t o p i c s – day 1implant placement post extraction 0 treatment options immediate implant...

TAOi Annaul Congress 2017 with the B&B Team

T O P I C S – Day 1

• Factors influencing the long-term stability of dental implants • Surgical procedures in posterior sites: Standard implant placement

with or without flap elevation • Surgical procedures in posterior sites: Implant placement with GBR • Implant placement and sinus floor elevation: Lateral window vs.

Osteotome technique, when simultaneous, when staged? • Prosthetic planning and restorative principles in posterior sites • Fundamental esthetic principles revisited in the context of anterior

maxillary implant restorations - a critical appraisal • Esthetic risk assessment and basic surgical principles in esthetic sites • Prosthetic handling of esthetic challenges: case reports


Implant Placement in Posterior Sites with Bone Defects

• This is a frequent clinical situation today ‣ often postextraction sites ‣we also frequently see an atrophied alveolar crest

• The anatomy in the posterior mandible is difficult and often borderline ‣Crest width and crest height is often reduced ‣ Position and course of mandibular canal ‣ Lingual undercuts

Whenever possible: Simultaneous GBR

2-wall defect

1-wall defect

3


• Crest width at implant site ✓ Crest width > 6 mm are uncritical ✓ Crest width between 4 and 6 mm can be borderline ✓ Crest width < 4 mm require a staged approach

• Shape of alveolar crest ✓ Tapered vs. rectangular

• Diameter of implant to be inserted ✓ Standard diameter vs. diameter reduced ✓ Exposed implant surface must be inside the bone

Important Aspects for Decision Simultaneous vs. Staged


20 Years of GBR Technique

Principle of GBR by using Barrier Membranes


SECOND EDITION

20 Years of

in Implant DentistryREGENERATION GUIDED BONE

DANIEL BUSER, DDS, Dr Med Dent

Edited by

TABLE OF CONTENTS

1. The Development of Guided Bone Regeneration over the past 20 Years

Buser 2. Bone Regeneration: Biologic Basis Bosshardt & Schenk 3. Properties of Barrier Membranes Bornstein, Bosshardt & von Arx 4. Bone Grafts and Bone Fillers for GBR Procedures Jensen, Bosshardt & Buser 5. Harvesting Procedures for GBR Procedures von Arx 6. Implant Placement with Simultaneous GBR Buser 7. Implant placement in Postextraction Sites Buser & Chen 8. Horizontal Ridge Augmentation with GBR von Arx & Buser 9. Vertical Ridge Augmentation with GBR Simion & Rocchietta


Clinician

Patient

Treatment Approach

Bio- materials

Factors influencing Treatment Outcomes

Late placement

Immediate placement

Early placement

Timing Procols for implant placement

Buser & Chen 2008


Implant Placement post Extraction

0

Treatment Options

Immediate Implant Placement • Same day

ITI Treatment Guide 3: Chen & Buser 2008

4-8 ws > 6 mos12-16 ws

Early Implant

Placement • with soft tissue healing • 4-8 weeks

Early Implant

Placement • with partial bone healing • 12-16 weeks

Late Implant Placement • Complete bone healing • > 6 months



0

Treatment Options

Immediate Implant

Placement • Same day


4-8 ws > 6 mos12-16 ws

Early Implant Placement • with soft tissue healing

• 4-8 weeks

Early Implant Placement • with partial bone healing

• 12-16 weeks

Late Implant

Placement • Complete bone healing • > 6 months


• We have to differentiate between incisors, premolars and molars ✓Healing for incisors: 2-4 weeks (type 2)

✓Healing for canines/premolars: 4 weeks (type 2) ✓Healing for molars: 3-4 months (type 3)

• Critical are defects with no horizontal defect wall at the bottom ✓ Bone fillers tend to glide apically

• In self-contained defects, bone augmentation is often done without membrane

Surgical Approach in Posterior Sites

Implant Surgery with GBR



0

Treatment Options

Immediate Implant Placement • Same day


4-8 ws > 6 mos12-16 ws

Early Implant

Placement • with soft tissue healing

• 4-8 weeks

Early Implant

Placement • with partial bone healing

• 12-16 weeks

Late Implant Placement • Complete bone healing • > 6 months








2015: 10 years



0

Treatment Options

Immediate Implant

Placement • Same day


4-8 ws > 6 mos12-16 ws

Early Implant Placement • with soft tissue healing

• 4-8 weeks

Early Implant Placement • with partial bone healing

• 12-16 weeks

Late Implant

Placement • Complete bone healing • > 6 months


• In cases, when bone lesions do not allow sufficient primary implant stability ü Periapical pathologies

• In sites without risk for buccal flattening within 4 months ü First molars in the mandible or maxilla ü To wait 3-4 months often allows implant

placement without bone grafting procedures (–> reduction of cost)

Early Implant Placement (Type 3)

Implant Surgery with GBR



2004/05: 4 mos

TAOi Annaul Congress 2017 with the B&B Team2004/07: 2 mos post op


2004/01 2004/05 2004/07


2008: 4 years

ITI Treatment Guide Series – Dec 2013

2004/06




3 mos 5 mos

7 mos


2009: 5 years


2009: 5 years


2016: 12 years



2017: 13 years



0

Treatment Options

Immediate Implant Placement

• Same day

4-8 ws > 6 mos12-16 ws

Early Implant Placement • with soft tissue healing • 4-8 weeks

Early Implant Placement • with partial bone healing • 12-16 weeks

Late Implant Placement • Complete bone healing

• > 6 months





Fibrin Sealant (Tisseal) from Baxter

Fibrinogen & Thrombin



TAOi Annaul Congress 2017 with the B&B Team2008: 3 years


2010: 5 years


2010: 5 years


Conclusions


• Don’t compromise on a thick buccal and oral bone wall at implant placement

• If bone defects are present, they must be augmented with GBR ✓ Resorbable collagen membrane combined with autogenous bone chips and DBBM

particles

✓ Whenever possible, a simultaneous GBR technique is used

Conclusions: Basic Surgical Principles in posterior Sites

t o p i c s – day 1implant placement post extraction 0 treatment options immediate implant...

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