BASIC PRINCIPLES AND PRACTICE OF ORAL IMPLANTOLOGY AND OSSEOINTEGRATION. AS08951.ppt
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1 BASIC PRINCIPLES AND PRACTICE OF ORAL IMPLANTOLOGY AND OSSEOINTEGRATION AS08951.ppt
2 OSSEOINTEGRATION Definition AS08952.ppt
3 OSSEOINTEGRATION A direct structural and functional connection between ordered living bone and the surface of a load carrying implant P-I I Branemark AS08953.ppt
4 OSSEOINTEGRATION Relies on an understanding of:- Tissue healing and repair Tissue remodelling Soft tissues Hard tissues Effects of forces in all vectors Immune response to the insertion of foreign bodies AS08954.ppt
5 HISTORY Century 17 Dental transplantation 20 Subperiosteal Transosteal Vitreous carbon Blade Osseointegrated AS08955.ppt
6 RESEARCH BASE Vital microscopy Repair and regeneration of bone and marrow 1965 First jaw implant Clinical research AS08956.ppt
7 SUCCESS Rates Criteria Research reports AS08957.ppt
8 HARVARD SUCCESS CRITERIA The dental implant must provide functional service for 5 years in 75% of cases AS08958.ppt
9 SUBJECTIVE CRITERIA Adequate function Absence of discomfort Improved aesthetics Improved emotional and psychological wellbeing AS08959.ppt
10 OBJECTIVE CRITERIA Bone loss no greater than 33% of vertical length of implant Good occlusal balance and vertical dimension Gingival inflammation amenable to treatment Mobility of less than 1mm. in any direction Absence of symptoms of infection Absence of damage to surrounding structure Healthy connective tissues AS ppt
11 SUCCESS RATES % Subperiosteal Staple 95 Vitreous carbon 50 Blade Osseointegrated AS ppt
12 BRANEMARK SYSTEM Development Integrated Design Quality Control Precision Reliability AS ppt
13 ALTERNATIVE TECHNOLOGY IMZ ITI 3M Corevent Apatite coated AS ppt
14 INDICATIONS FOR TREATMENT Factors precluding wear of a removable prosthesis Poor anatomy for denture support Poor oral muscular coordination Poor mucosal tissue tolerance Parafunctional habits Unrealistic expectations Hyperactive gag reflex Psychological inability to wear Unfavourable number and location of abutments Single tooth loss AS ppt
15 INDICATIONS Fully edentulous Partially edentulous Single tooth AS ppt
16 INDICATIONS - FULLY EDENTULOUS Poor retention Functional disturbances Psychological disturbances AS ppt
17 MEDICAL EVALUATION Cardiovascular Respiratory Renal Musculoskeletal Neurological Endocrine AS ppt
18 SPECIFIC MEDICAL CONDITIONS Diabetes Coronary artery disease Alcoholism Drug therapy - anticoagulants - anti epileptics - antidepressants - others Osteoporosis Smoking AS ppt
19 PSYCHE Perception of outcome hypercritical demanding unrealistic expectation Time and expense Aesthetics Maintenance AS ppt
20 DENTAL EVALUATION Assessment of overall oral health Prior to implant therapy, completion of:- Oral Surgery Periodontal therapy Endodontics Temporisation of restorative dentistry Oral hygiene controlled and maintained AS ppt
21 RADIOLOGY OPG Lateral Cephalogram Periapicals CT Scan MR - axial - coronal - 3D reconstruction - Dentascan AS ppt
22 DIAGNOSIS Bone Quantity Bone Quality Associated structures - inferior alveolar nerve - mental nerve - maxillary antrum - nasal floor - incisive canal Pathology - retained dental remnants - periapical pathology - cysts - other pathology AS ppt
23 ALVEOLAR FORM A Good alveolar ridge form B Moderate residual ridge form C Advanced resorbtion / Basal bone only D Basal bone resorbtion E Extreme resorbtion AS ppt
24 BONE QUALITY 1 Mainly cortical plate compact bone 2 Thick compact bone with a dense trabecular core 3 Thin cortical plate with dense trabecular core 4 Thin cortical plate with low density trabecular core AS ppt
25 BONE QUALITY AS ppt
26 ANATOMY Mental nerve Inferior alveolar nerve Nasal cavity Maxillary antrum Incisive canal Soft tissues AS ppt
27 SURGICAL REQUIREMENTS Standardised surgical protocol Surgical environment Implant equipment - reusable - disposable/single use Fully evaluated and prepared patient Trained staff AS ppt
28 EQUIPMENT FIRST STAGE AS ppt
29 STAINLESS STEEL Guide drill 2mm twist drill Pilot drill 3mm twist drill Countersink AS ppt
30 TITANIUM Tap Implant Coverscrew AS ppt
31 ANAESTHESIA General Local Sedation AS ppt
32 SURGICAL Aseptic technique Gentleness Precision AS ppt
33 SURGICAL PRELIMINARIES Induction of anaesthesia Endotracheal intubation Throat pack Scrub and gown Surgical preparation Draping AS ppt
34 AS ppt
35 SURGICAL PROCEDURE Local Anaesthetic Try in stent Tattoo Surgical incision Flap reflection Flap retraction Try in stent AS ppt
36 AS ppt
37 AS ppt
38 SURGICAL PROCEDURE Smooth ridge Use stent Guide drill Small twist drill Pilot drill Large twist drill Depth guide AS ppt
39 AS ppt
40 AS ppt
41 AS ppt
42 AS ppt
43 AS ppt
44 SURGICAL PROCEDURE Countersink Fixture insertion Cover screw Debridement Closure AS ppt
45 AS ppt
46 AS ppt
47 AS ppt
48 AS ppt
49 AS ppt
50 AS ppt
51 POSTOPERATIVE CARE Haemostasis Analgesia Antibiotic regime Chlorhexidine mouthwash Suture removal Temporary prosthesis AS ppt
52 SECOND STAGE Soft tissue Bone removal Cover screw removal Healing abutment Replacement Dressings AS ppt
53 AS ppt
54 AS ppt
55 KEY POINTS Implant positioning Drill speeds Torque Irrigation - bucco/lingual - axial - separation rpm - 20rpm AS ppt
56 MAXILLARY IMPLANTS Lack of well defined cortex Poorer quality cancellous bone Lack of bucco/lingual width Reduced height of available bone Proximity of anatomical structures - nose - antrum - incisive canal AS ppt
57 TECHNIQUE MODIFICATIONS Countersinking Self tapping implants Wide implants AS ppt
58 COMPLICATIONS WITH OSSEOINTEGRATED IMPLANTS AS ppt
59 COMPLICATIONS Preoperative Perioperative Postoperative Transient Persistent Permanent Soft tissue Hard tissue AS ppt
60 SERIOUS COMPLICATIONS Jaw fracture Haemorrhage Ingestion Inhalation Neurological Death AS ppt
61 COMPLICATIONS Patient selection Psyche Anatomy Systemic disease Implant factors Surgical Prosthodontic Errors in judgement Deviation from established protocol AS ppt
62 ANATOMY Unsuitable morphologically Reduced bone density Reduced bone volume Attached tissue Nerve position AS ppt
63 PREVENTION OF NERVE DAMAGE CT Bone density measurement Drill sleeves Discretion is better part of valour AS ppt
64 COMPLICATIONS Peroperative Failure to obtain anaesthesia Haemorrhage Stuck implant Loose implant Lost implant AS ppt
65 SURGICAL FAILURE Poor planning Poor surgical technique Lack of precision Thermal injury Faulty placement Damage to adjacent structures AS ppt
66 SURGICAL Haemorrhage Stuck implant Loose implant Lost implant AS ppt
67 COMPLICATIONS Wound dehiscence Infection Mucosal perforation Fistula formation Anatomical - antral - nasal - neurological AS ppt
68 STAGE ONE SURGERY Failure to obtain anaesthesia Faulty placement Anatomical Surgical AS ppt
69 SURGICAL Stripped bone threads Exposed implant threads Fractured drill Sheared implant hex Excessive countersink Eccentric drill AS ppt
70 COMPLICATIONS Second stage Loose implant Excess bone coverage Exposed threads Coverscrew problems AS ppt
71 STAGE TWO SURGERY Wrong abutment length Faulty abutment seating Retained sutures Gingival hyperplasia Mobile tissue Destroyed cover screw hex Failure of integration AS ppt
72 FAULTY PLACEMENT Labial / buccal Lingual Too close Straight line in mandibular anteriors Angulation Divergence Correct by use of a surgical template AS ppt
73 POSTOPERATIVE Fascial space infections Haematoma Jaw fracture Sinusitis Wound dehiscence AS ppt
74 WOUND DEHISCENCE Poor flap design Poor surgical technique Poor repair Poor tissue quality Previous surgery Underlying medical condition Superficial implant placement AS ppt
75 PERSISTENT Neurological damage Aesthetics Speech Function Psychological AS ppt
76 COMPLICATIONS Long term Anatomical Neurological Deintegration Progressive thread exposure Gingivitis Hyperplastic tissue Fractured Implant AS ppt
77 PROSTHODONTIC Avoid premature loading Passive fit Good design Good oral hygiene Loss of integration Soft tissue problems Oral hygiene and maintenance Retrievable v cemented AS ppt
78 COMPONENT FAILURE Fractured fixture Fractured abutment screw Fractured punch blade Fractured screw driver tip Fractured castings AS ppt
79 MANAGEMENT OF FAILURE Failing implants FAIL Removal Abandon Alternative site Larger diameter Replacement after healing AS ppt
80 GRAFTING TECHNIQUES AS ppt
81 GRAFTING Autogenous Allogenic - Local symphysis third molar angle tuberosity - Distant rib iliac crest tibia calvarial - frozen - freeze dried - demineralized AS ppt
82 BIOMATERIALS - methyl methacrylate - silicone - proplast - teflon - calcium phosphates - plaster of paris - tricalcium phosphate - hydroxyapatite - goretex AS ppt
83 GRAFTS Autogenous bone Freeze dried bone Synthetic biomaterials AS ppt
84 FREEZE DRIED BONE Commercial preparation Multiple donors Screened for HIV, Hep B and C Sterilised by irradiation Risk of prion borne disease Not licensed in Australia AS ppt
85 CALCIUM PHOSPHATES Plaster of paris Tricalcium phosphate Hydroxyapatite AS ppt
86 INDICATIONS FOR GRAFTING Anterior maxilla Posterior maxilla Anterior mandible Posterior mandible After resection Post traumatic AS ppt
87 TECHNIQUES Cortico-cancellous cancellous blocks Trephined core Sinus Lift Vascularised bone flap AS ppt
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