CAMLOG ROOT-LINE 2 Surgical Procedure

8 CAMLOG ® ROOT-LINE 2 IMPLANT PRELIMINARY REMARKS It is known from general physiology that both non-loading and underload- ing of the bone induce degradation just as much as overloading (inactivity atrophy, pressure atrophy). The area between these two extremes is called normal loading. This consists in a balance between growth and degrada- tion. Working with bridge restorations in conventional prosthetics has led to identification of consistently high rates of bone degradation in non- loaded or underloaded teeth pillar (Misch/Frost 1990). W. Schulte recog- nized this in 1982 and proposed early (immediate, if possible) implantation to offset atrophy of the periodontal structures, which commences immedi- ately after tooth loss. The implant supports the alveolar bone and prevents the bony areas from being either overloaded or subjected to inactivity at- rophy (stress-shielding). VERTICAL DIMENSION FOR OCCLUSAL PLANE For implantologist, the information on the length of the implant being used plays an important role in prosthetic planning and restoration. The loading of the implant-bone interface is determined by the leverage ratio from the osseointegration-related resistance to the prosthetic load arm (equal to the supracrestal implant length plus crown length from the im- plant shoulder). If IL is less than CL, measures must be taken to reduce loading (e.g. using prosthetic splints). The aspect ratio from the single crown to the implant should be at most CL 0.8:IL 1. IL CL CL = Crown Length IL = Implant Length IMPLANT POSITION PLANNING ESTHETICS The use of therapeutic methods from an esthetic perspective is very depen- dent upon the initial situation and the visibility of the esthetic impairment. In the “esthetic zone” (anterior maxillary area), the smile line determines the extent of work that may be necessary. If prominent transversal or verti- cal hard- or soft-tissue deficits are present that affect the extraoral soft tissue profile, then lip and cheek support will have to be provided through suitable augmentative methods such as implant positioning or prosthesis design. These can restore the patient’s physiognomy to a large extent. PATIENT COMPLIANCE The greater the patient’s desire for a functional – and especially for an es- thetic – restoration and the more compromised the initial situation, the more extensively the patient must be educated. Temporary limitation of function and esthetics may result from the surgery and the patient might be required to wear a long-term provisional. The extent of pre-treatment and the particulars of the case will affect the overall duration of treatment. In selecting a prosthetic restoration, make sure to take into account, in ad- dition to the functional and esthetic aspects of the case, any manual and visual impairments uncovered by the history that may affect the patient’s ability to manage oral hygiene and prosthesis care. PATIENT INFORMATION When the process of ruling out contraindications, collecting clinical and radiographic information, and making a diagnosis is complete, an informa- tional conference is held with the patient, using documents and models for demonstration. Risks of treatments and possible alternatives are fully dis- cussed and documented. TREATMENT CONCEPTS