220 volume 2 • issue 3 July / September 2012 • pp. 220-223 Diana Paula Radu, I. Luchian, Ioana Rudnic, Silvia Mârţu
Abstract
The scope of the study is to critically evaluate and, implicitly, to establish a correlation among the status of edentation, the missing odonto-periodontal support and the necessary implantary therapy.
Materials and method: The experimental group was formed of 179 patients, 93 women and 86 men, with ages between 18 and 72 years, who addressed the Clinics of Periodontology and some private consulting room between 2010-2012. The investigations involved both a minute cli-nical examination, by descriptive and canonic methods, and paraclinical exams: gnatophotostatic examinations on intra- and extra-oral (front and profile) photos, patterns of study and radiological evaluation by OPT with markers.
Results and discussion: The highest values were regis-tered for III class Kennedy edentations, especially in the 31-50 years group of age, and mainly in women. This eva-luation led to a higher number of implantary treatments. The necessary of implantary treatments was of 100% in IV, V and VI class Kennedy edentations, as well as in total edentations.
Conclusions: The necessary number of interventions on bone structures for the optimization of the implantary field is of 43.92%, the highest ratios being represented by controlled bone regeneration.
Keywords: periodontophated field, implanto-prosthetic support, necessary preimplantary treatment.
INTRODUCTION
In the last 3 decades, implantary therapy has recorded an unprecedented development. The phenomenon has multiple causes, related both to the evolution of the implantary materials and techniques, and to thelarge popularization of this therapeutical alternative. Nowadays, practically all patients, especially the young ones, who address a stomatological office, ask about this therapeutical variant.
A good knowledge on the indications and counter-indications of this method of treatment,
as well as onthe factors involved in the implan-tary success/failure, explains why, on one hand, the oral implant must not be viewed as an uni-versal solution, while, on the other, this alterna-tive should not be left aside, when its success is granted.[1,2]
In recent decades, the indications on dental implants have been considerably extended, as due to the new techniques of alveolar bone con-servation and reconstruction [3]. Controlled
bone regeneration and a series of techniques and methods of bone grafting with new products have been shown as assuring a high success
ratio. [4,5] The periodontophated field imposes
clinical and paraclinical evaluation methods for reaching a correct prognostic of preservation or extraction of teeth prior to implantation. [6-8]
The criteria leading to the selection of the implantary variant as a treatment method of edentation are extremely diverse and, in several cases, its avoidance has nothing to do with the clinical situation under consideration.[8,9]
The scope of the study isto critically evaluate
and, implicitly, to establish a correlation among the status of edentation, the missing odonto-peri-odontal support and the necessary implantary therapy.
MATERIALS AND METHOD
The investigations were performed on an experimental group formed of 179 patients, 93 women and 86 men, with ages between 18 and 72 years, who addressed the Clinics of Periodontology and some private consulting
EPIDEMIOLOGICAL STUDY ON THE IMPLANT TREATMENT NEEDS
IN CASES OF BONE AFFECTION IN PATIENTS WITH
PERIODONTAL DISEASES
Diana Paula Radu1, I. Luchian1, Ioana Rudnic2, Silvia Mârţu3
1. PhD student, Dept. of Periodontology, Faculty of Med. Dent. “Gr. T. Popa” U.M.Ph. Iaşi 2. Assit Prof., PhD, Dept. of Periodontology, Faculty of Med. Dent. “Gr. T. Popa” U.M.Ph. Iaşi 3. Prof. PhD, Dept. of Periodontology, Faculty of Med. Dent. “Gr. T. Popa” U.M.Ph. Iaşi Contact person: Diana Radu-Ghica, e-mail: laserterapie@yahoo.com
International Journal of Medical Dentistry 221 EPIDEMIOLOGICAL STUDY ON THE IMPLANT TREATMENT NEEDS IN CASES OF BONE AFFECTION
IN PATIENTS WITH PERIODONTAL DISEASES
room between 20102012, with the following dis-tribution according to age and sex (table 1):
Table 1. Distribution on groups of age and sex
The investigations included both a minute cli-nical examination, involving the descriptive and canonic methods, and also paraclinical examina-tions: gnatophotostatic examinations on intra- and extra-oral (front and profile) photos, patterns of study and radiological evaluation by OPT with markers.
RESULTS AND DISCUSSION
Starting from these determinations, corrobo-rated with investigations on the general and loco-regional status of the patients from the experimental group, the necessary of implantary treatment and of the additional interventions, to be applied locally, on both soft parts and bone structures, was estimated. Evaluation of the old-ness of the edentation status of all patients is shown in fig 1.
Fig. 1. Oldness of mandibulare dentation
All patients forming the experimental group received a treatment, yet not all of them benefi-ted from an implantary treatment with or without additional methods for the correction of the muco-osseous offer.
Special stress has been laid on the evaluation of the muco-osseous support quality, which also permitted drawing of some conclusions on the necessary of preparatory interventions that
should be made for the optimization of the new structures and, respectively, of the bone structures.
The results of clinical and paraclinical inves-tigations permitted structuring of the experi-mental group according to the type of edentation (Kennedy classification), on the basis of which a subsequent analysis of the necessary implanting treatments was also performed.
The observation was therefore made that the highest part is represented by III class Kennedy edentations, especially in the 31-50 years group of age, and mainly in women, the consequence of this situation being a higher number of implants.
The necessary of implantary treatments was of 100% in IV, V and VI class Kennedy edentati-ons, and also in the case of totaledentations.
In order to investigate the necessary of correc-tion intervencorrec-tions at the level of the hard parts, a quantitative analysis of the alveolary crests, structured as a distribution on Misch classes (table 2, figs. 2,3) was performed.
Table 2. Quantitative analysis of alveolary crests (distribution on Misch classes)
222 volume 2 • issue 3 July / September 2012 • pp. 220-223 Diana Paula Radu, I. Luchian, Ioana Rudnic, Silvia Mârţu
Fig. 3. Classification of bone offer by Misch, according to sex
Thus, whichever the age or sex of the patients, a relatively high ratio of B and C class edentati-ons, known as assuming a height of the alveolary crest below 8-10 mm and a width below 2.5, sho-uld be mentioned:46.03%.
Apart from the interventions necessary at the level of the edentatedcrests included in C and D Misch and Judy classes, a certain number of interventions (7.57%) should have been realized, as well, at the level of the edentated crests from B Misch and Judy class, for expanding their width.
From the perspective of the correction provi-ded by the attached mucous membrane, mention should be made of the fact that, in such cases, too, melioration interventions had been indica-ted to patients with edentations included in C and D Misch classes, as well as in some cases from class B. (table 3, fig. 4)
From the view point of the distribution of the correction interventions on categories, the structure of the experimental group was the following:
Table 3. Distribution on categories of correction interventions necessary at bone structure level
One may observe the increased necessary of interventions of controlled bone regeneration (33.73%), addressing both height and vestibulo-oral augmentation, followed by interventions for
correcting the width of the alveolary crest (split-technique, 32.53%). (fig. 4)
The last position is occupied by lateralization of the inferior alveolar nerve, a much more dif-ficult technique, with relativelyunpredictable neurological results (8.43%).
Fig. 4. Type of preimplantary surgical intervention
For the improvement of bone offer in an exclusively vertical direction, some authors recommend osseoelongation. The fewer recom-mendations in favour of this intervention (25.30%) are due, on one hand, to the limited indication (exclusively vertical augmentation) and, on the other, to the necessity of an ampler edentation. Thus, from the view point of results, osteodistraction assures a much more predictible and constant in time increase of bone capital. [9]
Mention should be made of the fact that, even if, for 88.36% of the investigated patients, implantary treatment had been indicated, only some of them could benefit from this type of treatment, the reason being a financial one.
In numerous cases, in spite of the steadfast indications for implantary therapy, which avoids the preparation of integer teeth and might assure all conditions for attaining optimum results of the prosthetic implantary treatment, realized both morphologically and functionally, the high costs of such type of therapy do not permit its
practical application. [4]
International Journal of Medical Dentistry 223 EPIDEMIOLOGICAL STUDY ON THE IMPLANT TREATMENT NEEDS IN CASES OF BONE AFFECTION
IN PATIENTS WITH PERIODONTAL DISEASES
Consequently, without being transformed into an universal solution, dental implant is frequently viewed as an efficient method, that should be considered when establishing the
treatment of a partially mandibularly edentated
patient, on also evaluating the multipledifficul-ties to be met especially in the mobile therapy applied at this level.
CONCLUSIONS
• The necessary of interventions on the soft parts for optimization of the implantary field is of 44.98%, the highest number being repre-sented by vestibuloplasties throughlateral transpositionalflap.
• The necessary of interventions onbone struc-tures for optimization of the implantary field is of 43.92%, the most numerousbeing repre-sented by controlled bone regeneration.
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