THE BIOHPP IN THE IMMEDIATE LOADING FOR THE AESTHETIC COVER OF ABUTMENT ON FIXTURE

Objective

In the last years patients request of the adoption of therapeutics protocols capable of combining aesthetics and speed of execution this factor determined on the company side the urge of the development towards the production of new materials capable of satisfying both the characteristics. We can deÞne Òimmediate loadingÓ by the application of a prosthesis if made in the one week following the implantation (tab 1). Even though this approach gives relief to the patient, it increases the risk of implantation failure therefore it is very important to select the patients with predetermined characteristics but also select the implantation site in those patients. Only through this rigorous selection the medium and long-term results of these two kinds of protocols (conventional and immediate) are overlapping.

For the immediate loading protocol many materials have been considered. Recently the BioHpp has been introduced to the market this product is derived by the PEEK strengthened by ceramics particles. The characteristics that make the material interesting are: the elastic modulus of 4000 MPa, resistance to rupture superior to 1200 N, adhesion to compost materials superior to 25 MPa , speciÞc weight 1,6 g/cm3.

The BioHpp can be used either by pressing or milling, this last procedure allows the technician to use a material already treated by the company without the risk of damaging the microscopic structure.

This material is capable of absorbing part of the chewing force, this phenomenon is known as Off Peak (Grap. 1). Thanks to this capability the BioHpp the abutment clad in this material can be applied right after the implantation without having to remove it and therefore preserving the modelling of the gingival tissue in the groove area, granting the maximal respect of the per-implant tissues.

Fig. 1 Fig.3

Conclusions

We believe that the BioHpp is since today an optimal material to make our prosthetic structures on Þxtures similar to a gradual system of absorption of chewing force a lot alike a the natural dental element (3). Internal research reassure that the thermo pressing of the BioHpp on titanium, with the ÒFor 2 PressÓ instrument, grants a very intimate union of the two materials (Þg.3) this characteristic is fundamental in order to keep the request of materials as similar as possible, or that present an high adhesion for the guarantee of stability in time of the restorations themselves. The combination of these characteristics make this material suggested for single or multiple rehabilitations with excellent prerogatives of good clinic result and acceptance from the patients.

Fig.2

V.Giannelli 1, L.C.Campos1, C. Baroncini 2, G. Ghirlanda1 1 Odontoiatra Libero Professionista, Roma 2 Odontotecnico, Roma Ref.: V.Giannelli email: dott.vittoriogiannelli@gmail.com

Graf.1

carico immediato

Barcellona Consensus 2002 <24 ore

ITI Consensus 2003 <48 ore

European Association of Osseointegration 2006 < 72 ore

Revisioni sistematiche della Cochran library 2007 < 1 settimana

Tab.1

Bibliography!1 Prof. Damaso Caprioglio-Mauro GandolÞni "soluzione ortodontica delle agenesie dentarie" 1996

2 Abrahamsson I, Berglundh T, Lindhe J. The mucosal barrier following abutment dis/reconnection. J Clin Periodontolol 1997;24:568-72

3 Assorbimento graduale di forze. M.Martignoni

Tab 1 ITI Treatment Guide, Volume 4. Quintessenza

Materials and methods !One of the use of the BioHpp appreciated by its creators is doubtlessly the customizability of the abutments that Bredent makes available for the single rehabilitation.

The patient DGL (Pic.1): 35 years old, non-smoker, came to us complaining about a mobility of the deciduous upper lateral incisors. From the clinic exams we can objectively we observed the presence of the elements 5.2 and 6.2 both with a mobility of stage 3.

The lack of the elements of second sequence concerns a high numbers of patients (1). From the radiographic exams of Þrst and second level we notice two characteristics: the complete roots reabsorbing of the deciduous upper lateral incisors and the lack of the permanent lateral incisors. The deÞciency of bucco-palatal and mesial-distal basal bone in this case the standard protocol would be to apply an orthodontic therapy and bone regeneration but the patient for various reasons refuses this therapy and request us to use an aesthetic immediate restoration. We proceed with the extraction of the two elements and the immediate insertion of a mini Þxture (Midi 3,0 mm x 14 mm).

Via the imprint taken during the surgery with a polyvinylsiloxane (One Phase, Hydro Medium DEI Italia), we developed a master model on which we customize two abutment MD in titanium (Þg.2) using thermo pressed BioHpp. These abutment have been inserted following the company advices and using temporary crowns Þxed with temporary cement composed mainly by zinc oxide (TempBond, Kerr). Radiographic check-ups have been made after 1 and 3 months following the surgery. When the integration was completed the temporary crowns were removed and the abutments were Þnished and polished; and the deÞnitive imprint was taken, always using polyvinylsiloxane (One Phase, Hydro Medium DEI Italia), but without removing the abutments themselves (2). Two crowns made in integral ceramic were made cemented with dual cement compost (Relyx unicem 2, 3M Italia).

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t

THE BIOHPP IN THE IMMEDIATE LOADING FOR THE AESTHETIC COVER OF ABUTMENT ON FIXTURE

Objective

In recent years, patients have been requesting the adoption of therapeutic protocols which are capable of combining aesthetics with speed of execution. For manufacturers, this has urged development towards the production of new materials which are capable of satisfying both requirements. We can define “immediate loading” by a prosthesis which is applied one week following the implantation (tab 1). Even though this approach gives relief to the patient, it increases the risk of implantation failure. Therefore, it is not only very important to select patients with predetermined characteristics, but also to select the implantation site in those patients. Only through this rigorous selection process can the medium and long-term results of these two kinds of protocols (conventional and immediate) overlap.

In recent years, patients have been requesting the adoption of therapeutic protocols which are capable of combining aesthetics with speed of execution. For manufacturers, this has urged development towards the production of new materials which are capable of satisfying both requirements. We can define “immediate loading” by a prosthesis which is applied one week following the implantation (tab 1). Even though this approach gives relief to the patient, it increases the risk of implantation failure. Therefore, it is not only very important to select patients with predetermined characteristics, but also to select the implantation site in those patients. Only through this rigorous selection process can the medium and long-term results of these two kinds of protocols (conventional and immediate) overlap.

BioHpp can be used either by pressing or milling; the latter procedure allows the technician to use a material which has already been treated by the manufacturer without the risk of damaging the microscopic structure.

This material is capable of absorbing part of the chewing force; a phenomenon known as ‚off-peak‘ (Graf. 1). Thanks to the capability of BioHpp, the abutment clad in this material can be applied straight after implantation wi-thout having to remove it, therefore preserving the modelling of the gingival tissue in the groove area and allowing maximal respect of the per-implant tissues.

Materials and methods

One of the uses of BioHpp appreciated by its creators is, without doubt, the customisability of the abutments, made available by Bredent for single rehabilitation.

The patient DGL (Pic.1): 35 years old, non-smoker, came to us complaining about the mobility of the deciduous upper lateral incisors. From the clinical examinations we objectively observed the presence of the elements 5.2 and 6.2, both with a mobility of stage 3.

The lack of the elements of second sequence concerns a high numbers of patients (1). From the radiographic exams of first and second level we noticed two characteristics: the complete roots reabsorbing of the deciduous upper lateral incisors and the lack of the permanent lateral incisors. The deficiency of bucco-palatal and mesial-distal basal bone meant that, in this case, the standard protocol would be to apply an orthodontic therapy and bone regene-ration. However, for various reasons, the patient refused this therapy and requested the use of an immediate aesthetic restoration. We proceed with the extraction of the two elements and the immediate insertion of a mini fixture (Midi 3,0 mm x 14 mm).

Via the imprint taken during the surgery with a polyvinylsiloxane (One Phase, Hydro Medium DEI Italia), we developed a master model on which we customised two abutments MD in titanium (fig.2) using thermo-pressed BioHpp. These abutments were inserted following the manufacturers advice and also using temporary crowns fixed with temporary cement composed mainly of zinc oxide (TempBond, Kerr). Radiographic check-ups were completed after one and three months following surgery. When the integration was complete, the temporary crowns were removed and the abutments were finished and polished. The definitive imprint was taken using polyvinylsiloxane (One Pha-se, Hydro Medium DEI Italia) but without removing the abutments themselves (2). Two crowns made in integral ceramic were fabricated and cemented with dual cement compost (Relyx unicem 2, 3M Italia).

Conclusions

Today we believe that BioHpp is an optimal material for use in our prosthetic structures on fixtures which offer a gradual system of chewing force absorption just like the natural dental element (3). Internal research assures us that the thermo-pressing of BioHpp on titanium, performed with the “For 2 Press” unit, grants a very intimate union of the two materials (fig.3). This characteristic is fundamental in keeping the requested materials as similar as pos-sible, so that they present a high adhesion which guarantees stability in time for the restorations themselves. The combination of these characteristics recommends the use of this material for single or multiple rehabilitations. Good clinical results and patient satisfaction are a testament to its excellent advantages.