Processing was carried out in ytterbium YB fiber laser in argon atmosphere, and implants were delivered sterile packaged after ultrasonically cleaned [ 27 ]. After titanium, zirconia material was also employed for RAI fabrication with the rapid prototyping technology. Dispersion of a zirconium oxide powder into a liquid solution of polyacrylate was used to form a solidified ceramic object by high-end digital light processing 3D printing method as similar with the powder bed fusion technique [ 17 ].
Considering the early attempts, it could be noticed that root analogue implant fabrication required exhausted and complex clinical and laboratory procedures and had some drawbacks formerly. The proposal method of Lundgren required a long surgical time which could be regarded as a disadvantage. The computer milled anatomical implant system suggested by Coatoam also required a long time and additional complex procedures. Besides, insufficient primary stability was another matter for these trials because of the periodontal space and the enlargement of the socket during the extraction.
ReImplant system tried to compensate this problem by integrating an extra measurement and data transfer onto the laser scanned root. This measurement was obtained on the cervical part of the root, and then applied to the whole root surface. An experimental study in monkeys, regarding the root analogue implants of upper central and lateral incisors showed a mean bone-to-implant contact of In accordance with this finding, it could be considered that the extra measurement and the width enlargement of socket could also act as another incongruence for achieving the appropriate passive fit into the fresh socket.
On the other hand, in cases with unfavorable root shape such as concave contours or complex morphology, original root shaped implant could jeopardize the placement and the hygienic maintenance. However, PACE system could be used to eliminate the disadvantages of unfavorable root form, and it would also take less time to perform in clinical practice because it was totally prefabricated [ 25 ].
After revealing the clinical advantages in an animal study [ 28 ], a year-old woman was subjected to replacement of a maxillary left central incisor [ 19 ]. After the implantation with an approximately 1. Simultaneously, in a dog study, the usage of multi-rooted single tooth implant with a custom shaped lingual splint which is bonded by a self-curing luting cement onto the surrounding teeth was tested.
Bone-to-implant contact and mineral apposition rates yielded no significant change, however, the vertical bone loss was significantly lower 0. The implants of this system were roughened, large-grit sandblasted, and acid-etched SLA surface characteristics similar to the conventional threaded implants as an advantage for clinical predictability. On the other hand, considering the poor clinical findings, it should be further investigated to reassure tangible results. Rapid manufacturing techniques also seem promising for fabricating modern root analogue implants.
The accuracy of root analogue implant fabricated by powder bed fusion methods revealed acceptable discrepancy. The volumetric measurement of the 3D surface model of the tooth was 0. The local disparity of RAI was more pronounced at the incisal area and the root apex, with a maximum of 0. In addition to the favorable results, it was suggested that a perfect fit of RAI on the buccal cortical bone could be accused for esthetic failure and also pressure-induced bone loss or fracture of the buccal plate. Therefore, reducing the diameter about 0. Pirker and Kocher reported the clinical results of computer milled zirconia RAI.
Zirconia was used because of its well-known improved biomechanics and esthetic results.
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The diameter of the implant next to the thin cortical bone was reduced for avoiding fracture and pressure-induced bone loss. Owing to the 3D additive manufacturing technology, remarkable characteristics such as functionally graded titanium material, and 3D interconnected controlled porous structure could be delivered to the custom root shaped dental implants [ 33 , 34 , 35 ].
Thus, minimizing the stress-shielding effects, providing a long-term stable fixation, and improving bone ingrowth could be possible [ 36 ].
Basics of clinical diagnosis in implant dentistry Rathee M, Bhoria M - J Int Clin Dent Res Organ
Additionally, lower risk of implant surface contamination is another advantage of laser metal sintering method since minimal postprocessing treatment is required [ 35 ]. Regarding these knowledge and available clinical results, it could be suggested that combining the root analogue implant strategy with digital technology provide a number of advantages over the previous procedures such as faster preoperative preparation, relatively easier surgical procedures, simpler fabrication of esthetic restoration, and improved biomechanics.
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Also it would be a cheaper alternative for immediate implant and prosthetic requirements in compromised clinical conditions. As another matter of fact, comprehensive experimental and clinical studies indicate the importance of the cervical region of the dental implant because the maximum stress is pronounced around the implant neck [ 37 ]. The ideal characteristics of dental implant is suggested that a wider neck for a better stress distribution [ 38 ], and a large surface area as well as possible with a minimal thread geometry for a better long term crestal bone stability [ 39 ].
Therefore, the original root shaped dental implant would be a plausible strategy to achieve better crestal bone stability and supporting esthetics.
Implants in Clinical Dentistry 2002 - Palmer
In addition to that, optimized surface roughness and chemical factors should be taken into account for a good long term biological health. In the literature, the micro-nano hybrid surface topography of titanium alloy was mentioned beneficial on biological responses of osteoblasts [ 40 ]. Alkaline phosphatase activity of the cells was greater onto nanotextured rough surfaces, and calcium deposition was higher on microtextured rough surfaces rather than nanotextured surfaces [ 41 ].
With the guidance of this knowledge, custom root analogue implants could be better designed with optimized macro and micro surface features in the future. As a brief, considering the prevalent knowledge of clinical dental implant practice, screw-type dental implant has been the most plausible and predictable approach for replacing edentulous alveolar sites. However, it seems not so convenient and could not meet the clinical needs for immediately restoring the fresh extraction socket.
Custom root shaped implant strategies emerged as the only realistic implementation and the prospective preference of immediate implant placement for both single- and multi-rooted teeth. Contemporary computer aided digital technologies assist to overcome the hazardous anatomical drawbacks of jaws, and also to eliminate the excessive surgical augmenting procedures and compromise healing. Lastly, it should be noted that there are scarce number of objective clinical data regarding 3D planned and manufactured root analogue dental implant methods, and further clinical studies are required to conclude significant results.
Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution 3. Help us write another book on this subject and reach those readers. Login to your personal dashboard for more detailed statistics on your publications. We are IntechOpen, the world's leading publisher of Open Access books. Built by scientists, for scientists. Our readership spans scientists, professors, researchers, librarians, and students, as well as business professionals. Downloaded: Abstract Native tooth has a unique design to serve perfect stomatognathic function and esthetics which could never be replaced with another material or apparatus if it is lost.
Introduction Natural teeth have unique design which serve complex stomatognathic functions and fulfill distinctive biomechanical needs.
The evaluation and clinical predictability of root shaped implants Considering the early attempts, it could be noticed that root analogue implant fabrication required exhausted and complex clinical and laboratory procedures and had some drawbacks formerly. Advantages of the root shaped implants for immediate placement and future considerations Owing to the 3D additive manufacturing technology, remarkable characteristics such as functionally graded titanium material, and 3D interconnected controlled porous structure could be delivered to the custom root shaped dental implants [ 33 , 34 , 35 ].
Conclusion As a brief, considering the prevalent knowledge of clinical dental implant practice, screw-type dental implant has been the most plausible and predictable approach for replacing edentulous alveolar sites. Acknowledgments The author reported no external funding. Conflict of interest The author reported no declaration of interest. Download chapter PDF. More Print chapter. How to cite and reference Link to this chapter Copy to clipboard. Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent.
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Implants In Clinical Dentistry.