Dr. Angelo C. Trödhan Center for Facial Esthetics
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Dr. Angelo C. Trödhan Center for Facial Esthetics

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Dr. Angelo C. Trödhan Center for Facial Esthetics Dr. Angelo C. Trödhan Center for Facial Esthetics Presentation Transcript

  • Center for Facial Esthetics Clinic OA Dr. Angelo C. Trödhan Dr. Izabela Schlichting www . perfectsmileandface . com www . kieferchirurgie .at www . parodontose .at
  • Center for Facial Esthetics Clinic OA Dr. Angelo C. Trödhan Dr. Izabela Schlichting
    • WorkShop
    • Implantology
    • How to manage soft tissues and immediate loading
    • Non invasive methods
  • PART I Basic Principles of Anatomy Physiology Atraumaticy
  • Basic Principles
    • Soft Tissue is the Issue
    • But the Bone makes the tone
    • Use autraumatic surgical Procedures whenever Possible
    • Use the Tissues Regenerative Capacities whenever Possible
    • COPY NATURE
  • 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 !
  • 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
  • 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 !
  • 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 !
  • BONE Quality
    • Is hard to determine
    • Can be measured by Bone-Densiometry (expensive !)
    • Can be approximately determined by CT
    • Most reliably felt by the hand of the Implantologist !
  • BONE Atrophy
    • Reduces Implant Length and width
    • Forces us to put Implants in non-anatomical Positions and angles
    • Makes Bone augmentation necessary
  • BONE Augmentation
    • The Less The more Success
    • Primarily Bone Spreading and Condensing / Sinuslift
    • If necessary Bone Distraction
    • Free Grafts as little as possible
  • Soft Tissue/Gingiva
    • Is supported by the Bone and Periosteum
    • Free Gingiva is supported by the natural crown / Implant Neck / Prosthetic Crown
  • 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, 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 ?
  • 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
  • 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 Future cosmetic line Implant Position
  • 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 !)
  • PART III Decision making
  • After clinic Investigation, radiography and Cast-model Planning You Know:
    • The bone height and width
    • All esthetic necessities
    • Which size of Implant You will insert
    • Where You will insert the Implant
  • Q1-IMPLANT
    • Q-IMPLANT ® standard
    • Neck = 4mm
    • Q-IMPLANT ® short
    • Neck = 2mm
    • Variable Insertion Depth
    2 4
    • Length
    • 8 mm
    • 10 mm
    • 12 mm
    • 14 mm
    • Diameter
    • 3.5 mm
    • 4.5 mm
  • SurfOss II Surface ...... Not only Titanium !!!
  • Single Part Implant System
    • Copys the natural shape of the root
  • Single Part Implant System
    • Copys the natural shape of the root
    • Selfcutting screw-design
  • Single Part Implant System
    • Copys the natural shape of the root
    • Selfcutting screw-design
    • Bone Trap
  • Single Part Implant System
    • Copys the natural shape of the root
    • Selfcutting screw-design
    • Bone Trap
    • Variable Insertion Depths for better prosthetic and esthetic handling
  • Single Part Implant System
    • Copys the natural shape of the root
    • Selfcutting screw-design
    • Bone Trap
    • Variable Insertion Depths for better prosthetic and esthetic handling
  • 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 necessary) Provisional
  • Single Tooth Traumatic loss of front teeth WITHOUT fracture of the alveolar ridge (11/21: luxated, 22: crown fractured) Dr. Angelo Trödhan
  • 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