Implants in the severely resorbed mandibles: whether or not to augment? What is the clinician’s preference?

Abstract

IntroductionThe aim of this study is to inventory in the Netherlands which therapy is the clinician’s first choice when restoring the edentulous mandible.Material and methodsA questionnaire was sent to all Dutch Oral and Maxillofacial surgeons. As part of this, the surgeons were invited to treat five virtual edentulous patients, differing only in mandibular residual height.ResultsIn cases of a sufficient residual height of 15 mm, all surgeons were in favour to insert solely two implants to anchor an overdenture. In case of a residual height of 12 mm, 10% of the surgeons choose for an augmentation procedure. If a patient was presented with a mandibular height of 10 mm, already 40% of the OMF surgeons executed an augmentation procedure. Most (80%) surgeons prefer the (anterior) iliac crest as donor site. The choice of ‘whether or not to augment’ was not influenced by the surgeon’s age; however, the hospital, where he was trained, did. Surgeons trained in Groningen were more in favour of installing short implants in mandibles with reduced vertical height.DiscussionAs the option overdenture supported on two interforaminal implants is reimbursed by the Dutch health assurance, this treatment modality is very popular in the Netherlands. From a point of costs and to minimize bypass comorbidity, surgeons should be more reluctant in executing augmentation procedures to restore the resorbed edentulous mandible as it is dated in literature that also in mandibles with a residual height of 10 mm or less, solely placing implants, thus without an augmentation procedure in advance, is a reliable treatment option.Electronic supplementary materialThe online version of this article (doi:10.1007/s10006-011-0285-6) contains supplementary material, which is available to authorized users.

Two Implants in a Severely Resorbed Mandible: A Case Report of Early Loading

“…From the cost-benefit standpoint, the over denture supported on two interforaminal implants option is a reliable treatment option and is the treatment of choice for many surgeons [6].…”

Análise das tensões geradas por implantes curtos e convencionais reabilitados com próteses fixas unidas e isoladas, por meio do método de correlação de imagem digital

“…Entretanto, todos estes métodos provocam certos índices de morbidade (das Neves et al, 2006;Morand;Irinakis, 2007;Ogawa et al, 2010;Raviv et al, 2010;Perdijk et al, 2011) e é nessa perspectiva que os implantes curtos surgem com uma proposta mais conservadora, simples, de menor custo e rapidez (Stellingsma et al, 2004;Grant et al, 2009;Perdijk et al, 2011;Esposito et al, 2011;Guljé et al, 2012;Sánchez-Garcés et al, 2012).…”

“…Áreas anodônticas na região posterior da mandíbula e maxila apresentam frequentemente menor altura óssea, devido à proximidade ao nervo alveolar inferior e ao assoalho do seio maxilar, respectivamente (Misch et al, 2006;, o que contraindica, na maioria das vezes, a utilização de implantes convencionais nesta região (Perdijk et al, 2011). Apesar da existência de métodos capazes de aumentar a altura óssea nessas áreas, como enxerto autógeno e lateralização do nervo alveolar inferior, foram constatados altos índices de morbidade, além de resultar em aumento de custos ao paciente e elevar o tempo de tratamento (das Neves et al, 2006;Raviv et al, 2010;Perdijk et al, 2011).…”

“…Apesar da existência de métodos capazes de aumentar a altura óssea nessas áreas, como enxerto autógeno e lateralização do nervo alveolar inferior, foram constatados altos índices de morbidade, além de resultar em aumento de custos ao paciente e elevar o tempo de tratamento (das Neves et al, 2006;Raviv et al, 2010;Perdijk et al, 2011).…”

“…Uma opção conservadora seria a utilização de implantes curtos (Stellingsma et al, 2004;das Neves et al, 2006;Grant et al, 2009;Perdijk et al, 2011), contudo não há um consenso na literatura a respeito da sua eficiência, embora muitos pesquisadores tenham encontrado uma elevada taxa de sucesso (Stellingsma et al, 2004;Misch et al, 2006;Tawil et al, 2006;das Neves et al, 2006;Degidi et al, 2007;Grant et al, 2009;.…”