Immediate Placement for Patient with Periodontal Disease: What is the Best Implant System To Use for This?

In a periodontally infected site where you plan to develop a vertical component of bone, you need an implant system that will change the biology of the extraction defect. In chronic periodontitis, there is an elevation of inflammatory cytokines and an increased osteoclastic response. The use of an implant with a bioactive calcium phosphate impregnation will bring the pH back to neutral, activate osteoblastic synthesis of type I collagen, reduce the catabolic phase of bone while accelerating bone bonding by up to 500%. In addition, the ability to platform switch with healing abutments or immediate loading will keep the dento-gingival complex above the implant top. The only system that has all of these features is Intra-Lock International. Their Ossean surface helps to prevent crestal bone remodeling during early healing. We have also found that there is a rebound of the biotype around the implant as a result of the anabolic effects of this surface. Simonpieri, et al in Implant Dentistry 2009 (Volume 18, No. 3;220-227) reported that this system shows no measureable bone loss in their full arch cases at up to 4 year follow-up. RJM

Try using Groovy Implant systems of Nobel Biocare ! I'm sure this will help.

Following Dr. Miller`s advice, maybe you can try with a 3I´s Nanotite Prevail System. It has the same features as the ability of platform swicth and also the calcium phosphate surface.

The best Implant is the PerioSeal Implant System

Wow, Dr. Callan, that's an informative and helpful answer, never would have expected that from you. Now we interrupt Dr. Callan's ongoing commercial to get back to helpful responses...

Robert - after reading your last post, is there a declaration of interest that needs to be expressed here? Kind Regards, Bill Schaeffer

I have not seen the case. In our office we would have LANAPed the case splinted 5-12 then after healing re-evaluate. Why jump into implants without handeling the perio? Here is a case she was refered to me to have all her teeth removed 3+ years ago and has not lost any teeth http://www.youtube.com/watch?v=Dd846LBK9GQ&feature=player_embedded

I look forward to listening to Robert Miller at the November AAID meeting when he will address the ph and catabolic phenomenon around dental implants.

Is the patient a smoker as well? with the kind of perio you've described and if the patient is a smoker as well,you're courting disaster even with the "BEST" implant system.What's the rush? treat the perio,get rid of the bugs,stabilize,extract,graft if need be,wait and then place your implants.You and your patient will both sleep better

Just had another look at the AAID program which is great and would really like to see Dr. Millars talk. Alas it is our ADI members meet here in the UK on the same weekend. Dr. Millar do you have an article which I could read beside the abovementioned paper. Regards

I'm sorry but is it just me that thinks this thread is getting bizarre? Dr T - despite what various vested-interest parties will tell you - all implants will work similarly well/poorly here. There is NO magic implant system that will grow your bone for you. But I have a few major concerns about your post; I really hope that the patient's "severe periodontal disease" is now under control. If not, then you are trying to "rebuild the house whilst it's still on fire!" It sounds as though you have a VERY severe vertical defect extending over the entire front of your patient's upper jaw. Do you have the skill-set to try vertical augmentation - at the same time as placing the implants? How will you temporise the case without ANY compression of your graft? ABSOLUTELY NO MAGICAL IMPLANT IS GOING TO MAKE THE DIFFERENCE IN THIS TECHNICALLY VERY CHALLENGING CASE. Kind Regards, Bill Schaeffer

Sorry DT, I forgot to add that if the bone loss from upper right premolar to upper left premolar is "almost down to the apex" of the teeth, then why are you grafting at all? Unless you are able to do massive vertical grafting or distraction osteogenesis, then you are going to have pink prosthetic gum. You don't need to graft vertically 2, 3 or 4 mm. With bone loss that severe, this grafting doesn't change what you're going to do with the prosthetics. Kind Regards, Bill

i've tried this before and it really depends alot on the type of final restoration you're putting in place. for instance, if you're placing fixed stuff, the aesthetic outcome WILL be poor because your platforms WILL be above gum height.if you're just placing attachments then you can hide the exposed platforms. for best final result aesthetically, clean up the area, put him or her in a temp plate,and place the implants in a well healed arch where you can easily determine the final gingival height.

p.s.- thanx ClearChoice for convincing yet another uninformed patient that they can have teeth in a day

Peter; What type of articles would you like? I have bone physiology papers or papers directly relating to the Ossean surface and the chemistry of calcium phosphate impregnated surfaces as they pertain to bone retention. RJM

Thanks Robert just an insight into catabolic phase thus the bone physiology papers , as I have an interest in the effects of Ca and Phospahte on osteogenesis. I will read the paper above which relates to the implant surface. Regards Peter

Thank you dr schaeffer, I was getting nauseus!

As per the best implant in a perio involved site. There is no magic bullet as per implants. You first have to clean the site and give the persons biology time to heal the site. Then place the implant. You will have about 5 to 10 % more success if you take the time.

I agree with some of the comments about conflicts of interest. If this format and the participants are to have credibility the participants need to state their conflicts. SOme of us know the players and can judge acordingly but I am concerned about the neophytes who do not know them and will be influenced by them. This is going back to the "good old days??" when everything was anecdotal. Lets not lose the crdibility that implants have gained since that time. Regarding the question. What a "crap shoot". Perio disease with no way of judgingthe degree of potential bone loss? Probably a smoker if the patient has extensive perio? Adding a graft into an infected site? A patient with a history of losing their original bone and you expect to grow some new bone? Hoping for the advantages of platforn switching with so many intangibles? Good luck. you'll need it. Extract the teeth and reassess in 6 months. Not placing implants is an option you know.

seriously guys, Implant surgeons, treatment planning, and good dentistry. this is what what makes implant dentistry work. remember the days of machined surface implants? these worked. in cases like this, you could even vertically augment at the time of placement. yes, even with machined surface implants we could do this. implant surfaces do not equal success, we cannot rely on them to make up for bad treatment planning. this thread focuses on implant surfaces as keys to success. they all work. we know this. this sounds like a challenging case with a challenging patient. i hope you get the result you expected. don't rely on implant surfaces or other claims of success from implant companies. ps. bugs before implants equals bugs after implants

For clinicians who want copies of the research papers on bone physiology, please email me at info@robertmillerdds.com. Just give me the specifics on the areas you are interested in. RJM

califagp- Glad you liked my answer!! I suggest you read the literature. califagp--I only answered one part of the question. If you like you may call me at 501-224-1122 and we can discuss this in more detail.

Oh dear. After Don's last two posts here I thought I'd "follow the money". I went to the Perioseal website to follow up on the great research about this implant. This link will take you to their websites "research" section. http://www.perioseal.com/studiesimplantnews.html I can't say I was too surprised to see Don Cullen's name on each and every one of the papers quoted here. Donald, I don't recall seeing your declaration of interest either on this thread, so I will make it really easy for you; ARE YOU IN ANY WAY PAID BY PERIOSEAL, THE IMPLANT COMPANY YOU'VE JUST SAID MAKES "THE BEST IMPLANT"? Was that easy enough for you to answer Donald? Kindest Regards, Bill Schaeffer