The Italian Implantology School is a technique strongly characterized and distinguished by precise and absolutely typical elements, many of which have been adopted and absorbed by the Swedish Implantology School to the point of creating confusion in the implantologists of the latest generations. Therefore it is necessary to understand exactly what is the Italian Implantology School, take a step back and consider how the two schools looked in the late '70s, as they were practically polar opposites:
The Italian School was based on the following cornerstones:
- Compulsory Immediate Loading
- Absence Of Prosthetic Connection
- Implant with Reduced Emergence (platform switching)
- Free Placement of Abutment
- Parallelization by Bending
- Machined Surface
- Titanium Grade Two
- Flapless Placement Technique
- Biological Respect Area
- Absence of Physiological Resorption Around the Implant
- Non-parallel Placement Axes
- Atraumatic and Minimally Invasive'
- Broad Spires and Pitch
- No Need for Reconstructive Surgery
- No Need for Implant Osteoplasty
- Hygienic AND / OR Cosmetic Prostheses
- Possibility of Treating All Types of Bone from D1 to D5
- Immediate Splinting by Electrical Intraoral Welding
- Bicorticalism
The Swedish School was based on the following cornerstones, Very Different from the Italian School’s:
- Compulsory Deferred Load
- Presence of Prosthetic Connection
- Wide Implant Emergence
- Forced Abutment Positioning
- Parallelization by Angled Abutment
- Machined Surface
- Titanium Grade Two
- Placemnt Technique with a Flap.
- Lack of Area of Biological Respect
- Presence of Physiological Resorption around the Implant
- Parallel Axes Placement
- Traumatic and invasive
- Very Reduced Threads and Pitch
- Use of Reconstructive Surgery
- Use of Implant Osteoplasty
- Cosmetic Prosthetics only
- Possibility of Treating Only the Types of Bone from D1 to D2
- Submersion of Implant Body
- Monocorticalism
In 2015 the situation is as follows. The characteristics that each school has adopted from the other are highlighted in bold:
The Italian School relies on the following cornerstones:
- Compulsory Immediate Loading
- Absence of Prosthetic Connection
- Implant with Reduced Emergence (platform switching)
- Free Placement of Abutment
- Parallelization by Bending
- Machined Surface in the Coronal Half, and Treated in the Apical Half
- Titanium Grade Two
- Flapless Placement Technique
- Biological Respect Area
- Absence of Physiological Resorption Around the Implant
- Non-parallel Placement Axes
- Atraumatic and Minimally Invasive
- Broad Spires and Pitch
- No Need for Reconstructive Surgery
- No Need for Osteoplasty
- Hygienic AND / OR Cosmetic Prostheses
- Possibility of Treating All Types of Bone from D1 to D5
- Immediate Splinting by Electrical Intraoral Welding
- Bicorticalism
The Swedish School relies on the following cornerstones:
- Immediate Loading Adopted where Possible
- Presence of Prosthetic Connection
- Implant with Reduced Emergence (platform switching)
- Free Positioning of the Abutments (by using lengthening abutments and adapters)
- Parallelization by Angled Abutment
- Treated Surface
- Titanium Grade 4/5
- Flapless Placement Technique
- Biological Respect Area
- Presence of Physiological Resorption around the Implant
- Non-parallel Placement Axes (by using angled abutments)
- Traumatic and Invasive
- Large Spires and Pitches
- Use of reconstructive Surgery
- Use of Implant Osteoplasty
- Only Aesthetic Prostheses
- Possibility of Treating All Types of Bone from D1 to D5
- Submergence of the Implant Body and Splinting by Electrical Intraoral Welding
- Monocorticalism
As seen from the above lists, while there are some differences between the two schools, the Italian adopted by the Swedish one feature, though only half-way, while the Swedish adopted Italy's most important features.
Let us now examine in detail the conceptual design features that identify the Italian school from its inception:
Screw with Broad Spire - Advantage: bone block between the spires has a generous size.
Large Pitch Screw - Advantage: it ensures bone block’s vascularization (Plateau of Lemons).
Reduced and Free Emergence - Advantage: never being greater than 2.5 mm (even in the case of core diameters up to 4 mm), it ensures minimal irritation on soft tissue, and therefore ensures a very low presence of periimplantitis. (Theory the viscous coupling of James).
Area of Biological Respect (implant part between the last spire and the bottom of the prosthesis) - Advantage: being broad and variable and without prosthetic connection, it allows optimal positioning in relation to the anatomical conditions.
Titanium Grade 2 - Advantage: it allows parallelization by bending, moving abutments, customization and building modified implant structures (S-implants).
Transmucosal - Benefit: prevents surgical re-entries.
Compulsory Immediate loading - Advantage: better patient compliance, respect for the physiology of bone, better bone integration, synergy with bone-repair mechanisms.
Immediate Splinting even intraosseous or submucosal - Advantage: distribution and dispersion of the loads during bone healing in immediate loading.
Immediate Parallelization by Bending – Low cost and ease of immediate prosthetics, ease of execution and lack of bacterial colonization of prosthetic gaps. Ability to instantly retrieve any divergence. Possibility to offset the abutment placement.
Minimal Invasiveness - Best example of conservative surgery: the maximum drilling diameter is of 2,5mm even for 6mm diameter placements. This guarantees a minimum damage both to the bone tissue and to the epithelial tissue for accommodating the core, while the coils will open the way simply by cutting, moving and compacting the trabeculae of the cancellous bone tissue without removing any. Advantage: biological saving, reduced inflammatory reactions, reduced pain after surgery.
Low Traumatic Effects - Advantage: absent or low postsurgical reactions, immediate recovery, reduction of complications, maximum preservation of hard and soft tissue.
Flap - Only in case of need. No need in basic implantology, and drastic reduction in the number of flaps in advanced implantology. Advantage: reduction of complications for tissue dehiscence and exposure of the surgical bed.
Single Stage Implants - Lack of prosthetic connection. Advantage: reduction of the occurrence of periimplantitis.
Therapeutic Adaptability and Manageability - Maximum degree of adaptability to the patient conditions and to anatomical configurations, size and quality of the bone, with the possibility of strong customization of therapy. Advantage: the exclusion of pre-implant augmentation surgery.
Absence of Reconstructive Surgery - Advantage: it makes possible to provide fixed implantoprosthetic solutions to categories of patients normally excluded because of the impossibility of undergoing such surgeries.
No Osteoplastic Surgery - Advantage: great saving in vertical bone and easier postsurgical recovery.
Absence of Bone Physiological Retraction – Advantage: retention of pre-surgical bone dimensions.
Perimplantitis - Statistically insignificant. Advantage: no loss of implant placements due to periimplantitis. Absence of action to contain the phenomenon.
Denture Hygiene - Not only in the interdental spaces, but also and especially in the peri-implant space. Advantage: drastic reduction in mucositis and periimplantitis due to prosthetic trauma.
Biological Respect Area (implant part between the last spire and the bottom of the prosthesis) - Advantage: longer life of the implant restoration.
Elasticity - Greater consistency of the elasticity coefficients between implants and bone. Advantage: reduction of implant failures in areas with the highest elastic deformation, thanks to reduced internal trauma. Possibility of tooth-implant connections.
Harmful Load – Very limited. The harmful load of an implant is the expression of the capacity to produce damage. The higher is the harmful load, the more frequent will be the damage: mucositis, periimplantitis, peri-implant bone resorption etc.
Multitype Implantology and Implant Units – Thanks to the use of intraoral welding, different structures can be built and modified with Needle implants, Bipodes and Tripodes, serving needs of advanced implantology and bicorticalism. In fact the possibilities offered cover almost entirely the need of a dental practice.