Background: Based on the classic publication from Tarnow 1992, 40% of anterior teeth rehabilitations with dental implants turn out not to be sufficient or satisfactory. Using titanium implant bodies we have to be concerned with tissue recession and the greyish appearance of the implant shoulders. Metal shadow through the gingiva especially in thin mucosa types, loss of the papilla formation with unfavorable „black triangles“ and anomalous lining of the gingiva margins are also of concern.
Aim: Since the revival of full ceramic dental implants made of Zirkonium dioxide in the year 2005 the objectives were to be able to eliminate or at the very least avoid the occurence of the facts mentioned above by having an inert white material without a connection gap problem as observed in the tissue level two-piece design. In this presentation data obtained from 87 patients with 125 full ceramic monotype Straumann implants shall be presented retrospectivly over a period of 9 years.
Materials and Method: A new measurement method was develloped to obtain accurate data. A mixture of metallpowder with temporary cement serves as a marker for the papilla tip which can be recognized sharply in the single-tooth-radiograph. After calibration the distances of the biological width and the bony contact point at the implant to the papilla tip was measured. Clinically the distance from the papilla tip to the contact point of the crowns was visualized and accurately measured using an interdental ligature under tension. So the total distance from the bone contact at the implant to the contact point of the crowns was accurately measured. According to Tarnow the height of the papilla formation was measured in relation to the length of the clinical crown.
Results: The succes rates appear to be above 96%. The analysis of the data shows very clearly there is no need to be concerned with tissue recession as it is frequently observed around titanium implants, but rather we can consistently observe an improvement and growth of the hard and soft tissues.
In the majority of cases, it was observed that over time there would be full interdental papilla formation with the absence or subsequent closure of the initial “black triangles”. This was observed even when the distance from the bone contact to the interdental crown contact was above the critical distance of 5 mm decribed by Tarnow. There were no differences between immediate loading cases and classic two-stage treatment concepts. Only patients with existing compromised papilla levels maintained a more or less empty space between the crowns. However in all these cases the papilla available was enough to achieve very sufficient initial aesthetic result which continue to improve during the following years. Conclusion: It became very obvious there is a new fascinating potential using these full ceramic monotye dental implants leading to a new much higher aesthetic results in the aesthetic zone. Following 3, 5 and 9 years long term studies reveal the stability of the results.
About Dr. Kniha:
Heinz Kniha was born in1954 in Munich; 1965-1974 High School Rupprecht-Gymnasium in Munich; 1974-High School exam; 1974-1975 General Military service; 1975-1983-Studied Medicine and Dentistry at the University Erlangen and Hamburg; 1981- Dental Exam passed at the University Hamburg; 1982-Dental Doctor in the Field of Dentistry at the University Hamburg; “Histological and ultrastruktural Cytodifferenciation of pleomorphic Adenomas of the Salivary Glands”; 1983-Medical Exam passed at the University of Hamburg; 1985-Medical Doctor in the Field of Medicine at the University of Hamburg; “Histological and ultrastructural Investigations of monomorphic Salivary Gland tumors”; 1983-1985-Residency at the Clinic of Oral and Maxillofacial Surgery at the University Munich (Chief Prof. Dr. Dr. D. Schlegel); 1986-Investigation program: Allogenic Transplantatons in Animal Models for plastic u. reconstructive Surgery under regard of microsurgical tissue transfer techniques at the University of California, Irvine, USA, Dep. for Plastic and Reconstructive Surgery Prof.Dr.D.W. Furnas; 1987-1988-Residency at the Clinic of Oral and Maxillofacial Surgery University Munich Prof. Dr. Dr. D. Schlegel; Since 1988- Oral and Maxillofacial Surgeon; 1989-Lectured at the University Munich Habilitation thesis: The allogenic Transplantation of microvascular reanastomosed big combined tissue units in animal models under immunsuppression with Cyclosporin A; Since 1996 -Faculty member at the University of Munich teaching in Implantology and Oral and Maxillofacial Surgery; Since 2005-Professor at the University of Munich; Since 2007-Member of the International Colleges of Dentists (ICD); Since 1989-in Private Clinic as Oral and Maxillofacial surgeon in Munich; Since 1993-Member of the International Team of Implantology (Center Waldenburg, Switzerland). Main fields in our clinic are implantology and periodontal rehabilitations. Munich, 2020 -Prof. Dr. Dr. Heinz Kniha.