dental implants _perio_

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  • 1. Dental ImplantsDefinition -A Dental Implant is defined as A substance that is placed into the jaw to support a crown or fixed or removable denture.

2. Indications: For completely edentulous patients withadvanced residual ridge resorption. For partially edentulous arches where RPDmay weaken the abutment teeth. In patients with maxillofacial deformities. 3. For single tooth replacement where fixedpartial dentures cannot be placed . Patients who are unable to wear RPD. Patients desire . Patients who have adequate bone for theplacement of implants. 4. CONTRAINDICATION Presence of non treated or unsuccessfullytreated periodontal disease Poor oral hygiene. Uncontrolled diabetes. Chronic steroid therapy . High dose irradiation. Smoking and alcohol abuse. 5. ADVANTAGES- Preservation of bone Improved function Aesthetics Stability and support. 6. Disadvantages- Can not be used in medically compromisedpatients who cannot undergo surgery. Longer duration of treatment. Need of a lot of patients cooperation Very much expensive. 7. CLASSIFICATION(A) Depending on the placement with in thetissue. Epiosteal implants- These implants receive theirprimary bone support by resting on it.eg- Sub-periosteal implants. Transosteal Implants- These implants penetrateboth cortical plates and passes through the entirethickness of alveolar bone. 8. Endosteal implants- This kind of implantsextends into basal bone for support. It transect only one corticalplate.(B)Depending on materials used . Metallic Implants- Ti Ti alloy micro enhanced pure Ti plasma sprayed Ti Co,Cr,Mo alloy 9. Non metallic Implants- Ceramic Carbon Alumina Polymer Composite(C) Depending on Design Screw shaped Cylinder shaped Tapered screw shaped. 10. PARTS OF IMPLANT 1.Implant body It is the component that is placed with in the bone during first stage of surgeryThreadedNon threaded2.Healing screw :During the healing phase this screw is normally placed in the superior surface of bodyFunction: Facilitates the suturing soft tissues. Prevents the growth of the tissue over the edge of the implant. 11. 3. Healing caps: are dome shaped screws placedover the sealing screw after the secondstage of surgery & before insertion ofprosthesis.4.Abutments:part of implant which resembles aprepared tooth & is inserted to be screwedinto the implant body5. Impression posts 12. IDEAL REQUIESETS to achieve an osseointigrated dental implant with a high degree of predictibility the implant must be- Sterile made of a highly biocompetible material Inserted with an atraumatic surgical techinique thatavoids overheating of the bone. Placed with initial stability Not functionally loaded during the healing period 13. PERIMPLANT MUCOSA Mucosal tissues around intraosseousimplants form a tightlyadherent band consisting of a densecollagenous lamina propria covered bystratified squamous keratinised epithelium.Implant epithelium junction isanalogous to the junctional epithelium aroundthe natural teeth in that the epithelial cellsattach to the titanium implant by means ofhemidesmosomes and a basal lamina. 14. The depth ofnormal noninflammed sulcus around anintraosseous implant is assumed to bebetween 1.5-2mm. The sulcus around an implant is lined withsulcular epithelium that is continuous apicallywith the junctional epithelium. 15. Main difference between periimplant & periodontal tissues is that1. Collagen fibers are non attached & run parallel to the implant surfaces owing to the lack of cementum.2. Marginal portion of the perimplant mucosa contains significantly more collagen & fewer fibroblasts than the normal gingiva. 16. THE IMPLANT-BONE INTERFACEThe relationship between endosseous implants & the bone consists of two mechanisms-1.OSSEOINTEGRATION- bone is in intimate but not ultrastructural contact with the implant.2.FIBROSSEOUS INTEGRATION-soft tissue such as fibers &/or cells, are interposed between the two surfaces. 17. IMPLANT SURGERY1. One stage -Coronal portions staysexposed through gingiva during thehealing period 2. Two stage Top of the implant Iscompletely submerged under gingiva 18. 1. TWO STAGE ENDOSSEOUS IMPLANT SURGERYFirst stage surgical technique1.Flap design & incision2.Flap elevation3.Implant placement4. Closure of the flap5. Post operative care 19. Flap design &Incision-Two types of incisions can be used. 1.crestal design- The incision ismade along the crest of the ridge,bisecting the existing zone ofkeratinized mucosa. 2.Remote incision It is made when bone augmentation is planned to minimize the incident of bone graft exposure. 20. The crestal incision is preferred in most instances because.-It results in less bleeding .-Easier flap management .-Less edema.-Less ecchymosis-faster healing-less vestibular changes postperatively 21. Flap elevation a full-thickness flap is raised bucally &lingually to the level of the mucogingivaljunction,exposing the alveolar ridge of the implantsites. Elevated flaps may be sutured to the buccalmucosa or the opposing teeth to keep the surgicalsite open during surgery. For a knife-edge alveolar process round bur isused to recontour the bone to provide a reasonableflat bed for the implant site 22. Implant placement once the implant site is prepared,a surgical guide is placed intraorally,& a small round bur or spiral drill is used to mark the implant site The site is checked for their appropriatefaciolingual location The site is then marked to a depth of1to2mm,breaking through the cortical bone 23. A small spiral drill, usually 2mm in diameter &marked to indicate appropriate depth, is used nextto establish the depth & align the axis of theimplant recipient site Spiral drill is used at a speed of 800 to 1000rpmwith copious irrigation to prevent overheating thebone. When multiple implants are used to support oneprosthesis, a paralleling or direction indicating pin 24. After the 2mm spiral drill, a pilot drillwith 2mm diameter at the lower part &wider diameter at the upper part is usedto enlarge the osteotomy site to alloweasy insertion of the following drill.Then the wider diameter spiral drill isused to drill to the depth reached withthe 2mm spiral drill. 25. The operator should drill to approximately0.5mm deeper than needed.this allows thedesired depth to be reached with the finaldrill without touching the bottom. Then the implant is placed with tappingprocedure. 26. Closure of the flap- once theimplants are screwed in & the cover screwsare placed. a combination of invertedmattress & interrupted sutures are placed- Flap should be closed without tension - 4.0 chromic gut suture is used that doesnot require removal during postoperativevisit. 27. Postoperative careantibiotics (amoxicillin,500mg tid ) patient should be asked to apply ice packsextraorally for the first 24 hours. chlorhexidine gluconate mouthrinses shouldbe used twice daily. pain medication should be prescribed. 28. patient should have a liquid or semiliquiddiet for the first few days &then gradualllyreturn to normal diet. patient should also refrain from tobacco &alcohol use for 1 to 2 weeks postoperatively.oral hygiene instructions should be given. 29. Second stage surgical technique Objectives:To expose the submerged implant without damaging thesurrounding boneTo control the thickness of the soft tissues surroundingthe implants To preserve or create attached keratinised tissuesaround the implantTo facilitate oral hygieneTo ensure proper abutment seating 30. Partial thickness flap- Gingivectomytechnique1. Flap design & incision2. Flap elevation & apical displacement3. Gingivectomy4. Post operative care 31. Flap design & incision the initial incision is made approximately2mm coronal to the facial mucogingivaljunction,with vertical incisions both mesially& distally 32. Flap elevation & apical displacement a partial thickness flap is then raised insuch a manner that a relatively firmperiosteum remains. the flap, containing a band of keratinizedtissue, is then placed facial to the emerginghead of the implant fixture & fixed to theperiosteum with 5.0 gut suture. 33. Gingivectomy Once the flap is positioned facially, theexcess tissue coronal to the cover screw isexcised, using a gingivectomy techinique. The cover screw is then removed, the headof the implant is thoroughly cleaned of anysoft or hard tissue overgrowth,& the healingabutments are placed on the fixture. 34. Postoperative care remind the patient for good oral hygienearound the implant. a chlorhexidine rinse for at least initial 2weeks while the tissues are healing. 35. One stage Endo-osseous Implantsurgery In this technique, the implant orhealing abutment protrudes about 2-3mmfrom the bone crest and the flaps areadapted around the implant flap design & incision placement of the implant closure of the flap postoperative of the care 36. Surgical technique(1) flap design & incision a crestal incision bisecting the existingkeratinized tissue& a vertical incision on oneor both ends are placed. then full thickness flaps are elevatedfacially & lingually. 37. Placement of implantssame as in two-stage implant surgical approach. the only difference is that the implant is placed insuch a way that the head of yhe implant protrudesabout 2 to 3mm from the bone crest. 38. Closure of the flap-the keratinized edges of the flap are tied withindependent sutures around the implant.Postoperative care- same as that for the two-stage surgicalapproach. 39. PERIIMPLANT COMPLICATIONS Periimplant disease- any pathologicalchanges of the periimplant tissue. Periimplant mucositis- Inflammatorychanges confined to the soft tissuessurrounding an implant. Periimplantitis Progressive periimplantbone loss in conjunction with a soft tissueinflammatory lesion. 40. Etiology Bacterial infection Biomechanical fac