Scribd Logo
Upload

Welcome to Scribd!

  • 138 views

    Basic Surgical Techniques For Endosseous Implant Placement

    Uploaded by

    Anshuman Dwivedi
    Basic surgical techniques for endosseous implant placement were summarized in 3 sentences: Dental implants are artificial titanium fixtures surgically placed into the jaw bone to substitute for missing teeth. The initial implant design involved a cylindrical titanium fixture that osseointegrates directly with bone. The surgical procedure involves an initial surgery to place the implant fixture, a healing period for osseointegration, connection of an abutment, and final prosthetic restoration.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd

    Basic Surgical Techniques For Endosseous Implant Placement

    Uploaded by

    Anshuman Dwivedi
    138 views101 pages
    Basic surgical techniques for endosseous implant placement were summarized in 3 sentences: Dental implants are artificial titanium fixtures surgically placed into the jaw bone to substitute for missing teeth. The initial implant design involved a cylindrical titanium fixture that osseointegrates directly with bone. The surgical procedure involves an initial surgery to place the implant fixture, a healing period for osseointegration, connection of an abutment, and final prosthetic restoration.

    Original Description:

    Dental Implant Basic course

    Original Title

    Basic Implant 2018

    Copyright

    © © All Rights Reserved

    Available Formats

    PPT, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Basic surgical techniques for endosseous implant placement were summarized in 3 sentences: Dental implants are artificial titanium fixtures surgically placed into the jaw bone to substitute for missing teeth. The initial implant design involved a cylindrical titanium fixture that osseointegrates directly with bone. The surgical procedure involves an initial surgery to place the implant fixture, a healing period for osseointegration, connection of an abutment, and final prosthetic restoration.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    138 views101 pages

    Basic Surgical Techniques For Endosseous Implant Placement

    Uploaded by

    Anshuman Dwivedi
    Basic surgical techniques for endosseous implant placement were summarized in 3 sentences: Dental implants are artificial titanium fixtures surgically placed into the jaw bone to substitute for missing teeth. The initial implant design involved a cylindrical titanium fixture that osseointegrates directly with bone. The surgical procedure involves an initial surgery to place the implant fixture, a healing period for osseointegration, connection of an abutment, and final prosthetic restoration.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 101
    At a glance
    Powered by AI
    The key takeaways are that dental implants are artificial titanium fixtures placed surgically into the jaw bone to substitute for missing teeth, and that osseointegration, where the implant fuses with living bone, is critical for long term success.

    Osseointegration is the direct fusion of living bone to the surface of a dental implant. It results in very high success rates of over 90% for implants. The epithelial attachment to implants is also important as there is no cementum layer for fiber attachment like natural teeth. Osseointegration allows for long term stability and function of dental implants.

    Good candidates for dental implants are partially or fully edentulous patients who cannot wear removable dentures and have adequate bone for implant placement. Factors like uncontrolled diabetes, radiation therapy, smoking and alcohol abuse can increase risk of failure. Periodontal disease is a contraindication. Inability to maintain oral hygiene is also a contraindication.

    Basic Surgical Techniques for Endosseous

    Implant Placement
    WHAT IS A DENTAL IMPLANT?

     Dental implant is an
    artificial titanium fixture
    which is placed surgically
    into the jaw bone to
    substitute for a missing
    tooth and its root(s).
    History of Dental Implants

    In 1952, Professor Per-Ingvar Branemark,


    a Swedish surgeon, while conducting research
    into the healing patterns of bone tissue, accidentally
    discovered that when pure titanium comes into
    direct contact with the living bone tissue, the two
    literally grow together to form a permanent
    biological adhesion. He named this phenomenon
    "osseointegration".
    First Implant Design by Branemark

    All current implant


    designs are
    modifications of this
    initial design
    Surgical Procedure

    STEP 1: INITIAL SURGERY


    STEP 2: OSSEOINTEGRATION PERIOD
    STEP 3: ABUTMENT CONNECTION
    STEP 4: FINAL PROSTHETIC
    RESTORATION
    Fibro-osseous integration

    • Fibroosseous integration
    – “tissue to implant contact with dense collagenous
    tissue between the implant and bone”
    • Seen in earlier implant systems.
    • Initially good success rates but extremely
    poor long term success.
    • Considered a “failure” by todays standards
    Osseointegration
    • Success Rates >90%
    • Histologic definition
    – “direct connection between living bone and load-
    bearing endosseous implants at the light
    microscopic level.”
    • 4 factors that influence:
    Biocompatible material
    Implant adapted to prepared site
    Atraumatic surgery
    Undisturbed healing phase
    Soft-tissue to implant interface
    • Successful implants have an
    – Unbroken, perimucosal seal between the soft
    tissue and the implant abutment surface.
    • Connect similarly to natural teeth-some differences.
    – Epithelium attaches to surface of titanium much
    like a natural tooth through a basal lamina and
    the formation of hemidesmosomes.
    Soft-tissue to implant interface
    • Connection differs at the connective tissue level.
    • Natural tooth Sharpies fibers extent from the
    bundle bone of the lamina dura and insert into the
    cementum of the tooth root surface
    • Implant: No Cementum or Fiber insertion.
    Hence the Epithelial surface attachment is
    IMPORTANT
    INDICATIONS AND CONTRAINDICATIONS :

    1. Patients with partially or fully edentulous arches may be considered for dental
    implants.

    2. Individuals who are unable to wear removable dentures and have adequate
    bone for insertion of an implant are good candidates, provided they are in good
    general health and are able to maintain good oral hygiene.

    3. Uncontrolled diabetes, prolonged steroid therapy, radiation therapy and abuse


    of alcohol and smoking may contribute to the failure of the implants.

    4. Presence of periodontal disease is also considered to be a contraindication for


    dental implant placement.

    5. Patients who failed to maintain plaque control are poor candidates for implant
    therapy.
    IMPLANT PLACEMENT

    • Always design a thing by considering it in its larger


    context-a chair in a room ,a room in a house ,a house
    in an environment, an environment in a city plan
    Team Approach
    • A surgical – prosthodontic consultation is done prior
    to implant placement to address:
    – soft-tissue management
    – surgical sequence
    – healing time
    – need for ridge and soft-tissue augmentation
    Clinical Assessment
    • Assess the CC and Expectations
    • Review all restorative options:
    – Risks and Benefits
    • Select option that meets functional and esthetic
    requirements
    IMPLANT CLASSIFICATION

    • DESIGN

    • HEX

    • STAGE

    • PIECE
    Cylindrical
    Implant

    Conical
    Implant
    OPTIMIZE THE IMPLANTATION

    Dia. 2,7 mm Lenght


    5 mm

    Dia. 3 mm
    IMPLANT DESIGN

    • Thread design

    Surface Treatment
    IMPLANT DESIGN

    Cylinder
    V-shape
    Reverse buttress
    Square
    THREAD DESIGN

    • Each thread design is going to place specific stresses on the


    bone. A cylinder will place predominantly shear stresses on
    the bone when loaded while a square thread will place
    predominantly compressive force. Typically, bone responds
    more favorably to compressive force and negatively to shear
    stress. The squarethread should be able to withstand more
    load. With this in mind one should consider the potential
    load and bone type when selecting an implant.
    SURFACE TREATMENT

    Machined
    Blasted
    Etched
    Ha
    combination
    IMPLANT DESIGN

    • Length and width


    • Larger implants-greater initial stability
    • Wider implants-more load distribution
    • Awareness of vital structures
    • Utilise good judgments to place the
    adequate implant for the site
    • Functional surface area:

    • “The area that actively serves to dissipate


    compressive and non-shear loads through the
    implant- bone interface and provide initial stability
    of the implant following surgical placement.” –Dr Carl
    Misch
    Subperiosteal
    Transmandibular Implant
    Blade Implant
    Endosteal Implants
    BONE

     Available bone using the Misch-Judy Classification.

     Type A >5mm width (buccal-lingual dimension), >10mm height


    (vertical),>7mm length (mesial ?distal dimension), <30
    degrees angulation,and a crown-implant ratio better than 1:1.

     Type B Barely sufficient in 1 or more measurement


     Type Bw Barely sufficient width
     Type Cw Compromised width
     Type Ch Compromised height
     Type D Deficient.
    BONE DENSITY

    • Bone Density Classification


    • D1 Dense cortical
    • Anterior mandible

    • D2 Variable thickness cortical bone with course trabecular within.


    • Posterior mandible

    • D3 Thin cortical bone with fine trabecular within.


    Posterior mandible,anterior maxilla

    • D4 Fine trabecular bone


    • Posterior maxilla

    • D5 Immature, non-mineralized bone.


    • Recent extraction sites
    Restoration
    • Classification

    • FP 1
    • FP 2
    • FP 3
    • RP 4
    • RP 5
    FP 1
    FP 2
    FP 3
    LABORATORY COMMUNICATION
     Long-term success is most dependent on proper
    management of formitted to the implant-bone interface.
    As long as those forable threshold of the bone, success
    can be expected. eliminated, reduced, or balanced are:
     -Magnitude
     -Duration
     -Direction
     -Type
     -Magnification
     Regular monitoring of the implant and restoration is
    necessarry
     insure these force factors are kept within range.
    STEPS IN IMPLANT RESTORATION
    • Pre-Surgical

    • Surgical

    • Post Surgical
    PRE-SURGICAL

     Patient Evaluation

     Case Selection

     Case Evaluation

     Case-Presentation
    PATIENT EVALUATION

    • Psychological

    • Medical
    Patient Evaluation
    • Medical history
    – vascular disease
    – immunodeficiency
    – diabetes mellitus
    – tobacco use
    – bisphosphonate use
    History of Implant Site

    • Factors regarding loss of tooth being replaced

    – When?

    – How?

    – Why?

    • Factors that may affect hard and soft tissues:

    – Traumatic injuries

    – Failed endodontic procedures

    – Periodontal disease

    • Clinical exam may identify ridge deficiencies


    Surgical Phase- Treatment Planning
    • Evaluation of Implant Site
    • Radiographic Evaluation
    • Bone Height, Bone Width and Anatomic
    considerations
    Basic Principles
    • Soft/ hard tissue graft bed
    • Existing occlusion/ dentition
    • Simultaneous vs. delayed reconstruction
    CASE SELECTION
    • Level Of Education

    • Expertise

    • Armamentarium and Facilities


    Case –Evaluation/Diagnostics

    • Models

    • Radiographs

    • CT Scan
    Models
    • Inter-Arch Distance

    • Available space Mesio-Distally

    • Available Bone-

    • Prosthesis Plan
    Radiographs
    • IOPA

    • OPG

    • Implant Overlay
    CAT SCAN

    • A fundamental part of implant diagnosis is a good


    radiographic study, which will contribute largely to
    the surgeons success. For a long time, most of the
    dentist had used panoramic and intra oral
    radiography, together with positioning guides , as
    their main diagnostic tools. Bone width and quality
    were estimated based on experience. Treatment
    planning was vague & imprecise.
    • Software like Implant 3D are user friendly, cost
    effective with all the features to make it ready for
    use. It is user friendly & does not require any special
    software to be loaded to take the CT images.
    • It allows the visualization of internal bone
    morphology in three dimensions; therefore the
    dental surgeon can plan his treatment precisely.

    • In cross sectional view, observation regarding bone


    quality,density can be made typically by direct
    measurement,if they are present in life size format.
    ADVANTAGES
    The advantage of CT Scan technology allows for an
    accurate assessment of :

    a) Bone height & width


    b) Identification of soft & hard tissue pathology
    c) Location of anatomical structures
    d) Measuring the vital qualitative dimensions
    necessary for implant placement.
    Smile Line
    • One of the most influencing factors of any
    prosthodontic restoration
    • If no gingival shows then the soft tissue quality,
    quantity and contours are less important
    • Patient counseling on treatment expectations is
    critical
    Anatomic Considerations
    • Ridge relationship
    • Attached tissue
    • Interarch clearance
    • Inferior alveolar nerve
    • Maxillary sinus
    • Floor of nose
    Width of Space and Diameter of Implant

    Attention must be paid to both the coronal and


    interradicular spaces
    A case against routine CT
    • Expense
    • Time consuming process
    • Use of radiographic template/proper fit requires DDS
    present
    • Contemporary panoramic units have tomographic
    capabilities
    • Usually adds no additional data over standard
    database
    Anatomic Limitations

    Buccal Plate 0.5mm


    Lingual Plate 1.0 mm
    Maxillary Sinus 1.0 mm
    Nasal Cavity 1.0mm
    Incisive canal Avoid
    Interimplant distance 1-1.5mm
    Inferior alveolar canal 2.0mm
    Mental nerve 5mm from foramen
    Inferior border 1 mm
    Adjacent to natural tooth 0.5mm
    CASE PRESENTATION

    • Diagnostic Wax Up

    • Case Reports

    • Possibilities

    • Animation

    • Models

    • Costing
    Dental Implant Surgery Phase I

    • Aseptic technique
    • Minimal heat generation
    – slow sharp drills
    – internal irrigation?
    – external cooling
    Dental Implant Surgery Phase I

    • Adequate time for integration


    • Adequate recipient site
    – soft tissue
    – bone
    • Kind & Gentle technique
    Disposition

    1. Chlorhexidine
    2. Analgesics
    +/- antibiotics
    Implant placement 3 months after menton bone
    grafting
    Exposure of Implant during Placement
    Limitations to Implant placement in the
    Maxilla

    • Ridge width
    • Ridge height
    • Bone quality
    Surgical Solutions to Anatomical Limitations

    Onlay Bone Graft Sinus Lift


    Stage II Surgery Preoperative Considerations

    • Done under local anesthesia


    • Pre-op medications
    – Chlorhexidine rinse
    Placement of
    healing abutment
    conclusions
    • The failing implant is very difficult to treat
    • Traumatic surgical manipulation with
    initial instability of implant increases risk
    of failure
    • Implant success is only as good as the
    prosthodontic reconstruction

    You might also like