Center for Facial Esthetics Clinic OA Dr. Angelo C. Trödhan Dr. Izabela Schlichting www . perfectsmileandface . com   www ...
Center for Facial Esthetics Clinic OA Dr. Angelo C. Trödhan Dr. Izabela Schlichting <ul><li>WorkShop </li></ul><ul><li>Imp...
PART I Basic Principles of Anatomy Physiology Atraumaticy
Basic Principles <ul><li>Soft Tissue is the Issue </li></ul><ul><li>But the Bone makes the tone </li></ul><ul><li>Use autr...
Physiology of Regular Alveola Vs. Implant Site („Bony Aspects“) Alveolar Bone Root Periodontal Ligament Crown Length Root ...
CONCLUSION Simple cylindrical Implants ALWAYS have to be: LONGER than the natural tooth WIDER than the natural tooth to ac...
BONE Physiology Bone heals/regenerates/is prevented from resorption by: The Periosteum (basal cells of Sinus membrane are ...
CONCLUSION WHENEVER POSSIBLE: Keep the Periosteum in place and intact ! (don´t denude the bone) Set microfractures in the ...
BONE Quality <ul><li>Is hard to determine </li></ul><ul><li>Can be measured by Bone-Densiometry (expensive !) </li></ul><u...
BONE Atrophy <ul><li>Reduces Implant Length and width </li></ul><ul><li>Forces us to put Implants in non-anatomical Positi...
BONE Augmentation <ul><li>The Less The more Success </li></ul><ul><li>Primarily Bone Spreading and Condensing / Sinuslift ...
Soft Tissue/Gingiva <ul><li>Is supported by the Bone and Periosteum </li></ul><ul><li>Free Gingiva is supported by the nat...
Keep Biological Width 1,5 – 2,3 mm If You reduce the gingiva You reduce Bone
Keep Biological Width 1,5 – 2,3 mm If You reduce the gingiva You reduce Bone: „ Brushing“- Recessions at Natural Teeth
PART II Basic Principles of Pre-Surgical Diagnosis in everyday praxis
See Me, Feel Me, Touch Me, Heal me ! From The WHO – Musical „Tommy“
SEE, TOUCH, FEEL ! You have to TOUCH before You understand
Inspection of the Future Implant-Site LOOK ! Configuration of Gingiva and  Alveolar Crest, Angulation of  adjacent teeth, ...
Radiography Panoramic X-Ray with 5mm metal balls for measurement (it also tells You the thickness of the mucosa especially...
Maximum Security: intra-OP digital Radiography
Maximum Security: intra-OP digital Radiography
Sometimes a Dental CT is helpful
On a Cast-Model You can simulate the Operation
Cardinal Principle of WHERE to place Implants for good cosmetic results Midline of Alveolar Crest Palate connection line F...
How Much Bone will I have ? The „Golden Rule“ Mandible: Measure the Alveolar Crest and subtract 2mm Maxilla: Measure the a...
PART III Decision making
After clinic Investigation, radiography and Cast-model Planning You Know: <ul><li>The bone height and width </li></ul><ul>...
Q1-IMPLANT <ul><li>Q-IMPLANT  ®  standard </li></ul><ul><li>Neck  = 4mm </li></ul><ul><li>Q-IMPLANT  ®  short </li></ul><u...
SurfOss II Surface ...... Not only Titanium !!!
Single Part Implant System <ul><li>Copys the natural shape of the root </li></ul>
Single Part Implant System <ul><li>Copys the natural shape of the root </li></ul><ul><li>Selfcutting screw-design </li></ul>
Single Part Implant System <ul><li>Copys the natural shape of the root </li></ul><ul><li>Selfcutting screw-design </li></u...
Single Part Implant System <ul><li>Copys the natural shape of the root </li></ul><ul><li>Selfcutting screw-design </li></u...
Single Part Implant System <ul><li>Copys the natural shape of the root </li></ul><ul><li>Selfcutting screw-design </li></u...
NO Abuttments Q-MultiCap for: Provisional Crown Impression Crown-Base
Simple Instruments Pilot-Drill 1,5 Form-Drill 3,5/4,5 Insertion Wheel Insertion-Handle
Q-Implant-Box
Impression & Preparation like on a natural tooth
MultiCap
OP - SCHEME Punch or Cut Pilot-Drill Form-Drill 3,5mm Form-Drill 4,5mm (if Q1/4,5 is Chosen) Insertion Suture (if necessar...
Single Tooth Traumatic loss of front teeth WITHOUT fracture of the alveolar ridge   (11/21: luxated, 22: crown fractured) ...
Immediate Implant-Insertion after extraction – Single tooth
Immediate Implant-Insertion after extraction - Bridge
Immediate Implant-Insertion after extraction – Single Tooth
Immediate Implant-Insertion after extraction – Single Tooth
One Week Later …
Radiographic follow up …
Gingiva after 2 Years
Single Tooth Immediate Implant-Insertion after extraction Dr. Angelo Trödhan
Edentulous Maxilla
Q2-Implant …  when angulation does not fit …  or two stage implantation is mandatory
Q2-Abuttments platescrew, Ginigvaformer Straight crown-bases Angle-Abuttments 15 degrees Q1-Head
Q2 – Single Stage Implantation
Q2: 2-stage Implantation
Q3-Implant:  affordable rigid Fixation of total prosthesis
Prosthesis without gum base
Anchors can be inserted in the old prosthesis ! Gaumenfrei
Solution for complicated Cases (Marcoumar-Patients)
Rigid fixation of lower Prosthesis at uncompetable Prize
I thank You For Your Attention Dr. Angelo Trödhan troed @ aon .at www.perfectsmileandface.com
Upcoming SlideShare
Loading in …5
×

Dr. Angelo C. Trödhan Center for Facial Esthetics

282
-1

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
282
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
17
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Dr. Angelo C. Trödhan Center for Facial Esthetics

  1. 1. Center for Facial Esthetics Clinic OA Dr. Angelo C. Trödhan Dr. Izabela Schlichting www . perfectsmileandface . com www . kieferchirurgie .at www . parodontose .at
  2. 2. Center for Facial Esthetics Clinic OA Dr. Angelo C. Trödhan Dr. Izabela Schlichting <ul><li>WorkShop </li></ul><ul><li>Implantology </li></ul><ul><li>How to manage soft tissues and immediate loading </li></ul><ul><li>Non invasive methods </li></ul>
  3. 3. PART I Basic Principles of Anatomy Physiology Atraumaticy
  4. 4. Basic Principles <ul><li>Soft Tissue is the Issue </li></ul><ul><li>But the Bone makes the tone </li></ul><ul><li>Use autraumatic surgical Procedures whenever Possible </li></ul><ul><li>Use the Tissues Regenerative Capacities whenever Possible </li></ul><ul><li>COPY NATURE </li></ul>
  5. 5. Physiology of Regular Alveola Vs. Implant Site („Bony Aspects“) Alveolar Bone Root Periodontal Ligament Crown Length Root Lenght NO Periodontal Ligament Dental Implant: Bone RESORBS on Pressure Bone GROWS on Pull of the Perio-Ligament OVERLOAD of Implant is ALWAYS RESORPTION !
  6. 6. CONCLUSION Simple cylindrical Implants ALWAYS have to be: LONGER than the natural tooth WIDER than the natural tooth to achieve the same SURFACE like the replaced tooth OR You have a screw design that gives MORE surface to the Implant than the replaced tooth and DISTRIBUTES FORCES better. Then the Implant Is primarily stable and can be loaded IMMEDIATELY
  7. 7. BONE Physiology Bone heals/regenerates/is prevented from resorption by: The Periosteum (basal cells of Sinus membrane are periost-like) Stabilized Blood Coagulum CALLUS (Haver´s/Volkmann vessels) Microfractures in the Spongiosa Bone speed up Bone Healing TWO TIMES !
  8. 8. CONCLUSION WHENEVER POSSIBLE: Keep the Periosteum in place and intact ! (don´t denude the bone) Set microfractures in the spongiosa By Bone Condensing and Bone Spreading !
  9. 9. BONE Quality <ul><li>Is hard to determine </li></ul><ul><li>Can be measured by Bone-Densiometry (expensive !) </li></ul><ul><li>Can be approximately determined by CT </li></ul><ul><li>Most reliably felt by the hand of the Implantologist ! </li></ul>
  10. 10. BONE Atrophy <ul><li>Reduces Implant Length and width </li></ul><ul><li>Forces us to put Implants in non-anatomical Positions and angles </li></ul><ul><li>Makes Bone augmentation necessary </li></ul>
  11. 11. BONE Augmentation <ul><li>The Less The more Success </li></ul><ul><li>Primarily Bone Spreading and Condensing / Sinuslift </li></ul><ul><li>If necessary Bone Distraction </li></ul><ul><li>Free Grafts as little as possible </li></ul>
  12. 12. Soft Tissue/Gingiva <ul><li>Is supported by the Bone and Periosteum </li></ul><ul><li>Free Gingiva is supported by the natural crown / Implant Neck / Prosthetic Crown </li></ul>
  13. 13. Keep Biological Width 1,5 – 2,3 mm If You reduce the gingiva You reduce Bone
  14. 14. Keep Biological Width 1,5 – 2,3 mm If You reduce the gingiva You reduce Bone: „ Brushing“- Recessions at Natural Teeth
  15. 15. PART II Basic Principles of Pre-Surgical Diagnosis in everyday praxis
  16. 16. See Me, Feel Me, Touch Me, Heal me ! From The WHO – Musical „Tommy“
  17. 17. SEE, TOUCH, FEEL ! You have to TOUCH before You understand
  18. 18. Inspection of the Future Implant-Site LOOK ! Configuration of Gingiva and Alveolar Crest, Angulation of adjacent teeth, Oral Hygiene TOUCH and FEEL ! Configuration of Alveolar Crest (Indentions, Height) on buccal/palate/lingual sites IMAGINE ! How You will proceed Surgically PLAN ! What other investigations do You need for atraumatic surgery and immediate loading ?
  19. 19. Radiography Panoramic X-Ray with 5mm metal balls for measurement (it also tells You the thickness of the mucosa especially in the maxilla) Intraoral X-Ray
  20. 20. Maximum Security: intra-OP digital Radiography
  21. 21. Maximum Security: intra-OP digital Radiography
  22. 22. Sometimes a Dental CT is helpful
  23. 23. On a Cast-Model You can simulate the Operation
  24. 24. Cardinal Principle of WHERE to place Implants for good cosmetic results Midline of Alveolar Crest Palate connection line Future cosmetic line Implant Position
  25. 25. How Much Bone will I have ? The „Golden Rule“ Mandible: Measure the Alveolar Crest and subtract 2mm Maxilla: Measure the alveolar Crest and divide it by two and subtract another 2mm (You will wonder how thick the mucosa is in the upper jaw and how little bone You have !)
  26. 26. PART III Decision making
  27. 27. After clinic Investigation, radiography and Cast-model Planning You Know: <ul><li>The bone height and width </li></ul><ul><li>All esthetic necessities </li></ul><ul><li>Which size of Implant You will insert </li></ul><ul><li>Where You will insert the Implant </li></ul>
  28. 28. Q1-IMPLANT <ul><li>Q-IMPLANT ® standard </li></ul><ul><li>Neck = 4mm </li></ul><ul><li>Q-IMPLANT ® short </li></ul><ul><li>Neck = 2mm </li></ul><ul><li>Variable Insertion Depth </li></ul>2 4 <ul><li>Length </li></ul><ul><li>8 mm </li></ul><ul><li>10 mm </li></ul><ul><li>12 mm </li></ul><ul><li>14 mm </li></ul><ul><li>Diameter </li></ul><ul><li>3.5 mm </li></ul><ul><li>4.5 mm </li></ul>
  29. 29. SurfOss II Surface ...... Not only Titanium !!!
  30. 30. Single Part Implant System <ul><li>Copys the natural shape of the root </li></ul>
  31. 31. Single Part Implant System <ul><li>Copys the natural shape of the root </li></ul><ul><li>Selfcutting screw-design </li></ul>
  32. 32. Single Part Implant System <ul><li>Copys the natural shape of the root </li></ul><ul><li>Selfcutting screw-design </li></ul><ul><li>Bone Trap </li></ul>
  33. 33. Single Part Implant System <ul><li>Copys the natural shape of the root </li></ul><ul><li>Selfcutting screw-design </li></ul><ul><li>Bone Trap </li></ul><ul><li>Variable Insertion Depths for better prosthetic and esthetic handling </li></ul>
  34. 34. Single Part Implant System <ul><li>Copys the natural shape of the root </li></ul><ul><li>Selfcutting screw-design </li></ul><ul><li>Bone Trap </li></ul><ul><li>Variable Insertion Depths for better prosthetic and esthetic handling </li></ul>
  35. 35. NO Abuttments Q-MultiCap for: Provisional Crown Impression Crown-Base
  36. 36. Simple Instruments Pilot-Drill 1,5 Form-Drill 3,5/4,5 Insertion Wheel Insertion-Handle
  37. 37. Q-Implant-Box
  38. 38. Impression & Preparation like on a natural tooth
  39. 39. MultiCap
  40. 40. OP - SCHEME Punch or Cut Pilot-Drill Form-Drill 3,5mm Form-Drill 4,5mm (if Q1/4,5 is Chosen) Insertion Suture (if necessary) Provisional
  41. 41. Single Tooth Traumatic loss of front teeth WITHOUT fracture of the alveolar ridge (11/21: luxated, 22: crown fractured) Dr. Angelo Trödhan
  42. 42. Immediate Implant-Insertion after extraction – Single tooth
  43. 43. Immediate Implant-Insertion after extraction - Bridge
  44. 44. Immediate Implant-Insertion after extraction – Single Tooth
  45. 45. Immediate Implant-Insertion after extraction – Single Tooth
  46. 46. One Week Later …
  47. 47. Radiographic follow up …
  48. 48. Gingiva after 2 Years
  49. 49. Single Tooth Immediate Implant-Insertion after extraction Dr. Angelo Trödhan
  50. 50. Edentulous Maxilla
  51. 51. Q2-Implant … when angulation does not fit … or two stage implantation is mandatory
  52. 52. Q2-Abuttments platescrew, Ginigvaformer Straight crown-bases Angle-Abuttments 15 degrees Q1-Head
  53. 53. Q2 – Single Stage Implantation
  54. 54. Q2: 2-stage Implantation
  55. 55. Q3-Implant: affordable rigid Fixation of total prosthesis
  56. 56. Prosthesis without gum base
  57. 57. Anchors can be inserted in the old prosthesis ! Gaumenfrei
  58. 58. Solution for complicated Cases (Marcoumar-Patients)
  59. 59. Rigid fixation of lower Prosthesis at uncompetable Prize
  60. 60. I thank You For Your Attention Dr. Angelo Trödhan troed @ aon .at www.perfectsmileandface.com
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×