As famously noted by Dr David Garber, ‘the tissue is the issue, but the bone sets the tone
Today we can regenerate vital bone – in simultaneous procedures often utilising malleable and form stable materials – procedures that allow membrane-free tissue-sparing approaches.
This predictability allows us to concentrate on optimal 3-dimensional implant placement – according to restorative preference and soft tissue emergence with minimised surgical time. With optimal planning and execution, we can add the early loading preferred by patients.
Guiding the drill
In the video by Dr Michael Klein (NYU) the implant – Dynamic from Paltop is placed in conjunction with a 3d printed guide customised to the patient’s exact anatomy. A sleeve is incorporated such that it ‘guides’ the sequential drill orientation and depth according to pre-operative hard and soft tissue scans.
Clinical partners of the Implant Store can create a digitised plan for pilot or fully guided surgery with a bespoke guide from £175.
Guiding the Handpiece
Unique to Paltop is a digital guidance sleeve incorporated into the contra-angle handpiece which allows ‘sleeve-in-sleeve’ guidance with tight tolerance for additional accuracy, direct drill lubrication and low friction.
Guiding the Implant
For immediate or early loading cases the balance of implant design parameters shifts towards increased mechanical stability. Implants such as Paltop Dynamic or Bioner Top DM combine an active apex for sharp bone engagement with a more aggressive tapered thread at the apical section.
The Top DM implant from leading Spanish manufacturer Bioner, features an expanding cone-shaped core of increasing diameter from the apical through to the coronal area.
This type of design favours insertion in areas of poor bone quality and a dual pitch thread critical for immediate placement.
Paltop Dynamic is typically placed (0.5mm) sub crestal which combined with the platform switch and PALTOP all concave abutment emergence ensures excellent soft tissue aesthetics. Bioner Top DM is designed with a straight neck + thread to the top of the platform specifically for (0.5-1mm) sub crestal placement.
Top DM implant from Bioner incorporates a single prosthetic platform meaning a definite transepithelial component can be placed during surgery sparing further soft tissue trauma and maintaining crestal bone. A depth gauge is included in the surgical kit allowing implant depth to be judged according to the soft tissue thickness.
Implant Depth Control with Customised Healing
The Umbrella Concept (Dr Alberto Miselli) is a three-dimensional approach that describes the placement of the implant 4mm below the (future) gingival zenith in conjunction with a customised healing abutment.
The concept respects the biologic width and preserves natural bone levels, soft tissue healing and emergence with no undue pressure on the soft tissue.
Guiding the Tissue
Management of the Emergence and Cervical Profile can control the location of the Plaque zone in relation to the Implant Platform and Crown’s cervical margin. A coronally located plaque zone away from the implant platform/crestal bone area reduces the risk or peri-imlpantitis. A location in proximity to the cervical margin also enabled easier oral hygiene for patients.
These critical aspects cannot be achieved with a stock healing abutment or an anatomically designed one.
Used for anterior and posterior cases, the Cervico system provides the foundation for exceptional aesthetic and biologically solid results in an easy, fast, and cost-effective manner.
Compatible with all major implant systems the Cervico protocol incorporates guides, pins, depth gauges and moulds to create fully customised healing with impressions transferable directly to the lab for perfectly seated final restorations.