DOCTORAL DISSERTATION. A Clinical and Radiolagical-Imaging Correlative Study in. the Evaluation of Dental-Implants-Based Prosthetic Restorations

Transcription

1 DOCTORAL DISSERTATION A Clinical and Radiolagical-Imaging Correlative Study in the Evaluation of Dental-Implants-Based Prosthetic Restorations Doctoral candidate Ioan Sebastian Cernuşcă-Miţariu CONTENTS List of Abbreviations 5 Introduction 6 GENERALITIES SECTION 7 Chapter I. Maxillary Bones Radiological Anatomy Notions 8 I.1. Oral and Maxillofacial Radiological Anatomy and Zones 8 I.1.1. The Superior Oral and Maxillofacial Upper Region 8 I.1.2. The Madibular-Cervical Lower Region 13 I.2. Quality of the Bone Substratum 18 I.2.1. Anterior Maxilla 18 I.2.2. Posterior Maxilla 19 I.2.3. Anterior Mandible 20 I.2.4. Posterior Mandible 20 Chapter II. Radiological-Imaging Methods Employed in Implants-based Prosthetics 22 II.1. Conventional Radiological Methods 22 II.1.1. Panoramic Radiography 22 II.1.2. Periapical Radiography 23 II.1.3. Digital Radiography 23 II.1.4. Occlusal Radiography 24 II.1.5. Cephalometric Radiography 24 II.2. Imaging Methods 24 II.2.1.Goals of Imaging. 24 II.2.2. Imaging Modalities 25 II.2.3. Presurgical Imaging 26 II.2.4. Computed Tomography 26 II.2.5. Magnetic Resonance Imaging 28 II.3. Radiological Image of Vital Structures in Oral Implantology 29 Chapter III. Implants-Based Prosthetic Notions 32 III.1. Principles of Implants Insertion 32 III.1.1. Anatomic Principles 32

2 III.1.2. Prosthetic Principles 34 III.1.3. Biomechanical Principles 34 III.2. Types of Dental Implants 35 Chapter IV. Notion and Conditions of Dental-Implant Osseous Integration 41 IV.1. Biocompatibility and Biomaterials Used in Implant-Based Prosthetics 41 IV.2. Osseous Integration and Gingival Integration 43 SPECIALITY SECTION 46 Chapter V. Rationale 47 CHAPTER VI. The Goals of the Doctoral Dissertation 48 CHAPTER VII. Materials and Methods 50 VII.1. Additional Radiological-Imaging Diagnosis Procedures 52 VII.2. Selection of Patients and Principles of Implant-Based Prosthetic Treatments 54 Chapter VIII. Material and methods Descriptive Approach of the Patients Groups under Scrutiny, along with a Presentation of Representative Cases 60 VIII.1. Group A. Unidental Maxillary or Mandibulary Edentation Cases 60 VIII.1.1. Study No. 1: Fixed Implant-Based Prosthetic Rehabilitation of a Patient, Employing Dental Implants without Osseous 60 VIII.2. Group B. Maxillary and Mandibulary Limited Pluridental Edentation Cases 64 VIII.2.1. Subgroup B1. 64 VIII Study No. 2. Fixed-Implant-Based Prosthetic Rehabilitation of a Patient Suffering of Limited Partial Edentation, Employing 64 Pluri-Implant Structures, without Osseous VIII.2.2. Subgroup B2. 67 VIII Study No. 3. Fixed-Implant-Based Prosthetic Rehabilitation of a Patient Suffering from Limited Partial Edentation, Employing Pluri-Implant Structures, With External Sinus-Lift Osseous 67 VIII.2.3. Subgroup B3. 71 VIII Study No. 4. Fixed Implant-Based Rehabilitation of a Patient Suffering from Limited Partial Edentation, Employing Pluri-Implant 71 Structures and the Transversal of the Alveolar Crest VIII.2.4. Subgroup B4. 74 VIII Study No. 5. Fixed Implant-Based Rehabilitation of a Patient Suffering from Limited Partial Edentation, Employing Pluri-Implant 74 Structures with Osseous-Destruction-Type Osseous VIII.3. Group C. Maxillary and Mandibulary Pluridental Edentation Cases 78

3 VIII.3.1. Subgroup C1. 78 VIII Study No. 6. Fixed Implant-Based Rehabilitation of a Patient Suffering from Extended Partial Edentation, Employing Pluri-Dental 78 Structures without Osseous VIII.3.2. Subgroup C2. 82 VIII Study No. 7. Fixed-Implant-Based Prosthetic Rehabilitation of a Patient Suffering from Extended Partial Edentation, 82 Employing Pluri-Implant Structures, With External Sinus-Lift Osseous VIII.4. Group D. 88 Monomaxillary and Bimaxillary Total and Subtotal Edentation Cases VIII.4.1. Subgroup D1a. 88 VIII Study No. 8. Fixed Implant-Based Prosthetic Rehabilitation of a Subtotally Bimaxillary-Edentated Patient, Employing Pluri- 88 Implant Structures, without Osseous VIII Study No. 9. Fixed Implant-Based Prosthetic Rehabilitation of a Totally Maxillary-Edentated Patient, Employing Pluri- 94 Implant Prosthetic Structures (8 Dental Implants), without Osseous VIII Study No. 10. Fixed Implant-Based Prosthetic Rehabilitation of a Totally Maxillary-Edentated Patient, Employing Pluri- 98 Implant Prosthetic Structures (5 Dental Implants), without Osseous VIII Study No. 11. Fixed Implant-Based Prosthetic Rehabilitation of a Totally Bimaxillary-Edentated Patient, Employing Pluri- 101 Implant Prosthetic Structures, without Osseous VIII Study No. 12. Fixed Implant-Based Prosthetic Rehabilitation of a Subtotally Mandibulary-Edentated Patient, Employing 105 Pluri- Implant Prosthetic Structures, without Osseous VIII.4.2. Subgroup D1b. 108 VIII Study No. 13. Overdenture-Type (Fixed Component + Mobilizable Component) Implant-Based Prosthetic Rehabilitation of a Totally 108 Mandibulary-Edentated Patient, Employing 4 Dental Implants and Mobilizable Prosthesis, without Osseous VIII Study No. 14. Overdenture-Type (Fixed Component + Mobilizable Component) Implant-Based Prosthetic Rehabilitation of a Totally 113 Mandibulary-Edentated Patient, Employing 3 Dental Implants and Mobilizable Prosthesis, without Osseous VIII Study No. 15. Overdenture-Type (Fixed Component + Mobilizable Component) Implant-Based Prosthetic Rehabilitation of a Totally 116 Mandibulary-Edentated Patient, Employing 2 Dental Implants and Mobilizable Prosthesis, without Osseous VIII.4.3. Subgroup D1c. 122 VIII Study No. 16. Complex Implant-Based Prosthetic Rehabilitation of a Totally Mandibulary-and Partially Maxillary-Edentated 122 Patient, Employing Implant-Supported Adjunct and Conjunct Prosthetic Structures, without Osseous

4 VIII.4.4. Subgroup D VIII Study no. 17. Fixed Implant-Based Rehabilitation, Employing Pluri-Implant Structures, With External Sinus-Lift Osseous 126 and Bilateral Osseous Augmentation CHAPTER IX. RESULTS AND DISCUSSIONS 142 CHAPTER X. SUGGESTED FURTHER RESEARCH AND DEVELOPMENTS 152 CHAPTER XI. CONCLUSIONS 153 Bibliography 156 Annexes 171

5 DOCTORAL DISSERTATION A Clinical and Radiolagical-Imaging Correlative Study in the Evaluation of Dental-Implants-Based Prosthetic Restorations Doctoral candidate Ioan Sebastian Cernuşcă-Miţariu Key Words Dental Implant Oral and Maxillofacial Radiology Implant-Based Prosthetic s 3D Computed Tomography Orthopantomography Osseous s Peri-Implantitis Digital Radiology Biomaterials Partial Edentation Total Edentation External Sinus-Lift

6 DOCTORAL DISSERTATION A Clinical and Radiolagical-Imaging Correlative Study in the Evaluation of Dental-Implants-Based Prosthetic Restorations Doctoral candidate Ioan Sebastian Cernuşcă-Miţariu Abstract At present, the implants-based prosthetic restoration represents an alternative to adjunct or conjunct classic prosthetics (not easily accepted by the younger people, as well as many others). In the long run, the choice of the prosthetic mode depends on a series of factors and it is decided upon by both the dental physician and the patient. Implantology has advanced a lot recent, as a result of increased biocompatibility and osseous integration of the implants, as evinced by clinical, radio-imagist, and experimental data. The first treatment stage consists of an evaluation of the soft and hard tissues that will interact with the dental implant. The place and the position of the inserted implant must be correlated by the physician with the quantity and quality of the tissues, in order to learn whether a surgical correction or osseous augmentation is necessary. The choice of the type of implant that will be applied is based on the clinical and radio-imagistic data, viz., on the dimensions, osseous density, as well as on the gingivalmucous quality. Preference is being given to implants that require the least invasive intervention, such as the screw-based, the cylindrical or the blade ones.

7 If the application of the implants is recommended to be performed by the surgeon, the prosthetic loading can be done by the prosthetics specialist, who will observe several rules and take into account the particulars of each case. If osseous reconstruction was necessary, one must consider the type and the size of the implant that was introduced in the osseous structure. The study performed and described in the doctoral dissertation has monitored the evolutional therapeutic progress of different types of dental implants, whose fabricating technology is similar to that of the type of implants patterned by the other of this paper and by collaborators. It was also aimed at constituting an experimental group of patients and, last but not least, of a manufacturing line. The over 200 prosthetic-implant cases were periodically clinically and radioimagistically evaluated. The patients benefited from the application of 850 dental implants. Four groups and subgroups of patients were under scrutiny. Our results, successes and setbacks, compare favorably with those reported by published clinical studies. The osseous integration success rate of the 200 cases (850 dental implants, respectively) was 96%. The majority of the patients were women, 45% of them being 41- to 60-years old. As shown in my doctoral dissertation, 90% of the peri-implantitis cases that occurred after the prosthetic loading correlated with the absence of fixed gum and peri-implantary adherences, requiring pro-prosthetic surgical interventions. A significant percentage of peri-implantitis cases were observed in the case of patients who wore temporary mobile prostheses after the insertion of implants. No significant correlation was observed between diverse cases, in as far as the types of implants being used: Mis, Evolution, Tatum, or Bio-micron. The doctoral dissertation has demonstrated, beyond the shadow of a doubt, the role and merits of the clinical-imagistic means of evaluation and monitoring of the implants-based prosthetic restoration cases, in view of their success or failure.