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| Path of insertion in implant dentistry
Path of insertion in implant dentistryOcclusion is an important variable in the success or failure of most prosthodontic reconstructions. With natural teeth, a certain degree of flexibility permits compensation for any occlusal irregularities. Implant dentistry is not as forgiving. The most significant factor affecting stability of an implant-supported restoration is occlusal loading. Excess loading may lead to loosening of abutment screws and, if undetected, to possible fracture. Overloading may also damage the implant and superstructure and lead to loss of osseointegration.The literature generally agrees in recommending an implant placement in axis with the load and therefore perpendicular to the occlusal plane. In optimal situations and for little spans this can be realized. Nevertheless, if conditions are not optimal and the number and the distribution of the implants are more complex placement of the implants with distant inclinations will be necessary. In fact, frequently implants are positioned in relation to future tooth replacement and within the extent of existing bone and they so present quite different angulations. The choice of a common milling axis to prepare the abutments is based on several clinical and technical elements together with the experience of the operator. Technicians usually define the milling implant axis arbitrarily without an exact evaluation of the angular inclination of each individual implant. As a consequence some implants may present excessive angular preparations (millings) in order to compensate for a common path of insertion. Extremely angulated abutments often have reduced height, compromised fixation screws and reduced structural integrity or may represent areas of stress concentration, prone to technical failure. Since 2005 we defined the A.M.I. (mean implant axis) methodology in controlling the angular preparation of multiple implant abutments. This method increase the probability to better prepare abutment by evaluating all implant angulations (using RAP or RAP DGT model holder base), calculating the mean implant axis (A.M.I.) and by preparing the abutments within the possible angular ranges offered by the chosen milling taper. A dedicated software has been developed to calculate the mean implant axis among a set of implants so to give the clinician and the technician a fast and precise system to prepare implant abutments. Till today no other standard methodologies have been defined in order to establish such a fundamental technical data. |