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DENTAL IMPLANTS DR JEBIN,MDS.,D.ICOI
What is implant? A dental implant is an artificial root that replaces the natural tooth root. Crown Gum Implant Tooth Root Jawbone
Parts of implant Cover screw Implant abutment interface Implant collar Fixture
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
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
Clinical Options
Restorative Option This patient has healthy beautiful teeth. One option is to cut away the healthy tooth structure and provide
Restorative Option Or, preserve those two healthy teeth... Place a single implant and provide a restoration that looks, feels and
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.
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.
Types Of Implant System
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
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.
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.
3. Tapered Implants: Resemble a tooth root. design for both Threaded and Press fit type Implant. Initially design for immediate placement into extraction socket.
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.
Surfaces
Specific Micro Surface Design: Machined Acid Etch Shot Blasted Titanium Plasma Spray Hydroxyl Apetite (HA) Plasma Spray Porous Sintered Surfaces TiUnite
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
Acid Etch Advantages: increase in surface area. Disadvantages: possibility of contamination
Short Blasted Advantages: Increase in surface Roughness may promote ossteoblastic activity Disadvantages: Possibility of contamination
Titanium Plasma Spray Shows the SEM image of a Surface morphology of an commercial pure (CP)Ti plasma-sprayed with titanium dental implants surface
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.
Porous Sintered Surface
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.
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
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
Case planning and preparation
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.
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)
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
The placement of an endosseous implant is complicated by a initial bacterial load present at the time of surgery.
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
Propionibacterium acnes Staphylococcus epidermidis Streptococcus intermedius Wolinella recta Porphyromonas Prevotella Mixed Flora in endodontically involved teeth Hence
Any active endodontic lesions adjacent to the implant site should be treated before endosseous implant placement.
Any active endodontic lesions adjacent to the implant site should be treated before endosseous implant placement. Overhanging restoration / localized periodontal diseases periostits
Patient s Attitudes: Chief complaints Expectations Esthetic expectations Desired functional results
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
Diagnostic aids Panoramic Radiographs Lateral Cephalograms Tomograms and CT scans Mounted Study Cast and Diagnostic Wax up
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.
Implant Selection
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.
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
Make an incision for elevation of a fl Drill to the appropriate depth Check orientation of the preparation si direction indicator
Drill to the desired depth to enlarg Check orientation of the prepared site
Drill to the desired depth to enlarg Implant placement with implant d
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
Sinus Lift
Sinus Lift Indirect sinus lift
Direct sinus lift
Complications Membrane perforation. Presence of bony septae which divide sinus into separate compartments. Postoperative infection. Wound dehiscence. Barrier Membrane exposure. Transient sinusitis.
Reconstruction of atrophic maxilla and mandible Various grafting techniques Block grafts Interpositional Bone Graft Alveolar Distraction Osteogenesis
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)
Healing
The word osseointegration was defined as a direct structural and functional connection between ordered, living bone and the surface of a load carrying implant.
Prosthetic phase
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.
Healing abutment/gingival former
Esthetic abutment
Angled Esthetic Abutment
Multiunit abutment
Ball abutment
Bar supported over denture
Restorative solutions are the Goal With the internal connection, three broad categories of restorations are possible: Cement retained restorations Screw retained restorations Overdenture restoration
Treatment Alternative One stage Immediate Function: One stage Delayed Function Two stage Delayed Function
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
One stage Delayed Function The one stage surgical procedure does not require a second surgical stage, abutments are left protruding through the soft tissue.
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.
1 Abutment connection 2 Impression abutment level 3 Laboratory procedures 4 Final restoration
Maintenance phase The importance of the maintenance procedures should never be underestimated by either the patient or the therapist.
Implant Hygiene Products Soft bristle toothbrush Non-abrasive toothpaste Proxy brush Dental floss Electric toothbrushes End-tuft brush Antimicrobial rinses Plastic scalers
Implant Hygiene Products
Why the implants fail.?
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.
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
Short term complications: (six months post operative) Postoperative infection Dehiscent Implants. Radiolucencies. Antral complications. Implant mobility.
LONG TERM COMPLICATIONS 1 Ailing Implants. 2 Failing implants. 3 Failed implants.
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.
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..
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.
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.
Implants are the standard of care, For you and your patient it s as easy as Crown & Bridge
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