dr. angelo c. trödhan center for facial esthetics

Dr. Angelo C. Trödhan

Center for Facial EstheticsCenter for Facial EstheticsClinic OA Dr. Angelo C. TrödhanClinic OA Dr. Angelo C. Trödhan

Dr. Izabela SchlichtingDr. Izabela Schlichting

www.perfectsmileandface.com www.kieferchirurgie.at www.parodontose.at

Center for Facial EstheticsCenter for Facial EstheticsClinic OA Dr. Angelo C. TrödhanClinic OA Dr. Angelo C. Trödhan

Dr. Izabela SchlichtingDr. Izabela Schlichting

WorkShopImplantology

How to manage soft tissues and

immediate loading

Non invasive methods

PART IPART IBasic PrinciplesBasic Principles

ofofAnatomyAnatomy

PhysiologyPhysiologyAtraumaticyAtraumaticy

Basic PrinciplesBasic Principles

Soft Tissue is the Issue

But the Bone makes the tone

Use autraumatic surgical Procedures whenever Possible

Use the Tissues Regenerative Capacities whenever Possible

COPY NATURE

Physiology of Regular Alveola Vs. Implant Physiology of Regular Alveola Vs. Implant Site („Bony Aspects“)Site („Bony Aspects“)

Alveolar BoneRoot

Periodontal Ligament

Crown Length

Root Lenght

NO Periodontal Ligament

Dental Implant:

Bone RESORBSon Pressure

Bone GROWS on Pullof the Perio-Ligament OVERLOAD of Implant

is ALWAYS RESORPTION !

CONCLUSIONCONCLUSIONSimple cylindrical Implants ALWAYS have to be:LONGER than the natural toothWIDER than the natural toothto achieve the same SURFACE like the replaced tooth

You have a screw designthat gives MORE surface to the Implant than thereplaced tooth and DISTRIBUTES FORCESbetter. Then the ImplantIs primarily stable and can be loadedIMMEDIATELY

BONE PhysiologyBONE PhysiologyBone heals/regenerates/is prevented from resorption by:

The Periosteum(basal cells ofSinus membraneare periost-like)

Stabilized Blood CoagulumCALLUS (Haver´s/Volkmannvessels)

Microfractures in the Spongiosa Bone speed up Bone Healing TWO TIMES !

CONCLUSIONCONCLUSION

WHENEVER POSSIBLE:

Keep the Periosteum in place and intact !(don´t denude the bone)

Set microfractures in the spongiosaBy Bone Condensing and Bone Spreading !

BONE QualityBONE Quality

Is hard to determine Can be measured by

Bone-Densiometry (expensive !)

Can be approximately determined by CT

Most reliably felt by the hand of the Implantologist !

BONE AtrophyBONE Atrophy

Reduces Implant Length and width

Forces us to put Implants in non-anatomical Positions and angles

Makes Bone augmentation necessary

BONE AugmentationBONE Augmentation The Less The more

Success Primarily Bone

Spreading and Condensing / Sinuslift

If necessary Bone Distraction

Free Grafts as little as possible

Soft Tissue/GingivaSoft Tissue/Gingiva

Is supported by the Bone and Periosteum

Free Gingiva is supported by the natural crown / Implant Neck / Prosthetic Crown

Keep Biological WidthKeep Biological Width1,5 – 2,3 mm1,5 – 2,3 mm

If You reducethe gingivaYou reduceBone

Keep Biological WidthKeep Biological Width1,5 – 2,3 mm1,5 – 2,3 mm

If You reducethe gingivaYou reduceBone:

„Brushing“-Recessions atNatural Teeth

PART IIPART IIBasic PrinciplesBasic Principles

ofofPre-Surgical DiagnosisPre-Surgical Diagnosis

in everyday praxisin everyday praxis

See Me, Feel Me,See Me, Feel Me,Touch Me, Heal me !Touch Me, Heal me !

From The WHO –From The WHO –Musical „Tommy“Musical „Tommy“

SEE, TOUCH,SEE, TOUCH,FEEL !FEEL !

You have to TOUCHYou have to TOUCHbefore You understandbefore You understand

Inspection of the Future Inspection of the Future Implant-SiteImplant-Site

LOOK ! Configuration of Gingiva and Alveolar Crest, Angulation of adjacent teeth, Oral Hygiene

TOUCH and FEEL ! Configuration of Alveolar Crest (Indentions, Height) onbuccal/palate/lingual sites

IMAGINE ! How You will proceed Surgically

PLAN ! What other investigations do Youneed for atraumatic surgery and immediateloading ?

RadiographyRadiography

Panoramic X-Ray with 5mm metal balls for measurement(it also tells You the thickness of the mucosa especially inthe maxilla)

Intraoral X-Ray

Maximum Security:Maximum Security:intra-OP digital Radiographyintra-OP digital Radiography

Sometimes a Dental CTSometimes a Dental CTis helpfulis helpful

On a Cast-Model You can On a Cast-Model You can simulate the Operationsimulate the Operation

Cardinal Principle of WHERE to place Implants for Cardinal Principle of WHERE to place Implants for good cosmetic resultsgood cosmetic results

Midline of Alveolar Crest

Palate connection line

Future cosmetic line

Implant Position

How Much Bone will I have ?How Much Bone will I have ?The „Golden Rule“The „Golden Rule“

Mandible: Measure the Alveolar Crest and Mandible: Measure the Alveolar Crest and subtract 2mmsubtract 2mm

Maxilla: Measure the alveolar Crest and Maxilla: Measure the alveolar Crest and divide it by two and subtract another divide it by two and subtract another

2mm2mm(You will wonder how thick the mucosa is (You will wonder how thick the mucosa is in the upper jaw and how little bone You in the upper jaw and how little bone You

have !)have !)

PART IIIPART IIIDecision makingDecision making

After clinic Investigation, radiography and After clinic Investigation, radiography and Cast-model Planning You Know:Cast-model Planning You Know:

The bone height and width All esthetic necessities Which size of Implant You

will insert Where You will insert the

Implant

Q1-IMPLANTQ1-IMPLANT

Q-IMPLANT ® standard

Neck = 4mm

Q-IMPLANT ® short

Neck = 2mm

Variable Insertion Depth

Length 8 mm 10 mm 12 mm 14 mm

Diameter 3.5 mm 4.5 mm

SurfOss IISurfOss IISurfaceSurface

...... Not only Titanium !!!...... Not only Titanium !!!

Single Part Implant SystemSingle Part Implant System

Copys the natural shape of the root

Selfcutting screw-design

Selfcutting screw-design Bone Trap

Selfcutting screw-design Bone Trap Variable Insertion

Depths for better prosthetic and esthetic handling

Selfcutting screw-design Bone Trap Variable Insertion

Depths for better prosthetic and esthetic handling

NO AbuttmentsNO Abuttments

Q-MultiCap for:Provisional CrownImpressionCrown-Base

Simple InstrumentsSimple Instruments

Pilot-Drill 1,5 Form-Drill 3,5/4,5 Insertion Wheel

Insertion-Handle

Q-Implant-BoxQ-Implant-Box

Impression & Preparation like Impression & Preparation like on a natural toothon a natural tooth

MultiCapMultiCap

OP - SCHEMEOP - SCHEME

Punch or Cut Pilot-Drill Form-Drill3,5mm

Form-Drill4,5mm(if Q1/4,5 isChosen)

Insertion Suture (if necessary) Provisional

Single ToothSingle ToothTraumatic loss of front teeth WITHOUT fracture of the alveolar ridge (11/21: luxated, 22: crown fractured)

Immediate Implant-Insertion after Immediate Implant-Insertion after extraction – Single toothextraction – Single tooth

Immediate Implant-Insertion Immediate Implant-Insertion after extraction - Bridgeafter extraction - Bridge

Immediate Implant-Insertion after Immediate Implant-Insertion after extraction – Single Toothextraction – Single Tooth

Immediate Implant-Insertion after extraction – Immediate Implant-Insertion after extraction – Single ToothSingle Tooth

One Week Later …One Week Later …

Radiographic follow up …Radiographic follow up …

Gingiva after 2 YearsGingiva after 2 Years

Single ToothSingle Tooth

Immediate Implant-Insertion after extraction

Edentulous MaxillaEdentulous Maxilla

Q2-ImplantQ2-Implant… … when angulation does not fitwhen angulation does not fit

… … or two stage implantation or two stage implantation is mandatoryis mandatory

Q2-AbuttmentsQ2-Abuttments

platescrew, platescrew, GinigvaformerGinigvaformer

Straight crown-basesStraight crown-bases

Angle-Angle-Abuttments 15 Abuttments 15 degreesdegrees

Q1-HeadQ1-Head

Q2 – Single Stage ImplantationQ2 – Single Stage Implantation

Q2: 2-stage ImplantationQ2: 2-stage Implantation

Q3-Implant: Q3-Implant: affordable rigid affordable rigid Fixation of total prosthesisFixation of total prosthesis

Prosthesis without gum baseProsthesis without gum base

Anchors can be inserted in the old Anchors can be inserted in the old prosthesis !prosthesis !

Gaumenfrei

Solution for complicated Cases Solution for complicated Cases (Marcoumar-Patients)(Marcoumar-Patients)

Rigid fixation of lower Prosthesis at Rigid fixation of lower Prosthesis at uncompetable Prizeuncompetable Prize

I thank You For Your I thank You For Your AttentionAttention

Dr. Angelo Trödhan

troed@aon.at

www.perfectsmileandface.com

dr. angelo c. trödhan center for facial esthetics

bone condensing

bone height

bone spreading

little bone

bone healing

pressure bone

bone atrophy

bone quality

Documents

2000 esthetics exam

video esthetics

complete denture esthetics

esthetics jed - part iii

esthetics in tooth preparation

philosophy and esthetics

esthetics by elena

esthetics in dental implants

esthetics project two

okklusion - natural esthetics

beautysafe esthetics

esthetics - compendium

milady standard esthetics fundamentals

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