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Dental implants. surgical stages
Basic Surgical Techniques for Endosseous Implant Placement discusses the history and process of dental implants. It describes how Branemark discovered that titanium bonds directly to living bone, called osseointegration. The document outlines the 4 steps of a typical surgical procedure: 1) initial surgery, 2) osseointegration period, 3) abutment connection, and 4) final prosthetic restoration. It also discusses factors that influence osseointegration like biocompatible materials and atraumatic surgery.
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Dental implants. surgical stages
- 1. Basic Surgical Techniquesfor Endosseous Implant Placement Bilozetskyi Ivan
- 2. Dental implantis an artificial titanium fixture which is placed surgically into the jaw bone to substitute for a missing tooth and its root(s). WHAT IS A DENTAL IMPLANT?
- 3. In 1952, ProfessorPer-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". History of Dental Implants
- 4. All current implant designsare modifications of this initial design First Implant Design by Branemark
- 5. STEP 1: INITIALSURGERY STEP 2: OSSEOINTEGRATION PERIOD STEP 3: ABUTMENT CONNECTION STEP 4: FINAL PROSTHETIC RESTORATION Surgical Procedure
- 6. Fibro-osseous integration • Fibroosseousintegration – “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
- 8. 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
- 9. Soft-tissue to implantinterface • 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.
- 10. Soft-tissue to implantinterface • 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
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- 18. The “Parts” • Implantbody-fixture • Abutment (gingival/temporary healing vs. final) • Prosthetics
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- 21. Team Approach • Asurgical – prosthodontic consultation is done prior to implant placement to address: – soft-tissue management – surgical sequence – healing time – need for ridge and soft-tissue augmentation
- 22. Clinical Assessment • Assessthe CC and Expectations • Review all restorative options: – Risks and Benefits • Select option that meets functional and esthetic requirements
- 23. Patient Evaluation • Medicalhistory – vascular disease – immunodeficiency – diabetes mellitus – tobacco use – bisphosphonate use
- 24. History of ImplantSite • 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
- 25. Surgical Phase- TreatmentPlanning • Evaluation of Implant Site • Radiographic Evaluation • Bone Height, Bone Width and Anatomic considerations
- 26. Basic Principles • Soft/hard tissue graft bed • Existing occlusion/ dentition • Simultaneous vs. delayed reconstruction
- 27. Smile Line • Oneof 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
- 28. Anatomic Considerations • Ridgerelationship • Attached tissue • Interarch clearance • Inferior alveolar nerve • Maxillary sinus • Floor of nose
- 29. Radiological/Imaging Studies • Periapicalradiographs • Panoramic radiograph • Site specific tomograms • CAT scan (Denta-scan, cone beam CT)
- 30. Width of Spaceand Diameter of Implant Attention must be paid to both the coronal and interradicular spaces
- 32. A case againstroutine 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
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- 36. Anatomic Limitations Buccal Plate0.5mm 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
- 37. Dental Implant SurgeryPhase I • Aseptic technique • Minimal heat generation – slow sharp drills – internal irrigation? – external cooling
- 38. Dental Implant SurgeryPhase I • Adequate time for integration • Adequate recipient site – soft tissue – bone • Kind & Gentle technique
- 48. 1. Chlorhexidine 2. Analgesics +/-antibiotics Disposition
- 49. Implant placement 3months after menton bone grafting
- 52. Exposure of Implantduring Placement
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- 56. Limitations to Implantplacement in the Maxilla • Ridge width • Ridge height • Bone quality
- 57. Surgical Solutions toAnatomical Limitations Onlay Bone Graft Sinus Lift
- 58. Summers, RB. ANew concept in Maxillary Implant Surgery: The Osteotome technique. Compendium. 15(2): 152, 154-6 • Ridge expansion technique – 3-4 mm of crestal alveolar width required • Sinus floor elevation technique – 8-9 mm of alveolar bone height required in order to place a 13 mm implant (4-5 mm sinus floor elevation)
- 60. Introduction Ridge expansion technique •1.6 mm pilot hole • Summers osteotome # 1-4 – sequenced tapered osteotomes. – ridge expansion (displacement) versus bone removal. • Final drill coincident with the final implant size (sometimes not necessary)
- 62. Introduction Sinus floor elevationtechnique • 1.6 mm pilot hole • Summers osteotome # 1-4 – Sinus floor microfractured superiorly – Sinus floor can be elevated 4-5 mm – May backfill with bone allograft/alloplast • Final drill coincident with final implant size
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- 66. A. Rake, K.Andreasen, S. Rake, J. Swift A Retrospective Analysis of Osteointegration in the Maxilla Utilizing an Osteotome Technique versus a Sequential Drilling Technique, 1999 AAOMS Abstract • 155 maxillary implants in 84 patients restored for at least 6 months – 57 were placed utilizing the osteotome technique – 98 were placed utilizing the drilling technique • One implant failed of the 98 in the drill group • None of the implants had failed of the 57 in the osteotome group
- 67. Stage II SurgeryPreoperative Considerations • 3-6 months after stage I
- 68. Stage II SurgeryPreoperative Considerations • Done under local anesthesia • Pre-op medications – Chlorhexidine rinse
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- 78. • The failingimplant 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 conclusions