2003/4/10 Tarnow in Taiwan

From biologically-driven ,because biology is never changed 

-- Anatomy of tooth and implant 

-- there is biological width formation below the microgap 1.5-2mm. 

-- probing peri-implant need sliding around the peri-implant sulcus ,not just point probing.

-- Biologic width study --

       COIR 1996;7:212-219 

       JCP 1997;24(8) : 568-572

      JP 1997;68:186-198 

      JP 2000;71:1412-1424 

--Effect of occlusal trauma on implant 

     magnetidue 

     direction 

     frequency 

     duration 

  " all or none" -- microcrack on implant( it's different on tooth) 

HA vs titanium 

  inflammation ----> pH reduction ---> HA dissolution 

       1. sped of integration

      2. percenatge of integartion 

3. failure due to occlusal loading 

4. failure due to peri-implantitis

5. biologic width concerns 

Checklist of implant 

   1. microgap

2. high polished surface

3. machined surface(commercial pure Ti; Ti-Al-Van)

4.Rough surface  (coated (HA,TPS),uncoated (substrated)-acid-etched 

Immediate loading -- crossarch ,rigidly splinting ,>4-implants 

     Implant survival by surface (NYU study) 

        machined 74/104 (survival rates :71.2%)

        rough surface 843/879(survival rates : 96.4%) 

      But,machined surface is highly resistant to peri-implantitis ???

Stephen L. Wheeler : HA (89%)vs TPS(95%)

Need keratinized gingiva ?? 

   JOMI 1996:11:626-633 (HA-coated) -- 

  IJPRD 1991;11:113-125   

Implant in perio compromised P'ts 

    JP 1995;66(2) : 150-157 

Surface topography 

   Sa--average height deviation from the eman plane in um 

   Scx-- average distance between the surface irregularities in spatial direction 

   Sdr -- surface developed ratio ,the ratio between the measured surface and total flat surface

 Fibrin-network develops 

   Davies' study  (Osseotite) 

    distance osteogenesis 

    contact osteogenesis

Each implant system must be judged by its own long-term multi-center study .

Critical factors in implant esthetics --

   3-D implant placement ( buccal : under FGM 3mm; slightly palatally )

  immediate vs delayed socket placement

        1. Height of soft tissue

        2. thickness of soft tissue 

      3. amount of KG 

    Tarnow ,Forum (2000) socket classification  

   be careful of gingival recession 

   PPAD 2001:13

  COIR 1993;4(3):151-157

  JOMI 1999;14:351-360 

Do Site Development before implant installation . 

Do One miracle at One  time.

Guide p't to follow your tx plan,not follow his!!

Incision Design --papillae concern , mid-buccal height concern 

  semi-submerged + smaller diameter healing abutment 

   JOMI 2001:16 

Biologic determinants of esthetic 

   1. adjacent to tooth (JP1992>5mm) 

   2. between tooth and implant (IJPRD 1997;17:327-333;1999;19;21-29) 

 Is the  5mm rule also true for papillae between teeth and implants ??

      IJPRD 2000;20:11-17 

      JP 2001;72:1364-1371 

    3. Between Implants 

       Salama 1998 PPAD 

       Compendium 2001 total tooth replacement 

       JP 2000;71:546-549 ( inter-implant distance <>

       JOMI 2000:15:527-532   

       2002 unpublished paper about "vertical distance"

    4. Pontic design (ovate pontic) 

Golden rules-- Do all sites development before implant placement into the esthetic zone 

KISS principle 

 Based on evidence 

avoid adjacent implants if possible

immediate implant only on ideal cases  

Gingival architecture ,Think Biologically