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Implantology as an essential part of orthodox dentistry has been subjected to a very fast development driven by optimising the existing dental implant systems.
The ”crestal” procedure
Frequently a sufficient quantity of bone substance does not exist to anchor the implant ”crestally”, it means the implant cannot be anchored straight down from the crest of the jawbone into the jaw by a certain mechanism of screws. Predominantly applied, this traditional ”crestal” technique in dental surgery is performed by removing bone tissue (a graft) for example from the crest of the pelvic bone and replanting this removed graft together with the implant down into the jaw bone while the dental implant is directly anchored into the graft. In this way the implantation is carried out in two surgical steps.
The risks of this procedure are obvious: The grafted bone cannot grow to the maxillary sinus in whole or in part. A loss of the graft accompanied by infected pus-covered wounds in the maxillary sinus and a further considerable loss of the original bone tissue at hand would be the result. If the graft and the implant had already been planted during the transplantation, they would have been rejected by then. Problems in the wound coverage of the soft tissue lead to further surgical operations. Injuries hereabouts particularly in the salivary glands may occur. In addition, the taking of the graft has to be performed under a general anaesthetic.
As consequences of the removal of the graft from the pelvic bone are to be mentioned: Although 75 per cent of the patients are able to walk without any crutches 14 days later, the end result of the direct damages to the hip will however be considerably worse: 30 per cent of the patients cannot wear a belt any longer. Patients succeed in walking without any pain and in an upright posture often not until after having exercised for months or even years and after daily therapeutic exercise and physiotherapy. The bone grafting in itself might be associated with complications averaging about at 15 to 20 per cent. Bone that is not loaded, so even the transplanted bone tissue in the maxillary sinus, will loose up to 80 per cent of its volume within one year. Even if the integration and healing of the transplant succeeds, it is to be assumed that the graft will go numb (necrosis) at least partially because of the lacking blood supply and thus represents in itself a possible risk of infection or it is slowly reabsorbed.
The basal osseous integrating procedure
The advancing procedure of placing basal osseous integrating implants is able of establishing a firmly fixed provision by inserting the implant into the jaw from the outer side of the jaw- bone. The advantage of this option consists in the fact that the force transmitting surfaces in the jawbone do not coincide with the area exposed to bacterial attack. In this way the loss of the implant happens seldom and protected against any infections, the body itself tends the bone area in question for the prevailing task in an optimal manner. The loss of the implant can be often prevented in this way.
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Procedure of a lateral insertion of a BASAL – Implant |
Dental indication in favour of the basal osseous integrating implant is given in the following instances anyway:
1. If the upper and lower jaw are atrophied, the advantage of this method will be the decisive fact that the existing supply of vertical bone tissue will be insignificant. No bone substance has to be transplanted – augmented – or separated for the implantation. As mentioned above, patients do not have to undergo the disadvantages of the traditional surgical technique and the transplantation of bone from the iliac crest while under a general anaesthetic.
2. If bite discrepancies, in particular a class III angle bite are given, the provision of the toothless upper jaw will always be accompanied by difficulties, as the false teeth without a previous surgical operation will tilt and the patient will not be enabled to chew and bite in a normal way. While previously a sagittal cleavage of the lower jaw including an adjustment-osteotomy was carried out under a general anaesthetic, nowadays the provision of basal osseous integrating implants allows to tend always firmly attached sagittal levels from and up to 2.5 cm without having to operate on the lower jaw.
This is a considerable advantage for the patient, because he does not have to undergo an adjustment-osteotomy of the lower jaw. This means the lower jaw is cut off in the mounting branch, then moved backwards and screwed again. If necessary, dental screws and plates will have be removed later on. Likewise, even today the shifting forward with or without any bone interposed is done for achieving congruent jaws in order to integrate complete denture prosthetics or an endosseous implant afterwards. Even this operation may be replaced by the more gentle procedure of the basal osseous integrating implant. Only in one sitting, mostly on an outpatient basis, at least four implants that will carry the construction of the prosthetics later on are placed at a strategic site in each jaw. By optimising the pillar-position of the implant, with regard to the prosthetics and the implant the leverage is neutralized to a large extent and diverted into the jaw without causing any damage. Thus, the adjustment of the jaw will be avoided and the patient can be provided with firmly attached dental restorations.
3. If telescopic removable dentures are not advocated by dental indication, as the overloading of the few left teeth will be forced which consequently will endanger these remaining teeth in the future, the basal osseous integrating procedure is able of implanting a tooth that only after a little while can be loaded adequately and is suitable for the attachment of firmly fixed dentures. So an augmentation of the pillars will be easily performed.
Further options, in particular mixtures and variations of them
Within the context of the conventional procedure a variance is given inasmuch that on the one hand the dental implant and the graft of the pelvicbone are implanted into the jaw simultaneously and on the other hand the dental implant is placed at another point of time that is during a second surgical operation. The transition between the orthodox procedure and the basal osseous integrating procedure is possible at any time and due to the lack of insufficient detailed information is chosen, not until the integration of the graft taken from the pelvic bone or the ‘crestal’ implant into the jaw has not been successful and they have been rejected.
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BASAL Implants 
