(2015 Consensus Report)
Short implants for bone deficiencies or using longer implants by increasing the bone height by performing bone grafting with advanced surgeries?
We, maxillofacial surgeons, advise One of the most confusing points is the treatment options for patients with limited bone height.
If our patient needs an implant and our patient does not have a sufficiently high bone structure, we have two options.
By performing advanced surgical procedures, we will be able to increase the bone height and place the ideal implant. If there is an implant candidate with limited bone height in our clinic, it is necessary to make a very careful decision, make very good analysis and apply the right treatment option to the right patient.
This is the point of the matter. It is complicated and requires a lot of experience.
In which patient short implants guarantee a successful result and in which patient bone grafting is absolutely necessary.
We would like to guarantee our patient an implant treatment that he can use for many years. .
I would like you to know that I have to read a lot of articles and perform both types of surgeries hundreds of times before I can make a decision on this subject.
However, what does the whole world say about this scientifically and what do the latest research suggest? ,
Since I know that it would not be correct to study solely based on our own clinical experiences without reading and following these, I would like to share with you the latest consensus report of scientists who have read and examined all the articles on this subject and published a consensus report impartially.
SUMMARY OF THE LATEST CONSENSUS REPORT PUBLISHED ON THIS TOPIC
There is a need for ideal bone presence to ensure successful osseointegration for implant-supported prosthesis teeth.
The bone to be implanted must have a successful primary stability ( It must be sufficient to provide initial adhesion) and have sufficient volume to completely surround the implant.
An ideal implant length is 10 mm and above. In fact, it is much more convenient to use 12-13 mm long implants in the presence of suitable bone.
Many studies have shown that the ideal or long implant length is much more successful in long-term retention.
Personally, I have had this for 16 years. type of action As a maxillofacial surgeon who performs surgery, I can easily say that long implants are more successful, based on the hundreds of articles I have read and my personal experience.
Unfortunately, not every patient has the ideal bone height to apply these implant lengths.
This In this case, our patient's existing bone height, the quality and volume of this bone, as well as our patient's needs, age, systemic condition, smoking habit, area of missing teeth and even our patient's social situation are very helpful in determining the treatment protocol we will use.
TREATMENT OPTIONS IN CASES WITH VERY SERIOUS BONE DEFICIENCY
There is no other option other than bone regeneration in patients with very severe bone deficiency. If bone regeneration is in an area such as sinus augmentation, very good results are obtained with particle bone grafts.
There is no need to take bone from the patient and create a second surgical field. It is even possible to create very beautiful bone with particulate bone grafts using the GBR method using non-resorbable membranes. is to use one's own bone.
Ramus block grafts in the mouth provide more predictable success and this is my favorite.
In cases where much more comprehensive and wider bone is required, I achieve the best results by taking a graft from the iliac bone, called the hip bone.
/> This area is like the body's bone bank and it is possible to remove enough bone to repair a complete upper jaw if necessary.
These surgeries should be performed in very experienced hands by a team that is very knowledgeable about their job.
Under general anesthesia. These are surgeries that require hospitalization for a few days.
However, there is a group of patients who have a bone structure of around 6-9 mm, which we call the gray area. In order to reach the ideal implant size in these patients, should vertical elevation surgery or 6-8 mm short implants be chosen?
The published 2015 consensus report showed that bone grafting applications with short implants and long implants have similar success rates.
But bone grafting applications require longer treatment times, longer recovery periods, and longer It brings with it many complications and additional costs.
In the presence of limited bone, the use of 6-8 mm short implants seems more logical.
However, when short implants are to be used. Existing bone volume and bone quality are very important.
When we prefer short implants, I use wider implants than standard diameter implants and try to increase the number.
Standard implant diameters of 3.5-3. I do not use short implants with a diameter of 8 and 4 mm.
In other words, it is not possible for an implant with a diameter of 3.5-4 mm and a length of 6 mm to carry chewing loads in the long term.
Therefore, it is 6-8 mm long. If I am going to use short implants, I try to use implants with a diameter of 5 or 6 mm and increase the number of implants. However, if there is not enough bone to do this, I perform advanced grafting procedures.
Otherwise, it is very difficult to talk about a guaranteed success and this issue should be discussed in detail with the patient. If the patient does not want advanced surgical procedures, he/she should know that the use of short and thin implants will not last very long. For this reason, I perform advanced bone grafting procedures.
If the remaining bone height is less than 5 mm, a vertical bone grafting procedure will be required to apply the implant.
There are many proven procedures for these surgeries. There is technique. These are the sinus lifting operations that we perform very frequently in the upper jaw posterior region.
This method, which can only be used for vertical bone deficiencies in the upper jaw posterior region, is extremely successful.
For other regions, intraoral or extraoral surgery is performed. I perform vertical and horizontal bone elevation surgery by taking some bone from the pelvic bone, which we call the iliac bone.
In such cases, if possible, I find it more correct to perform the grafting procedure by taking bone from the inside of the mouth. However, if the amount of graft that can be taken through the mouth is not sufficient, I prefer iliac bone graft.
When advanced bone repairs, which are a serious application area of jaw surgery, are performed by very experienced surgeons, the results are very successful and this success is predictable. It is a success.
I often perform this type of surgery. Although it is relatively tiring and costly for patients and us doctors, it is effective. The results are very successful and pleasing in case of cubed hands.
However, the post-operative recovery period of such surgeries is longer, relatively more troublesome, and their costs are higher as additional costs such as hospitalization and general anesthesia are added.
Apart from this, although its usage area is relatively limited, I am using a new application called BOX technique.
In summary, short implants work very successfully in bone deficiencies with the right indication and the right patient selection. It seems wise to use short implants in order not to cause additional distress to the patient with advanced surgeries and to minimize the costs and risks of complications.
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