Dr. Youngku Heo
It is not true that all implants will be osseointegrated only by way of taking a long healing time. The main key factor for osseointegra-tion is immobilization of the implant during the healing time.
Two conditions are essential for Anytime Loading. First, insertion torque must achieve grater than 35N/cm in which level the micromotion could be prevented against any occlusal loads. Second,stability dip could be eliminated by changing the drilling/fixation protocol which could minimize bone damage.
Dr. Jeffery Platt
Neobiotech's refined osteotomy preparation, characterized by burs designed for passive fit, significantly increases the primary stability of the implant. This approach is especially crucial in the coronal avascular bone area, where it facilitates a high level of initial implant stability, essential for successful osseointegration.
The stability curve for implant placement has evolved significantly since the original Branemark protocol. With advancements such as Straumann's SLA Active surface and NeoBiotech's innovative designs,we now see a dramatic improvement in the ability of patients to receive restorations earlier. This shift not only follows but enhances the traditional stability curve by providing more reliable early loading options.
Dr. Ricardo Alves
An atraumatic surgical technique is critical to reduce bone resorption.Heat generation during osteotomy varies according to the bone quality and osteotomy depth, among other factors. Excessive temperature(>47ºC for 1 minute) can cause hyperemia, cell degeneration, necrosis,increased osteolytic activity and fibrosis.Avoid excessive temperature increase by performing a interrupted sequential drilling using sharp burs and sufficient volume of cold saline solution. In cases of guided surgery, special care must be taken to ensure adequate access of the cooling solution to the osteotomy site.
High insertion torque does not guarantee successful osseointegration. Undersized osteotomy can increase primary stability in soft bone without major concerns, but in dense cortical bone undersized osteotomy can result in hight strains, microcracks and extensive bone resorption. High insertion torque can be detrimental for bone level stability. Cortical tapping/cortical drill are recommended in dense bone.
Prof. Galaktion Makhviladze
The key aspects of “AnyTime Loading“ implant placement are the“Passive Placement” by tapping with cortical tap at compact bone and an “Active Placement” with self-compaction by undersized drilling in cancellous bone to achieve strong and unchangeable initial fixation of implant with optimal 30 Ncm- 40Ncm torque without stability dip.
The whole “AnyTime Loading” protocol is founded on phisiology with minimizing trauma and stress-free drilling and implant placement. To prevent bone trauma caused by overcompression, it is highly recommended always to use “Bone Tap” when compact bone structure is presented during the drilling procedure.
Dr. Mongkol Thaveeprungsiporn
With proper implant design – surface treatment – drilling protocol, we can achieve optimum primary stability of dental implant placement while avoiding excessive surgical bone trauma and implant compression necrosis. These lead us to plan any time loading of dental implant restorations by clinical validation of initial dental implant stability test with assessment device during the healing period.
Dr. Edgar Cabrera
In patients with severe bone atrophy the all on 4 - 6 concept using CMI fixation are strongly recommended especially for elderly-disabled patients to provide enabling immediate chewing function w/reduced number of implants and avoiding excess bone augmentation procedures. Primary stability is one of the most important parameters to the immediate loading of an implant is an important requirement for the long-term success of dental implants.
The immediate loading of dental implants restored by a full-arch splinted fixed prosthesis has shown excellent results. It has been proposed as a simpler, more predictable, less expensive, and less time-consuming method.
Prof. Janghyun Paek
Implant stability is crucially dependent not only on the insertion torque but also on where this stability is derived along the length of the implant. It is imperative to assess whether the coronal, middle, or apical sections of the implant contribute to this stability. Accurately documenting these factors is instrumental in making informed decisions regarding optimal loading times and investigating potential causes of implant failure, thereby minimizing risk and improving patient outcomes.
For successful AnyTime Loading, C fixation is crucial due to its significant role in mitigating the impact of force and magnitude during lateral force applications. To ensure optimal outcomes,comprehensive fixation across the C, M, and I areas—or at least CM fixation—is necessary. This should be achieved with an insertion torque of 30-40N/cm and stability values above 70 IST, enabling reliable and durable implant loading.
Dr. Marco Redemagni
In case of immediate post-extractive implant with immediate provisionalization, filling the buccal peri-implant to the alveolar bone gap with a biomaterial, grafting autologous connective tissue or a dermal matrix in the buccal area, and using a concave shift platform abutment, the root bump remains stable and the quantity of connective tissue around the implant components can be thicker,more stable, with adequate parabola and papillae, and less subject to recession.
The macrodesign and composition of the anatomical healing abutment or temporary prosthesis, along with CMI implants with stable CMI fixation, used during transmucosal contouring are crucial elements for establishing biologic and prosthetic conditions that minimize early bone remodeling, improve esthetic outcomes, and reduce the possibility for future peri-implant inflammation both in immediate placement and loading and in delayed, allowing for choosing AnyTime Loading.
Dr. Giuliano Garlini
The particular shape of the S reamer bur, combined with the powerful apex and the magic treads of the CMI active implants, are of great help in achieving primary stability in the sinus areas that can allow us to immediately load the implants or to insert the healing screws.
The maxillary sinus elevation procedure using the SCA kit is faster and more convenient as other drilling methods used; the risk for perforation of the maxillary sinus membrane is reduced by using S-reamers compared to the osteotome technique.
Prof. Richard Leesungbok
In a completely edentulous patient with severe bone atrophy, the “All on-4” treatment concept in the mandible and the “All-on-6” concept in the maxilla using computer-aided implant surgery with Top-Down treatment planning and CMI fixation are strongly recommended especially for elderly-disabled patients to provide enabling immediate chewing function with reduced number of implants and avoiding excessive bone augmentation that increase treatment costs and risks for patients.
In All-on-X prostheses, we should highlight the significance of sufficient Anterior-Posterior spread and Tripod/Trapezoidal support in withstanding masticatory forces in full-arch fixed bridges, especially in managing distal/anterior cantilevers.
Dr. Youngku Heo
30-40Ncm insertion torque under maximum bone-implant contact area with physiologic pressure (Active contact for D3-D4 soft bone,Passive contact for D1-D2 hard bone) should be established to bear occlusal loads.
Load if there is no dip for 3-4 wks under the ideal CMI fixation and ISQV/ISTV reaches higher than 70. All implants should be splinted to prevent the micromotion.
