New surgical procedures
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Piezosurgery is a novel bone surgery technology developed by Prof. Tomaso Vercellotti that also opens up new horizons for dental implantology. Specially developed surgical instruments that utilize microvibrations at ultrasound frequencies allow extremely atraumatic bone cutting with minimal damage to tissue. The biggest advantage of Piezosurgery compared with the conventional scalpels, drills and burs used for cutting bone is its selective cut. This means the instrument cuts easily through hard tissue (bone) while soft tissue such as nerves, blood vessels or gum tissue remains undamaged even if it comes into direct contact with the tip of the instrument. Another advantage of Piezosurgery is that there is practically no bleeding, the bone is not traumatized and wound healing is therefore much better. We use this innovative technology mainly for taking bone grafts, for the sinus lift procedure and for all operations in which there is a danger of injuring nerves or blood vessels.
Further information on Piezosurgery
PRP: Growth factors from the patient's blood
A recent development in implantology is the administration of factors which stimulate bone growth. The aim of this strategy is to accelerate integration of the implants into the bone and thus shorten the often tedious healing phase (with provisional bridge or dentures) following implant placement.
The platelet rich plasma (PRP) obtained from the patient's blood contains high concentrations of a number of growth factors in addition to the platelets. These growth factors lead to good bone regeneration and help achieve faster and better wound healing particularly in high-risk patients (e.g. diabetics, smokers). In our practice we use the automatic PCCS system from the company 3i to obtain the PRP. The system requires only 60 ml of the patient's blood to prepare the concentrate.
Zygomatic and pterygoid implants
Immediate rehabilitation of the atrophic upper jaw
Zygoma implants and pterygoid implants are an interesting alternative to bone grafting in the case of severe bone loss in a toothless upper jaw. Special very long (about 50 mm) implants are anchored in the zygomatic bone or the pterygoid bone and used to support a fixed implant bridge. The bone volume of the zygomatic / pterygoid bone remains quite stable even when there is bone loss in the region of the jawbones. One can either combine two to four normal implants at the front with two zygoma implants or use four zygoma implants (two on each side), if necessary combined with two pterygoid implants. The bridge which is screwed onto the implants is then fitted using the All-On-4 method. If there is severe bone loss in the upper jaw, zygoma implants are the only means of providing immediate fixed tooth replacement without extensive bone grafting. The stress and risk of the operation are far less than in the case of major bone augmentation. Further advantages are the drastically shortened treatment times due to the possibility of immediate loading of the implants and the considerably lower cost as no bone grafting and no hospitalization are necessary.
Example from our practice
This 56-year-old patient consulted us because she had serious problems with her poorly fitting removable upper dentures. The X-ray and CT scan showed massive bone loss (atrophy) in the upper jaw so that placement of implants would have required prior major bone augmentation. For this bone graft we would have had to take bone from the hip. This is quite a stressful procedure for the patient. After the bone graft patients have to remain in hospital for a few days and there is often some difficulty walking in the first weeks after the operation due to the bone removal from the hip. In addition, in the initial phase not even provisional dentures can be used so as not to jeopardize the integration of the grafted bone. Then, for about nine months after the procedure, only a provisional removable full denture can be worn. It should also be mentioned that such large bone grafts have a relatively high failure rate of about 15-20%.
After thorough discussion of all the options, our patient therefore decided on zygoma implants. In an outpatient operation under general anaesthesia we removed the remaining teeth from the upper jaw and stably anchored four zygoma implants, two on each side, in the zygomatic bone. On the very same day we were able to install a fixed provisional bridge on the implants (immediate loading). Three months later the definitive prosthetic rehabilitation was performed (see pictures below).
Chapter overview: Implants
- What is an implant?
- Single-tooth implant
- Implants in the toothless jaw
- Bone augmentation
- New surgical procedures
- Immediate implants
- Risks and complications of dental implants
- Costs and guarantee of implant treatment
- Questions and answers about dental implants
Download the entire illustrated text Better Quality of Life with Dental Implants:
Better Quality of Life with Dental Implants (pdf 2 MB, possibly long download time)