Stepped, Root-Analog Wide Diameter Implants: A New Approach to Surpass Conventional Implant Therapy

When osseointegrated implants were first introduced, they were only recommended for the restoration of moderately or severely atrophied edentulous jaws. Disregarding anatomical structures standard cylinder implants were used, varying in length only. This compromise often caused fracture of prosthetic components, incessant screw loosening and eventually a failure of the implant. Today's efforts towards attaining esthetic and functional long-term success of implant-supported prostheses focus not only on prosthetic aspects but on preservation or reconstruction of skeletal and soft tissue structures. According to anatomical studies, root-analog implants corresponding in shape, diameter and length to the root geometry of the natural dentition are consistent with the anatomy of the maxilla and mandibula. The earliest possible placement of an anatomically shaped implant prevents the atrophy of alveolar process and maintains gingival height for better soft tissue esthetics. An anatomic implant diameter is of importance for the: Functional load distribution Prosthetic and bio-mechanical stability Higher degree of implant-to-bone contact Correct soft tissue adhesion Reconstruction of an anatomic emergence profile When small diameter implants are used due to narrow ridge dimension, the finished restoration will be significantly larger than the implant. To achieve normal restorative dimensions the crown must be ridge-lapped which results in limited hygiene possibilities and stress on the implant and abutment screw. Whenever it is possible to match implant diameter to the size of the replaced tooth, a smoother and more natural emergence profile results. Therefore the availability of tooth analog implant diameters for the reconstruction of molars, premolars, canines, lateral ad central incisors expands treatment options and enhances the therapeutic outcome. An ideal implant placement according to anatomic considerations is achievable because of the flared root-analog stepped implant design, without risk of damage of adjacent anatomical structures. The availability of an implant diameter according to root diameter, and the earliest possible implant placement post extraction are important parameters for a successful esthetic and functional result. Clinical cases will underline the benefits of root-analog wide diameter implants such as: increased prosthetic and bio-mechanical stability, reduced screw stress, higher degree of implant-to-bone contact, taking full advantage of remaining bone under the maxillary sinus in order that surgical procedures can be reduced, improved emergence profile and avoidance of ridge-lap designs. Keywords: root-analog implants, wide diameter implants, esthetics of implantcrowns, natural emergence profile, soft-tissue management, hygiene access of implants, functional load distribution, biomechanical stability, preservation of soft tissue, implant placement