Partner Magazine logo 10

5 SCIENCE | CLINICAL RESEARCH further indication for the importance of soft tissue thickness. According to the study, the buccal gingival margin retracts apically by 1.5 mm long-term (2 to 8 years) after immediate implantation and thin tissue, whereas the values for thick tissue are only approximately 0.6 mm [12]. Sipos strongly suggests extremely careful techniques in immediate implantation. The buccal papilla should be preserved as best possible by suitable incision or by dispensing with incision altogether, so that the fragile blood supply is restored as fast as possible. In the case of buccal bone dehiscences, one can expect a worsening of the esthetic outcome for all techniques [13]. For the first time, a systematic review sponsored by the CAMLOG Foundation analyzed the prognosis for immediate loading in relation to the type of restoration [14]. Professor Mariano Sanz concluded that immediately loaded implants under overdentures in the lower jaw and as support for permanent total restorations in both jaws had the same risk of loss as implants with delayed loading. However, the prognosis for implants in individual tooth gaps or partially edentulous jaw sections was somewhat poorer. Next to savings in time, Sanz mentioned better bone stability as advantages of immediate loading. Differences in marginal soft tissue levels or clinical inflammation parameters between immediate and delayed loading could not be demonstrated. The clinical aspects were rounded off by Dr. Mario Beretta (University of Milan, Italy), with a critical appraisal of immediate loading. In addition to the overall higher risk, augmentation and soft tissue management are more difficult to perform than for delayed loading. In the case of individual implants, Beretta recommends a stepwise approach with simultaneous implantation and augmentation, followed by connective tissue grafting (after approximately 4 months), exposure (4 weeks later) and impression taking (3 weeks later). Using temporary restorations, the soft tissue can then be shaped as desired. Consensus on the restoration of edentulous jaws A systematic review submitted for publication on the topic of implant- supported restorations in edentulous jaws, was presented by Professor Stefan Wolfart , lecturer at the University of Aachen, Germany [15]. According to the study, permanent restorations in the upper jaw with more than four implants show the best prognosis, with six implants being regarded as the standard. Four implants are promising for overdentures in the upper jaw. In the lower jaw, removable restorations are as successful as permanent restorations. Four implants can be regarded as optimal for overdentures, but two implants have also proven successful. Using more than four implants improves the prognosis for permanent restorations. Wolfart added that bars have proven themselves as anchors in the upper jaw, and there is also limited positive evidence for telescopes and locators. Ball attachments can be added for the lower jaw. Overall, the systematic review concludes that there is a lack of data in the literature on patient-related factors such as quality of life, ease of cleaning and costs [15]. There is also limited data on the permanent All-on-4 concept, which allows dispensing with sinus floor augmentation in the upper jaw and nerve lateralization in the lower jaw. A further advantage mentioned by Dr. Thomas J. Balshi (Fort Washington, USA) was the optimal relationship between the number of implants and the support area, and thus lower costs. However, according to the systematic review by Wolfart et al. there is only a single usable study which demonstrates very good results with regard to the survival rates of implants [15]. Balshi presented an ongoing study Dr. Pascal Valentini Prof. Stefan Wolfart Dr. Thomas J. Balshi