OBJECTIVE:The objective of this study was to assess the e�ciency and predictability of extra-short implants for the restoration of the vertically atrophic maxillae and mandibles. The treatment plan includes a new drilling protocol, vertical bone regeneration, the splinting of the extra-short implant, and the use of Multi-IM abutments to obtain a perfect seal and long-term tissue stability.

A MINIMALLY INVASIVE TECHNIQUE FOR TREATING SEVERE VERTICAL ATROPHY BTI Research and development team.

INTRODUCTION:Numerous studies have shown the predictability of short implants in the prosthetic restoration of atrophic maxi-llae. In a recent study we were able to verify that the survival rate of 1287 implants of <8.5 mm over 1 to 8 years was 99.3%, very similar to implants with conventional lengths. Recent progress in the design of BTI implants and in biomechanical research has enabled new implants to be developed with lengths of 5.5 and 6.5 mm called extra-short implants. Extra-short implants are highly indicated for treating severe maxillar atrophy and o�er a mi-nimally invasive alternative that reduces morbidity, costs and time. Similarly, a new protocol has been developed for the use of extra-short implants with the objective of obtaining reliable results and minimising the prosthetic and surgical complications.

BTI extra-short implants:

EXTREME VERTICAL REABSORPTION

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MATERIALS AND METHODS:

BTI EXTRA-SHORT IMPLANTS Article CLINICAL RESEARCH

STEP 1

Planning of the case. The case must be planned very carefully in these case of extreme vertical reabsorp-tion to avoid damaging anatomical structures such as the maxillary sinus and the inferior dental nerve.

STEP 2

The biological drilling is performed with increasing diameters, following the con-ventional protocol, subtracting -1 mm from the length estimated in the scanner. This safety distance of a millimetre shall be drilled with the front cutting drill.

STEP 5

In the surgical re-entry we can see how a large part of the vertical growth sought has been achieved, gaining the coronal millimetres necessary for the restoration of the area.

STEP 3

A �brin clot made with fraction 1 of PRGF-Endoret is inserted into the alveolus and it is condensed at the base. Thus the implant can be �tted on anatomical structures such as the dental nerve or the maxillary sinus without harming them.

3.8 INFAPACINFAPAL

FICSFIL

1.82.5

INFAPSCINFAPSL

4.3 5.5 x 6.53.25 4.5 5.34.8 5.1 FCF51L

550 - 800100 - 350

400 - 500 850 - 10001050-1400

HOUNSFIELD

STEP 4

In cases where the height of the residual bone ridge is less than or equal to 4 mm (minimum length of extra-short implants) you can set the implant in a supracrestal position and place a particulate bone graft (bone from drilling + PRGF-Endoret) covering 1-1.5 mm of the implant to achieve vertical growth around it.

Figure 1: A) The use of the front cutting drill that allows extra-short implants to be placed over the mandibular canal. B) and C) The placement of the PRGF-Endoret �brin membrane protects the inferior dental nerve. D) Placement of the implants. E) You can see the bone regeneration on the extra-short implant at 6 months on which there was vertical growth. F) The case was �nalised with the �tting of the screw-mounted prostheses.

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RESULTS:

The use of BTI extra-short implants has enabled us to develop a conservative and e�ective alternative in the treatment of severe bone reabsorption in the maxilla and mandible. Recently, the presence of an unfavourable crown-implant ratio was analysed in 28 patients with prostheses mounted on short and extra-short implants (42 implants). The results indicated that even when the average crown-implant ratio was 2.3 ± 0.3 (Ratio 1:2 / 1:3), there was no in�uence at all on the proximal bone loss or on the success of the prosthesis. Splinting extra-short implants increases the area over which the mechanical stress is distributed, thus increasing the stability of the prostheses and minimising the stress around the implant.

The surgical morbidity was minimal and no signs of impaired nerve function were observed in the lower dental nerve. In other studies in which 114 extra-short implants were inserted in 72 patients, with a mean follow-up time of 26 months after implant insertion, a mean survival of 98.4% was observed. The peri-implant bone loss was established at 1 mm one year after insertion and the analysis of the factors that in�uence this loss indicate that increasing the implant diameter tends to lessen the proximal bone loss. No complications were observed with the prosthetics during the trial period.

Article CLINICAL RESEARCH

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BTI EXTRA-SHORT IMPLANTS

A B C

D E F

CONCLUSIONS:

The extra-short implants are a minimally invasive alternative. They are a conservative procedure that is e�ective and predictable in the prosthetic restoration of severe maxillar atrophy. This conservative alternative lessens the risk of surgical morbidity, minimises costs and time, and reduces the stress that the clinician may su�er during the surgery.

Comercial B.T.I. Institute España, S.L.San Antonio, 15, 5º | 01005 Vitoria-Gasteiz (Álava), SpainTel.: 945 140 024 | Fax: 945 135 203www.bti-biotechnologyinstitute.com

3- Anitua E, Alkhraisat M, Orive G. Novel technique for the treatment of severely atrophied posterior mandible. JOMI 2013 (In Press).

BIBLIOGRAPHY:1- Anitua E, Orive G. Short implants in maxillae and mandibles: a retrospective study with 1 to 8 years of follow-up. J Periodontol 2010;81:819-26.

2- Anitua E, Orive G, Aguirre JJ, Andía I. Five-year clinical evaluation of short dental implants placed in posterior areas: a retrospective study. J Periodontol 2008;79:42-8. CLÍNICA

Article CLINICAL RESEARCHBTI EXTRA-SHORT IMPLANTS

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The front cutting drills have been specially designed for apical cutting without damaging the anatomical structures. They come in four diame-ters, for use with the suitable drilling procedure for the implant diameter.

FRONT CUTTING DRILL

Software for the diagnosis and digital planning of treatments and surgery in oral implantology.

BTI SCAN

BTI SCAN II SOFTWARE

FCF

Short and extra-short implants allow implants to be placed directly in these areas (without preliminary steps to increase the bone vertically), simplifying the technique and shortening the waiting time for the patient. BTI has a range of short and extra-short implants to suit di�erent degrees of vertical and horizontal atrophy of the maxillae.

SHORT AND EXTRA-SHORT IMPLANTS

IIPS5555 IIPS5565 IIPS5575 IIPS5585

ø 3 mm ø 3.5 mm ø 4.5 mm ø 5.1 mm

MULTI IM abutments (Ti GOLDEN)

ELEMENTS INVOLVEDBTI EXTRA-SHORT IMPLANTS

The new abutments are fabricated from pure titanium metal and then are subjected to the Ti-Golden treatment. This is a thermochemical treatment where nitrogen is included into the metal surface. The outcomes of Ti-Golden treatment are the increase in surface toughness, corrosion resistance, fatigue resistance in addition to improvements in the aesthe-tic and biological properties of the abutments. TINY® INTERNA EXTERNA