as08951.ppt basic principles and practice of oral implantology and osseointegration
TRANSCRIPT
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AS08951.ppt
BASIC PRINCIPLESBASIC PRINCIPLES
AND PRACTICE OFAND PRACTICE OF
ORAL IMPLANTOLOGY AND ORAL IMPLANTOLOGY AND
OSSEOINTEGRATIONOSSEOINTEGRATION
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AS08952.ppt
OSSEOINTEGRATIONOSSEOINTEGRATION
DefinitionDefinition
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AS08953.ppt
OSSEOINTEGRATIONOSSEOINTEGRATION
A direct structural and functional connection A direct structural and functional connection between ordered living bone and the surface between ordered living bone and the surface of a load carrying implantof a load carrying implant
P-I BranemarkP-I Branemark
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AS08954.ppt
OSSEOINTEGRATIONOSSEOINTEGRATION
Relies on an understanding of:-Relies on an understanding of:- Tissue healing and repairTissue healing and repair Tissue remodellingTissue remodelling Soft tissuesSoft tissues Hard tissuesHard tissues Effects of forces in all vectorsEffects of forces in all vectors Immune response to the insertion of Immune response to the insertion of
foreign bodiesforeign bodies
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AS08955.ppt
HISTORYHISTORY
CenturyCentury
17 17 Dental transplantationDental transplantation
2020 SubperiostealSubperiosteal
TransostealTransosteal
Vitreous carbonVitreous carbon
BladeBlade
OsseointegratedOsseointegrated
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AS08956.ppt
RESEARCH BASERESEARCH BASE
1952-19601952-1960 Vital microscopyVital microscopy
1960-19681960-1968 Repair and regeneration of Repair and regeneration of bone and marrowbone and marrow
1965 1965 First jaw implantFirst jaw implant
1965-1965- Clinical researchClinical research
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AS08957.ppt
SUCCESSSUCCESS
RatesRates CriteriaCriteria Research reportsResearch reports
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AS08958.ppt
HARVARD SUCCESS HARVARD SUCCESS
CRITERIACRITERIA
The dental implant must provide functional The dental implant must provide functional
service for 5 years in 75% of casesservice for 5 years in 75% of cases
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AS08959.ppt
SUBJECTIVE CRITERIASUBJECTIVE CRITERIA
Adequate functionAdequate function
Absence of discomfortAbsence of discomfort
Improved aestheticsImproved aesthetics
Improved emotional and psychological Improved emotional and psychological wellbeingwellbeing
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AS089510.ppt
OBJECTIVE CRITERIAOBJECTIVE CRITERIA
Bone loss no greater than 33% of vertical length of Bone loss no greater than 33% of vertical length of implantimplant
Good occlusal balance and vertical dimensionGood occlusal balance and vertical dimension Gingival inflammation amenable to treatmentGingival inflammation amenable to treatment Mobility of less than 1mm. in any directionMobility of less than 1mm. in any direction Absence of symptoms of infectionAbsence of symptoms of infection Absence of damage to surrounding structureAbsence of damage to surrounding structure Healthy connective tissuesHealthy connective tissues
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AS089511.ppt
SUCCESS RATESSUCCESS RATES
%%
Subperiosteal Subperiosteal 39 - 9039 - 90
StapleStaple 9595
Vitreous carbonVitreous carbon 5050
BladeBlade 65 - 9065 - 90
OsseointegratedOsseointegrated 80 - 10080 - 100
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AS089512.ppt
BRANEMARK SYSTEMBRANEMARK SYSTEM
DevelopmentDevelopment Integrated DesignIntegrated Design Quality ControlQuality Control PrecisionPrecision ReliabilityReliability
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AS089513.ppt
ALTERNATIVE ALTERNATIVE TECHNOLOGYTECHNOLOGY
IMZIMZ ITIITI 3M3M CoreventCorevent Apatite coatedApatite coated
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AS089514.ppt
INDICATIONS FOR TREATMENTINDICATIONS FOR TREATMENTFactors precluding wear of a removable prosthesisFactors precluding wear of a removable prosthesis Poor anatomy for denture supportPoor anatomy for denture support Poor oral muscular coordinationPoor oral muscular coordination Poor mucosal tissue tolerancePoor mucosal tissue tolerance Parafunctional habitsParafunctional habits Unrealistic expectationsUnrealistic expectations Hyperactive gag reflexHyperactive gag reflex Psychological inability to wearPsychological inability to wear Unfavourable number and location of abutmentsUnfavourable number and location of abutments Single tooth lossSingle tooth loss
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AS089515.ppt
INDICATIONSINDICATIONS
Fully edentulousFully edentulous
Partially edentulousPartially edentulous
Single toothSingle tooth
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AS089516.ppt
INDICATIONS - INDICATIONS -
FULLY EDENTULOUSFULLY EDENTULOUS Poor retentionPoor retention
Functional disturbancesFunctional disturbances
Psychological disturbancesPsychological disturbances
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AS089517.ppt
MEDICAL EVALUATIONMEDICAL EVALUATION
CardiovascularCardiovascular
RespiratoryRespiratory
RenalRenal
MusculoskeletalMusculoskeletal
NeurologicalNeurological
EndocrineEndocrine
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AS089518.ppt
SPECIFIC MEDICAL CONDITIONSSPECIFIC MEDICAL CONDITIONS
DiabetesDiabetes Coronary artery diseaseCoronary artery disease AlcoholismAlcoholism Drug therapyDrug therapy - anticoagulants- anticoagulants
- anti epileptics- anti epileptics- antidepressants- antidepressants- others- others
OsteoporosisOsteoporosis SmokingSmoking
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AS089519.ppt
PSYCHEPSYCHE
Perception of outcomePerception of outcome hypercriticalhypercritical demandingdemanding unrealistic expectationunrealistic expectation
Time and expenseTime and expense AestheticsAesthetics MaintenanceMaintenance
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AS089520.ppt
DENTAL EVALUATIONDENTAL EVALUATION
Assessment of overall oral healthAssessment of overall oral health
Prior to implant therapy, completion of:-Prior to implant therapy, completion of:- Oral SurgeryOral Surgery Periodontal therapyPeriodontal therapy EndodonticsEndodontics
Temporisation of restorative dentistryTemporisation of restorative dentistry
Oral hygiene controlled and maintainedOral hygiene controlled and maintained
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AS089521.ppt
RADIOLOGYRADIOLOGY
OPGOPG Lateral CephalogramLateral Cephalogram PeriapicalsPeriapicals CT ScanCT Scan - axial- axial
- coronal- coronal
- 3D reconstruction- 3D reconstruction
- Dentascan- Dentascan MRMR
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AS089522.ppt
DIAGNOSISDIAGNOSIS Bone QuantityBone Quantity Bone QualityBone Quality Associated structuresAssociated structures - inferior alveolar nerve- inferior alveolar nerve
- mental nerve- mental nerve- maxillary antrum- maxillary antrum- nasal floor- nasal floor- incisive canal- incisive canal
PathologyPathology - retained dental remnants- retained dental remnants- periapical pathology- periapical pathology- cysts- cysts- other pathology- other pathology
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AS089523.ppt
ALVEOLAR FORMALVEOLAR FORM
AA Good alveolar ridge formGood alveolar ridge form
BB Moderate residual ridge formModerate residual ridge form
CC Advanced resorbtion / Basal bone onlyAdvanced resorbtion / Basal bone only
DD Basal bone resorbtionBasal bone resorbtion
EE Extreme resorbtionExtreme resorbtion
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AS089524.ppt
BONE QUALITYBONE QUALITY
11 Mainly cortical plate compact boneMainly cortical plate compact bone
22 Thick compact bone with a dense Thick compact bone with a dense trabecular coretrabecular core
33 Thin cortical plate with dense trabecular Thin cortical plate with dense trabecular corecore
44 Thin cortical plate with low density Thin cortical plate with low density trabecular coretrabecular core
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AS089525.ppt
BONE QUALITYBONE QUALITY
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AS089526.ppt
ANATOMYANATOMY
Mental nerveMental nerve Inferior alveolar nerveInferior alveolar nerve Nasal cavityNasal cavity Maxillary antrumMaxillary antrum Incisive canalIncisive canal Soft tissuesSoft tissues
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AS089527.ppt
SURGICAL REQUIREMENTSSURGICAL REQUIREMENTS
Standardised surgical protocolStandardised surgical protocol
Surgical environmentSurgical environment
Implant equipmentImplant equipment - reusable- reusable
- disposable/single use- disposable/single use
Fully evaluated and prepared patientFully evaluated and prepared patient
Trained staffTrained staff
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AS089528.ppt
EQUIPMENTEQUIPMENT
FIRST STAGEFIRST STAGE
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AS089529.ppt
STAINLESS STEELSTAINLESS STEEL
Guide drillGuide drill 2mm twist drill2mm twist drill Pilot drillPilot drill 3mm twist drill3mm twist drill CountersinkCountersink
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AS089530.ppt
TITANIUMTITANIUM
TapTap ImplantImplant CoverscrewCoverscrew
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AS089531.ppt
ANAESTHESIAANAESTHESIA
GeneralGeneral
LocalLocal
SedationSedation
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AS089532.ppt
SURGICALSURGICAL
Aseptic techniqueAseptic technique GentlenessGentleness PrecisionPrecision
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AS089533.ppt
SURGICAL PRELIMINARIESSURGICAL PRELIMINARIES
Induction of anaesthesiaInduction of anaesthesia
Endotracheal intubationEndotracheal intubation
Throat packThroat pack
Scrub and gownScrub and gown
Surgical preparationSurgical preparation
DrapingDraping
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AS089534.ppt
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AS089535.ppt
SURGICAL PROCEDURESURGICAL PROCEDURE
Local AnaestheticLocal Anaesthetic
Try in stentTry in stent
TattooTattoo
Surgical incisionSurgical incision
Flap reflectionFlap reflection
Flap retractionFlap retraction
Try in stentTry in stent
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AS089536.ppt
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AS089537.ppt
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AS089538.ppt
Smooth ridgeSmooth ridge
Use stentUse stent
Guide drillGuide drill
Small twist drillSmall twist drill
Pilot drillPilot drill
Large twist drillLarge twist drill
Depth guideDepth guide
SURGICAL PROCEDURESURGICAL PROCEDURE
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AS089539.ppt
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AS089540.ppt
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AS089541.ppt
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AS089542.ppt
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AS089543.ppt
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AS089544.ppt
CountersinkCountersink
Fixture insertionFixture insertion
Cover screwCover screw
DebridementDebridement
ClosureClosure
SURGICAL PROCEDURESURGICAL PROCEDURE
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AS089545.ppt
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AS089546.ppt
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AS089547.ppt
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AS089548.ppt
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AS089549.ppt
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AS089550.ppt
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AS089551.ppt
POSTOPERATIVE CAREPOSTOPERATIVE CARE
HaemostasisHaemostasis
AnalgesiaAnalgesia
Antibiotic regimeAntibiotic regime
Chlorhexidine mouthwashChlorhexidine mouthwash
Suture removalSuture removal
Temporary prosthesisTemporary prosthesis
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AS089552.ppt
SECOND STAGESECOND STAGE
Soft tissueSoft tissue Bone removal Bone removal Cover screw removalCover screw removal Healing abutmentHealing abutment ReplacementReplacement DressingsDressings
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AS089553.ppt
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AS089554.ppt
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AS089555.ppt
KEY POINTSKEY POINTS
Implant positioningImplant positioning - bucco/lingual- bucco/lingual
- axial- axial
- separation- separation Drill speedsDrill speeds - 2000rpm- 2000rpm
- 20rpm- 20rpm TorqueTorque IrrigationIrrigation
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AS089556.ppt
MAXILLARY IMPLANTSMAXILLARY IMPLANTS
Lack of well defined cortexLack of well defined cortex
Poorer quality cancellous bonePoorer quality cancellous bone
Lack of bucco/lingual widthLack of bucco/lingual width
Reduced height of available boneReduced height of available bone
Proximity of anatomical structuresProximity of anatomical structures - nose- nose
- antrum- antrum
- incisive canal- incisive canal
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AS089557.ppt
TECHNIQUE MODIFICATIONSTECHNIQUE MODIFICATIONS
CountersinkingCountersinking
Self tapping implantsSelf tapping implants
Wide implantsWide implants
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AS089558.ppt
COMPLICATIONS WITH COMPLICATIONS WITH OSSEOINTEGRATED OSSEOINTEGRATED
IMPLANTSIMPLANTS
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AS089559.ppt
COMPLICATIONSCOMPLICATIONS PreoperativePreoperative PerioperativePerioperative PostoperativePostoperative TransientTransient PersistentPersistent PermanentPermanent Soft tissueSoft tissue Hard tissueHard tissue
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AS089560.ppt
SERIOUS COMPLICATIONSSERIOUS COMPLICATIONS
Jaw fractureJaw fracture HaemorrhageHaemorrhage IngestionIngestion InhalationInhalation NeurologicalNeurological DeathDeath
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AS089561.ppt
COMPLICATIONSCOMPLICATIONS Patient selection Patient selection
PsychePsyche AnatomyAnatomy Systemic diseaseSystemic disease
Implant factorsImplant factors SurgicalSurgical ProsthodonticProsthodontic Errors in judgementErrors in judgement Deviation from established protocolDeviation from established protocol
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AS089562.ppt
ANATOMYANATOMY
Unsuitable morphologicallyUnsuitable morphologically Reduced bone densityReduced bone density Reduced bone volumeReduced bone volume Attached tissueAttached tissue Nerve positionNerve position
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AS089563.ppt
PREVENTION OF NERVE PREVENTION OF NERVE DAMAGEDAMAGE
CTCT Bone density measurementBone density measurement Drill sleevesDrill sleeves Discretion is better part of valourDiscretion is better part of valour
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AS089564.ppt
COMPLICATIONSCOMPLICATIONS
PeroperativePeroperative
Failure to obtain anaesthesiaFailure to obtain anaesthesia
HaemorrhageHaemorrhage
Stuck implantStuck implant
Loose implantLoose implant
Lost implantLost implant
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AS089565.ppt
SURGICAL FAILURESURGICAL FAILURE
Poor planningPoor planning Poor surgical techniquePoor surgical technique Lack of precisionLack of precision Thermal injuryThermal injury Faulty placementFaulty placement Damage to adjacent structuresDamage to adjacent structures
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AS089566.ppt
SURGICALSURGICAL
HaemorrhageHaemorrhage Stuck implantStuck implant Loose implantLoose implant Lost implantLost implant
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AS089567.ppt
Wound dehiscenceWound dehiscence InfectionInfection Mucosal perforationMucosal perforation Fistula formationFistula formation AnatomicalAnatomical - antral- antral
- nasal- nasal
- neurological- neurological
COMPLICATIONSCOMPLICATIONS
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AS089568.ppt
STAGE ONE SURGERYSTAGE ONE SURGERY
Failure to obtain anaesthesiaFailure to obtain anaesthesia Faulty placementFaulty placement AnatomicalAnatomical SurgicalSurgical
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AS089569.ppt
SURGICALSURGICAL
Stripped bone threadsStripped bone threads Exposed implant threadsExposed implant threads Fractured drillFractured drill Sheared implant hexSheared implant hex Excessive countersinkExcessive countersink Eccentric drillEccentric drill
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AS089570.ppt
Second stageSecond stage
Loose implantLoose implant
Excess bone coverageExcess bone coverage
Exposed threadsExposed threads
Coverscrew problemsCoverscrew problems
COMPLICATIONSCOMPLICATIONS
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AS089571.ppt
STAGE TWO SURGERYSTAGE TWO SURGERY
Wrong abutment lengthWrong abutment length Faulty abutment seatingFaulty abutment seating Retained suturesRetained sutures Gingival hyperplasiaGingival hyperplasia Mobile tissueMobile tissue Destroyed cover screw hexDestroyed cover screw hex Failure of integrationFailure of integration
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AS089572.ppt
FAULTY PLACEMENTFAULTY PLACEMENT
Labial / buccalLabial / buccal LingualLingual Too closeToo close Straight line in mandibular anteriorsStraight line in mandibular anteriors AngulationAngulation DivergenceDivergence Correct by use of a surgical templateCorrect by use of a surgical template
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AS089573.ppt
POSTOPERATIVEPOSTOPERATIVE
Fascial space infectionsFascial space infections HaematomaHaematoma Jaw fractureJaw fracture SinusitisSinusitis Wound dehiscenceWound dehiscence
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AS089574.ppt
WOUND DEHISCENCEWOUND DEHISCENCE
Poor flap designPoor flap design Poor surgical techniquePoor surgical technique Poor repairPoor repair Poor tissue qualityPoor tissue quality Previous surgeryPrevious surgery Underlying medical conditionUnderlying medical condition Superficial implant placementSuperficial implant placement
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AS089575.ppt
PERSISTENTPERSISTENT
Neurological damageNeurological damage AestheticsAesthetics SpeechSpeech FunctionFunction PsychologicalPsychological
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AS089576.ppt
Long term Long term
AnatomicalAnatomical NeurologicalNeurological DeintegrationDeintegration Progressive thread exposureProgressive thread exposure GingivitisGingivitis Hyperplastic tissueHyperplastic tissue Fractured ImplantFractured Implant
COMPLICATIONSCOMPLICATIONS
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AS089577.ppt
PROSTHODONTICPROSTHODONTIC Avoid premature loadingAvoid premature loading Passive fitPassive fit Good designGood design Good oral hygieneGood oral hygiene Loss of integrationLoss of integration Soft tissue problemsSoft tissue problems Oral hygiene and maintenanceOral hygiene and maintenance Retrievable v cementedRetrievable v cemented
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AS089578.ppt
COMPONENT FAILURECOMPONENT FAILURE
Fractured fixtureFractured fixture Fractured abutment screwFractured abutment screw Fractured punch bladeFractured punch blade Fractured screw driver tipFractured screw driver tip Fractured castingsFractured castings
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AS089579.ppt
MANAGEMENT OF MANAGEMENT OF FAILUREFAILURE
Failing implants FAILFailing implants FAIL RemovalRemoval AbandonAbandon Alternative siteAlternative site Larger diameterLarger diameter Replacement after healingReplacement after healing
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AS089580.ppt
GRAFTING TECHNIQUESGRAFTING TECHNIQUES
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AS089581.ppt
GRAFTINGGRAFTING
AutogenousAutogenous - Local- Localsymphysissymphysisthird molarthird molarangleangletuberositytuberosity
- Distant- Distantribribiliac crestiliac cresttibiatibiacalvarialcalvarial
AllogenicAllogenic - frozen- frozen- freeze dried- freeze dried- demineralized- demineralized
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AS089582.ppt
BIOMATERIALSBIOMATERIALS
- methyl methacrylate- methyl methacrylate- silicone- silicone- proplast- proplast- teflon- teflon- calcium phosphates- calcium phosphates
- plaster of paris- plaster of paris- tricalcium phosphate- tricalcium phosphate- hydroxyapatite- hydroxyapatite- goretex- goretex
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AS089583.ppt
GRAFTSGRAFTS
Autogenous boneAutogenous bone Freeze dried boneFreeze dried bone Synthetic biomaterialsSynthetic biomaterials
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AS089584.ppt
FREEZE DRIED BONEFREEZE DRIED BONE
Commercial preparationCommercial preparation Multiple donorsMultiple donors Screened for HIV, Hep B and CScreened for HIV, Hep B and C Sterilised by irradiationSterilised by irradiation Risk of prion borne diseaseRisk of prion borne disease Not licensed in AustraliaNot licensed in Australia
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AS089585.ppt
CALCIUM PHOSPHATESCALCIUM PHOSPHATES
Plaster of parisPlaster of paris Tricalcium phosphateTricalcium phosphate HydroxyapatiteHydroxyapatite
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AS089586.ppt
INDICATIONS FOR INDICATIONS FOR GRAFTINGGRAFTING
Anterior maxillaAnterior maxilla Posterior maxillaPosterior maxilla Anterior mandibleAnterior mandible Posterior mandiblePosterior mandible After resectionAfter resection Post traumaticPost traumatic
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AS089587.ppt
TECHNIQUESTECHNIQUES
Cortico-cancellous blocksCortico-cancellous blocks Trephined coreTrephined core Sinus LiftSinus Lift Vascularised bone flapVascularised bone flap