Download - Basic Implant Lecture 2007
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Basic Surgical Techniques for
Endosseous Implant PlacementDivision of Oral and Maxillofacial Surgery
University of Minnesota
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Dental implantisan artificial titanium
fixturewhich is placedsurgically into the
jaw bone tosubstitute for a missing
tooth and its root(s).
WHAT IS ADENTAL IMPLANT?
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In 1952 !rofessor !er"Ing#ar $ranemar%
a &wedish surgeon while conducting research
into the healing patterns of bone tissue accidentally
disco#ered that when pure titanium comes into
direct contact with the li#ing bone tissue the two
literally grow together to form a permanentbiological adhesion. 'e named this phenomenon
"osseointegration".
'istory of ental Implants
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ll current implant
designs are
modifications of thisinitial design
*irst Implant esign by $ranemar%
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Fibro-osseous integration
Fibroosseous integration
tissue to implant contact with dense collagenous
tissue between the implant and bone
Seen in earlier implant systems.
Initially good success rates but extremely
poor long term success. Considered a failure by todays standards
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Osseointegration
Success Rates >90%
Histologic definition
direct connection between living bone and load-
bearing endosseous implants at the light
microscopic level.
4 factors that influence:
Biocompatible material
Implant adapted to prepared site
Atraumatic surgery
Undisturbed healing phase
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Soft-tissue to implant interface
Successful implants have an Unbroken, perimucosal seal between the soft
tissue and the implant abutment surface.
Connect similarly to natural teeth-somedifferences.
Epithelium attaches to surface of titanium much
like a natural tooth through a basal lamina and theformation of hemidesmosomes.
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Soft-tissue to implant interface
Connection differs at the connective tissue
level.
Natural tooth Sharpies fibers extent from the
bundle bone of the lamina dura and insert into
the cementum of the tooth root surface
Implant: No Cementum or Fiber insertion.
Hence the Epithelial surface attachment is
IMPORTANT
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Subperiosteal
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TransmandibularImplant
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Blade Implant
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Endosteal Implants
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The Parts
Implant body-fixture
Abutment (gingival/temporary healing vs.
final)
Prosthetics
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Clinical Components
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abutment
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Team Approach
A surgical prosthodontic consultation is
done prior to implant placement to address:
soft-tissue management
surgical sequence
healing time
need for ridge and soft-tissue augmentation
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Clinical Assessment
Assess the CC and Expectations
Review all restorative options:
Risks and Benefits
Select option that meets functional and
esthetic requirements
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Patient Evaluation
Medical history
vascular disease
immunodeficiency
diabetes mellitus
tobacco use
bisphosphonate use
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History of Implant Site
Factors regarding loss of tooth being replaced
When?
How?
Why?
Factors that may affect hard and soft tissues:
Traumatic injuries
Failed endodontic procedures
Periodontal disease
Clinical exam may identify ridge deficiencies
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Surgical Phase- Treatment Planning
Evaluation of Implant Site
Radiographic Evaluation
Bone Height, Bone Width and Anatomic
considerations
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Basic Principles
Soft/ hard tissue graft bed
Existing occlusion/ dentition
Simultaneous vs. delayed reconstruction
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Smile Line
One of the most influencing factors of any
prosthodontic restoration
If no gingival shows then the soft tissue
quality, quantity and contours are less
important
Patient counseling on treatmentexpectations is critical
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Anatomic Considerations
Ridge relationship
Attached tissue
Interarch clearance
Inferior alveolar nerve
Maxillary sinus
Floor of nose
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Radiological/Imaging Studies
Periapical radiographs
Panoramic radiograph
Site specific tomograms
CAT scan (Denta-scan, cone beam CT)
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Width of Space and Diameter of Implant
Attention must be paid to both the coronal andinterradicular spaces
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A case against routine CT
Expense
Time consuming process
Use of radiographic template/proper fitrequires DDS present
Contemporary panoramic units have
tomographic capabilities Usually adds no additional data over
standard database
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Image Distortion
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Anatomic Limitations
Buccal Plate 0.5mm
Lingual Plate 1.0 mmMaxillary Sinus 1.0 mm
Nasal Cavity 1.0mm
Incisive canal AvoidInterimplant distance 1-1.5mm
Inferior alveolar canal 2.0mm
Mental nerve 5mm from foramenInferior border 1 mm
Adjacent to natural
tooth
0.5mm
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Dental Implant Surgery Phase I
Aseptic technique
Minimal heat generation
slow sharp drills
internal irrigation?
external cooling
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Dental Implant Surgery Phase I
Adequate time for integration
Adequate recipient site
soft tissue
bone
Kind & Gentle technique
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Disposition
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1. Chlorhexidine
2. Analgesics
+/- antibiotics
Disposition
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Implant placement 3 months after menton bone
grafting
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Exposure of Implant during
Placement
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Summers Osteotomes
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Limitations to Implant placement in the
Maxilla
Ridge width Ridge height
Bone quality
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Surgical Solutions to Anatomical
Limitations
Onlay Bone Graft Sinus Lift
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Summers, RB. A New concept in Maxillary
Implant Surgery: The Osteotome technique.
Compendium. 15(2): 152, 154-6
Ridge expansion technique
3-4 mm of crestal alveolar widthrequired
Sinus floor elevation technique
8-9 mm of alveolar bone heightrequired in order to place a 13 mmimplant
(4-5 mm sinus floor elevation)
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Introduction
Ridge expansion technique 1.6 mm pilot hole
Summers osteotome # 1-4
sequenced tapered osteotomes.
ridge expansion (displacement) versus
bone removal. Final drill coincident with the final
implant size (sometimes not
necessary)
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Introduction
Sinus floor elevation technique 1.6 mm pilot hole
Summers osteotome # 1-4
Sinus floor microfractured superiorly
Sinus floor can be elevated 4-5 mm
May backfill with bone allograft/alloplast
Final drill coincident with final
implant size
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Surgical Technique
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k d k if i
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A. Rake, K. Andreasen, S. Rake, J. SwiftA Retrospective
Analysis of Osteointegration in the Maxilla Utilizing an
Osteotome Technique versus a Sequential Drilling
Technique, 1999 AAOMS Abstract
155 maxillary implants in 84 patients restored
for at least 6 months
57 were placed utilizing the osteotome technique
98 were placed utilizing the drilling technique
One implant failed of the 98 in the drill group
None of the implants had failed of the 57 in the
osteotome group
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Stage II Surgery Preoperative
Considerations 3-6 months after stage I
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Stage II Surgery Preoperative
Considerations Done under local anesthesia
Pre-op medications
Chlorhexidine rinse
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Placement ofhealing abutment
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The failing implant is very difficult to treat
Traumatic surgical manipulation with
initial instability of implant increases riskof failure
Implant success is only as good as the
prosthodontic reconstruction
conclusions