Surgical procedures in partially edentulous patients with ITI implants

Today, partially edentulous patients represent the majority of patients seeking treatment with implant-supported prostheses. This chapter presents the specific aspects of the surgical handling of partially edentulous patients with either single-tooth gaps, extended edentulous spaces or distal extension situations. Due to differences in treatment objectives, a distinction is made between sites without esthetic priority (non-esthetic sites) and with esthetic priority (esthetic sites). In non-esthetic sites, the primary goal of the surgical therapy is to achieve a predictable hard and soft tissue integration of the implant to re-establish function with the implant-supported prosthesis. In esthetic sites, the goal of surgical therapy is to achieve successful tissue integration and to obtain esthetic soft tissue contours to re-establish both function and esthetics. Therefore, the surgeon must have a clear understanding of the specific needs in a given situation, and must master the necessary surgical techniques concerning a correct implant placement and a correct soft tissue handling to achieve the treatment objectives. In non-esthetic sites, a non-submerged approach is clearly preferred, thus avoiding a second-stage procedure for abutment connection. If a soft tissue correction is necessary to re-establish keratinized peri-implant mucosa, this is done at the time of implant placement with mucogingival surgery. In esthetic sites, a submerged implant placement is preferred to achieve esthetically pleasing soft tissue contours. If a soft tissue augmentation is necessary, this is done at the time of implant placement with connective tissue grafts. Thus, the second surgical procedure after 8-10 weeks of healing is reduced to a mucosaplasty like a punch biopsy, avoiding an open flap procedure. Based on favorable properties of the TPS surface, short implants (6 or 8 mm) and short healing periods of 3-4 months have been successfully utilized in partially edentulous patients in the last 14 years. The introduction of the SLA surface allows a further reduction of the healing period to 6 weeks of healing in all sites with normal bone density (class I-III). In summary, the ITI philosophy offers straightforward surgical concepts to predictably achieve the treatment objectives with the least demanding surgical protocol, reducing the related chairtime and costs for the patient and the clinician.