Biologische Prinzipien in der oralen Implantologie

Replacing missing teeth and roots with artificial devices was first attempted almost 2,000 years ago. Two different surgical approaches and implant configurations have evolved, and both achieve high levels of clinical success. The major difference between these two approaches (the submerged and the nonsubmerged approaches) is the implant configuration, not the surgical technique. The presence of an interface (microgap) between the implant and abutment, as well as the location of the interface in relation to the alveolar crest, is critical and has significant biologic implications. These implications include the location and dimensions of the soft and hard tissues and the inflammatory response in the adjacent peri-implant soft tissues. A histologic comparison of soft and hard tissue attachment between teeth and implants reveals similar epithelial attachment mechanisms and structures. However, differences are found between teeth and implants in regard to connective tissue and bony integration, because implants do not have cementum or periodontal ligament structures. The biology associated with implants suggests that they be positioned within the bony housing based on a tissue-driven implant placement technique in addition to a restoration-driven approach. With such placement, dental implants can achieve biologically based, physiologic (and therefore natural) tissue relationships.