Practical Implant Dentistry: The Science and Art (2nd Edition)

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Nonetheless, these represented attempts at placing multiple elements at the same time 18 , It was in that Giuseppangelo Fonzi — 20 invented the mineral tooth, a discovery that would be of great importance for the future evolution of implant dentistry. His greatest achievement was the idea of manufacturing single artificial teeth that could be implanted directly into the socket using platinum hooks, fulfilled important aesthetic and functional requirements, and were also chemically unalterable.

This was designed and placed in a fresh human extraction socket by the Italian Maggiolo in Considered French because he practiced in Paris and published his book in Nancy, Maggiolo was actually from Chiavari, in the region of Liguria. He graduated in medicine in Genoa and moved to France during the period of the Cisalpine Republic. It often happens that the gold posts securing the artificial teeth to the natural roots remain locked in the bone even after they are worn out, acting as partial anchors.

Therefore, before splinting the artificial crowns to more stable teeth or extracting them, the attempt could be made to replace the posts with roots made of the same metal, so that they can become stable within the sockets while retaining the artificial crowns firmly, as if they were placed on natural roots. The procedure is feasible whenever an old root is still fully inside its alveolus, emerging from it by no more than half of its length and only if the socket has all of its natural retention capacity.

If conditions are such that success is plausible, then one must manufacture an artificial metal root proportionate to the opening left by the root to be replaced. The dentist should thus have available a series of artificial roots, in the various sizes of the roots of incisors, canines and bicuspids, which are the only teeth whose sockets permit the procedure to be performed. What follows is a description of their manufacturing technique Figs.

Original diagram for manufacturing the endosseous implant. Gold casting made according to the original diagram for the modern reproduction of this artifact. The first piece no. One of the tube ends must be enlarged by hammering a thin tapered mandrel into it. A lateral opening, similar to the one designed for my snap teeth, described previously, is then cut on this side of the tube or body. A gold plate must be prepared, an oval with the same shape as the horizontal section of the natural tooth to be replaced, and a hole the diameter of the larger end of the tube must be made in the center.

The two pieces nos.

Description:

Its two ends must be curved slightly to fit the margins of the alveolus opening as precisely as possible. Then a second small gold tube must be prepared, with a diameter similar to the one of the opposite and thinner end of the tube. It must be cut into four sections, being sure to keep its upper extremity intact, as this will bring the four sections together into a sort of ring. The four wings are then reduced and separated from each other with a file. At this point, they will be curved to form a sphere resembling the one shown in drawing no.

The small sphere must now be inserted onto the thinner end of the tube, so that two thin wings correspond to the larger ends of the elliptic plate and the other two to the smaller ends The author specifies that the four wings of his small sphere must be placed so that two of them are oriented according to the long axis of the elliptic plate and the remaining two toward the short one, in order to adapt them roughly to the apical third of the root being replaced. The ring connecting the four wings must then be soldered to the thinner tube section. The ends of three thin wings will also be soldered halfway on the tube; further ahead I will explain why the fourth plate is not soldered like the others.

The three pieces, which—once soldered—will give the implant its shape, must be made of 18K gold, not only because this alloy is solid enough, but also because does not cause any problems and remains inside the alveolus Figs. Now that our artificial root is ready, we will prepare the site for its insertion. The old root must be extracted. Since damage to the socket walls must absolutely be avoided, it will be firstly divided into three pieces, using forceps with sharp beaks, suitable for its longitudinal separation. One beak must be introduced into the root canal, forcing the other one from the outside, perpendicular to its axis.

Firmly snapping the forceps will split the root up to the apex. In fact, it is advisable to avoid haste when extracting teeth or roots. Its base, formed by the oval plate, must be pushed below the gum, which will quickly shift above it. Attention should be paid to ensure that the notch on the larger portion of the tube is rotated toward the inside of the mouth. Positioning the thumb toward the index finger, placed in the oral cavity, gradually but firmly compress the socket walls against the metal root.

The compressions must be repeated for two-three weeks. The patient should be advised not to displace the artificial root; he must rinse with astringent alcohol solutions while the artificial root gradually becomes fixed in the alveolus.

Dental Implants: Surgery, Advantages, Risks, & New Technology - Dentist Advice

Numerous examinations have demonstrated that, after extraction, the alveolus walls do not preserve the central cavity for a long time, but progressively close it as they move toward each other. My artificial root is stable for several reasons. If the alveolus walls have not been fractured during extraction, it is easy to see why, during healing, they will facilitate its fixation inside the newly formed bone.

Furthermore, since the artificial root is thin below the oval plate and consists only of the smooth portion of the tube and the small sphere, the alveolar bone walls can converge and close around the root, increasing its stability, so that the only way to remove it later will be by fracturing the socket. I already mentioned that one of the four sphere wings should not be soldered to the tube like the others.

Sometimes, in fact, the sphere can be slightly larger than the alveolar cavity, preventing the artificial root from reaching the bottom of the alveolus and making it less stable. However, our compression of the alveolus forces the free wing against the bone wall like a spring, thus providing further fixation, a crucial condition for the success of the procedure.

The artificial root proves to have achieved sufficient stability when, gently pressing on its outer surface, it does not move even when the pressure is applied to the gum. This proves that the alveolus is stabilizing it permanently.

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It is not a good idea to immediately insert the snap tooth, which should not be fitted to the artificial root until it has achieved maximum stability; otherwise, all of our good work will have been vain. Therefore, I recommend that the snap tooth not be inserted until another month has elapsed from the time complete fixation of the artificial root has been ascertained, so that it the tooth cannot alter the stability of the root. This procedure does not cause any problems because the healing tissues can easily enter through the metal vents.


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The procedure can be considered one of the finest examples of dental art, because it has such important advantages that, for some time now, I have never failed to consider the option of employing it. I have almost always achieved very satisfying results, both for the persons I have treated and for myself. Original drawings of the artificial tooth for insertion into the implant His implant precedes ours by nearly two centuries and, despite the limited surgical possibilities of the time, the lack of anesthetics and antibiotics, and the complete lack of occlusal knowledge, it essentially encompasses many of the concepts that developed during our era and are wrongfully considered the exclusive and original brainchild of some of our contemporary colleagues.

In the United States, dentists—who since the 19th century had been at the forefront of dental science—conducted numerous implant attempts and experiments. Around the s Chapin A. Harris and Horace H. Hayden, founders of the Baltimore College of Dental Surgery , attempted endosseous implants employing iron teeth of their own design After removing the ligature used for temporary splinting to the adjacent teeth, he placed a porcelain crown on that implant, an operation that—in his opinion—was successful.

Today we know that lead is not biocompatible. Reactive and inflamed hypertrophic tissue must have formed around that implant, giving the illusion of temporary stability.

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Three similar implants placed in surgically prepared sockets were also performed by Perry and Edward and , and reportedly were equally successful. Slightly different implants, also lead-coated, were performed by Edmunds in New York. It is interesting to note that during the same year he worked on his colleague Juan Josef Ross, from Guatemala, placing one of these implants in an artificial socket made near an upper incisor that have fallen out years earlier. He reported that four days later Dr. Lead is, in fact, a much more cytotoxic element than the 18K gold employed by Maggiolo.

The choice of lead as coating material for the internal platinum frameworks was probably due to the fact that it is easy to use.

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In fact, it can be melted Moreover, before it hardens completely, the internal platinum framework can be easily immersed in it. It is also very easy to roughen, modify and adapt in the event of emergencies Harris, Perry, Edward and Edmunds may have employed lead because it cannot be attacked by some of the most corrosive acids, failing to consider its high toxicity. Indeed, it is a tricky and powerful poison that has been known to cause intoxication since antiquity.

Hippocrates identified it as what had poisoned a galena miner; Pliny the Elder described its toxic effects on slaves forced to do the same work. Even when lead was being tested as an implant material, the effects of saturnism in workers who had daily contact with the element such as typesetters were well known.

In the same year in which Edmunds inserted his first lead-coated platinum capsule , Lewis implanted a porcelain tooth with an internal gold support, thus assuring of a successful outcome as well! In the implantology field, Payne is the last author of the 19th century and the first of the 20th. Other attempts were made by several authors. In Rogers tried to place metal implants in the jaw; in Lewis made and used a platinum root-shaped implant with a porcelain crown, following impression taking of the alveolar cavity with a plaster-based material.

In Wright designed a porcelain tooth with a porous root in order to facilitate its fixation within the socket. On the basis of this experiment, the following year Friel replicated the model, providing the root with a certain number of holes connected to each other by a central channel that opened at the crown to facilitate drainage in the event of an apical abscess 18 , While not as biocompatible as studies would attempt to demonstrate even 70 years later, 15 porcelain was nevertheless a better material than the ones proposed previously.

The first artificial porcelain root, inserted in August , was checked in November of the following year and showed good stability. Nevertheless, it is important to note that the artificial crown placed on the implant had been blocked with two splintings to the crowns of the adjacent teeth. This brings us to E. Original drawing of the Greenfield drill for the endosseous basket X-ray of a Greenfield basket, which is perfectly osseointegrated.

Practical Implant Dentistry The Science and Art

The surgical cut made with a Greenfield drill implicated leaving the central bone core original drawing. Casto in and Kauffer in placed spiral-shaped implants, both stating that they were satisfied with the outcomes. As we will see later, the failure of those implants and similar ones that we will examine lay precisely in mechanical expansion, which was rigid and forced beyond the endurance of living bone tissue.

That year, Weigele placed a frustum-shaped piece of ivory into artificial sockets, protected by mucosa sutured over it; the ivory should have promoted a slow resorption reaction by ankylosis, one that would allow the temporary load of a post crown to be inserted subsequently. Years later, Weigele reported that he had used his ivory cones as endosseous overstructure supports for the temporary anchorage of lower complete dentures. With the same hope of finding—at last—the ideal biocompatible material, Wuhrman used vented platinum structures, assuming that it was inert, given that it was a pure element with a high molecular weight.

The idea was brilliant, but unsuccessful.


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