surgical ap in implant 21.07.09
TRANSCRIPT
![Page 1: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/1.jpg)
SURGICAL CONSIDERATIONSURGICAL CONSIDERATIONIN IMPLANTOLOGYIN IMPLANTOLOGY
Dr.Dr. Boworn KlongnoiDr.Dr. Boworn Klongnoi
![Page 2: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/2.jpg)
![Page 3: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/3.jpg)
Treatment conceptsTreatment concepts
• Patient driven concept ?
• Surgeon driven concept ?
• Prosthodontist driven concept ?
?
![Page 4: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/4.jpg)
General in dental implantGeneral in dental implant
A proper planning is important for A proper planning is important for
obtaining an acceptable final resultobtaining an acceptable final result Complete treatment plan needs Complete treatment plan needs
consultation from both consultation from both surgeon surgeon
and and prosthodontistprosthodontist Surgeon should also has the Surgeon should also has the
knowledge of prosthodontic knowledge of prosthodontic
planning planning
![Page 5: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/5.jpg)
OsteointegrationOsteointegration
Direct bone deposition on the Direct bone deposition on the
implant surface without implant surface without
intermediate fibrous tissue or intermediate fibrous tissue or
fibrocartilage formationfibrocartilage formation
““Functional ankylosis”Functional ankylosis”
![Page 6: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/6.jpg)
Bone regenerationBone regeneration
Sequence of bone Sequence of bone
regenerationregeneration- Immediate Immediate
(Inflammatory) response (Inflammatory) response
- Bone formationBone formation
- Bone remodalingBone remodaling
![Page 7: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/7.jpg)
Bone regenerationBone regeneration
![Page 8: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/8.jpg)
Bone regenerationBone regeneration
Blood clotBlood clot holds a pool of holds a pool of
chemoattractive and mitogenic chemoattractive and mitogenic
growth factorsgrowth factors- PDGFPDGF
- TGF-TGF-β β - VEGFVEGF
Blood clot provides a temporary Blood clot provides a temporary
extracellular matrix on which extracellular matrix on which
cells can growcells can grow
![Page 9: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/9.jpg)
Bone regenerationBone regeneration
![Page 10: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/10.jpg)
Bone regenerationBone regeneration
Bone marrowsBone marrows
SurroundingSurrounding Mesenchymal progenitor cellsMesenchymal progenitor cellsCirculationCirculation
Soft tissue Soft tissue
PeriosteumPeriosteum
![Page 11: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/11.jpg)
Bone regenerationBone regeneration
![Page 12: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/12.jpg)
Haematoma Haematoma Vessel- and collagen formationVessel- and collagen formation Mineralisation of collagenMineralisation of collagen Bone maturationBone maturation RemodellingRemodelling
Anatomical fundamentalsAnatomical fundamentals
REM: Aggregation auf der Kollagenmatrix
![Page 13: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/13.jpg)
De novo bone formation on implant surfacesDe novo bone formation on implant surfaces
1. early osteopontin expression at initial cement layer formation
2. collagen matrix on the cement layer is mineralised by alc. phosph. and BSP
3. osteocalcin and osteopontin expression at initial mineralisation
4. osteopontin essential part of the organic bone matrix beneath the lining cells and surrounding the
osteocyt lacunas
praeosteoblast
osteoblast
osteocyte
lining cells
cement layer
implant
new formed bone
osteocalcin activated by Cbfa1
osteopontin
bone sialoprotein
osteopontin
osteopontin
alcal. phosphatase
collagen
Sodek,J. und Cheifetz,S.: Molecular Regulation of Osteogenesis, aus Bone Engineering; em squared incorporated, Toronto, Canada;37 (1999 )
Cbfa1
![Page 14: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/14.jpg)
Healing of endosseus implantsHealing of endosseus implants
Osteoconduction
Migration of osteogentic cellsto the implant surface
De novo bone formation - contact osteogenesis
Remodelling
![Page 15: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/15.jpg)
Prerequisites for osteointegrationPrerequisites for osteointegration
1. Precise fitting 1. Precise fitting
(design and inserting techniques)(design and inserting techniques)
2. Primary stability2. Primary stability
3. Adequate loading (Biomechanics)3. Adequate loading (Biomechanics)
4. Bioinert / bioactive materials4. Bioinert / bioactive materials
5. Proper surface configuration 5. Proper surface configuration
![Page 16: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/16.jpg)
Precise fittingPrecise fitting
ShapeShape SurfaceSurface Retention formRetention form
![Page 17: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/17.jpg)
Cortical bone osteointegrationCortical bone osteointegration
Maximum direct bone-implant contactMaximum direct bone-implant contact Press-fitting phenomenonPress-fitting phenomenon Cause Cause local overloadlocal overload Overload -> microcrack, fissureOverload -> microcrack, fissure Bone becomes avascular and necrotic Bone becomes avascular and necrotic
in early stagein early stage In second stage - bore hole replace by In second stage - bore hole replace by
lamella bone in 3 monthslamella bone in 3 months In 15 months - 60-70% living bone In 15 months - 60-70% living bone
contactcontact
![Page 18: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/18.jpg)
Cancellous bone osteointegrationCancellous bone osteointegration
Provide less primary stabilityProvide less primary stability Only 20-25% density compare to Only 20-25% density compare to
compact bonecompact bone Vascular rich / osteoblast richVascular rich / osteoblast rich Divided into two area Divided into two area
1. Trabeculae contact1. Trabeculae contact
2. Marrow contact2. Marrow contact
![Page 19: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/19.jpg)
Stages of implant surgeryStages of implant surgery
1. Two stages surgery1. Two stages surgery
2. One stage surgery2. One stage surgery
3. Immediate function3. Immediate function
![Page 20: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/20.jpg)
Non-Submerged Method
(One-stage implant)
Submerged Method(Two-stage implant)
![Page 21: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/21.jpg)
Possibilities of loadingPossibilities of loading
Alveolus healingAlveolus healing periimplant bone healing functional loading periimplant bone healing functional loading
extra
ction
impla
ntat
ion
reen
try
* Schliephake; Konzepte zur Verkürzung der Behandlungsdauer. Implantologie; 9/4: 357-372 (2001)
Immediate implantation + immediate loading
Immediate implantation + shortened healing phase
Immediate implantation + standard healing
delayed implantation + shortened healing phase
delayed implantation + standard healing phase
![Page 22: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/22.jpg)
tt
immediate-, rsp. early loadingimmediate-, rsp. early loading
biologicalbiological
mechanicalmechanical
implant retention
![Page 23: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/23.jpg)
1. Two stages surgery1. Two stages surgery
Widely acceptable procedureWidely acceptable procedure
stage I : Implant fixture placementstage I : Implant fixture placement
stage II : Soft tissue exposure for abutment stage II : Soft tissue exposure for abutment
placement period between both placement period between both
stage depends on bone quality stage depends on bone quality
![Page 24: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/24.jpg)
![Page 25: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/25.jpg)
![Page 26: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/26.jpg)
![Page 27: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/27.jpg)
BoneBone
Higher failure rate is sometimes Higher failure rate is sometimes
encountered in type I and II boneencountered in type I and II bone
OverheatOverheat
Optiomal drill spead / irrigation / Optiomal drill spead / irrigation /
pretappingpretapping
![Page 28: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/28.jpg)
Implant site preparationImplant site preparation
If the temperature of the bone exceeds If the temperature of the bone exceeds
47 C for 1 minute, bone resorption and 47 C for 1 minute, bone resorption and
fat cell degeneration occursfat cell degeneration occursEriksson and Albrektsson 1983Eriksson and Albrektsson 1983
Dense bone Dense bone : 1500 rpm: 1500 rpm
Cancellous boneCancellous bone : 800 rpm: 800 rpmMisch 1993Misch 1993
![Page 29: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/29.jpg)
Bone tappingBone tapping
Recommended for cases in which the Recommended for cases in which the
bone is dense, compact and poorly bone is dense, compact and poorly
vascularized (Type I or II)vascularized (Type I or II) Not recommended for type III or IVNot recommended for type III or IV
OverpreparationOverpreparation
Fibrous encapsulationFibrous encapsulation
![Page 30: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/30.jpg)
Implant site preparationImplant site preparation
Overheating the bone is due to 3 Overheating the bone is due to 3
factorsfactors- Using dull drillUsing dull drill
- Inadequate irrigationInadequate irrigation
- Torquing or drilling at high speedTorquing or drilling at high speed
Collins and Collins 1998Collins and Collins 1998
![Page 31: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/31.jpg)
Implant insertionImplant insertion
PrinciplePrinciple- Primary stability is requiredPrimary stability is required- No excessive forceNo excessive force- For screw-implant : 10-20 rpmFor screw-implant : 10-20 rpm
20-50 Ncm20-50 Ncm
![Page 32: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/32.jpg)
Selection length of the fixtureSelection length of the fixture
Anatomical limitation : Anatomical limitation :
1. Inferior alveolar nerve1. Inferior alveolar nerve
2. Maxillary sinus2. Maxillary sinus
3. Bone mass3. Bone mass
Anchorage neededAnchorage needed
![Page 33: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/33.jpg)
![Page 34: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/34.jpg)
Tip size by drill diameter
Drill Tip
![Page 35: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/35.jpg)
L= - c - sL= - c - sHHMM
L= L= – 2 – 2 = 8 – 2 – 2 = 815155/45/4
![Page 36: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/36.jpg)
Prediction for proper direction of fixture :Prediction for proper direction of fixture :
There are many way to determineThere are many way to determine
1. Surgical stent1. Surgical stent
2. Guide pin2. Guide pin
3. Occlusion3. Occlusion
4. Teeth adjacent to the space4. Teeth adjacent to the space
5. Intraop. X-Ray5. Intraop. X-Ray
![Page 37: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/37.jpg)
![Page 38: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/38.jpg)
![Page 39: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/39.jpg)
Importance of correct directionImportance of correct direction
Correct prosthetic-implant Correct prosthetic-implant
angulationangulation
Correct loading transferCorrect loading transfer
Correct intercoronal distanceCorrect intercoronal distance
Correct path of prosthetic insertionCorrect path of prosthetic insertion
![Page 40: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/40.jpg)
Stage II procedureStage II procedure
Keep keratinized tissue as Keep keratinized tissue as
important pointimportant point
Create interdental papillae when Create interdental papillae when
possible - in esthetic areapossible - in esthetic area
Abutment selection Abutment selection
![Page 41: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/41.jpg)
![Page 42: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/42.jpg)
![Page 43: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/43.jpg)
![Page 44: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/44.jpg)
BoneBone
Long-term success of dental implants Long-term success of dental implants
appears to be highly dependent on appears to be highly dependent on
both quality and quantity of the both quality and quantity of the
available boneavailable boneJaffin Ra, Berman CL 1991Jaffin Ra, Berman CL 1991
Jaw shape and bone quality must be Jaw shape and bone quality must be
regarded as the regarded as the most influential factorsmost influential factors
affecting implant survivalaffecting implant survivalFriberg et al 1991Friberg et al 1991
![Page 45: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/45.jpg)
Edentulous mandible and maxillaEdentulous mandible and maxillaClassificationClassification Bone Quanlity Bone Quanlity
1 1 The entire mandible/maxilla is composed of The entire mandible/maxilla is composed of
homogeneous compact bone.homogeneous compact bone.
22 A thick layer of compact bone surrounds a A thick layer of compact bone surrounds a
core of dense trabecular bone.core of dense trabecular bone.
33 A thin layer of cortical bone surrounds a core A thin layer of cortical bone surrounds a core
of low-density trabecular bone of favorable of low-density trabecular bone of favorable
strength.strength.
44 A thin layer of cortical bone surrounds a core A thin layer of cortical bone surrounds a core
of low-density trabecular bone.of low-density trabecular bone.
Lekholm U, Zarb GA 1985Lekholm U, Zarb GA 1985
![Page 46: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/46.jpg)
Edentulous mandible and maxillaEdentulous mandible and maxilla
ClassificationClassification Bone QuantityBone Quantity
A A Most of the alveolar ridge is present.Most of the alveolar ridge is present.
BB Moderate ridge resorption has occured.Moderate ridge resorption has occured.
CC Advanced alveolar ridge resorption has Advanced alveolar ridge resorption has
occurred, and only nasal bone remains.occurred, and only nasal bone remains.
DD Some resorption of the basal bone has taken Some resorption of the basal bone has taken
place.place.
EE Extreme resorption of the basal bone has Extreme resorption of the basal bone has
taken place.taken place.
Lekholm U, Zarb GA 1985Lekholm U, Zarb GA 1985
![Page 47: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/47.jpg)
![Page 48: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/48.jpg)
Surgery department
Dental faculty
Mahidol University
![Page 49: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/49.jpg)
Maxilla vs. MandibleMaxilla vs. Mandible
MaxillaMaxilla- Healthy :Healthy : Type II-III, Jaw shape A-CType II-III, Jaw shape A-C
- Resorbed :Resorbed : Type III-IV, Jaw shape D-EType III-IV, Jaw shape D-E
- Limitation :Limitation : Maxillary sinusMaxillary sinus
MadibleMadible- Healthy :Healthy : Type I-II, Jaw shape A-CType I-II, Jaw shape A-C
- Resorbed :Resorbed : Type I-III, Jaw shape D-EType I-III, Jaw shape D-E
- Limitation :Limitation : Mandibular canalMandibular canal
![Page 50: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/50.jpg)
Bone morphology forBone morphology for implant placement implant placement
planning planning
![Page 51: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/51.jpg)
Bone resorptionBone resorption
Change of angle classChange of angle class
Change of intermaxillaryChange of intermaxillary
distancedistance
![Page 52: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/52.jpg)
physiological tooth axis
implant axis at labial bone resorption
![Page 53: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/53.jpg)
DefectDefect
Bone?Bone?
Soft tissue?Soft tissue?
![Page 54: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/54.jpg)
Guided bone regeneration Guided bone regeneration Bone condensing, spreading, splittingBone condensing, spreading, splitting Autogenous bone graft Autogenous bone graft Bone substituteBone substitute Sinus lift Sinus lift Nerve transpositioningNerve transpositioning Interpositional bone graftInterpositional bone graft Microvascular free flap Microvascular free flap
Several surgical techniques available Several surgical techniques available
for correction of atrophic ridge for correction of atrophic ridge
![Page 55: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/55.jpg)
Guided tissue regenerationGuided tissue regeneration
Osteopromotion systemOsteopromotion system
Promote osseous healing Promote osseous healing
in defectin defect
Exclude non-osteogenic Exclude non-osteogenic
soft tissue from defect soft tissue from defect
healinghealing
![Page 56: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/56.jpg)
Guided tissue regenerationGuided tissue regeneration As soft tissue support and prevention for As soft tissue support and prevention for
collapse of spacecollapse of space Creation of clot space provide osteogenic cells Creation of clot space provide osteogenic cells
migrationmigration Protection of granulation tissueProtection of granulation tissue Promote vascular network formationPromote vascular network formation
![Page 57: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/57.jpg)
![Page 58: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/58.jpg)
![Page 59: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/59.jpg)
Ideal position for GTRIdeal position for GTR
![Page 60: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/60.jpg)
No restorative material
No restorative material
CollapseCollapse
![Page 61: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/61.jpg)
Bone condensingBone condensing
PrinciplePrinciple- Nonablative implant bed preparationNonablative implant bed preparation- Condensation of spongiosa at bone-Condensation of spongiosa at bone-
implant contactimplant contact- Alveolar ridge extension Alveolar ridge extension horizontallyhorizontally and and
verticallyvertically IndicationIndication
- To improve primary stability in To improve primary stability in DD33, D, D44 bone bone density density
- Thin alveolar ridge (>3 mm)Thin alveolar ridge (>3 mm)- Closed sinus liftClosed sinus lift
![Page 62: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/62.jpg)
![Page 63: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/63.jpg)
Bone condensingBone condensing
ProceduresProcedures- IncisionIncision- Initial preparatonInitial preparaton
Lindemann-burLindemann-bur
- Apply bone condenser Apply bone condenser instrumentinstrument
- Preparation of implant bedPreparation of implant bed
![Page 64: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/64.jpg)
![Page 65: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/65.jpg)
![Page 66: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/66.jpg)
![Page 67: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/67.jpg)
![Page 68: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/68.jpg)
Bone spreadingBone spreading
PrinciplePrinciple- Nonablative implant bed Nonablative implant bed
preparation as well as preparation as well as alveolar ridge extensionalveolar ridge extension
- Condensation of Condensation of spongiosaspongiosa at bone- at bone-implant contactimplant contact
IndicationIndication- Thin alveolar ridge (at Thin alveolar ridge (at
least 3 mm)least 3 mm)- Bone density DBone density D33 and D and D44
![Page 69: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/69.jpg)
Bone spreadingBone spreading
InstrumentsInstruments- Standard surgical setStandard surgical set
- Standard implant setStandard implant set
- Bone condenser setBone condenser set Osteotome set (Steri Os)Osteotome set (Steri Os) Bone condenser (Dentsply Friadent)Bone condenser (Dentsply Friadent) Summers Osteotome set (Implant Innovations)Summers Osteotome set (Implant Innovations) Dilatatoren set (Osteo Ti)Dilatatoren set (Osteo Ti)
![Page 70: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/70.jpg)
Bone spreadingBone spreading
PreceduresPrecedures- Incision & Flap preparationIncision & Flap preparation
Parapapilla incisionParapapilla incision Crestal incisionCrestal incision
- Cortical osteotomyCortical osteotomy Fine Lindemann-bur, DiscFine Lindemann-bur, Disc A width of 2-4 mmA width of 2-4 mm
- Pilot drill at center of alveolar Pilot drill at center of alveolar
ridgeridge Lindemann-burLindemann-bur
![Page 71: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/71.jpg)
Bone spreadingBone spreading ProceduresProcedures
- Apply bone condenser Apply bone condenser
instrumentsinstruments Use the instrument Use the instrument step-by-stepstep-by-step Apply through pilot hole until the Apply through pilot hole until the
expected depthexpected depth Rotation and anteroposterior Rotation and anteroposterior
extensionextension Stop the manuveurs if the alveolar Stop the manuveurs if the alveolar
ridge width is adequate for ridge width is adequate for
implant placementimplant placement
- Preparation of implant bedPreparation of implant bed Last implant preparation burLast implant preparation bur
![Page 72: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/72.jpg)
![Page 73: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/73.jpg)
![Page 74: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/74.jpg)
![Page 75: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/75.jpg)
![Page 76: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/76.jpg)
![Page 77: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/77.jpg)
![Page 78: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/78.jpg)
Segmental bone splittingSegmental bone splitting
PrinciplePrinciple- Pre / Intraimplantation osteotomy of Pre / Intraimplantation osteotomy of
alveolar ridge bucco-linguallyalveolar ridge bucco-lingually- Mobilisation of segments in transverse Mobilisation of segments in transverse
directiondirection IndicationIndication
- Atrophic alveolar ridge width (2 mm)Atrophic alveolar ridge width (2 mm)- Adequate bone heightAdequate bone height
![Page 79: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/79.jpg)
Segmental bone splittingSegmental bone splitting
Instruments and materialsInstruments and materials- Standard surgical setStandard surgical set
- Standard implant setStandard implant set
- Diamond discDiamond disc
- ChiselsChisels
- Bone condenser setBone condenser set
- Bone substitues (if need)Bone substitues (if need)
![Page 80: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/80.jpg)
Segmental bone splittingSegmental bone splitting ProceduresProcedures
- Incision and flap preparationIncision and flap preparation- Osteotomy of cortical boneOsteotomy of cortical bone
Diamond discDiamond disc Distance from neighbouring teeth Distance from neighbouring teeth ~ ~ 1 mm1 mm Osteotomy at midcrestal bone and mesial/distalOsteotomy at midcrestal bone and mesial/distal
- Splitting the alveolar ridgeSplitting the alveolar ridge ChiselsChisels Green-stick fractureGreen-stick fracture
- Preparation of implant bedPreparation of implant bed Stability mostly from lingual sideStability mostly from lingual side
![Page 81: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/81.jpg)
![Page 82: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/82.jpg)
Segmental bone splittingSegmental bone splitting
ProceduresProcedures- Fixation of segment (with plate and screws)Fixation of segment (with plate and screws)
- Periimplant / Interlamellar bone Periimplant / Interlamellar bone
augmentation augmentation Autogenous boneAutogenous bone Bone substituesBone substitues
![Page 83: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/83.jpg)
![Page 84: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/84.jpg)
![Page 85: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/85.jpg)
![Page 86: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/86.jpg)
Bone augmentationBone augmentation
![Page 87: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/87.jpg)
![Page 88: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/88.jpg)
![Page 89: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/89.jpg)
![Page 90: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/90.jpg)
5 mm.5 mm.
3 mm.3 mm.
![Page 91: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/91.jpg)
![Page 92: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/92.jpg)
![Page 93: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/93.jpg)
![Page 94: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/94.jpg)
![Page 95: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/95.jpg)
![Page 96: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/96.jpg)
![Page 97: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/97.jpg)
![Page 98: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/98.jpg)
![Page 99: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/99.jpg)
![Page 100: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/100.jpg)
![Page 101: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/101.jpg)
![Page 102: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/102.jpg)
![Page 103: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/103.jpg)
![Page 104: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/104.jpg)
![Page 105: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/105.jpg)
![Page 106: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/106.jpg)
![Page 107: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/107.jpg)
![Page 108: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/108.jpg)
Bone graftBone graft
Autogenous bone graft are considered to Autogenous bone graft are considered to be the “gold standard”be the “gold standard”
AdvantagesAdvantages• No risk of immunological rejectionNo risk of immunological rejection• No risk of disease transmissionNo risk of disease transmission• Osteoinductive and osteoconductive potentialOsteoinductive and osteoconductive potential• Source of osteoprogenitor cellsSource of osteoprogenitor cells
Burchardt 1983,Hirsch and Ericsson 1991,Lundgren et al 1996,Raghoebar et al 1993,Wood and Moore 1988
![Page 109: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/109.jpg)
Autogenous bone graftAutogenous bone graft
Disadvantages Disadvantages
Limited amount of graft available in Limited amount of graft available in
intraoral donor sitesintraoral donor sites
The need for a general anesthesia and The need for a general anesthesia and
hospitalization in extraoral donor siteshospitalization in extraoral donor sites
Additional surgical sites Additional surgical sites
Donor site morbidity Donor site morbidity
Laurie et al 1984,Nkenke et al 2001,Nkenke et al 2002,Nkenke et al 2004,Younger and Chapman 1989
![Page 110: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/110.jpg)
![Page 111: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/111.jpg)
Bone graftBone graft
Using bone substitutes avoids or Using bone substitutes avoids or reduces problems associated with reduces problems associated with autogenous bone graft harvestingautogenous bone graft harvesting
![Page 112: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/112.jpg)
![Page 113: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/113.jpg)
![Page 114: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/114.jpg)
![Page 115: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/115.jpg)
![Page 116: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/116.jpg)
![Page 117: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/117.jpg)
![Page 118: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/118.jpg)
![Page 119: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/119.jpg)
Ideal grafting characteristicsIdeal grafting characteristics The ability to produce bone by The ability to produce bone by cellular proliferationcellular proliferation from from
viable transplanted osteoblasts or by osteoconduction of cells viable transplanted osteoblasts or by osteoconduction of cells along the graft‘s surfacealong the graft‘s surface
The ability to produce bone by The ability to produce bone by osteoinductionosteoinduction of recruited of recruited mesenchymal cellsmesenchymal cells
RemodelingRemodeling of the initially formed bone into mature lamellar of the initially formed bone into mature lamellar bonebone
MaintainanceMaintainance of the mature bone over time without loss of the mature bone over time without loss through function through function
The ability to The ability to stabilize implantsstabilize implants when placed simultaneously when placed simultaneously with the graftwith the graft
Low infectionLow infection rate rate EaseEase of availability of availability Low antigenicityLow antigenicity High level of High level of reliabilityreliability
![Page 120: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/120.jpg)
Bone graftBone graft Sinus lift in 94 Pt., 362 ImplantsSinus lift in 94 Pt., 362 Implants 9 types of bone grafting materials9 types of bone grafting materials
- Autogenous boneAutogenous bone- DFDBA (Lifenet)DFDBA (Lifenet)- Calcium carbonate (Biocoral)Calcium carbonate (Biocoral)- Bioactive glass (Bioglass)Bioactive glass (Bioglass)- Polymer of polylactic & polyglycolic acids Polymer of polylactic & polyglycolic acids
(Fisiograft)(Fisiograft)- Bovine-derived bone and peptide (Pepgen P-15)Bovine-derived bone and peptide (Pepgen P-15)- Calcium sulfate (Surgiplaster sinus)Calcium sulfate (Surgiplaster sinus)- Bovine deproteinized bone (Bio-Oss)Bovine deproteinized bone (Bio-Oss)- Hydroxyapatite (Fingranule)Hydroxyapatite (Fingranule)
Scarano et al 2006Scarano et al 2006
![Page 121: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/121.jpg)
Bone graftBone graft
Scarano et al 2006Scarano et al 2006
![Page 122: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/122.jpg)
100 %100 %
tt
Bone substitueBone substitue
New boneNew bone
Auto.boneAuto.bone
![Page 123: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/123.jpg)
Maxillary sinusMaxillary sinus
Maxillary sinus is a pyramid-Maxillary sinus is a pyramid-shaped cavity with its base shaped cavity with its base adjacent to the nasal wall adjacent to the nasal wall and apex pointing to the and apex pointing to the ZygomaZygoma
Adult sinusAdult sinus• 2.5 – 3.5 cm. wide2.5 – 3.5 cm. wide• 3.6 – 4.5 cm. tall3.6 – 4.5 cm. tall• 3.8 – 4.5 cm. deep3.8 – 4.5 cm. deep• Volume 12-15 cmVolume 12-15 cm33
Van den Bergh et al 2000Van den Bergh et al 2000
![Page 124: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/124.jpg)
HistoryHistory
Maxillary sinus graft was first described Maxillary sinus graft was first described
by Tatum at Alabama implant by Tatum at Alabama implant
conference in 1976conference in 1976 First published by Boyne & James in First published by Boyne & James in
19801980 Osteotome technique Osteotome technique was described was described by by
Summers in 1994Summers in 1994
![Page 125: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/125.jpg)
Sinus liftSinus lift PrinciplePrinciple
- - Elevation of Schneiderian membraneElevation of Schneiderian membrane to to
recontour the sinus in the cranial direction recontour the sinus in the cranial direction
and followed by and followed by bone graftbone graft
IndicationIndication- Insufficient alveolar height of post. maxilla Insufficient alveolar height of post. maxilla
- Optimal interarch spaceOptimal interarch space
![Page 126: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/126.jpg)
Sinus liftSinus lift ProceduresProcedures
- Incision and flap preparationIncision and flap preparation- Osteotomy to perform a bone windowOsteotomy to perform a bone window
Round diamond burRound diamond bur Preventing tear of sinus membranePreventing tear of sinus membrane
- Elevation of Schneiderian membraneElevation of Schneiderian membrane- If residual ridge ≥ 4 mm : Simultaneous If residual ridge ≥ 4 mm : Simultaneous
implantation is possibleimplantation is possible Misch 1987, Watzek 1996, Ulm et al 1995Misch 1987, Watzek 1996, Ulm et al 1995
- Bone augmentationBone augmentation
![Page 127: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/127.jpg)
![Page 128: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/128.jpg)
![Page 129: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/129.jpg)
![Page 130: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/130.jpg)
Sinuslift Consensus Conference, Nov.96, Babson College, Ma, USA,
special supplement JOMI, Vol.13, 1998
1107 Sinus augmentationen
2997 Implantation 229 Implants loss
![Page 131: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/131.jpg)
Simultaneosimplantation
2-Stageimplantation
0 20 40 60 80 100
84.5 %
93.1 %
Sinuslift Consensus Conference, Nov.1996, Babson College, Ma, USA
5-year survival rate of implants 5-year survival rate of implants
![Page 132: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/132.jpg)
AuthorAuthor
BlomqvistBlomqvist
BlockBlock
FugazzottoFugazzotto
KhouryKhoury
KüblerKübler
LekholmLekholm
LorenzettiLorenzetti
OlsonOlson
Peleg (a)Peleg (a)
Peleg (b)Peleg (b)
Peleg Peleg
RaghoebarRaghoebar
RaghoebarRaghoebar
SmedbergSmedberg
v. d. Berghv. d. Bergh
WannforsWannfors
WannforsWannfors
WatzekWatzek
WiltfangWiltfang
ZitzmannZitzmann
Number of Number of sinus liftssinus lifts
9797
2727
167167
216216
3939
4747
??
4545
6363
2424
2020
9898
182182
7575
6060
??
??
1414
6363
3030
Year
1998
1998
2002
1999
1999
1999
1998
2000
1999
1999
1998
1999
2001
2001
1998
2000
2000
1998
1999
1998
Number of Patients
50
16
150
216
23
47
13
29
63
21
20
52
99
39
42
20
20
7
53
30
Number of Implants
201
73
167
467
67
181
?
120
160
57
55
204
392
207
161
76
74
53
132
79
F/U
50
72
36
49
24-48
36
?
38,2
24-48
8-10
26,4
32
12-124
36
12-72
12
12
70
24
30
Implant
Survival rate
84,2%
95,9%
97,8%
94,0%
94,1%
76,0%
?
97,5%
100,0%
100,0%
100,0%
93,3%
91,8%
100,0%
100,0%
79,0%
89,0%
95,4%
95,0%
95%-100%
Implant-ation
sec
sim
sec
sim
sim/ sec
sim
sec
sim/ sec
sim
sim
sim
sec
sec
sim
?
sim
sec
sec
sim
sim/ sec
sim: 1629 sec: 1224
TotalTotal 994 12401240 2853 93,59 %
Sinus lift & Implant survival ratemplant survival rate
![Page 133: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/133.jpg)
Nerve transpositioningNerve transpositioning
PrinciplePrinciple- Transposition of inferior alveolar nerve to Transposition of inferior alveolar nerve to
achieve primary stability without bone achieve primary stability without bone augmentationaugmentation
IndicationIndication- Inadequate alveolar height of posterior Inadequate alveolar height of posterior
mandiblemandible- Optimal interarch spaceOptimal interarch space- Compression of mental nerveCompression of mental nerve
![Page 134: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/134.jpg)
![Page 135: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/135.jpg)
![Page 136: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/136.jpg)
![Page 137: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/137.jpg)
![Page 138: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/138.jpg)
![Page 139: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/139.jpg)
![Page 140: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/140.jpg)
Distraction osteogenesisDistraction osteogenesis
PrinciplePrinciple- Controlled, gradual vital bone regeneration Controlled, gradual vital bone regeneration
between osteotmy segmentsbetween osteotmy segments- Increase alveolar ridge height without bone Increase alveolar ridge height without bone
graftgraft IndicationIndication
- Vertical alveolar atrophyVertical alveolar atrophy- Adequate bone widthAdequate bone width- Open biteOpen bite
![Page 141: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/141.jpg)
![Page 142: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/142.jpg)
![Page 143: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/143.jpg)
![Page 144: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/144.jpg)
Microvascular free flapMicrovascular free flap
Local or regional tissues are unavailable or inadequateLocal or regional tissues are unavailable or inadequate
Application of locoregional tissues would result in Application of locoregional tissues would result in
significant or esthetic losssignificant or esthetic loss
When bone reconstruction is requiredWhen bone reconstruction is required
Pt. must withstand a long operative proceduresPt. must withstand a long operative procedures
![Page 145: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/145.jpg)
![Page 146: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/146.jpg)
![Page 147: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/147.jpg)
![Page 148: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/148.jpg)
![Page 149: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/149.jpg)
![Page 150: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/150.jpg)
![Page 151: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/151.jpg)
![Page 152: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/152.jpg)
![Page 153: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/153.jpg)
![Page 154: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/154.jpg)
![Page 155: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/155.jpg)
![Page 156: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/156.jpg)
![Page 157: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/157.jpg)
![Page 158: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/158.jpg)
Post-surgical interim prosthesis managementPost-surgical interim prosthesis management
Relieve acrylic in area of implantRelieve acrylic in area of implant Reline with tissue conditionerReline with tissue conditioner Avoid loading by all means Avoid loading by all means Avoid wearing in 1st-2nd weeksAvoid wearing in 1st-2nd weeks Soft dietSoft diet Daily gentle cleansing Daily gentle cleansing
![Page 159: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/159.jpg)
Soft tissue managementSoft tissue management
Flap designFlap design
Modified palatal roll technique Modified palatal roll technique
Free gingival graft Free gingival graft
Connective tissue graftConnective tissue graft
Vascularized interpositional periosteal-Vascularized interpositional periosteal-
connective tissue (VIP-CT) flapconnective tissue (VIP-CT) flap
Papilla regenerationPapilla regeneration
Membrane Membrane
![Page 160: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/160.jpg)
Flap designFlap designPrinciplePrinciple
Preserve blood supplyPreserve blood supply Preserve the topographic of alveolar ridge and Preserve the topographic of alveolar ridge and
mucobuccal fold mucobuccal fold Identification of important anatomic structuresIdentification of important anatomic structures Provide access for implant instrumentation and Provide access for implant instrumentation and
use of surgical guidesuse of surgical guides Provide access for harvesting of local boneProvide access for harvesting of local bone Provide for closure away from implant or tissue Provide for closure away from implant or tissue
augmentation sitesaugmentation sites Minimize bacterial contaminationMinimize bacterial contamination Facilitate circumferential closure around Facilitate circumferential closure around
permucosal implant structurespermucosal implant structures
![Page 161: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/161.jpg)
Flap designFlap design
Buccal (Facial) flapBuccal (Facial) flap
a: - submerged implanta: - submerged implant
b: - nonsubmerged implantb: - nonsubmerged implant
- abutment connection - abutment connection
![Page 162: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/162.jpg)
Papilla reflectionPapilla reflection
IndicationIndication- Immediate implant placementImmediate implant placement- No need of augmentationNo need of augmentation
![Page 163: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/163.jpg)
![Page 164: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/164.jpg)
Parapapilla incisionParapapilla incision
IndicationIndication- Immediate / Delayed implantationImmediate / Delayed implantation
- Limited defect only coronallyLimited defect only coronally
![Page 165: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/165.jpg)
Parapapilla incision with vestibular extensionParapapilla incision with vestibular extension
IndicationIndication- Immediate / Delayed implantationImmediate / Delayed implantation- Alveolar ridge defectAlveolar ridge defect
![Page 166: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/166.jpg)
U-shaped peninsula flapU-shaped peninsula flap
IndicationIndication- Esthetic implant siteEsthetic implant site- Access of the buccal Access of the buccal
aspect is unnecessaryaspect is unnecessary- No need of No need of
augmentationaugmentation- To prevent scarring and To prevent scarring and
soft tisssue recessionsoft tisssue recession
![Page 167: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/167.jpg)
U-shaped peninsula flapU-shaped peninsula flap
![Page 168: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/168.jpg)
(Mid)crestal incision(Mid)crestal incision
![Page 169: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/169.jpg)
![Page 170: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/170.jpg)
Curvilinear incisionCurvilinear incision
IndicationIndication- As trapezoidal flap- As trapezoidal flap
AdvantagesAdvantages- Incorporation with a greater volume of mucosal Incorporation with a greater volume of mucosal
tissue tissue Improving elasticity Improving elasticity- Flexible for flap adaptation or transpositionFlexible for flap adaptation or transposition- Good esthetic resultsGood esthetic results- Allow for correction of hard and soft tissue Allow for correction of hard and soft tissue
defects simultaneous with implatationdefects simultaneous with implatation- Cutback incision reduces the need of periosteal Cutback incision reduces the need of periosteal
releasing incisionreleasing incision
![Page 171: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/171.jpg)
Curvilinear incisionCurvilinear incision
![Page 172: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/172.jpg)
Modified palatal roll techniqueModified palatal roll technique
![Page 173: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/173.jpg)
Modified palatal roll techniqueModified palatal roll technique
![Page 174: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/174.jpg)
![Page 175: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/175.jpg)
![Page 176: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/176.jpg)
![Page 177: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/177.jpg)
Free gingival graftFree gingival graft
![Page 178: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/178.jpg)
![Page 179: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/179.jpg)
![Page 180: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/180.jpg)
Connective tissue graftConnective tissue graft
![Page 181: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/181.jpg)
![Page 182: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/182.jpg)
![Page 183: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/183.jpg)
![Page 184: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/184.jpg)
![Page 185: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/185.jpg)
![Page 186: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/186.jpg)
Skin graftSkin graft
![Page 187: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/187.jpg)
![Page 188: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/188.jpg)
![Page 189: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/189.jpg)
VIP-CT flapVIP-CT flap
![Page 190: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/190.jpg)
![Page 191: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/191.jpg)
![Page 192: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/192.jpg)
![Page 193: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/193.jpg)
![Page 194: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/194.jpg)
![Page 195: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/195.jpg)
![Page 196: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/196.jpg)
![Page 197: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/197.jpg)
![Page 198: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/198.jpg)
Papilla regenerationPapilla regeneration
![Page 199: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/199.jpg)
![Page 200: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/200.jpg)
![Page 201: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/201.jpg)
![Page 202: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/202.jpg)
![Page 203: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/203.jpg)
![Page 204: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/204.jpg)
![Page 205: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/205.jpg)
![Page 206: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/206.jpg)
MembraneMembrane
![Page 207: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/207.jpg)
![Page 208: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/208.jpg)
1 week1 week
2 weeks2 weeks
![Page 209: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/209.jpg)
![Page 210: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/210.jpg)
![Page 211: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/211.jpg)
![Page 212: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/212.jpg)
![Page 213: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/213.jpg)
![Page 214: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/214.jpg)
![Page 215: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/215.jpg)
![Page 216: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/216.jpg)
![Page 217: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/217.jpg)
![Page 218: Surgical AP in Implant 21.07.09](https://reader037.vdocuments.site/reader037/viewer/2022103014/54791566b4af9f2c7c8b457e/html5/thumbnails/218.jpg)
THANK YOU VERY MUCHTHANK YOU VERY MUCH
FOR YOUR ATTENTIONFOR YOUR ATTENTION