Healing Abutment Selection. Perio Implant Part I. Implant Surface Characteristics. Single Tooth Restorations. Credit and Thanks for Lecture Material

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1 Healing Abutment Selection Perio Implant Part I Credit and Thanks for Lecture Material Implant Surface Characteristics!CAPT Robert Taft!CAPT Greg Waskewicz!Periodontal Residents NPDS and UMN!Machined Titanium!Tiunite!Osseotite Single Tooth Restorations Implant Dimensions! Problem Screw Loosing " Wider platforms " Internal Hex " Internal connection! Problem Fracture " Wider s " Internal Connections 1 of 7

2 Impact of diameter change Implant Diameter Selection Implant Size 3.7mm 4.0mm 5.0mm 6.0mm Seating Surface 5 " mm2 5 " mm2 12! mm2 21 mm2 Surface Area Baseline 8% 35% 61% 3i XP Osseotite Implant The Single-Tooth Implant as a Standard of Care. Neuman M. Int J Oral Maxillofac Implants 1999;14: Priest G. Int J Oral Maxillofac Implants 1999 Scheller H*. Int J Oral Maxillofac Implants 1998 Laney WR*. Int J Oral Maxillofac Implants 1994 Lindh T*. Clin Oral Implants Res 1998 undisputed first choice for uncomplicated restoration of the single missing tooth Pretreatment Evaluation! Chief Complaint! Medical History! Dental IQ! Intraoral exam! Study Models 3 D! Hard tissue evaluation! Radiographic evaluation! Soft Tissue Evaluation Medical and Systemic Health! Risk factors Vs. Contraindication "Radiation >60 Gy-osteoradionecrosis "IV Bisphosphonates -osteonecrosis 2 of 7

3 Any Long Term Threats?!Xerostomia!Immunosupression!Diabetes!Poor bone metabolism!poor oral hygiene!parafunctional habits!smoking!bisphosphonates Horizontal! wear of all teeth! shallow anterior guidance! supported RPD Vertical! wear of maxillary lingual surfaces! steep guidance Bruxism Diagnosis Anatomic Features! Bone volume! Bone density! Jaw relations! Resorptive pattern Quality and its influence on success!!!3% failures : Type I, II, III!35% failures: Type IV Jaffin and Berman, J Perio of 7

4 Radiographic Distortion!Periapical and occlusal - variable (technique sensitive)!panoral - 25% to 30 %!Lateral ceph - 8%!Computed tomography - negligible Space Requirements Dental Implant Versus Natural Tooth! Unlike natural teeth, the dental cannot attach to gingival fibers.! Gingivodental fibers and transseptal fibers do not exist in the gingival tissue surrounding the abutment The Interdental Papilla! Emergence Profile " Coronal aspect of 2-3mm apical to gingival margins of adjacent teeth. 4 of 7

5 Internal Connection Retention! NobelPerfect!! Scalloped design Papillae & Alveolar Crest (Teeth) <5 mm 100% 6 mm 56% 7 mm 27% Tarnow DP, Magner AW, Fletcher P. The effect of the distance from the contact point to the crest of bone on the presence or absence of the interproximal dental papilla. J Periodontol 1992;63: The Interdental Papilla! Horizontal Dimension (Tarnow, J Periodontol 2000) # Implant shoulder to alveolar crest was 1.4 mm. # 2 s <3mm apart have an overlap of the horizontal effect resulting in horizontal bone loss. # Inter- distance >3mm preserves peak of alveolar crest. Spacing- Mesial Distal! Implant size mm between natural tooth and! Multiple s =Implant size + 3mm between s and 1.5 mm between natural tooth and! Implant size is based on largest dimension of the fixture 5 of 7

6 Pre-Op Planning 1.5mm 3.0mm! Location & number of s! Need for grafting 1.5mm! Design of the surgical guide! Interim restoration 3.0mm 1.5mm Biologic Width Around Implants Platform switch! Bone level ( Hermann, J Periodontol 2000) "Vertical bone loss determined by position of micro-gap at -abutment interface. "In absence of an interface, the rough smooth border determines the position of the alveolar crest. Platform switch Video Clip 6 of 7

7 Anatomic Limitations > 10 mm vertical bone height Drill is 1-2mm longer than the $6 mm bone width B-L Spacing Buccal Lingual! 1mm osseous on both buccal and lingual of! Esthetic areas may need 2 mm buccal bone for esthetics $5 mm anterior to mental foramen Opposing Dentition: Any influence on treatment plan? What did we forget?! Longest drill or combination of + mount device in the surgical drill kit Is there room for what we planned? 7 of 7