DENTAL IMPLANTS DR JEBIN,MDS.,D.ICOI

Transcription

1 Good Morning

2 DENTAL IMPLANTS DR JEBIN,MDS.,D.ICOI

3 What is implant? A dental implant is an artificial root that replaces the natural tooth root. Crown Gum Implant Tooth Root Jawbone

4 Parts of implant Cover screw Implant abutment interface Implant collar Fixture

5 Why Dental Implants? Tooth loss leads to bone loss - Anterior The more teeth that are lost, the greater the impact to your patient s appearan ce and psychologi cal

6 Why Dental Implants? Tooth loss leads to bone loss - Posterior The average reduction in ridge height in the mandible during the first year after extraction is Note: 4mm Wear to from 5mm. clasp on an otherwise healthy adjacent tooth

7 Clinical Options

8 Restorative Option This patient has healthy beautiful teeth. One option is to cut away the healthy tooth structure and provide

9 Restorative Option Or, preserve those two healthy teeth... Place a single implant and provide a restoration that looks, feels and

10 Single Tooth Implant: Advantages High success rates Decreased risk of caries of adjacent teeth. Decreased risk of endodontic problems on adjacent teeth. Decreased cold or contact sensitivity of adjacent teeth. Psychological advantage. Decreased abutment tooth loss.

11 Advantages of Implantsupported Prostheses Bone maintenance. Restoration and maintenance of Occlusal vertical dimension. Maintenance of facial esthetics (muscle tone). Esthetic improvement Improved phonetics. Improved occlusion. Increased prosthesis success.

12 Types Of Implant System

13 1. Endosseous or root form Implants Screw or Thread type Implants Cylindric or Press fit type Implants Tapered Implants 2. Blade form Implants 3. Subperiosteal Implants 4. Transosseous Implants Mandibular staple Implant Transmandibulor Implants or Bosker Implant

14 Endosseous or root form Implants 1. Screw or Thread type Implants: Uses threads for primary stabilization. For the placement of the Threaded Implant the osteotomy site is tapped or prethreaded with a thread former bur, to create the threads in the wall of the osteotomy site.

15 2. Cylindric or Press fit type Implants: Uses friction for primary stabilization. The placement of a Cylindric Implant depends on the friction between the Implant surface and the bone. Thus no tapping is required.

16 3. Tapered Implants: Resemble a tooth root. design for both Threaded and Press fit type Implant. Initially design for immediate placement into extraction socket.

17 Dental Implants can be characterized by their macro and microscopic surface configuration. Macroscopically, we deal with two basic types of implants: Screws Cylinders Microscopically we deal with an assortment of surface treatments and coatings which are all designed to promote osseointegration.

18 Surfaces

19 Specific Micro Surface Design: Machined Acid Etch Shot Blasted Titanium Plasma Spray Hydroxyl Apetite (HA) Plasma Spray Porous Sintered Surfaces TiUnite

20 Machined Surface morphology of a machined commercial pure (CP)Ti dental implant under low magnification Surface morphology of a machined commercial pure (CP)Ti dental implant under high magnification

21 Acid Etch Advantages: increase in surface area. Disadvantages: possibility of contamination

22 Short Blasted Advantages: Increase in surface Roughness may promote ossteoblastic activity Disadvantages: Possibility of contamination

23 Titanium Plasma Spray Shows the SEM image of a Surface morphology of an commercial pure (CP)Ti plasma-sprayed with titanium dental implants surface

24 Hydroxyl Apetite (HA) Plasma Spray Advantages: Increases the surface provides an accelerated biointegration. HA is osteoconductive and promotes rapid and more complete osseointegration. Disadvantages: HA is soluble in oral fluids and if the HA is exposed, it will cause implant failure with accelerated bone loss.

25 Porous Sintered Surface

26 Groovy These have the grooves on the threads of the implants It has been shown in scientific studies that they increase stability compared to implants without grooves.

27 TiUnite SEM image of the TiUnite surface, showing the presence of pores with dimensions around 1-10 micron-m and smaller pores with diameter below 1 micron-m

28 What is TiUnite? TiUnite is a highly crystalline and phosphate enriched titanium oxide. TiUnite is a osseoconductive biomaterial, with its bone and soft tissue stimulating capacity

29 Case planning and preparation

30 Pre Surgical Planning Organized pre surgical team planning is key to the success of an implant restoration. important considerations: Implant placement Occlusal design Hygiene maintenance need to be discussed.

31 Medical Contraindication 1 Absolute Contraindications Recent myocardial infarction Valvular prosthesis Severe renal disorder Uncontrolled diabetes Uncontrolled hypertension Generalized osteoporosis Chronic severe alcoholism Radiotherapy in progress Heavy smoking(20 cig. a day)

32 Oral Contraindications: Ridge dimensions are insufficient to accommodate proper implant placement Lateral oral interferences are present Habits such as Tobacco use Alcohol consumption Poor oral hygiene Bruxism Nail biting Pencil biting Tongue habits

33 The placement of an endosseous implant is complicated by a initial bacterial load present at the time of surgery.

34 Before Placement Of an Implant Survey the surgical site clinically and radiographically to evaluate 1. Any residual infection is present in the bone 2. Presence of a periapical lesion in adjacent teeth

35 Propionibacterium acnes Staphylococcus epidermidis Streptococcus intermedius Wolinella recta Porphyromonas Prevotella Mixed Flora in endodontically involved teeth Hence

36 Any active endodontic lesions adjacent to the implant site should be treated before endosseous implant placement.

37 Any active endodontic lesions adjacent to the implant site should be treated before endosseous implant placement. Overhanging restoration / localized periodontal diseases periostits

38 Patient s Attitudes: Chief complaints Expectations Esthetic expectations Desired functional results

39 Patient s dental history: Condition of soft tissue Condition of teeth Edentulous areas Current prosthesis and ability to provide esthetics, phonetis, and function Temporomandibular joint problems

40 Diagnostic aids Panoramic Radiographs Lateral Cephalograms Tomograms and CT scans Mounted Study Cast and Diagnostic Wax up

41 Surgical guide/template The most important aim of a surgical guide is to guide the surgeon where to place the implant optimally. In addition, the surgical guide provides information about the tooth and supporting structures that have been lost. A well designed surgical guide provides visual communication between the restorative dentist, implant surgeon and dental laboratory technician.

42 Implant Selection

43 Influence of implant diameter and length on crestal stress distribution 1). Greater the diameter of the dental implant less the crestal bone stress. 2). Greater the length of the implant less the crestal bone stress.

44 Implant Placement Procedure 1 Twist Drill ø 2.0 mm 2 Tapered Drill ø 3.5 mm 3 Tapered Drill ø 4.3 mm 4 Screw Tap 5 Implant placement

45 Make an incision for elevation of a fl Drill to the appropriate depth Check orientation of the preparation si direction indicator

46 Drill to the desired depth to enlarg Check orientation of the prepared site

47 Drill to the desired depth to enlarg Implant placement with implant d

48 Use the Surgical Torque Wrench to rotat Use the screwdriver to pick up the C thread it into the implant Close and suture the tissue flap

49

50 Sinus Lift

51 Sinus Lift Indirect sinus lift

52 Direct sinus lift

53 Complications Membrane perforation. Presence of bony septae which divide sinus into separate compartments. Postoperative infection. Wound dehiscence. Barrier Membrane exposure. Transient sinusitis.

54 Reconstruction of atrophic maxilla and mandible Various grafting techniques Block grafts Interpositional Bone Graft Alveolar Distraction Osteogenesis

55 Combination of bone graft and platelet rich plasma (PRP), decrease the healing time. Soft tissue grafts: Used to increase the width of attached gingiva. Connective tissue grafts (most commonly used)

56 Healing

57 The word osseointegration was defined as a direct structural and functional connection between ordered, living bone and the surface of a load carrying implant.

58 Prosthetic phase

59 Abutments Abutments are simply transmucosal extensions for the attachment of prostheses. Abutments can be used to provide a restorative connection above soft tissues and to provide for the biologic width.

60 Healing abutment/gingival former

61 Esthetic abutment

62 Angled Esthetic Abutment

63 Multiunit abutment

64 Ball abutment

65 Bar supported over denture

66 Restorative solutions are the Goal With the internal connection, three broad categories of restorations are possible: Cement retained restorations Screw retained restorations Overdenture restoration

67 Treatment Alternative One stage Immediate Function: One stage Delayed Function Two stage Delayed Function

68 One stage Immediate Function Procedure overview restoring teeth with the implants and Immediate Function is similar to crown & bridge. Requirements for Immediate Function High initial implant stability Controlled loads Osseoconductive implant surfaces

69 One stage Delayed Function The one stage surgical procedure does not require a second surgical stage, abutments are left protruding through the soft tissue.

70 Two stage Delayed Function The two stage surgical procedure protects dental implants from functional loading by submerging the implants below the mucosa at the time of placement. This requires a second surgical stage to uncover the implant.

71 1 Abutment connection 2 Impression abutment level 3 Laboratory procedures 4 Final restoration

72 Maintenance phase The importance of the maintenance procedures should never be underestimated by either the patient or the therapist.

73 Implant Hygiene Products Soft bristle toothbrush Non-abrasive toothpaste Proxy brush Dental floss Electric toothbrushes End-tuft brush Antimicrobial rinses Plastic scalers

74 Implant Hygiene Products

75 Why the implants fail.?

76 Classification Surgical Complications: Inoperative Complications 1.Oversize Osteotomy. 2.Perforation of cortical plates. 3.Inadequate soft tissue flaps for Implant coverage. 4.Broken burs. 5.Improper Instrumentation 6.Hemorrhage. 7.Poor angulations & Position of Implant.

77 PROSTHETIC COMPLICATIONS: Component & framework breakage 1.Fractured Frameworks &Mesostructure bars 2.Partial loosening of cemented bars and prostheses 3.Inaccurate fit of castings 4.Inadequate Torque application 5.In accurate frame work abutment interface 6.Occlusal factors 7.Implant Fracture 8.Implant loss

78 Short term complications: (six months post operative) Postoperative infection Dehiscent Implants. Radiolucencies. Antral complications. Implant mobility.

79 LONG TERM COMPLICATIONS 1 Ailing Implants. 2 Failing implants. 3 Failed implants.

80 Ailing Implant The ailing implant is the least seriously affected Implants. Nothing more than a radiographic evidence of diminishing but static bone loss may direct the implantologist to be suspicious.

81 Failing Implant The failing implants are firm. Osseointegration develops apically and is responsible for the implants stability. Routine radiography reveals progressive bone loss around the cervical areas of the implant. BONE RESORPTION..

82 Failed Implant The simplest definition of a failed implant is mobility. This can be diagnosed by: 1 Tapping and receiving a dull sound. 2 Manipulating by two mirror handles and detecting movement. 3 By the use of the Periotest and eliciting a response of +9 or higher.

83 Keys to Success 1) Take in consideration maintenance liability and health of bone. 2) Give consideration to angiogenesis and blood supply. 3) Do plan the final prosthesis before starting the case.

84 Implants are the standard of care, For you and your patient it s as easy as Crown & Bridge

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