nanos gigantium humeris insidentes

2009년 12월 3일자 광고성 기사
- 돈 한푼 안 받았다^^ 정말 그 때 그생각 그대로, 그 이후로 이 임프란트 때문에 고생도 많이 했지만 그냥 일반적인 임프란트 합병증의수준을 벗어나지 않았고 나름 훌륭한 장점들을 많이 가지고 있다. 기술된 내용을 완벽히 충족할 만한 임프란트를 개발해주길 많은 과학자나 임상가들에게 바라고 싶다.  이 임프란트 사용환자들로 논문을 쓰고 있는데 accept될런지 모르겠다.

원문은 http://www.kda.or.kr/kda/modules/kdanews/news/newsview2.aspx?newsID=59244

2007년 9월호에 대치협회지에 썼던 내용들을 보강하여
2008년7,8월호에 군자출판사에서 만들었던 clinical implant( 현재 절판)라는 잡지에 썼던 내용입니다.
현재는 거의 이런 비슷한 류의 임플란트들이 많이 나오고 있네요.. 잡지도 절판되고 공유차원에서 올려봅니다.
두개의 파일로 되어 있습니다.

3 Factors for Successful Dental Implants in Boston, Newton, and Framingham, MA
Posted by Cary Feuerman, DMD on July 8, 2010 at 10:30am

After 25 years in private practice in periodontics, dental implants, and bone regeneration, I am constantly looking for ways to tweak the treatment protocols to achieve faster treatment turnaround times while maintaining ideal functional and esthetic outcomes for our patients; all with a success rate that approaches 98%. My partner and I have many implant systems in our office to accommodate the needs and desires of our restorative colleagues. Most recently though, we have been attracted to implants with 3 specific design features that help us to realize our treatment goals.

1. Tapered implant body (roughened surface to the top) with an aggressive thread design. This allows for maximum initial stability which is especially important in our "teeth in a day" immediate implant placement and restoration cases.

2. "Platform switch" design for connection of the permanent abutment to the implant. This has been proven to help preserve crestal bone which, in turn, helps to maintain the overlying soft tissue levels thereby enhancing the esthetic outcome.

3. Internal conical connection of the permanent abutment to the implant. This connection has also been proven to eliminate or significantly reduce micromovement of the abutment. Abutment micromovement due to poor fit or inherent engineering design can contribute to bacterial invasion. The inflammatory infiltrate which ensues may contribute to bone loss and soft tissue alteration.

Three examples of implant fixtures which incorporate these design features are listed below:

NobelBiocare NobelActive

Astra Tech OsseoSpeed TX

Dentsply Ankylos C/X




We all have great outcomes in the past with traditional implant design. However, we work so hard to re-build bone and soft tissue so that our patients have beautiful results which mimic natural teeth. Doesn't it make sense to try to preserve these structures? What do you think?
Comments are appreciated.

Photo Credits: NobelBiocare, Astra Tech Dental, Dentsply

http://www.webdental.com/profiles/blogs/3-factors-for-successful

Inadequate screw preload, the misfit of the mating components and rotationa characteristics of the
screws are considered to be the reasons leading to screw loosening or fracture.26

Biologic width around an implant is apical to the fixture/abutment connection, one of the
reasons that maintaining or reforming a papilla between two implants presents with such difficulty.
32

The collar design (Fig. 8) that defines the shape of the abutment/fixture interface determines
the quality of the soft tissue attachment as well the osteolytic impact of hygiene and function on
crestal bone levels.

2008년 02월 09일 — Sabine C. Girod, professor of surgery at the Stanford University Medical Center, discusses dental implants and the impact it can have on a persons everyday life. Dental implants now look and feel like a patient's own teeth, and are much more secure than dentures. Learn why implants can help prevent the bone loss and gum recession that often result from bridgework and dentures

Ankylos implant는 85-87년 Nentwig교수가 개발한 이래 특별한 디자인 컨셉의 변화없이 근 20년을 롱런하고 있는 임플란트 입니다. blasting media가 별달리 특이하지도 않고, 보철또한 브로네막의 개념을 많이 벗어나 있지만, 회사에서 얘기하는 것과 달리 경험상 앵킬로스만이 가지는 특징을 분류해 봅니다.  

1, tapered abutment가 풀린적이 없다.(지난 5년간)
2, 1 for all의 개념으로서 모든 픽스쳐와 보철이 호환된다
3, abutment switching의 개념을 먼저 확보한 개념이다.

...등으로 요약할 수 있는 것 같습니다.

실제 앵킬로스 수술을 해보면, 드릴링 과정이 매우 단순하며, 삭제에 너무 주력하지 않고 골을 condensing, compressioning등, 남겨두려는 쪽으로의 드릴링을 추천합니다.

본환자는 발치 45일후 아직은 완전히 골화되지 않은 primary callus단계를 보여주며, 부드러운 trephining만으로도 드릴링이 완성되었고, osteotome을 통해 lateral condensing과 bicortical engagement를 시도한 것으로 상악동 점막을 천공시키지는 않았고 살며시 얻혀놓는 의도로 식립한 경우 입니다.

particulated auto-bone을 구개측의 dead space에 넣었으며, 무엇보다 중요한 것은 발치와에 대한 절개선의 디자인일 것으로 생각됩니다. 술후의 closure를 위해서요.

발치와의 인접한 곳에서는 항상 발치와의 함몰부위와 비슷한 레벨의 두께를 가지는 절개선을 가하는 것이 좋을 것 같습니다.  

최근 Dentsply Friadent의 합병회사로 인해 Cellplus표면으로 변화된다고 하나, 아직 개발국인 독일에서도 Ankylos Cellplus는 통과되지 않았다고 하네요. 아마 국내에는 향후 2년정도는 기존의 컨셉이 통용되지 않을까 생각합니다.

Ankylos implant는 반드시 2회법으로 가는 것을 추천합니다.

standard, balance, syncone abutment가 있긴하지만, 실제로 standard abutment만으로도 90% 이상의 케이스를 소화할 수 있습니다.

제가 가진 1999년부터의 케이스를 보면, 아직까지 골소실이 거의 없으며, bony overgrowth가 관찰될 정도로 좋은 경과를 보여주는 것 같습니다.

아마 이런 원인으로는 2차수술뿐만 아니라, 미리 체결된 cover screw를 기계적 마찰이나 자극을 주지 않는 원바디형이기 때문이라는 생각이 들며, 또한 surgical trauma가 최소한으로 가는 디자인의 이차수술이 가능하기 때문이라 생각합니다.

또, 힐링과 어버트먼트의 각이 동일해서 잇몸을 누르지 않는 것도 하나의 효과라고 생각합니다.


본환자의 경우 발치와의 구개측에서 퍼내는 동작으로 피판을 형성후 layer suture를 mattress로 해준경우 입니다. 미리 장력을 없애기 위해 반드시 시행하여야 할 과정입니다. 자가골이 아닌 것을 사용했을 경우 반드시 흡수사를 이용하는 것또한 잊지 말아야 할 것 입니다.

mattress를 할때는 정상 연조직과 신생연조직을 동시에 포함해야 찢어지지 않습니다.

-출처 : 이우임상커뮤니티-

ANKYLOS Clinical Studies

AICRG; Part I: A 6-Year Multi-Centered, Multi-Disciplinary Clinical Study of a New and Innovative Implant Design - H.F. Morris, S. Ochi, P. Crum, I. Orenstein, S. Winkler.
Over 1,500 implants were placed and followed over a period of 3-5 years – 44% of the centers reported 100% survival and 63% of the centers reported only one failure. Overall survival was 97.5%.

AICRG; Part II: Crestal Bone Loss Associated with The ANKYLOS Implant: Loading To 36 Months - Chou, H.F. Morris, S. Ochi, L. Walker, D. DesRosiers.
Bone loss varied among the research centers, from 0.5mm to 2.0 mm. Following loading, the mean loss was about 0.2 mm per year.

AICRG; Part III: The Influence of Antibiotic Use on the Survival of a New Implant Design - H.F. Morris, S. Ochi, R. Plezia, H. Gilbert, C.D. Dent, J. Pikulski, P. Lambert.
The results of this study suggest that the use of antibiotics for ANKYLOS implant placement is not necessary

AICRG; Part IV: Patient Satisfaction Reported for ANKYLOS Implant Prosthesis - H.F. Morris, S. Ochi, A. Rodrequez, P. Lambert.
Patients with ANKYLOS implant/prostheses indicated: 1) that they were highly satisfied with their restorations [99.4%], 2) would recommend this form of treatment to their friends and relatives [99.1%] and 3) would not hesitate to seek the same treatment, if necessary in the future [98.0%].

AICRG; Part V: Factors Influencing Implant Stability at Placement and Survival of ANKYLOS Implants - H. F. Morris, S. Ochi, I. Orenstein, V. Petrazzuolo.
About 2.8% of the implants placed were found to be mobile following placement. While mobility can be attributed to “surgical errors” all implants mobile at placement were stable at uncovering.

The crown margin on the abutment can be extended apically to a distance of about 1 mm from the implant shoulder to provide additional space for the soft tissue. Even with a small thickness of soft tissue covering the crestal bone, it is possible to achieve a natural emergence profile with this implant. The implant must be inserted slightly below or even with the crestal-bone level to allow development of a mucosal layer that is as thick and wide as possible. Journal of Oral Implantology Volume 30, Number 3 June 2004 New Prosthetic Restorative Features of the Ankylos Implant System Paul Weigl, DMD 2005/07/19 x  

Several requirements need to be present to ensure long-term success of immediately-loaded implants.
These include:
(1) excellent stability of the implant,
(2) excellent bone density for the implant bed, and
(3) elimination of micromotion in the bone-implant interface during the healing period.
Journal of Oral Implantology: Vol. 30, No. 3, pp. 189–197. PRESENT STATUS OF IMMEDIATE LOADING OF ORAL IMPLANTS G. E. Romanos, 2005/07/19 x  

have also shown that small-diameter implants (3.5 mm in diameter) with a 14-mm length had a total surface similar to multirooted teeth.
Nentwig G-H, Reichel M. Vergleichende Untersuchungen zur Mikromorphologie und Gesamtoberfläche enossaler Implantate. Z Zahnärztl Implantol. 1994;10:150–154. 2005/07/19 x  

Early loading can be advantageous to healing in fractured areas.36–39 A significant increase in blood vessel formation, as well as active remodeling in fractured zones, has been shown under loading.40 36.
Sarmiento A, Schaeffer JF, Beckermann L, Latta LL, Enis JE. Fracture healing in rat femora is affected by functional weight-bearing. J Bone Joint Surg Am. 1977;59:369–375. 37. Goodship AE, Kenwright J.

The influence of induced micromovement upon the healing of experimental tibial fractures.
J Bone Joint Surg. 1985;67B:650–655. 38. Kenwright J, Richardson JB, Cunningham JL. et al.
Axial movement and tibial fractures. A controlled randomised trial of treatment. J Bone Joint Surg. 1991;73B:654–659. 39. Goodman S, Aspenberg P. Effects of mechanical stimulation on the differentiation of hard tissues. Biomaterials. 1993;14:563–569. 40. Hert J, Pribylova E, Liskova M. Reaction of bone to mechanical stimuli. 3. Microstructure of compact bone of rabbit tibia after intermittent loading. Acta Anat (Basel). 1972;82:218–230.    

To reduce excessive loading forces during mastication, a soft diet is advised for the first 4–6 weeks of healing.  

Friberg et al4 reported that implants placed in extremely soft bone and/or lacking initial stability, as evidenced by “lack of resistance during final tightening of the cover screw or mobility of the fixture mount when still on the implant,” constituted 32% of the implant failures recorded.
Friberg B, Jemt T, Lekholm U. Early failures of 4641 consecutively placed Branemark dental implants: a study from stage 1 surgery to the connection of completed prostheses. Int J Oral Maxillofac Implant. 1991;6:142–146.

An implant removed because of mobility, chronic pain, discomfort, or infection at any time was recorded as a failure. For the purposes of this study, stage I is defined as the period from implant placement to implant uncovering. Stage II is the time of uncovering (abutment connection) of the implant(s). Stage III is the period from uncovering and abutment connection to just before prosthesis insertion. Stage IV is the period from prosthesis insertion to the end of the evaluation period.
Journal of Oral Implantology: Vol. 30, No. 3, pp. 162–170. Harold F. Morris  

Bone training installation -> 6wks ( uncovering - temporary splinting) -> soft diet -> 12wks (final prosthesis)

Slightly microrough surfaces have a beneficial effect on the deposition of connective issue cells.9 Furthermore, when plaque is deposited on microrough surfaces, the tendency toward inflammation is no greater than with smooth surfaces.16

9. Klinge B, Meyle J. Clin Oral Implants Res 2006;17:93–96.
16. Zitzmann et al. J Clin Periodontol 2002;29:456–461.



Inadequate screw preload, the misfit of the mating components and rotationa characteristics of the
screws are considered to be the reasons leading to screw loosening or fracture.26

Biologic width around an implant is apical to the fixture/abutment connection, one of the
reasons that maintaining or reforming a papilla between two implants presents with such difficulty.
32

The collar design (Fig. 8) that defines the shape of the abutment/fixture interface determines
the quality of the soft tissue attachment as well the osteolytic impact of hygiene and function on
crestal bone levels.

Fig. 2. No caption available.
From:   anonymous: Implant Dent, Volume 12(4).December 2003.268-271

Fig. 2. Leading competitors for the Japanese market for dental implants.
From:   anonymous: Implant Dent, Volume 12(4).December 2003.272-274

Titanium alloys are considered to be the most attractive metallic materials for biomedical applications. Ti-6Al-4V has long been favored for biomedical applications. However, for permanent implant applications the alloy has a possible toxic effect resulting from released vanadium and aluminum. For this reason, vanadium- and aluminumfree alloys have been introduced for implant applications.


Some designs of titanium dental implants and their prosthesis components have a small diameter and thickness wall, especially with internal abutment fixation (see the last five implants in Figure 1). In these cases the implant must be made of Ti-6Al-4V to prevent fracture. However, when titanium alloys
are implanted, higher levels of the component elements can be detected in tissues locally and systemically.4
L. Morais et al.4 analyzed the vanadium ion release during the implant healing process. Titanium alloy implants were inserted in the tibiae of rabbits.
After 1, 4, and 12 weeks, they were submitted to removal torque testing. The kidney, liver, and lung were
extracted and analyzed by atomic absorption spectrometry. In comparison with the control values, the content of vanadium increased slightly after 1 week and significantly after 4 weeks, and decreased slightly after 12 weeks, without reaching the 1 week values.

To avoid ion release, it is necessary to develop new titanium alloy processing or increase the mechanical properties of cp Ti. One solution is nanocrystalline materials, which can offer very high strength, toughness, and fatigue resistance. Processing of nanomaterials to improve both strength and ductility is of primary importance for fatigue strength and fracture toughness. R.Z.
Valiev et al.5 refined the microstructure of bulk billets using severe plastic deformation and increased the mechanical properties of titanium grade 2.