Placement & Loading Protocol
The GAO Consensus Project, which started in September 2023, aimed to establish a Treatment Guideline for Neobiotech's concepts and solutions based on the real clinical experiences of global GAO Core Members. Over the past six months, Core Members have conducted several online meetings, and finally, they gathered in Istanbul, Turkey, for the Consensus Meeting.
The Consensus Meeting held on April 20th, the day before the symposium, was attended by 11presenters (10 main speakers and 1 GAO Core Member) and about 20 Core Members. Unlike typical lectures, the meeting proceeded with about 20 core members freely discussing topics presented by the speakers. The presenters analyzed and demonstrated various clinical and research data on each topic, shared diverse opinions, and engaged in heated discussions about Neobiotech's unique CMI concepts, and AnyTime Loading.
The Consensus Meeting concluded with a summary of the issues that needed consensus to establish the Treatment Guideline based on the discussions in each session, and a commitment to future meetings for the final protocol. This Consensus Meeting not only included GAO core members but also attracted around 100 dentists from 20 countries, showcasing the enthusiasm for "Under the first topic of Placement and Loading Protocol, the GAO aims to produce comprehensive GAO Treatment Guidelines. This process involves dissecting and analyzing concepts, identifying critical issues, and gathering validation, proof, clinical data,and related studies."
Session 1 (01~03) : Rethinking the Osseointegration Process: Classic vs. Neo
Session 2 (04~06) : Proposal for Multi-centerStudy and Histological Experiment
Session 3 (07~09) : Bone Assessment Techniques,Tools, and Clinical Insights
Session 4 (10~11) : Comprehensive Considerations in Implant Loading Period
Conclusion
4 stories of the GAO Consensus
In the first session, the differences and backgrounds of Neobiotech's AnyTime Loading graph and the existing osseointegration formation graph were compared and analyzed. The relationship between bone trauma during surgery and implant design was explored based on papers and data.
The second session focused on analyzing and discussing the histological and clinical experiments needed to verify the AnyTime Loading theory,sharing ideas for new research.
In the third session, drilling protocols for the CMI Fixation concept were compared with those of other companies, discussing clinical approaches and introducing a new surgical engine being developed by Neobiotech.
The final session involved reestablishing the implant concept through clinical cases applying CMI Fixation and engaging in lively discussions based on literature data about various considerations for successful implant prosthetics.
Introduction to CMI Protocols and AnyTime Loading
ㆍMoving beyond the longstanding reluctance to load implants early, this report introduces CMI protocols, which facilitate Immediate Load,Early Load, and Conventional Load, collectively termed AnyTime Loading, as developed by NeoBiotech.
ㆍAlthough secondary bone growth from the SLA Active surface has enhanced stability,primary bone loss resulting from surgery remains unaddressed.
ㆍBy reducing or eliminating bone trauma/primary bone loss, we can achieve optimal implant fixation for AnyTime Loading,as desired by both surgeons and patients.
Reducing Osteotomy Trauma
ㆍCool saline and intermittent drill pressure to decrease temperature.
ㆍUtilize sharp drills and create osteotomies quickly, though not at increased drill speeds;slightly lower speeds may be more beneficial.
ㆍLarger osteotomy sizes increase bone temperature.
ㆍEach patient presents a unique surgical scenario, and the process is not entirely automatic.
CMI Implant Characteristics
ㆍTapered body implants are essential for CMI concept and AnyTime Loading implant, enabling immediate, early, or conventional loading, unlike straight body implants.
ㆍCMI implants provide stability in soft and cortical bone, with thread designs reducing pull-out forces and increasing Bone Implant Contact (BIC).
ㆍCMI implant design diminish lateral and occlusalforces. Insertion torque values should not exceed 45 N/cm.
Importance of BIC and Bone Growth
ㆍPrimary contact between native bone and implant surfaces is critical. The IS-II and IS-III implants offer the contact surface of other implants.
ㆍIntimate bone contact with implant threads is necessary for stability. Minimizing bone trauma is achieved through pre-tapping the cortical bone, self-compaction of medullary bone, and passive fit to cortical bone.
Varying Drilling Protocols
ㆍDrilling protocols must adapt to different bone densities.
ㆍSlight under-drilling with cortical tap drills achieves ideal torque and BIC, surpassing traditional osteotomy preparation designs.
ㆍSelf-tapping implants may damage SLA surfaces if over-torqued, slowing or halting secondary bone growth.
ㆍAssess osteotomy bone density (D1 to D4) in coronal, middle, and inferior sections.
ㆍAdjust drilling techniques based on bone density for optimal fixation and bone compression.
ㆍEnsure stable C fixation before considering immediate or early loading without splinting crowns.
AnyCheck and Insertion Torque Values(ITV)
ㆍUtilize AnyCheck to verify stability (value over 70 IST) and monitor values at surgery, 2, 4, and 6 weeks.
ㆍWith an AnyCheck value over 80, immediate loading is possible but requires verification at 2 weeks.
ㆍThe height of the healing abutment affects AnyCheck readings. (standard :4mm)
Cautions with Bone Grafts and Immediate Loading
ㆍExercise caution with immediate loading following tooth extraction and bone grafting.
ㆍAllow 3 months for bone grafts to mature before loading, especially if the implant is entirely in grafted bone.
ㆍA follow-up multi-center study by the GAO will verify and standardize AnyTime loading theory and protocols.
ㆍBone density will be categorized into five groups for standardized drilling and loading protocols.
ㆍITV (30-40 N/cm) and AnyCheck values to ensure consistent data collection.
ㆍA surgery/stability chart will be used by all GAO members to equalize data collection.
Standardization and Protocols
ㆍEnsure consistent implant placement protocols across surgeons.
ㆍA prototype drilling machine developed by Dr.Heo aims to standardize bone density determination.
ㆍStabilizing the C fixation of the osteotomy is crucial for successful AnyTime loading.
Post-Extraction and Immediate Implant Placement
ㆍMinimize pressure on implants for optimal cosmetic outcomes.
ㆍAnyCheck helps determine appropriate abutment.
ㆍSmaller implant diameters allow for more bone contact.
Considerations for Bruxers and Occlusion
ㆍImmediate loading in bruxers poses a high failure risk if occlusion is not managed.
ㆍEnsure primary and secondary contacts are well-placed.
Efficient Prosthesis &Follow-up / Monitoring
ㆍConduct quarterly recall visits in the first year with x-rays to monitor bone loss.
By adhering to these guidelines and protocols, the GAO and NeoBiotech aim to establish a standardized, reliable approach to implant placement and loading, ensuring success and minimizing failures.
