Operative surgery of dental implant

Header Dakhel Al- muala .BDS , M Sc , F I C M S

Al –sadder teaching hospital Department of Oral and maxillofacial surgery.certificate oral and maxillofacial surgery,

Bristol university hospital Foundation trust U.K

E –mail : header.dakhel @yahoo.com

There are different approaches.

1 .Immediate post-extraction implant placement .

2 .Delayed immediate post-extraction implant placement

( 2 weeks to 3 months after extraction.)

3.Late implantation ( 3 months or more after tooth extraction .)

According to the timing of loading of dental

implants, the procedure loading could be classified into:

1 .Immediate loading procedure . 2 .Early loading (1 week to 12 weeks) .

3 .Delayed loading (over 3 months)

Osseointegration

the formation of a direct interface between an implant and bone, without intervening soft tissue.

a direct connection between living bone and load bearing endosseous implant.

Osseointegrated implant is a type of implant defined as

"an endosteal implant containing pores into which osteoblasts and supporting connective tissue can

migrate.

peri-implantitis

There are four main factors necessary to achieve

a successful osseointegrated bone to implant interface.

1 -A biocompatible material. 2- Precisly adapted implant to the prepared bony site.

3 .Atraumatic surgery , to minimize tissues damage. 4 .An immobile implant, un disturbed healing phase .

Peri-implantitis is usually, but not always,

associated with: A. A chronic infection .

B. Heavy smokers. C. Patients with diabetes.

D. Patients with poor oral hygiene. E. Cases where the mucosa around the implant is

thin .

A recent theory argues that rather than being an active

biological tissue response.

The integration of bone with an implant is the lack of a negative tissue response.

Anatomic considerations include

Bone density. A. The volume of bone .

B. Height of bone available. The failure rate of implantation is greater for regions with very low density which in result in low

primary stability.

Particularly for mandibular mental foramen

there must be sufficient alveolar bone above the mandibular canal.

Such insult may cause irreparable damage to the nerve.

often felt as a paresthesia (numbness) or dysesthesia (painful numbness) of the gum, lip

and chin .

This condition may persist for life and may be accompanied by unconscious drooling

Use of CT scanningcomputed tomography

cone beam computed tomography or CBCT (3D X-ray imaging) is used

preoperatively to accurately pinpoint vital structures, the zone of safety may be reduced

to 1 mm through the use of computer-aided design and production of a surgical drilling

and angulation guide.

Surgical incisions.

Flap design Crestal incision.

an incision is made over the crest of the site where the implant is to be placed. This is referred to as a

'flap .'

'flapless' surgery. where a piece of mucosa is punched-out from over

the implant site.

Proponents of 'flapless' surgery believe that it decreases recovery time.

while its detractors believe it increases complication rates because the edge of bone cannot be visualized.

Because of these visualization problems flapless surgery is often carried out using a surgical guide constructed following computerized 3D planning of a pre-operative CT scan.

Drilling procedures.

maximum heat production 47 C for one min.

The speed of the drill measured at 345 rpm and 2900 rpm did not seem to affect the temperature .

low speed high torque hand piece.

Factors controlling heat production during bone cutting. 1. The use of sharp drills.

2. Fluid cooling of the drill .

In soft bone use of final drill of half depth only.

with minimal use of countersink use of smaller drill diameter than standard.

In dense bone use of oversized drill diameters .

Soft tissues closure. when top of the implant is exposed through the

mucosa , bone never grow over the exposed portion.

Suture materials. Non absorbable material.

absorbable material.

Healing phase.

non loading phase 3 -6 months. 3 months for mandible

and 6 months for maxilla .

Post-Operative complication A. surgical

1 -Pain. 2 .minor bleeding or OOZING.

3 .Try to avoid smoking completely. 4 .Swelling.

5 .Fluid intake is very important, Please avoid hot liquids until the numbness has worn off, and the bleeding has stopped.

6 .Oral Hygiene. 7 .Your Medications.

B.Early implant loss.

1.disability of the host to achieve osseointegration. 2.reduced bone quality.

3 .inflammation. 4 .smooth implant surface.

5.burned bone . 6 .loading during healing period .

C. esthetic .

D. Prosthodontic.

E. biologic.

F. Late implant loss. 1.errors in surgical phase.

A.unfavorable position of the implant. B. insufficient interproximal distance.

C.deficient primary stability. D. thermal damage of bone.

E. contamination of the surface. 2 .unfavorable implant design.

3 .errors in functional phase. 4 .peri- implatitis.