September 2008, Volume 4, Issue 8
Published by AEGIS Communications
Dentatus Narrow Body Implants: To Fit Where Others May Not
The development of implantology began half a century ago with emphasis on implant design, surgical procedures, and instrumentation. The focus has since shifted to overcoming persistent technical and restorative difficulties in response to ever-increasing patient demands for esthetic results.
The original slim implant, introduced by Dentatus (New York, NY) in 1993, was the predecessor of the ANEW Implant System for screw-retained restorations. The prosthetic protocol developed by Dentatus in conjunction with the Department of Implant Dentistry at New York University College of Dentistry was to serve a wider range of patients’ needs, including:
- those unable to undergo conventional implant therapy because of limited bone or age and physical contraindications;
- those with limited interdental space of adjacent roots;
- those requesting fixed, affordable teeth at the start of treatment.
The Dentatus Ti alloy implants available in 1.8-mm, 2.2-mm, and 2.4-mm diameters and three thread lengths are designed for interim and long-term customized restorations. In 2004, Dentatus received FDA approval for the Narrow-Bodied Ti alloy implants, “For long-term use and for any length of time as decided by the healthcare provider.”
In October 2007, the International Journal of Periodontics summarized a retrospective report by Dr. Stuart Froum and colleagues following 48 Narrow Diameter Implants (NDIs) in 27 patients for 1 to 5 years postloading: “No implant failures were reported, yielding 100% survival rate. The screw-retained attribute of this system allows retrievability of the restoration...and allows flexibility in a variety of narrow edentulous spaces.”1
ANEW Implants provide ideal alternatives for patients with limited bone, narrow spaces, and knife-edge ridges. It could be argued that there is no better alternative for replacing congenitally missing maxillary lateral incisors. They are indispensable for single-tooth replacement, quadrant and full-arch splinted restorations as well as for intraoral emergency repairs. The implants, with a narrow, polished platform and a short screw abutment, help to create exceptional esthetics with sculpted tissue forms for tooth emergence profiles.
This user-friendly system has few components. Surgically, a common-diameter Pilot CePo™ drill is used to create the osteotomies. This is followed up with wider marked reamers for larger 2.2-mm and 2.4-mm diameter implants. The anti-rotational Ti-Index copings that become incorporated into the restoration are attached with the resin non-hygroscopic Screw-Cap to the implant thread. The Screw-Caps can be re-accessed or replaced for removing restorations without causing cross-thread damage to implants. Anew impression copings and analogs are used for creating customized laboratory-constructed restorations in materials of choice.
The ANEW Implants were tested in a number of university environments and by implantologists in the United States and abroad who have found them indispensable in surgical bone and tissue reconstructive procedures. Interim restorations, disassembled without tapping force or friction, are easy to monitor and make space adjustments for tooth position and tooth emergence profiles.
ANEW CLINICAL-TECHNICAL PROCEDURES
The osteotomies for implants can be made with a surgical flap or directly through the soft tissue. The flapless procedure, in safe environments, is more often performed by prosthodontists and restorative dentists who want to expand their implant services to the larger range of patients’ needs.
- The osteotomies are aligned to an approximate angle for lingual and occlusal crown access to the Screw-Caps for convenient assembly and removal. For multi-unit restorations, the implants can be visually aligned to approximate common angles, as the low-profile abutment thread tolerates substantial divergences without creating stress described in the following technical sequenced steps.
- The implants are installed into osteotomies created with a Dentatus CePo Pilot Needlepoint Drill. They are refined with the marked reamers for the selected wider-diameter implants, installing the implant for the smooth platform to snugly seat in the mucosal ridge interface (Figure 1).
- The Anew index copings placed over the implant square extension are firmly attached to the implants with the gray technical Screw-Cap capped with brass plugs to prevent resin blocking its access.
- Temporary crowns or hollow bridges prepared in advance may be used in chairside procedures. The restoration, placed over the Screw-Caps, is marked for creating space with the Dentatus trephine instrument for placing the restoration over the protruding Screw-Caps.
- Auto-cure tooth-colored resin (in tacky consistency) is firmly adapted around the indexed coping and Screw-Cap assembly without the use of lubricants. The crown, filled with resin, is seated with light pressure, clearing blocking embrasures for easy crown removal before the resin is polymerized (Figure 2).
- The gray technical Screw-Cap is removed with the square driver for touch-up and polishing the crown. The sleeve is carefully removed before attaching the completed restoration.
- The final assembly is made with the intimate fitting white Screw-Cap that is reduced to the crown level and filled with off-color resin for visible re-access (Figure 3).
- Many studies report excellent bone adaptation around the slim implants that are on par and at times greater than found in large implant fixtures. The reported references among the hundred or more published articles cite validated data and successful clinical prosthetic results. This has ultimately convinced the early skeptics that the slim Dentatus implants are indeed extremely useful, and are now an accepted modality in mainstream implantology. As to the question of whether large or slimmer implants will dominate the market, it is reasonable to expect that both systems will be used to serve the larger range of patients’ needs.
Practitioners of the art have come to realize the importance of giving patients teeth at the first appointment, as patients become more compliant when they can function and enjoy their occupational and personal lifestyles without embarrassment. This realization is a tribute and an opportunity for Dentatus to move on with the introduction of implants with significant user-friendly components.
Founded in 1930, Dentatus AB in Stockholm, Sweden, continues to maintain its leadership position with distinctive Swedish-American designed products distributed worldwide and widely used in restorative procedures.
References1. Froum S, Cho S-C, Cho YS, et al. Narrow-Diameter Implants: A Restorative Option for Limited Interdental Space. Int J Periodontics Restorative Dent. 2007;27:449-455.
The preceding material was provided by the manufacturer. The statements and opinions contained therein are solely those of the manufacturer and not of the editors, publisher, or the Editorial Board of Inside Dentistry. The preceding is not a warranty, endorsement, or approval for the aforementioned products or services or their effectiveness, quality, or safety on the part of Inside Dentistry or AEGIS Communications. The publisher disclaims responsibility for any injury to persons or property resulting from any ideas or products referred to in the preceding material.
|Figure 1 Implant with the attached gingival sleeve to stop resin entrapment installed with the R/A Hpc Driver.||Figure 2 Crown-form filled with auto-cure resin attached to the implant; the gingival sleeve must be removed before attaching the finished crown.|
|Figure 3 Completed crown attached with the white resin Screw-Cap, capped with tooth-colored resin for future re-access.|