E-Book, Englisch, 304 Seiten
ISBN: 978-0-86715-834-2
Verlag: Quintessence Publishing Co, Inc
Format: EPUB
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)
Tomas Linkevicius, DDS, Dip Pros, PhD, is a professor at Vilnius University in Vilnius, Lithuania, where he completed his postgraduate studies in prosthetic dentistry and obtained his prosthodontist specialty. Dr Linkevicius received his dental degree in 2000 from Kaunas Medical University in Kaunas, Lithuania and defended his doctoral dissertation at R?ga Stradins University in R?ga, Latvia in 2009. Dr Linkevicius has authored dozens of publications in international peer-reviewed journals. He has also contributed to several books, including Cementation in Dental Implantology (Springer, 2015) and Implants in the Aesthetic Zone (Springer, 2019). During the course of his research, Dr Linkevic?ius developed zero bone loss concepts, an evidence-based clinical protocol that demonstrates how to achieve and maintain crestal bone stability around dental implants. He lectures internationally on this topic and is an active member of several professional organizations, such as the Academy of Osseointegration and the European Academy of Osseointegration. Dr Linkevicius maintains a practice specializing in prosthodontics and implant dentistry and continues to study zero bone loss concepts at the Vilnius Research Group.
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INTRODUCTION TO ZERO BONE LOSS CONCEPTS I will start with the first questions I ask during my courses and lectures: Do you have crestal bone loss around implants that you place and restore? Are you here because you want to understand why this sometimes happens? Most people I speak to respond in the affirmative: Many of their implants have some degree of bone loss. This is a major issue that can be encountered in any practice. However, crestal bone loss does not have to occur. With this idea in mind, I created zero bone loss concepts: the protocols to achieve the status of zero bone loss. Zero bone loss is achievable—not just months after prosthetic delivery but years after completion of treatment. Figure 1 demonstrates an extraordinary case with results for which we constantly strive. The inevitable questions are: Why was this case so successful? What can we do to attain these outstanding results? Fig 1 (a) Maxillary implant in 2013. (b) The same patient in 2018. This is the question that I hope to answer with this book, using concepts taken from two realms: clinical practice and scientific research. However, each of these, taken individually, has its shortcomings. Clinical Practice There are many books that show very successful clinical outcomes, but they are frequently based only on the authors’ experiences. The results are great, but just because one clinician reports these results, it does not mean that readers will have the same outcomes. The unfortunate response is the well-known phrase, “It works in my hands.” Readers may try to mimic the results with less than desirable outcomes and then become discouraged. Usually, those readers or course participants may begin to blame themselves, questioning their ability to perform contemporary treatment. In the speaker’s world, there is a new term, podium dentistry, which refers to clinicians presenting only their good experiences rather than the entire picture, including complications. Scientific Research It can be a challenge for strict science to be taken seriously by the clinical world because it is often viewed as too far removed—or even boring. Evidence-based implant dentistry is of course the ideal situation, but it is seldom achieved, because the truth is that clinical studies are very difficult to perform correctly and without bias. Another challenge that arises is that ethical rules are becoming stricter, and patients are becoming more and more reluctant to take part in clinical trials. These factors have made it more difficult to get approval from ethics committees and conduct clinical trials. The result is a situation where the scientific and clinical worlds start to distrust each other, which is the worst outcome. Therefore, true success is achieved when treatment is performed based on clinical evidence with the appropriate logic and technical skills. Integration of Science and Clinical Practice The purpose of this book is to combine these worlds—scientific and clinical—into one. This gives clinicians exactly what they need: clinical procedures backed by solid clinical evidence. That was the idea behind the development of the zero bone loss concepts. I was once confronted by a colleague with the argument that it is not possible to have zero bone loss around implants. Of course, I agreed, but explained that we must do our best to move in that direction. We are making great progress, because one of the studies demonstrated only 0.2 mm of crestal bone loss—almost zero!1 I strongly believe that it is possible to achieve bone stability with different implant systems, surfaces, implant-abutment connections, and prosthetic solutions (Fig 2). It is even possible with or without platform switching. However, clinicians must understand the surgical and prosthetic aspects as well as the biologic and mechanical principles of implant treatment to achieve success. There have been successful and unsuccessful cases with the same implant systems (Fig 3). This highlights the fact that implant design is not the sole factor involved in achieving crestal bone stability. While it is possible to achieve zero bone loss with nearly any implant system, some systems demand more work and understanding to accomplish this goal than others. The clinician must be very familiar with the implant system of choice, including its strengths and weaknesses. This is the way to success (Fig 4). Fig 2 Zero bone loss concepts with different implants. (a) Straumann Tissue Level implant. (b) Conelog implant (Camlog). (c) V3 implant (MIS Implants Technologies). (d) BioHorizons Tapered implant. (e) Straumann Bone Level implant. Fig 3 Crestal bone stability (a) and bone loss (b) using the same kind of implant. Fig 4 Long-term (7-year) follow-up of an implant placed and restored according to zero bone loss concepts. (a) Before restoration in 2011. (b) The implant with the restoration in 2012. (c) Implant status 3 years after treatment in 2014. (d) In 2017, there is bone gain around the implant. The outcome of implant treatment relies on the stability of the crestal bone, and that is the key factor that will determine whether treatment will succeed or fail. Therefore, each technique and concept in this book is focused on keeping the bone intact. The point is not to determine only the most important factors that affect bone stability but rather to discuss how the many factors work with each other and how this collaboration influences bone stability. The techniques and concepts presented in this book are all supported by scientific studies, an overwhelming majority of which are clinical studies. My team and I have published over 20 papers in many prestigious dental journals, including The International Journal of Oral and Maxillofacial Implants, Clinical Oral Implants Research, and The International Journal of Periodontics and Restorative Dentistry ( Table 1). The clinical and laboratory procedures that we follow and recommend to our readers are based on scientific evidence. Rather than relying only on our own clinical experience, our protocols are backed by science. It is this marriage of science and practice that makes this book and its concepts exceptional. Another exceptional fact about the cases discussed in this book is that all clinical and in vitro studies were performed in a private practice environment. Clinical trials are usually performed at universities, but my team developed a special system in which the private practice is connected to the universities and under strict guidance to contribute to the field of knowledge in implant dentistry. Table 1 List of published research supporting zero bone loss concepts It is very important to me that this book is not based just on clinical findings and case reports; rather, it is based mostly on controlled clinical trials and soundly designed in vitro studies. Relying only on case reports can be quite dangerous. For example, in case reports, the use of rubber dam is suggested as a safe way to reduce cement remnants2; however, a controlled clinical study demonstrated completely opposite results.3 In 2011, we created and published a simple and reliable technique for evaluation of cement remnants after cementation.4 This technique involves cementing a crown with an access hole in the occlusal surface, which is closed with composite to prevent cement from venting during the cementation process while allowing the restoration to be removed together with the abutment. Using this technique, we found that rubber dam is not able to prevent cement remnants (Fig 5). Fig 5 Rubber dam is not efficient in preventing cement remnants in a clinical situation. (a and b) The abutment and rubber dam are placed on the implant. (c) The crown is cemented. (d) The rubber dam and crown are removed. (e) Cement remains on the surface that is in contact with the peri-implant tissues. (f) There are no cement remnants in the peri-implant tissues. This highlights the fact that case reports are subjective and resemble the opinions of the authors. This must be kept in mind when attending courses, listening to lectures, or reading textbooks. The level of evidence is important, and it ranges from in vitro studies to randomized clinical trials (Fig 6). Animal and in vitro studies form the lowest spot in the ladder of evidence, and thus they cannot be directly taken into the clinical world. Of course, some experiments can only be performed on animals, but we must not forget that, for example, dogs heal up to eight times faster than humans. Therefore, the results of studies in dogs should be regarded as best-case scenarios. However, we often see that animal studies are used to back clinical protocols, which is not correct. In vivo study should be used only as a guide before clinical trials are conducted. For example, consider the pharmaceutical industry. Would you use a medicine that was tested only on animals without clinical evaluation? The answer of course is no, and this is why the hierarchy of evidence should not be forgotten. Case reports also have their place in the hierarchy. A simple case report may be more important than a serious animal study, but we cannot base clinical strategy...
