Basic Dental Implantology Present Dr Emmanuel Motega Resident
Basic Dental Implantology Present: Dr Emmanuel Motega, Resident OMFS Chairman: Dr Zacharia Shukuru Date: 20 th Desember, 2017
Outline �Introduction �Classification of dental implants �Case selection and treatment planning �Dental implant surgery �Prosthetic option on implants �Surgical challenges and complications �References
Introduction �Definition • Dental implantology is the field of dentistry that is concerned with the replacement of missing teeth and their supporting structures with artificial prostheses anchored to the jawbone.
Introduction cont… • Dental implant is an alloplasstic/synthetic biocompatible material placed in the jaw bone to substitute for a missing tooth and its root(s)
Introduction cont… �History • Successfully replacement of missing teeth and their supporting structures with artificial teeth has been an aspiration of humankind for centuries. • Archaeologists found a fragment of a mandible of Mayan origin, dating from about 600 AD which had three tooth-shaped pieces of shell placed into the sockets of three missing lower incisor teeth.
Introduction cont… �In 1952 the a Swedish orthopaedic surgeon, P I Brånemark, discovered the phenomenon of osseointegration of titanium implants �Defined it as “a direct structural and functional connection between ordered living bone and the surface of a loadcarrying implant”.
Introduction cont…. • Function of teeth • Chewing • Aesthetic • Phonation • Couses of loss of teeth • • • Dental caries Periodantal problems Trauma
• Introduction cont… Effects of unreplaced missed teeth. • • Difficult in chewing hence poor general health. Poor aesthetic- facial disfigurement Difficult phonation. Over eruption of opposing teeth. Tilting of adjacent teeth. Drifting of adjacent teeth. Alveolar bone resorption TMJ problems ( pain, clicking, hearing problem)
Introduction cont… �Besides functional problems, tooth loss can lead to psychological problems due to low self-esteem and social impairment thus considerably affecting the quality of one's life.
Introduction cont… �Different ways of missing teeth replacement • Denture ( partial or complete). • Bridges/ crowns. • Implants � Advancement of dental sciences and public awareness of dental treatment options, a Dental Implant have been always considered as an option.
Introduction cont. . • Advantages of dental implants over the conventional tooth replacement. • • Prevents bone loss ( osseointergration). Strongest and long lasting treatment for replacing a missing tooth. Discomforts from Flanges and palatal extension can be avoided once the denture is retained by implants Option for fixed prosthesis where the conventional bridge is not possible.
Dental implant � Indications for implant treatment: • Restore dental aesthetics • Restore lost dental function: �Chewing �Speech • Space maintenance and occlusal stability • Orthodontic anchorage • Convenience and comfort • Bone preservation and prevention of disuse atrophy after tooth loss
�Parts of implant • Implants consist of; �Osseous part that interacts with the bone �Transmucosal component that interacts with the mucosa � Restoration (crown or bridge abutment, or anchors for dentures)
� The materials used commonly for implants include commercially pure titanium, titanium alloys or occasionally ceramic materials (e. g. zirconium dioxide or aluminium oxide).
Dental Implant And Natural Tooth.
Classification of dental implant �Great majority of modern implants today are endosteal in design. �Endosteal implants are subdivided into several different types characterized by their • Geometry • Shape • surfaces and function • materials:
• Endosteal implants �Cylindrical or root form implants �Blade implants and the ramus frame �Pin implants �Disc implants �Pterygoid or zygomatic implants �Trans-osteal implants
BLADE IMPLANTS Trans-osteal implants
�Cylindrical or Root Form Implants • Root form implants can show variations with respect to: • Thread Design �Thread �Non thread • Geometry �Tapered �Parallel sided
• Diameter �Implants are classified according to their general diameter in cross section. • One-piece or Two-piece Implants �Implants are manufactured either as one piece or two-piece fixtures
Case Selection Treatment and Planning �Adequate case assessment and treatment planning is a prerequisite for satisfactory implant. �During the planning stages, many factors are considered for dental implants including patient’s expectations and financial and time constraints.
�Diagnosis and treatment planning • Patients presenting complaint and wishes and • • • desires Dental and social history Medical history Extra-oral examination including lip and smile lines Intra-oral examination including full periodontal charting Diagnostic imaging
• • • Additional investigations Photography Diagnosis and treatment plan presentation Written treatment plan and cost estimate Patient education and informed consent Communication with other members of the team and the referring practitioners
�Contraindications • • • for implant treatment: History of Periodontal Disease Radiotherapy to the jaw bone Untreated intraoral pathology or malignancy Untreated periodontal disease Uncontrolled drug or alcohol use (abuse) Uncontrolled psychiatric disorders
• Recent myocardial infarction (MI) or cerebrovascular accident (CVA) or valvular prosthesis surgery • Intravenous bisphonate therapy • Immunosuppression - for example following organ transplant or treatment of systemic disease • Inability to maintain high levels of plaque control
Dental Implant Surgery �Surgical planning • Prior to surgery, careful and detailed planning to identify vital structures such as the inferior alveolar nerve or the sinus, as well as the available bone quality, density and volume is mandatory to ensure predictable long-term results. • Bone density and volume can be determined clinically and radiologically.
• A stent may sometimes be required to facilitate the placement of implants.
�Surgical timing • There are different approaches to place dental implants after tooth extraction. 1. Immediate post-extraction implant placement. 2. Delayed immediate post-extraction implant placement (2 weeks to 3 months after extraction). 3. Late implantation (3 months or more after tooth extraction)
�Basic procedure • The placement of a dental implant requires a preparation into the bone using precision drills with highly regulated speed and torque to prevent overheating or putting too much pressure on the bone.
�Healing time • In general implants are allowed to heal for 2– 6 months before they are used to support crowns, bridges, or dentures. • Some studies have shown that early loading of implant may not increase early or long term complications.
�Implant Placement • A surgical procedure � Two stage technique � One stage technique • Surgical approach � Raising a mucoperiasteal flap � Flapless technique
One Stage Surgery
�Advantages of one stage surgery • Easier mucogingival management around the implant • Simplified patient management since no 2 nd surgery.
Two Stage Surgery
�Advantages of two stage surgery • Simultaneuos procedures ( bone graft + implant) • Prevents movement of implants by patient • Augumentation of mucogingival tissues in 2 nd surgery if required.
Rising Mucoperiosteal Flap
Simple Creastal Incisions
Flapless Technique
Flap Incision Vs Flapless
�Advantages of flapless • Shorter and fast surgical treatment- less time needed for complete implantprosthetic restoration • Minimal bleeding and post operative discomfort • Possibility for immediate loading of the inserted implant
SURGICAL SITE PREPARATION �Patient drape �Chlorhexidine gluconate 0. 12% for 4 -5 mins �Atraumatic implant site preparation �Avoid damage to bone or vital structures �Copious irrigation to avoid heating and debris removal �Implant must be place in health bone �Implant site should be kept aseptic
BONE DRILLING �Atraumatic �Drill speed 1200 rpm �Torque 50 N �Intermitent drilling up and down �Low pressure drilling �Well sharpened drills �Drill reusage �Profuse irrigation during drilling �Gradual enlargement of the bur hole
Bone Drilling �Atraumatic �Drill speed 1200 rpm �Torque 50 N �Intermitent drilling up and down �Low pressure drilling �Well sharpened drills �Drill reusage �Profuse irrigation during drilling �Gradual enlargement of the bur hole
Drilling video �. . DesktopDental Implant Procedure SICmax implant iertion. mp 4
Post Surgery Care � Antibiotic � Pain killer � Chiorhexidine mouth wash 0. 12% � Soft Diet � Refrain from tobaccio, cigarate and alcohol one wk before surgery and several wks after surgery � Provisional restoration ( fixed or removable) � Ice pack application several times each after 20 -30 min to minimize swelling.
Implant stability �Implant stability is measured at two different stages: • Primary and secondary, which comes from mechanical engagement with cortical bone. • Secondary stability, which develop from regeneration and remodeling of the bone and tissue around the implant.
Prosthetic Options On Implants
Prosthetic Options On Implants 2. Multiple teeh replacement.
Prosthetic Options On Implants 3. Implant supported removable prosthesis ( implant over denture)
Prosthetic Options On Implants
Prosthetic Options On Implants �Implant supported fixed prosthesis
Prosthetic Options On Implants Implant supported fixed prosthesis
Implant Supported Bridge
Surgical Challenges Inadequate alveolar bone height. Inadequate alveolar bone width. Anatomical structures – � � � • • • � Inferior alveolar nerve, mental foramen Incisive nerve maxillary sinus, floor of the nose, Bone pathology- eg cysts, cementomas etc
Complications of Dental Implant � � � Nerve injury Maxillary sinus perforation Perforation of the buccal/lingual cortical plate Drilling adjacent root of tooth Off axis implant � � � Infection Implant failure Connection screw loosening or fracture Implant body fracture Prosthesis fracture. Peri-implantitis
IMPLANTS KEEPS THE WORLD SMILLING
References 1. 2. 3. Newman, Takei, Klokkevold, Carranza’s Clinical Periodontology, 10 th Edition and 11 th Edition. Lindhe, Lang, Karring. Clinical Periodontology & Implant Dentistry, 5 th Edition. Carle E. Misch. Contemporary Implant Dentistry. 3 rd edition.
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