We Introduce You to the Cortico-Basal Implantology !! (Strategic / Immediate Loading Implantology)

Cortico-Basal Implantology is a system that works on the principle of engaging the cortical or the basal bone and not the crestal bone.Since the basal bone remains stable and unaffected throughout the life, the predictability of the basal implants is definitely better as compared to conventional implants.
Cortico-Basal Implantology differs in the design of implants, the type of bone being actively engaged and the loading protocols. In Cortical implantology , the demand for a wide crestal bone does not exist, because only the presence of the 2nd cortical is essential for the anchorage of Implants and also the vertical parts of the Cortico-Basal Implants run outside of the alveolar bone for almost all of the implant length, as long as the thread is anchored in the 1st and 2nd cortical Therefore, cases with reduced Crestal bone dimensions or even those involving serious bone atrophy are considered acceptable in strategic Implantology and can be treated well as long as the 2nd cortical is available.

The overall evaluation of the case, its treatment planning, Implant engagement and the prosthetic regime for Strategic Implants or Cortico-Basal Implants differ significantly from the traditional concepts in Conventional Implantology. Therefore, also a New concept of teaching and a new terminology has been developed to allow easy and precise communication between Implantologists.

How Strategic Implantology Works :

The Strategic Implant functions according to the principles of traumatology and orthopedic (bone) surgery.Immediate loading protocols are used in this system just like traumatology. One significant difference between traumatology and strategic Implantology is found, however, in the origins of the load imposed on the bone. However,In Strategic Implantology significant amounts of the forces are imposed from the opposing jaw to the Implants and the splinting bridge. These forces are of occlusal and masticatory origin. In case of traumatology, all forces arise from the musculoskeletal system, and enter the bone through the joints & not concentrated on the fracture plate directly.

Strategic or Cortico-Basal Implants are non-homogenous Implants as they transmit the load to more stable cortical areas of maxilla and mandible that are least susceptible to resorption.These implants are osseo-fixated in the 2nd or 3rd cortical, whereas they obtain minimal or no anchorage from the 1st cortical until the implant undergoes later osseo-integration. Cortical anchorage and Immediate primary prosthetic splinting yield enough stability for treatment in Immediate loading protocol.

The Cortico-Basal Implants are anchored in the cortical bone by the Implantologist and the process of achieving this type of anchorage has been called “osseo-fixation”. This implies that for primary stability, and for the success of the treatment, the macro-mechanic anchorage osseo-fixation also called as the macro-mechanic anchorage in the 2nd or 3rd cortical is indispensable In conventional or crestal implantology, where implants are osse-integrated into the 1st cortical and the underlying cancellous bone, it is almost impossible to mobilize the already integrated implants after the “healing period” through incorrect occlusal contacts or maticatory slopes in unfavorable angulation to the plane of the bite. Such overloaded implants might fracture, or their abutments, additional screws, or the bridgework might also break. But they will not lose their osseo-integration.
However, the situation is not the same in case of Immediate loading protocols on osseo-fixated implants. Postoperative remodeling in the adjacent bone areas takes place around the osseo-fixated threads of the Implants and if in this duration inadequate forces of occlusion or mastication are imposed, unwanted additional traumatic remodeling will take place and the implant will become mobile and will be subsequently lost.
This implies that the prosthetic part over the strategic Implants is as important as the surgical part of placing the Implant as there is requirement of Immediate Functional Loading on these Implants for the success of this system.

In Immediate loading protocols the implants are splinted immediately (i.e. within 72 hours).This is important, whereas the occlusal and masticatory forces are only the “accessory help”. This is in fact the main decisive point for the patient to decide for this type of treatment and not for lengthy 2-stage protocol (delayed loading) involved in conventional implants . Splinting is usually done through fixed functional bridges or final prosthesis itself. This is good for the patient also as the patients prefer to receive fixed super-structures and this also decreases the overall expense of the treatment.
In conventional crestal implantology a delayed “2-stage treatment protocol and delayed loading of the implants is being followed.

3 TYPES OF BONE CORTICALS :

For the ease of communication amongst the Implantologists, the cortical parts of jaw bone are divided as 1st, 2nd and 3rd corticals.

1st Cortical :

All the crestal cortical bone is called the 1st Cortical. They are indicated by the yellow arrows in the pictorial representation.

2nd Cortical :

Screwable basal implants are positioned in such a way into bones, that their apical load transmitting threads are positioned (engaged) directly into the cortical distance (opposite) to the oral cavity. This part of the cortical bone is termed as the “2nd” cortical.

Examples of 2nd Cortical in Mandible :

Lingual cortical engagement in Distal mandible

Basal cortical engagement (BCE)

Interforaminal region (IFR)

Examples of 2nd Cortical in Maxilla :

Floor of the nose

Parts of the basal sinus corticals

Bone of the outer distal maxilla

3rd Cortical :

In strategic implantology only cortical bone is considered and necessary for implant anchorage. The amount of spongious bone between the 1st and the 2nd cortical and its quality” does not matter at all. Even sections without any spongious bone between the corticals may receive treatment. If there is spongious bone between the corticals available, it may later lead to additional osseo-integration along the implant`s surface.

The Supporting Polygon