Dental Tribune UK Edition, September 20-26, 2010, Vol. 4 No. 22

References 45. Ma PS, Nicholls JI, Junge T, Phillips KM. Load fatigue of teeth with different fer- rule lengths, restored with fiber posts, composite resin cores, and all-ceramic crowns. J Prosthet Dent 2009 Oct;102(4):229-34 46. Coppedê AR, Bersani E, de Mattos Mda G, et al. Fracture resistance of the implant-abutment connection in implants with internal hex and internal conical connections under oblique compressive loading: an in vitro study. Int J Prosthodont 2009 May-Jun;22(3):283-6 47. Steinebrunner L, Wolfart S et al. In-vitro evaluation of bacterial leakage along the implant-abutment interface of different implant systems. Int J Oral Maxillofac Implants 2005 Nov-Dec;20(6):875-81 48. Tesmer M, Wallet S et al. Bacterial Colonization of the DentalImplant Fixture–Abutment Interface: An In Vitro Study. J Periodontol December 2009;80(12):1991-7 49. Brunski JB, Puleo DA, Nanci A. Biomaterials and biomechanics of oral and maxillofacial implants: Current status and future developments. Int J Oral Maxillofac Implants 2000 Jan-Feb;15(1):15-46 50. English CE. Biomechanical concerns with fixed partial dentures involving implants. Implant Dentistry1993;2(4):221-242 51. Lazzara RJ, Porter SS. Platform switching: a new concept in implant dentistry for controlling post restorative crestal bone levels. Int J Periodontics Restorative Dent Feb 2006;26(1):9-17 52. Oh TJ, Yoon J, Misch CE, Wang HL. The causes of early implant bone loss: Myth or science? Journal of Periodontology March 2002;73(3):322-333 53. Tarnow DP, Magner AW, Fletcher P. The effect of the distance from the contact point to the crest of bone on the presence or absence of the interproxi- mal dental papilla. J Periodontol 1992 Dec;63(12):995-6 54. Chiapasco M, Zaniboni M. Clinical outcomes of GBR procedures to correct peri-implant dehiscences and fenestra- tions: a systematic review. Clin Oral Implants Res 2009 Sep;20 Suppl 4:113-23 55. Maeda Y, Miura J, Taki I, Sogo M. Biomechanical analysis on platform switching: Is there any biomechanical rationale? Clin Oral Implants Res 2007;18:581-584 56. Ericsson I, Persson LG, Berglundh T et al. Different types of inflammatory reactions in peri-implant soft tis- sues. J Clin Periodontol 1995;22:255-261 57. Lazzara RJ, Porter SS. Platform switching: A new concept in implant dentistry for controlling postrestorative crestal bone levels. Int J Periodontics Restorative Dent 2006;26:9-17 58. Baggi L, Cappelloni I, Di GM, Maceri F, Vairo G. The influence of implant diameterand length on stress distribution of osseointe- grated implants related to crestal bone geometry: A three-dimensional finite element analysis. J Prosthet Dent 2008;100:422-431 59. Nentwig, GN. The Ankylos implant system: Concept and clinical application. J Oral Implantology 2004;30:171-177 60. Zipprich H, Weigl P, Lange B, Lauer H-C. Erfassung, Ursachen und Folgen von Mikrobewegungen am Implantat-Abutment-Interface. Implantologie 2007;15:31-46 switched and subcrestally po- sitioned design demonstrated better stress based perform- ance and lower risk of bone overload than the other im- plant systems evaluated. Essential features Platform switching, together with a stable implant-abutment connection are increasingly ac- cepted essential implant design features required to reduce or eliminate early crestal bone loss. A bacteria-proof seal, a lack of micro-movement due to a long friction grip tapered channel and minimally invasive second-stage surgery without any major trauma for the perio- steal tissues are also important factors in preventing cervical bone loss. A preconfigured platform switched design has a signifi- cant impact on the implant treat- ment in esthetic areas as not only is the tissue biotype pre- served, but it has been shown to be enhanced by osseous genera- tion over the collar of the fixture (Figs 12a and 12b)59,60 . The endodontic implant al- gorithm parallels the question, which came first, the chicken or the egg as an example of circular cause and consequence. It could be reformulated as follows: ‘Which came first, X that can’t come without Y, or Y that can’t come without X?’ An equivalent situation arises in engineering and science known as circular reference, in which a param- eter is required to calculate that parameter itself. This is the es- sence of foundational dentistry. Nature wisely created a structure that could harmoni- ously interpolate hard and soft tissue, act as the portal of nu- trition and communication for the body and be the gate- keeper on guard and in func- tion throughout our lifetime. As such, our role is to ensure that however we reengineer nature, we must adhere to its rules, its logic and fundamentals. The best evidence This is not an easy task, as fil- tering out the best range of evidence from a wide range of sources, presenting clear, comprehensive analyses and incorporating patient experi- ence is a Herculean task. In many ways, this is analogous to Alice’s Adventures in Wonder- land as so much of what we do grows ‘curiouser and curi- ouser’ as each new innovation demands that we go through the looking glass and determine what Alice found there. ‘There’s no use trying,’ said Alice. ‘One can’t believe impossible things.’ ‘I daresay you haven’t had much practice,’ said the Queen. ‘When I was your age, I always did it for half an hour a day. Why, some- times I’ve believed as many as six impossible things before breakfast?’ Lewis Carroll. DT page 21DTß Fig 11c Fig 12a Fig 12b About the author Kenneth S Serota, DDS, MMSc gradu- ated from the University of Toronto, Faculty of Dentistry in 1973 and was awarded the George W Switzer Me- morial Key for excellence in Prostho- dontics. He received his Certificate in Endodontics and Master of Medical Sciences Degree from the Harvard- Forsyth Dental Center in Boston, MA. The founder of ROOTS – an online educational forum for dentists from around the world who wish to learn cutting edge endodontic therapy, he recently launched IMPLANTS (www. rximplants.com) and www.tdsonline. org in order to provide a clear under- standing of the endodontic/implant al- gorithm in foundational dentistry. September 20-26, 201022 United Kingdom EditionClinical Are you meeting your requirements for CPD? Core CPD for Dentists and Dental Care Professionals Thursday 18th November 2010, Leeds 4th National Conference on Decontamination of Dental Instruments Friday 19th November 2010, Leeds • Meet your requirements for verifiable CPD • Update your knowledge • Hear and meet a group of the UK’s leading experts • Networking opportunities • Exhibitor area TO BOOK OR TO REQUEST A CONFERENCE LEAFLET Visit http://www.gla.ac.uk/departments/dentalschool/ or Call 0141 201 9353/9264/0674

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