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Robert Elsenpeter is a freelance writer and frequent contributor to Dental Products Report and Dental Lab Products. He is also the author of 18 technology books, including the award-winning Green IT: Reduce Your Information System's Environmental Impact While Adding to the Bottom Line. As such, he’s particularly interested in the technological side of dentistry.
How one periodontist uses OsseoSpeed Profile EV implants by Dentsply Sirona Implants to waste less and do more.
The OsseoSpeed Profile EV implant offers features that both patients and implant doctors will likely find appealing. We talked to Dr. David Barack, DDS, a periodontist in Skokie, Illinois, about how he uses this implant in his practice, and what benefits other clinicians can expect from the system.
Tell us a little bit about the features of the OsseoSpeed Profile EV implant.
The OsseoSpeed Profile EV is available in diameters 4.2 and 4.8, and in either a straight or a conical body design. The unique difference of the implant is the sloped design of the implant neck which follows the naturally occurring slope of the anatomy.
When I started placing OsseoSpeed Profile EV implants, I initially used it only in the esthetic zone, where the challenges of differences in bone height are most common, in both extraction and healed sites. Over the past several years, there has been a growing trend in placement of implants into fresh extraction sites, because the research says that under the right protocols, you can preserve more bone and prevent more marginal bone loss during initial healing of implant placement.
The most common scenario in the esthetic zone is a thin facial plate that is vulnerable to early resorption. The OsseoSpeed Profile EV implant looked to be really, really well designed for that indication, where you have to work hard to preserve bone and prevent changes in the height of the tissue that would be unesthetic or where the implant is at risk for developing inflammation and other tissue-related issues.
As we used the Profile implant, we pretty quickly discovered that because of the sloped design at the implant neck, we didn’t have to sink these implants nearly as much as we do with the more traditional flat-platformed implants. If you can picture a socket that’s taller on the palate and proximal sides, but with a dip at the facial aspect, you have to sink a traditional flat platform implant to the area where you have the most bone recession and beyond the facial plate.
With the OsseoSpeed Profile EV implant, you don’t have to sink the implant as deeply because you can instead, position the shortest part of the implant to the shortest part of the bone. As a result, you’re using more of the existing bone. You are also able to match the level of the implant more closely to the neighboring teeth. You still may have to graft between the implant and the facial plate, but in the short-term, you’re preserving more tissue, and in the long-term you’re not creating as much pocketing or discrepancy between the height of the implant and the neighboring bone, so maintenance of these areas becomes easier.
What other ways have you found to use these implants?
I initially thought this was a niche implant. But looking at all our other cases, the reality is that even in the posterior areas, there are an abundance of cases that don’t have flat ridges. So now I have started adjusting how I look at cases in the posterior. When somebody has missing molars for some time, and still have their premolars, it is common for the bone to atrophy where the tooth is missing and curve up to the most distal tooth, resulting in a ramped osseous architecture. If the bone is lower on the distal and higher on the mesial and you are using a flat-platformed implant, you have to sink that implant so that it’s buried at the distal, resulting in a height discrepancy that can lead to challenges with emergence profile. It can often require clearing away more bone to make room for a healing abutment or a properly shaped tooth.
As we begin to use more and more Profile implants, it has gone from a niche to the workhorse implant. We are probably placing more Profile implants than flat implants right now.
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In addition to preserving tissue and bone, what other benefits are there for the patient?
If you can match the contours of a sloped bone with a sloped implant,you can eliminate the need for a certain amount of ridge augmentation and grafting procedures necessary for creating a more favorable bone architecture when using a flat-topped implant.
There’s also research to support that even in the anterior, there is an increase in the amount of keratinized tissue surrounding OsseoSpeed Profile implants. Eliminating bone augmentation procedures, reducing treatment time, and preserving hard and soft tissue esthetics are all beneficial for the patient.
What are some other advantages of using the OsseoSpeed Profile EV implant?
When we plan cases with 3D imaging, and you are trying to avoid grafting, the long axis of the implant is often not in a favorable position. One of the things we’ve noticed is that the Profile implant allows you to change the angulation of the implant, so it can be kept within the confines of the bone. As far as technique goes, it is very similar to prepping for any other OsseoSpeed EV implant.
We’re big fans of single-stage implant placement, meaning not only are we putting it in the extraction site, but we often put a healing abutment or a prosthetic abutment for an immediate provisional. One of the nice things about the healing abutments with the Profile is that it’s a two-piece, meaning there is an outer shape to the healing abutment and then an inner screw. It comes as one unit, but the screw rotates inside the healing abutment. We will often punch the membrane with a biopsy or a tissue punch, and then we can place the two-piece healing abutment, which doesn’t rotate. You put it into position, and as you tighten it, it’s not rotating-only the internal screw is. As we are seating that healing abutment into the implant, it’s going through a punched PerioDerm membrane, and it won’t rip or twist that membrane out of position, because it’s not rotating.
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How does the Profile system fit in with current trends in implant dentistry?
I’ve been placing implants since 1987, and the only “flavor” has been flat-top implants. So you mentally get into this rut that you’ve got to sink the implant; you’ve got to sink it, you’ve got to sink it. The OsseoSpeed Profile EV implant shifts the way we look at sloped ridge situations and our expectations for where and how we need to place these implants. It has allowed us to shift our approach from overly sinking the implants to a more optimal position that matches the contours of the existing bone. By doing that, we are able to raise our expectations of what can be accomplished-not only in esthetics and integration, but also in overall long-term, peri-implant health.
What advice do you have for someone considering OsseoSpeed Profile EV or who may be a new user?
If they’ve been placing implants for a while, the first thing I would say is: “Don’t be afraid. It’s not that complicated.” For those familiar with the Astra Tech Implant system, the preparation and placement protocol is the same but you have to make sure that you’re using components designed specifically for Profile implants. If you’re a surgeon and you’re referring your patients back to a restorative dentist, you have to make sure that the restorative dentist is aware that a Profile implant has been used to ensure they order the correct components.
With the correct components, it is absolutely just as easy to restore a Profile as any other OsseoSpeed EV implant. For added simplicity, there’s only one way for restorative components (impression coping, the healing abutment and abutment) to seat into the OsseoSpeed Profile EV implant due to the one-position-only interface design. You can almost close your eyes and screw these things in, because they can only engage in one way.