construction are essential to success of blade implants.
UNIVERSITY COLLEGE LEXINGTON,
OF
OF KENTUCKV DENTISTRY
KY.
40506