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Immediate Rehabilitation
To summarize the main feature of the implant
provided by Prof. Ciancaglini and his staff deals with the removal of
partial or total removable prosthesis (partial or total dentures) with
fixed prosthesis (bridges or arches) in one session and withe the careful
respect of individual estetic and functional parameters. That under local
anesthesia, without hospitalization and without any disconfort for the
patient. |
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 Upper arch with a prosthetic restoration anchored
to an insufficient number of abutements (supporting teeth).
The patient
complained of recurrent decementations of the prosthetic upper arch; she
wished not to experience any edentulism or removable prosthetic
rehabilitations even if temporarily; inasmuch she accepted only a fixed
restoration.
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 The
treatment plan included:
- the reintegration of a number of
prosthetic abutments, sufficient to an adequate esthetic and masticatory
function so to avoid the risk of decementations in all the functional
performances.
We decided to proceed in two steps as follows:
- 1a)
first step : insertion of implant fixtures for osteointegration but
loading only those in 'strategic' sites so to result a sufficient
ritention and stability of a temporary prosthetic restoration as far as
the ending of the suggested time to get full osteointegration of the
fixtures inserted but not loaded in early phase (delayed
loading)
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 2a)second step :
involvment in the prosthetic restoration of all the abutments (implant
fixtures) both those primarily loaded (immediate loading) and those left
unloaded (left 'at rest') for six months
As one can see in the
ortopantomographic x ray and in the iuxta gengival x rays no difference is
evident both in the quality and in the quantity of bone support around
immediate and delayed loaded implants.
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II° Case: Demonstration of the validity of tyhe technique
of immadiate loading in fixed prtosthesis. |
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 Patient
with a fracture of the posterior abutment in a bridge of excessive lenght
(framework extended from 43 to 48 including 5 dental units with three
pontics anchored to only two terminal abutments), replacing all the molar
and premolars.
The bridge was installed several years before the
fracture (about ten) to satisfy the pressing request of the patient who
refused the treatment with removable prosthesis (similar condition was
present on the left side)
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 The
fractured tooth (48) was extracted and in the same session we proceeded as
follows
- we installed an implant fixture at site 47 ( mesial to 48)as
a temporary abutment to load it immediately to replace the ceramo metal
bridge after relining and coronoplasty of the emergent profile and
occlusion.The implant installed in the same session in the other molar and
premolar site were not loaded in order to waite a four/six months time of
healing according the conventional protocols for
osteointegration. |
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 After six months the work was completed with the setting of a
veneer bridge (gold and acrilic) as the site was not relevant on an
esthetic standpoint ( not apparent in the smiling area); the golden
restoration is regarded as more reliable for plasticity compared with
ceramics when loaded with occlusal and masticatory function.
(clencher/grinder patient).
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 The radiological control by CT/dental scans and post processing
with densitometric analysis, shows that bone density
(osteointegration)around implants immediately loaded (fig...) is similar
to that around dalayed loaded implants (according to conventional
protocols that suggest a four/six months delay).
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 Conclusions:the osteointegrated implants ( titanium
screw/fixtures with adequate primary stability)can be loaded with a fixed
prosthesis immediately with healing/osteointegration perspectives similar
to those of delayed loaded (after 4-6 months) provided that the strategy
of occlusa/masticatory load (occlusal scheme) is compatible with the
gnatological pattern of that specific patient. (protocol suggested by
Prof. Ciancaglini in the Textbook: 'Riabilitazione Orale, Masson
Publishing Company, Milan,1999).
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