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

OR

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

2 4

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


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

[email protected]

www.perfectsmileandface.com

dr. angelo c. trödhan center for facial esthetics

Documents

bone condensing

bone height

bone spreading

little bone

bone healing

pressure bone

bone atrophy

bone quality