Dental Course

Fusion of Perio-Implant and Prosthodontics; Present, Past and the Future. 5-D Japan consensus “BOGR” for Perio-Implant therapy and 4-D concept implant therapy from the esthetic results to long-term prognosis.

Firstly, we would like to discuss our consensus of “BOGR”of Perio-implant treatment for optimal long-term results through my clinical cases. BOGR stands for “balanced osseo-gingival relationship”.

It is a relationship that follows the osseous physiological (natural) form which is scalloped and based on biologic width. In the past, we treated mainly resective therapy for periodontal patients. Now, we are practicing regenerative therapy in cases of severe periodontal teeth. We would like to introduce the diagnosis of regenerative therapy from a clinical point of view for soft tissue stability and the possibility of a new regenerative procedure.

Secondly, we would like to focus on the 4-D concept in esthetic implant therapy.

Many patients undergoing implant treatment imagine that their final restorations will look just like natural teeth.  But, in reality, practitioners must overcome many hurdles to meet their patients’ expectations.  

To overcome those hurdles, we tried many techniques such as immediate implant placement, simultaneous GBR and staged GBR.  The “timing” of the treatment sequence is just as important as the considerations taken into account in the traditional three-dimensional (3D) management of implant position.  In addition, a fourth consideration, ‘timing’ is as important as traditional bone and soft tissue requirements.  We, therefore, add time to the traditional 3D axes and describe our approach herein as the “four-dimensional (4D) concept for esthetic implant therapy.”  The new, expanded concept of 4D implant treatment planning, giving due consideration to the timing of implant treatment sequences, is necessary for predictable and esthetically pleasing treatment outcomes. We would like to show you clinical cases which realized the 4-D concept.

Finally, we would like to call attention to the negative prognosis of implant treatment

Dental implant treatment usually is not recommended for young patients who are still growing. In adults, craniofacial growth is assumed to have matured, subtle growth and unforeseen functional and esthetic implications have nevertheless been reported in patients undergoing partial edentulous implant treatment.

However, dental implants behave like ankylosed teeth and do not move with craniofacial growth. Dr. Daftary reported the problems of open contact, changing occlusion and esthetics caused by craniofacial growth. The dynamic nature of teeth position and occlusion, together with the ankylotic nature of implants, further complicates the treatments.  

We have experienced these issues with many of our patients and were able to successfully manage the problems in some cases.

We would like to share our observations of craniofacial growth in adults, and address both its implications for dental implant treatment as well as offer some potential solutions.