Techniques and Technologies Integrated Abutment Crown™

Rainier A. Urdaneta,Mauro Marincola,The Integrated Abutment Crown™, a Screwless and Cementless Restoration for Single-Tooth Implants: A Report on a New Technique, Journal of Prosthodontics, Vol.16:311-318, 2007

“ IAC’s clinical performance compares favorably to screw and cement

retained single implant restorations. ”

Five factors associated with Bone Gain Peri-implant Bone Levels

Rainier A. Urdaneta,Shadi Daher,Joseph Leary, Kimberly Emanuel, Sung-K Chuang,Factors Associated with Crestal Bone Gain on Single-Tooth Locking-Taper Implants: The Effect of Nonsteroidal Anti-Inflammatory Drugs, The International Journal of Oral & Maxillofacial Implants, Vol. 26,1063-78, 2011

•Implant size 5 x 8 is more likely than 5x11•Occluding with teeth•CP Coating•Larger the Titanium Spherical base•NSAIDs

Oikarinen K, Raustia AM, Hartikain en M, General and local contraindications for endosteal implants. An epidemiological panoramic radiographic study in 65-year-old subjects.

Community Dentistry and Oral Epidemiology, 1995;23:114-118.

431 patients:

Maxilla: 62% had less than 6mm of bone height

Mandible: 50% had less than 6mm of bone height

Are they necessary? Radiographic Study says they are.

Are they reliable?

Short implants with large diameter (6x5.7mm) have a long-term (>5 years) survival rate and crestal bone level maintenance similar to that observed for non-6x5.7mm implants. M.A. Gentile, S.K. Chuang, and T.B. Dodson. The International Journal of Oral & Maxillofacial Implants, Vol. 20, No.5, p.732-737, September 2005.

Newer literature says, Yes !

Crown-to-implant ratio guidelines for natural teeth should not be applied to potential implant site or existing implant restoration.John K. Schulte. Crown-to-implant ratios of single tooth implant-supported restorations. Journal of Prosthetic Dentistry, Vol 98,(1),1-5,2007.

Hardeep Birdi, DMD, MS, John Schulte, DDS,MSD, et al, “ Crown-to-implant ratios of Short-Length Implants .Journal of Oral Implantology, 2010, 36:425-433.

Are they reliable?

“ Crown-to-implant ratios do not affect the success of short-length plateau-design implants.”

Newer literature says, Yes !

Plateau implants may be restored with single tooth restorations in situations where the length of the proposed crown is up to 4.95 times the length of the implant within the bone.Urdaneta RA, Rodriguez S, McNeil C, Weed M, Chuang SK. “The Effect of Increased Crown-to-Implant Ratio on Single-tooth Locking taper implants.” International Journal of Oral Maxillofacial Implants, July-August 2010; 25:729-743

Watzek G, Implants in Qualitatively Compromised Bone

“Both at the midline and lateral to it, one to five arteries were shown to approach the mandible lingually and enter it.They originated from the territory of the sublingual artery in the oral floor.”

Avoid Fatal Bleeding!How are they better?

Quintessence, 2004, p 48-49

How do they work?

“Every change in the function of a bone is followed by certain definite changes in its internal architecture and its external conformation.”

German Anatomist/Surgeon Julius Wolff (1836–1902)

Wolff’s Law (1892)

Wolff J. Das Gesetz der Transformation der Knochen.Berlin: Verlag von August Hirschwald, 1892

How do they work? Bone Healing is uniquely different!

How do they work? Rapid healing with cortical-like haversian bone!

Plateau Implant presents a unique healing pattern leading to rapid plateau filling with bone with high remodeling potential, leading to unique long-term haversian-like bone morphology

Plateau Implant healing: Leonard et al, 2009 COIR; Coelho et al., CIDRR 2009; Suzuki et al., 2008 JOMS; Granato et al., 2009 JBMR-B, CIDRR.

Plateau Implant long-term morphology: Coelho et al., 2010

How do they work? 8 years.

Paulo G. Coelho, DDS, PhDPaulo G. Coelho, DDS, PhDAssistant Professor of Biomaterials and BiomimeticsAssistant Professor of Biomaterials and BiomimeticsDirector for Research, Department of Periodontology and Implant DentistryDirector for Research, Department of Periodontology and Implant DentistryNew York University College of DentistryNew York University College of Dentistry

Cortical-Like Haversian Bone

Rapid healing with cortical-like haversian bone!

P.G.Coelho, C.Marin, R. Granato, M. Suzuki;Clinical Device-Related Article, HIstomorphologic Analysis of 30 Plateau Root Form Implants Retrieved After 8 to 13 years in Function. A Human Retrieval Study, Wiley InterScience 2009, Department of Biomaterials and Biomimetrics, New York University

How do they work? 10 years.

Development of a unique haversian-like channel system like the one observed in cortical bone, high mechanical properties

Rapid healing with cortical-like haversian bone!

10 years after loading

How do they work? 13 years.

Paulo G. Coelho, DDS, PhDPaulo G. Coelho, DDS, PhDAssistant Professor of Biomaterials and BiomimeticsAssistant Professor of Biomaterials and BiomimeticsDirector for Research, Department of Periodontology and Implant DentistryDirector for Research, Department of Periodontology and Implant DentistryNew York University College of DentistryNew York University College of Dentistry

Rapid healing with cortical-like haversian bone!

13 years in function: Arrows depict remodeling

cycles over the time

P.G.Coelho, C.Marin, R. Granato, M. Suzuki;, Histomorphologic Analysis of Plateau Root Form Implants Retrieved After 23 years in Function. A Human Retrieval Study, Department of Biomaterials and Biomimetrics, New York University

How do they work? 23 years.

Development of a unique haversian-like channel system like the one observed in cortical bone, high mechanical properties

23 years in function!

Osteonic Structures

Lamellar bone (White allows)

(Red allows)

5mmx8.3mm 5.1mmx9.4mm 5.4 mmx8.6mm 5.7mmx8 mm 4.8mmx8mm

Müftü S.,Bozkaya D, Müftü A, Evaluation of load transfer characteristics of five different implants in compact bone at different load levels by finite elements analysis, Journal of Prosthetic Dentistry,Volume 92, Issue 6, December 2004

Plateaus Provide Greater Surface Area

How do they work?

Stress = Force / Given Area Plateaus Provide Greater Surface Area

An increase in functional surface area serves to decrease the magnitude of mechanical stress imposed on prosthesis, implant, and biologic tissues.

How do they work?

Bidz MW, Misch CE ; Force Transfer in Implant Dentistry : basic concepts and principles,Oral Implantology 18:264-274, 306, 1992

More surface area at bottom

5.7mm ShortImplant

14mm LongImplant

Type II bone Type III bone Type IV bone

20N Horizontal Displacement

How do they work?

Stress Distribution Characteristics of Various Implant Systems due to Non-central Occlusal Loads,AO Annual Meeting, Boston, MA, March, 2003Bozkaya, D., Müftü, S. and Müftü, A.

Better distribution of compressive forces!

5.7mm ShortImplant

14mm LongImplant

Type II bone Type III bone Type IV bone 100N Vertical Displacement

How do they work?

Stress Distribution Characteristics of Various Implant Systems due to Non-central Occlusal Loads,AO Annual Meeting, Boston, MA, March, 2003Bozkaya, D., Müftü, S. and Müftü, A.

Better distribution of compressive forces!

“The distribution of mature bone was greatest along the apical portions of Plateau implants.”

How do they work?

Mitchell, S., Lemons, J., & Wellons, H., Tissue Interfaces for Titanium Alloy Plateau Implants,

IADR General Session and Exhibition, March 1994, Seattle, Washington, University of Alabama and Stryker Dental Implants, Kalamazoo, MI, USA

Better distribution of compressive forces!

“The seal provided by the locking taper design has been demonstrated to be hermetic with regard to bacterial invasion in vitro.”

Dibart, S., Warbington, M., Su, M.F., Skobe, Z., In Vitro Evaluation of the Implant-Abutment Bacterial Seal: The Locking Taper System, Journal of Oral and Maxillofacial Surgery, Vol. 20, No. 5, p. 732-737, September 2005.

How do they work? Bacterially Sealed Locking Taper Connection!

How do they work? Micromovement with all screw retained designs!

“All implant-abutment connections with a clearance fit exhibit a micro motion.”

Zipprich, Holger , Weigl, Paul/lange, Bodo/Lauer, Hans-Christoph,Micromovements at the Implant-Abutment Interface:Measurement, Cause , and Consequences, German Implantologie, Vol. 15, No. 1, p. 31-46, 2007.

QuickTime™ and aCinepak decompressor

are needed to see this picture.

Video Loop

CONCLUSION:

Reliability for a mission of 50 K cycles

at 200 N was not significantly different

between different abutment designs.

Failure modes differed.Bonfante, EA • Suzuki, M • Lubelski, W • Silva, NR • Coelho, PGUniversity of São Paulo, Bauru School of Dentistry, BrazilTufts University School of Dental Medicine, USA Plateaue Implant Dental Implant Center, USA New York University, Biomaterials and Biomimetics, USA

IADR, Barcelona, Spain, July 2010

Staining on nano-ceramic material Remove stains easily

• “Staining is superficial (20µm) and original composite color can be reestablished by polishing. ”

Taciana Emilia de Almeida Anfe, Carlos Martins AGRA,Glauco Fioranelli Vieira, Journal of Esthetic and Restorative Dentistry, Vol. 23, No.4, 260-267, 2011

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