|Year : 2020 | Volume
| Issue : 2 | Page : 457-462
Consensus regarding 16 recognized and clinically proven methods and sub-methods for placing corticobasal® oral implants
Ihde Antonina1, Alexander Lazarov2, Vivek Gaur2, Valeri Lysenko2, Vitomir Konstantinovic2, Gabor Grombkötö2, Lukas Palka2, Stefan Ihde2
1 Head of Dental Implant Faculty (2019 - 2021), International Implant Foundation, Munich, Germany
2 Department of Evidence and Research, International Implant Foundation, Munich, Germany
|Date of Submission||04-Mar-2020|
|Date of Acceptance||27-Apr-2020|
|Date of Web Publication||23-Dec-2020|
Dr. Ihde Antonina
International Implant Foundation, Head of Dental Implant Faculty (2019–2021), Leopoldstr. 116, DE-80802 Munich
This Consensus-Document is issued by the International Implant Foundation (Munich/Germany). It describes distinct methods of placement of cortico-basal oral implants in different areas of the jaw bone and the maxillo-facial skeleton. The implants utilize the method of “osseofixation” instead of “osseointegration” for achieving primary, functional stability, hence they work according to the (AO-) principles of fracture treatment. The concept of the technology allows for immediate functional loading, just as it allows for various types of loading following orthopaedic surgery. The 16 methods and sub-methods as described and displayed here have been undergoing extensive observation and testing and they have been approved by the Board of the International Implant Foundation. All Consensus Documents of the International Implant Foundation are revised every three years. This is the 3rd version of the Consensus Document on placement of corticobasal oral implants
Level of Evidence: S3 (evidence based, systematically developed consensus guideline).
Keywords: Cortical anchorage, corticobasal implantology, immediate functional loading, polished implant surface
|How to cite this article:|
Antonina I, Lazarov A, Gaur V, Lysenko V, Konstantinovic V, Grombkötö G, Palka L, Ihde S. Consensus regarding 16 recognized and clinically proven methods and sub-methods for placing corticobasal® oral implants. Ann Maxillofac Surg 2020;10:457-62
|How to cite this URL:|
Antonina I, Lazarov A, Gaur V, Lysenko V, Konstantinovic V, Grombkötö G, Palka L, Ihde S. Consensus regarding 16 recognized and clinically proven methods and sub-methods for placing corticobasal® oral implants. Ann Maxillofac Surg [serial online] 2020 [cited 2021 Oct 17];10:457-62. Available from: https://www.amsjournal.com/text.asp?2020/10/2/457/304412
| Introduction|| |
In an effort to define standardized treatment methods, the International Implant Foundation (Munich, Germany) publishes this consensus document on 16 clinically successful anchoring techniques for corticobasal oral implants. This consensus document describes only the proven methods, without recommending a specific number of implants per jaw or per segment. It is understood, however, that the number of implants used will be typically higher compared to treatment plans in conventional dental implantology. Level of evidence – S3 (evidence-based, systematically developed consensus guideline). Other applicable rules and documents are as follows: General rules for treatments in the field of traumatology and orthopedic surgery. Indications and treatment modalities with corticobasal jaw implants. IF Consensus Document 2019. Ann Maxillofac Surg 2019;9:379-86.
| General Methods|| |
Multidirectional insertion of implants, where implants are inserted (wherever possible) at an angle to each other. To allow the insertion of prosthetics, the following steps are then performed:
- The abutment heads are parallelized by bending the shafts of the implants to accommodate the prosthetic restoration or
- Angulation adapters (as intermediate elements) are cemented or
- By grinding the big abutment heads
- Prosthetic constructions and implants are connected by prosthetic screws (for the multiunit design of Corticobasal® implants).
Stability is achieved through mandatory placement of implants in cortical engagement at least in the strategic positions. Placement of additional supporting implants for stabilization.
• Full penetration and anchorage in the second or third cortical (i.e., not just support by the cortical) of the force-transmitting threads in the cortical is (in most areas of the jaw bones) mandatory. As a result, both extrusive and intrusive forces are transmitted into the cortical bone.
Anchoring the implants in the second and possibly third cortical bone layers, independently of the alveolar bone. Cortical areas that are resistant to resorption are preferred.
Placement of Corticobasal® implants in cases with severe and active periodontal involvement. Under the protection of strong topical disinfection agents, the teeth and subsequently the periodontally involved soft tissues are removed. Corticobasal® implants are placed instantly, and they are then splinted by a rigid construction.
Spongious, alveolar bone areas are avoided for anchorage. Achieving “osseo-integration” is not the primary aim of the treatment with the Corticobasal® implant. Corticobasal® implants are osseofixated in corticals and then splinted by a rigid construction.
Fixation of polished implant bodies made from implantable material with the aim of achieving mechanical anchorage in the cortical bone areas of the maxillofacial skeleton. Subsequent splinting by the prosthetic construction in an immediate loading protocol.
Creating antirotation features for an implant by bending intraosseous parts of the shaft of the implant.
Achieving primary stability by vertical condensation of the spongious bone by wide-body Corticobasal (R) implant.
| Site-Specific Methods|| |
Placement of implants between the mental nerves (in edentulous mandibles) with or without utilization of the caudal cortex of the mandible.
The threads of the implants are inserted in the direction of the chin, which prevents damage to the mental nerve. Typically, two implants are used on each side of the mandible.
Only if the bone of the anterior mandible exhibits insufficient mineralization, the caudal cortex can be used for anterior anchoring.
Anterior anchorage of segmented bridges with insertion of one or two long Strategic Implants® in the gap between the root of the canine and the mental foramen. The threads of the implant extend below the root of the canine. The implant will extend to, and can be anchored in, the caudal cortical bone of the mandible to the extent necessary to achieve stability.
Nerve bypass – Endosseous positioning of the Corticobasal® implant inside the distal (proximal) mandible, by bypassing the inferior alveolar nerve on the lingual or vestibular side, if necessary/possible by anchorage in the caudal cortical bone, but without penetrating with the apex of the implant through the cortical.
Nerve bypass – Endosseous positioning of the Corticobasal® implant inside the distal (proximal) mandible, by bypassing the inferior alveolar nerve on the lingual or vestibular side, if necessary/possible by anchorage in the caudal cortical bone, with penetration of the apex of the implant through the cortical.
Lingual cortical anchorage in the distal mandible – Implant placement with anchoring the load-transmitting threads in the lingual bone undercut, below the mylohyoid ridge (where applicable, with the aim to achieve truly penetrating anchorage). The apical thread of the implant must be fully anchored in the lingual cortical, and it may partly overproject this cortical into the floor of the mouth.
The inferior alveolar nerve will run caudally to the implant body. As a rule, two or more such implants are placed distally to the mental nerve (i.e., in the proximal, horizontal part of the mandible). Typically, the inclination of the heads of these implants (before bending) is toward the anterior implants.
Vestibular cortical anchorage in the distal mandible – Implant placement with anchorage in the vestibular cortical bone and crestal to the inferior alveolar nerve.
Vestibular cortical engagement in the distal mandible, with the implant running below the mandibular nerve – This method is used if the inferior alveolar nerve is located crestally, and if the distal mandible is wide and high enough to allow this type of placement.
Placement of a Strategic Implant® with the aim of a palatal/lingual and vestibular support reaching the cortex without utilizing the second cortical bone layer in a vertical direction. Main areas of application are as follows:
- Extraction sockets of the mandibular and maxillary premolars
- Lower and upper anteriors
- Tuberosity of the maxilla.
Penetrating anchorage of implants in the bony nasal floor – The implant is inserted through the maxillary alveolar bone. This technique can include the penetration of the mucosa of the nasal floor, with the result that the polished implant tip and eventually also a part of the thread can extend slightly into the lower airway.
Implant placement on the palatal side of the severely horizontally atrophied alveolar bone (knife-edge maxilla) without penetrating the alveolar bone and directly into the nasal floor. Method 7b is a special technique of application, based on Method 7a.
Use of the cortical floor of the maxillary sinus for penetrating implant anchorage.
Utilization of an intrasinusal septum for multicortical anchorage of a Strategic Implant®, including the penetration of parts of the implant's thread into the maxillary sinus.
Bypassing the upper canine root – Anchoring an implant in the cortical floor of the nose, with the abutment head positioned in the region of the first or second premolar and the shaft of the implant bypassing the root of the canine on the palatal side. Method 9 is a special case of Method 7a or 7b.
Bypassing the upper canine root – Anchoring an implant in the median raphe of the maxilla, with the abutment head positioned in the region of the first or second premolar and the shaft of the implant bypassing the root of the canine on the palatal side.
Placement of the apical thread of the implants into the cortical bone of the pterygoid plate of the sphenoid bone – Placement can be performed either directly into the pterygoid plate of the sphenoid bone or through the maxillary tuberosity and/or through the maxillary sinus.
In an optimum end position, the apex of the implant penetrates the internal pterygoid muscle (between the wings of the pterygoid process) because this tends to increase the anchorage in the pterygoid plate through compression. For this method, Corticobasal® implants or designs which include compression threads are applied.
Double tubero-pterygoid – Two parallel or slightly diverging implants are placed into the fusion zone between the distal maxilla and the sphenoid bone.
Anchorage in the bone on the palatal side of the maxillary sinus, without anchorage in the nasal floor or in the median raphe of the maxilla [Method 11].
Anchoring of the implant from lateral in the median raphe of the maxilla.
Anchorage of the implant in the body of the zygomatic bone: Using a trans-sinusal procedure or inserting from caudal, directly into the body of the zygomatic bone.
Placement of implants vestibular to the knife-edge ridge in the anterior mandible. The typical implant diameter is 2.7 mmd or 3.0 mmd. Anchorage in the base of the mandible. Vertical implant parts run partially subperiosteal. The anterior caudal cortex can be also used for such type of implant anchoring, however care must be taken not to damage closeby blood vessels, and a strategy for long-term preservation of the oral mucosa to cover the vertical implant struts must be applied.
Anchoring an implant in the fresh extraction socket of the first or second premolar with at least mesial and distal cortical anchorage in the bone of the extraction socket. Utilizing the medial cortical of the mandible increases the anchorage.
Anchoring a larger diameter implant into the fresh extraction socket of the palatal root of the upper first or second molar.
Inserting two implants in the region of the upper first premolar, with one implant being placed palatally into the floor of the nasal cavity (Canine root bypass, Method 9), whereas the other implant is anchored in the region of the vestibular root of the first premolar.
Inserting two or three Corticobasal® implants in the region of the upper 1st or 2nd molar as an alternative to anchorage in the tubero-pterygoid region, in the event that Method 10 is not feasible.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Oleg D, Alexander L, Vitomir KS. Immediate-functional loading concept with one-piece implants (BECES/BECES N /KOS/ BOI) in the mandible and maxilla- a multi-center retrospective clinical study. J. Evolution Med. Dent. Sci. 2019;8:306-315.
Rüedi UA. AO-Prinzipien des Frakturmanagements. Georg Thieme Verlag, Stuttgart Germany, ISBN 3-13-117441-2: Georg Thieme Verlag KG; 2008.
Ihde. New Systematic Terminology of Cortical Bone Areas for Osseo-Fixated Implants in Strategic Oral Implantology. J J Anatomy. 2016;1:007.
Pałka ŁR, Lazarov A. Immediately loaded bicortical implants inserted in fresh extraction and healed sites in patients with and without a history of periodontal disease. Ann Maxillofac Surg 2019;9:371-8.
] [Full text]
Lazarov A. Immediate functional loading: Results for the concept of the Strategic Implant®
. Ann Maxillofac Surg 2019;9:78-88.
] [Full text]
Lazarov A. Trans-and Intra-Sinus BCS Implants - Clinical Alternative for Advanced Upper Jaw Atrophy. Statistical Analysis of Complications Associated with Maxillary sinus. Bulgarian language: Dental World; 1 February, 2018.