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MDA Annual Session Grand Rapids, MI Implant Dentistry for the  Everyday Dental Practice Saturday April 19, 2008   Timothy ...
Visit  www.drkosinki.com
Standard of Care in dentistry <ul><li>The standard of care is continually evolving with the advent of new materials, new p...
<ul><li>Study reported in the  Journal of Periodontology  that removable partial dentures have a negative impact on the gi...
Advantages to dental implants as support for removable dentures: <ul><li>Less movement </li></ul><ul><li>No mobility of ab...
Candidates for implants According to the World Health Organization, 6-10% of the world’s population is missing some or all...
Attachments developed as esthetic, completely invisible, alternative to traditional prosthetic retention systems such as c...
TYPE OF PROSTHESES <ul><li>Implant supported fixed prostheses </li></ul><ul><li>Implant supported removable prostheses </l...
Advantages of freestanding implants over splinted implants <ul><li>Reduced number of fabrication steps </li></ul><ul><li>R...
Disadvantages <ul><li>Implants need to be relatively parallel </li></ul><ul><li>Correct angulation needed </li></ul>
Unique challenges to fabricating maxillary implant retained overdentures: <ul><li>Anatomic shape of the bone </li></ul><ul...
FREQUENTLY ASKED QUESTIONS CONCERNING DENTAL IMPLANTS
Q:  How do I know if I am a candidate for dental implants? A:  There are two basic criteria for people who desire dental i...
Q:  What are dental implants? A:  Dental implants are titanium fixtures that are surgically embedded into the jaw bone and...
<ul><li>Q:  Are the procedures painful? </li></ul><ul><li>A:  Most people relate that the implant placement procedure is s...
<ul><li>Q: How long do implants last? </li></ul><ul><li>A:  Modern dental implants have been successful for over 30 years....
<ul><li>Q:  What is the cost of dental implant therapy? </li></ul><ul><li>A:  The investment made in proper and comprehens...
<ul><li>Q:  Will my insurance cover implants? </li></ul><ul><li>A:  The type of coverage you have determines whether impla...
<ul><li>Q: Do implants require special care? </li></ul><ul><li>A:  No, regular maintenance visits are important as is dail...
<ul><li>Q:  How long does the entire process take? </li></ul><ul><li>A: This depends on the position that the implants are...
Q:  Will I leave your office without teeth? A:  We will always try to provide you with some type of transitional or tempor...
<ul><li>Q: Are dental implants experimental? </li></ul><ul><li>A:  Absolutely not. Implants have been thoroughly researche...
<ul><li>Q:  Can implants be placed the same day as an extraction? </li></ul><ul><li>A:  Whether an implant can be placed o...
<ul><li>Q:  What are some of the benefits to dental implants? </li></ul><ul><li>A:  Increased confidence when smiling, spe...
What dictates type of prosthesis: <ul><li>Number of implants to be placed </li></ul><ul><li>Location of implants </li></ul...
“ The vast majority of complications in implant dentistry are related to biomechanics. The complications include early loa...
The percentage of completely edentulous patients is decreasing, but the actual number of completely edentulous patients is...
<ul><li>Ceka attachments   800.232.7732 </li></ul><ul><li>(preat) </li></ul><ul><li>Locator attachments 760.743.7744 </li>...
Approximate cost of attachment <ul><li>Type of attachment Abutment Set Replacement </li></ul>ERA   $  58.00 $ 5.00 Locator...
<ul><li>Locator attachments (Zest Anchors, Escondido, CA) act as retentive devices for overdentures. The patient is able t...
LOCATOR IMPLANT ANCHORS  (Zest Anchors, Inc.) <ul><li>Supragingival attachment </li></ul><ul><li>Available as a straight a...
<ul><li>Bredent attachments can be used on implants that are up to 15 degrees divergent from the path of insertion. They a...
HOW TO TAKE CARE OF DENTAL IMPLANTS
<ul><li>Daily care is similar to the care of natural teeth.  </li></ul><ul><li>Restored dental implants need to be kept cl...
Access Oral Care 1-877-94-ACCESS
<ul><li>Gentle brushing with small soft manual or electric brush </li></ul><ul><li>Low abrasive, tartar control toothpaste...
<ul><li>Other adjuncts: </li></ul><ul><li>Antimicrobial mouth rinses </li></ul><ul><li>Interdental brushes or other aids t...
TEAM DENTISTRY <ul><li>DENTIST </li></ul><ul><li>DENTAL HYGIENISTS </li></ul><ul><li>ASSISTANTS </li></ul><ul><li>TREATMEN...
<ul><li>DIAGNOSTIC METHODS </li></ul><ul><li>HIGH TECH EQUIPMENT </li></ul><ul><li>DURABLE RESTORATIVE MATERIALS </li></ul...
THE MOST CRITICAL CRITEREA IN DENTAL IMPLANTOLOGY <ul><li>PROSTHETIC CRITERIA </li></ul><ul><li>SOFT TISSUE MANAGEMENT </l...
PROSTHETIC BIOMECHANICS <ul><li>ANATOMIC FACTORS </li></ul><ul><li>PROPER FUNCTION </li></ul><ul><li>ESTABLISH POSITION, N...
AN AGING POPULATION <ul><li>THE GROUP OLDER THAN 65 IS PROJECTED TO INCREASE FROM 12% OF THE POPULATION  IN 2000 TO MORE T...
<ul><li>POTENTIAL IMPLANT PATIENT POPULATION IS EVER INCREASING BY 2025 NEARLY 70 MILLION PEOPLE WILL BE 65 AND OLDER </li...
<ul><li>POTENTIAL IMPLANT PATIENT POPULATION IS EVER INCREASING BY 2025 NEARLY 70 MILLION PEOPLE WILL BE 65 AND OLDER </li...
ACCORDING TO MISCH THE LIFE SPAN AT FAILURE OF CROWNS IS 10.3 YEARS <ul><li>REASON FOR FAILURE:  DECAY, ENDODONTIC THERAPY...
<ul><li>70% OF THE US POPULATION IS MISSING AT LEAST ONE TOOTH </li></ul><ul><li>IN 1990 MORE THAN 4 MILLION BRIDGES WERE ...
<ul><li>STUDIES SHOW THAT THERE IS A 74%  15 YEAR SURVIVAL RATE ON BRIDGES.  </li></ul><ul><li>MEAN LIFE SPAN OF 9.6 -10.3...
ADVANTAGES OF SINGLE TOOTH DENTAL IMPLANTS   <ul><li>HIGH SUCCESS RATES </li></ul><ul><li>DECREASED RISK OF CARIES OF ADJA...
AVERAGE EDENTUALISM IS 20% WORLDWIDE BY AGE 60
1999-2002 TOTAL US EDENTUALISM OF BOTH ARCHES WAS 7.7% (20 MILLION PEOPLE)
ONE OR TWO ARCH EDENTUALISM  17% OF THE US POPULATION OR 30 MILLION PEOPLE
REDUCED OCCLUSAL FORCES IN EDENTULOUS <ul><li>CHEWING FORCES DECREASED TO 20-30% OF THOSE WITH NATURAL TEETH </li></ul><ul...
<ul><li>5 YEAR SURVIVAL RATE FOR RPDS IS 60% </li></ul><ul><li>44% ABUTMENT TOOTH LOSS IN 10 YEARS </li></ul><ul><li>ACCEL...
PSYCHOLOGICAL EFFECTS <ul><li>LOW SELF ESTEEM </li></ul><ul><li>SPEECH AFFECTED </li></ul><ul><li>AVOID SOCIALIZING </li><...
MISCH BONE DENSITY CLASSIFICATION <ul><li>D1 DENSE CORTICAL BONE IN THE ANTERIOR MANDIBLE </li></ul><ul><li>D2 POROUS CORT...
CRITERIA FOR  IMPLANT SUCCESS <ul><li>NOT MOBILE </li></ul><ul><li>NO  EVIDENCE OF PERIIMPLANT RADIOLUCENCY </li></ul><ul>...
<ul><li>A PROBE PENETRATES DEEPER NEXT TO AN IMPLANT COMPARED TO A TOOTH </li></ul><ul><li>TAKE CARE NOT TO CONTAMINATE TH...
TOOTH HAS CEMENTUM, BONE AND PERIODONTIUM IMPLANT IS OSSEOINTEGRATED WITH AKLYLOSIS ON IMPLANT TO BONE
TOOTH AND IMPLANT HAVE HEMIDESMOSOMES AND BASAL LAMINA AS ITS JUNCTIONAL EPITHELIUM
<ul><li>TOOTH HAS PERPENDICULAR CONNECTIVE TISSUE FIBERS WITH INCREASED FIBROBLASTS AND DECREASED COLLAGEN </li></ul><ul><...
TOOTH HAS GREATER VASCULARITY FROM THE PERIODONTAL LIGAMENT
NORMAL PROBING IS 3MM IN A HEALTHY TOOTH BUT 2.5-5MM IN AN IMPLANT DEPENDING ON THE SOFT TISSUE DEPTH
<ul><li>INSTRUMENTS TO MAINTAIN IMPLANTS MUST BE EFFECTIVE IN REMOVING BIOFILMS AND ACCRETIONS AND NOT DAMAGE THE IMPLANT ...
<ul><li>DON’T  GOUGE TITANIUM WITH ULTRASONIC AND SONIC SCALERS. USE PLASTIC OR RUBBER SLEEVES </li></ul>
<ul><li>NO STAINLESS STEEL TIPPED INSTRUMENTS </li></ul><ul><li>USE PLASTIC, GRAPHITE, NYLON OR TEFLON COATED INSTRUMENTS ...
<ul><li>USE RUBBER CAP WHEN POLISHING WITH FINE PROPHY PASTE OR TIN OXIDE </li></ul>
<ul><li>SIMPLY REMOVE THE PLAQUE AND CALCULUS </li></ul><ul><li>CHLORHEXIDINE  GLUCONATE EFFECTIVE IN REDUCING PLAQUE. </l...
CONVENTIONAL DENTAL IMPLANT APPROACHES <ul><li>PLANNING </li></ul><ul><li>SURGERY </li></ul><ul><li>REMOVE SUTURES </li></...
CAD/CAM GUIDED APPROACH <ul><li>PLANNING </li></ul><ul><li>SURGERY </li></ul><ul><li>TRANSITIONAL PLACMENT </li></ul><ul><...
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  1. 1. MDA Annual Session Grand Rapids, MI Implant Dentistry for the Everyday Dental Practice Saturday April 19, 2008 Timothy Kosinski, DDS, MAGD, Adjunct Assistant Professor, Department of Restorative Dentistry University of Detroit Mercy School of Dentistry
  2. 2. Visit www.drkosinki.com
  3. 3. Standard of Care in dentistry <ul><li>The standard of care is continually evolving with the advent of new materials, new procedures and new court rulings. Before applying the standard of care, dentists should consider new available treatments, as well as their state’s current interpretation of the standard of care. Joseph Graskemper, DDS, JD </li></ul>
  4. 4. <ul><li>Study reported in the Journal of Periodontology that removable partial dentures have a negative impact on the gingiva. Supporting teeth had more signs of periodontal disease. After 10 years only 56% of teeth that hold a removable partial denture remain intact. </li></ul>
  5. 5. Advantages to dental implants as support for removable dentures: <ul><li>Less movement </li></ul><ul><li>No mobility of abutment teeth over time </li></ul><ul><li>No decay </li></ul><ul><li>Can replace full or partial dentures in the maxilla and mandible </li></ul><ul><li>Increase retention and increased stability </li></ul>
  6. 6. Candidates for implants According to the World Health Organization, 6-10% of the world’s population is missing some or all of its teeth
  7. 7. Attachments developed as esthetic, completely invisible, alternative to traditional prosthetic retention systems such as clasps. These ensure stable retention of partials and dentures.
  8. 8. TYPE OF PROSTHESES <ul><li>Implant supported fixed prostheses </li></ul><ul><li>Implant supported removable prostheses </li></ul><ul><li>Implant retained removable overdentures </li></ul>
  9. 9. Advantages of freestanding implants over splinted implants <ul><li>Reduced number of fabrication steps </li></ul><ul><li>Reduced treatment costs </li></ul><ul><li>Fewer implants required </li></ul><ul><li>Less vertical space required </li></ul><ul><li>Prefabricated stock retention devices can be used </li></ul>
  10. 10. Disadvantages <ul><li>Implants need to be relatively parallel </li></ul><ul><li>Correct angulation needed </li></ul>
  11. 11. Unique challenges to fabricating maxillary implant retained overdentures: <ul><li>Anatomic shape of the bone </li></ul><ul><li>Implants often tipped facially </li></ul><ul><li>Creates angulation problems in restoration </li></ul>
  12. 12. FREQUENTLY ASKED QUESTIONS CONCERNING DENTAL IMPLANTS
  13. 13. Q: How do I know if I am a candidate for dental implants? A: There are two basic criteria for people who desire dental implants. <ul><ul><li>You must be relatively healthy, meaning no uncontrolled medical problems, such as uncontrolled diabetes, uncontrolled hypertension, or immunosuppressive diseases. </li></ul></ul><ul><ul><li>You must have enough bone to be able to place something in to it. </li></ul></ul>
  14. 14. Q: What are dental implants? A: Dental implants are titanium fixtures that are surgically embedded into the jaw bone and simulate the root of a tooth. They are used to attach a single tooth, multiple teeth or even to stabilize a denture so it does not move around.
  15. 15. <ul><li>Q: Are the procedures painful? </li></ul><ul><li>A: Most people relate that the implant placement procedure is similar to a simple or easier extraction. You are slightly sore, but not debilitated. Many state that following the procedure that if they knew what the surgery was going to be like, they would have done it a long time ago. Everyone is different, however, so our patients are provided the proper pain medications, as necessary. </li></ul>
  16. 16. <ul><li>Q: How long do implants last? </li></ul><ul><li>A: Modern dental implants have been successful for over 30 years. Dental implants are intended to be permanent, however, many things contribute to their long term success including home care and regular maintenance. Cigarette smoking can cause problems with implant healing. Engineering is an important part of the success of the dental implant reconstruction. Placing the correct type and number of implants is important. </li></ul>
  17. 17. <ul><li>Q: What is the cost of dental implant therapy? </li></ul><ul><li>A: The investment made in proper and comprehensive implant therapy is an investment in your overall health and quality of life. Appearance is improved and facial structures are preserved. There are many factors involved in cost including the number of implants and the type of teeth placed over them. A thorough consultation is required to determine final cost, but all fees are presented prior to any commitment for treatment. </li></ul>
  18. 18. <ul><li>Q: Will my insurance cover implants? </li></ul><ul><li>A: The type of coverage you have determines whether implants are a benefit. Some insurance companies cover the cost of implants. </li></ul>
  19. 19. <ul><li>Q: Do implants require special care? </li></ul><ul><li>A: No, regular maintenance visits are important as is daily home care. </li></ul>
  20. 20. <ul><li>Q: How long does the entire process take? </li></ul><ul><li>A: This depends on the position that the implants are placed and what we are intending to do with our restoration. The implants are placed and sutures are usually removed in about one week. Following a proper healing time (usually 4-5 months), the implants are uncovered and impressions are made for the final teeth. This may take a month or so depending on the complexity of the situation. </li></ul>
  21. 21. Q: Will I leave your office without teeth? A: We will always try to provide you with some type of transitional or temporary tooth.
  22. 22. <ul><li>Q: Are dental implants experimental? </li></ul><ul><li>A: Absolutely not. Implants have been thoroughly researched and the current technology results in an outstanding success rate in the hands of the well trained and experienced clinician. </li></ul>
  23. 23. <ul><li>Q: Can implants be placed the same day as an extraction? </li></ul><ul><li>A: Whether an implant can be placed on the same day as an extraction depends on the amount of bone that is available and whether there is any infection around the existing tooth. When teeth are lost, bone will shrink in several dimensions. Placing an implant immediately can reduce this bone loss and provide a better esthetic result. </li></ul>
  24. 24. <ul><li>Q: What are some of the benefits to dental implants? </li></ul><ul><li>A: Increased confidence when smiling, speaking and eating, especially if dentures or partials are replaced or retained with dental implants. </li></ul><ul><ul><li>Elimination of denture adhesives </li></ul></ul><ul><ul><li>Improved comfort, speech and appearance. </li></ul></ul><ul><ul><li>Preservation of the integrity of facial structures. </li></ul></ul><ul><ul><li>Adjacent teeth are not ground down for a bridge. </li></ul></ul><ul><ul><li>Implants can be easier and maintain since they are cleaned like natural teeth </li></ul></ul><ul><ul><li>Improved ability to taste food </li></ul></ul><ul><ul><li>Looking and feeling younger </li></ul></ul><ul><ul><li>Restored self esteem </li></ul></ul><ul><ul><li>Improved Quality of life </li></ul></ul>
  25. 25. What dictates type of prosthesis: <ul><li>Number of implants to be placed </li></ul><ul><li>Location of implants </li></ul><ul><li>Amount of implant/soft tissue support needed </li></ul><ul><li>Quality and quantity of bone </li></ul><ul><li>Size of the implants (length vs width) </li></ul><ul><li>Medical considerations </li></ul><ul><li>Psychological considerations </li></ul>
  26. 26. “ The vast majority of complications in implant dentistry are related to biomechanics. The complications include early loading implant failure, crestal bone loss, abutment screw loosening, porcelain or acrylic veneer fracture, and uncemented restorations.” Misch, 2007
  27. 27. The percentage of completely edentulous patients is decreasing, but the actual number of completely edentulous patients is increasing.
  28. 28. <ul><li>Ceka attachments 800.232.7732 </li></ul><ul><li>(preat) </li></ul><ul><li>Locator attachments 760.743.7744 </li></ul><ul><li>(Zest Anchors) </li></ul><ul><li>ERA attachments 800.243.9942 </li></ul><ul><li>(Sterngold) </li></ul><ul><li>Bredent attachments 877.328.3965 </li></ul><ul><li>(xpdent) </li></ul><ul><li>Hader attachments 800.243.9942 </li></ul><ul><li>(Sterngold) </li></ul>
  29. 29. Approximate cost of attachment <ul><li>Type of attachment Abutment Set Replacement </li></ul>ERA $ 58.00 $ 5.00 Locator $160.00 $28.00 Hader $170.00 $ 7.00 Bredent $119.00 $ 7.00
  30. 30. <ul><li>Locator attachments (Zest Anchors, Escondido, CA) act as retentive devices for overdentures. The patient is able to easily align and seat the overdentures. Implants should be placed in a parallel position. </li></ul><ul><li>The attachment resists wear and maintain satisfactory retention for up to 56,000 cycles of function. Nice to use when there is an occlusal clearance problem since it is only 3.17mm in total height. Male portions are easily changed chairside. </li></ul>
  31. 31. LOCATOR IMPLANT ANCHORS (Zest Anchors, Inc.) <ul><li>Supragingival attachment </li></ul><ul><li>Available as a straight abutment or at 10 or 20 degreees </li></ul><ul><li>Permits divergence between implants up to 20 degrees (40 degrees with extended range) </li></ul><ul><li>Self aligning to the top of the implants </li></ul><ul><li>Torque into place to 20Ncm </li></ul><ul><li>Low profile </li></ul><ul><li>Saves interocclusal space </li></ul><ul><li>Guides the overdenture into proper alignment similar to a milled bar </li></ul><ul><li>Cost minimal when compared to a milled bar </li></ul><ul><li>Can be set on supporting bars </li></ul>
  32. 32. <ul><li>Bredent attachments can be used on implants that are up to 15 degrees divergent from the path of insertion. They are available in 3 diameters with 3 different tissue heights </li></ul>
  33. 33. HOW TO TAKE CARE OF DENTAL IMPLANTS
  34. 34. <ul><li>Daily care is similar to the care of natural teeth. </li></ul><ul><li>Restored dental implants need to be kept clean and plaque free </li></ul><ul><li>Cleaning after meals is important </li></ul>
  35. 35. Access Oral Care 1-877-94-ACCESS
  36. 36. <ul><li>Gentle brushing with small soft manual or electric brush </li></ul><ul><li>Low abrasive, tartar control toothpaste </li></ul><ul><li>Dental floss for cleaning around the abutments </li></ul>
  37. 37. <ul><li>Other adjuncts: </li></ul><ul><li>Antimicrobial mouth rinses </li></ul><ul><li>Interdental brushes or other aids to remove plaque on either side of the implants </li></ul><ul><li>Disclosing tablets to stain the locations of plaque accumulation </li></ul>
  38. 38. TEAM DENTISTRY <ul><li>DENTIST </li></ul><ul><li>DENTAL HYGIENISTS </li></ul><ul><li>ASSISTANTS </li></ul><ul><li>TREATMENT COORDINATORS </li></ul><ul><li>FRONT DESK PERSONNEL </li></ul><ul><li>DENTAL SPECIALISTS </li></ul><ul><li>DENTAL TECHNICIANS </li></ul><ul><li>MANUFACTURERS </li></ul><ul><li>EDUCATORS </li></ul><ul><li>DIAGNOSTIC SERVICES </li></ul>
  39. 39. <ul><li>DIAGNOSTIC METHODS </li></ul><ul><li>HIGH TECH EQUIPMENT </li></ul><ul><li>DURABLE RESTORATIVE MATERIALS </li></ul><ul><li>ENDOSSEOUS DENTAL IMPLANTS </li></ul><ul><li>HIGH STRENGTH CERAMICS </li></ul><ul><li>CAD/CAM </li></ul>HIGH TECHNOLOGY IN THE 21ST CENTURY
  40. 40. THE MOST CRITICAL CRITEREA IN DENTAL IMPLANTOLOGY <ul><li>PROSTHETIC CRITERIA </li></ul><ul><li>SOFT TISSUE MANAGEMENT </li></ul><ul><li>BONE PREPARATION </li></ul>
  41. 41. PROSTHETIC BIOMECHANICS <ul><li>ANATOMIC FACTORS </li></ul><ul><li>PROPER FUNCTION </li></ul><ul><li>ESTABLISH POSITION, NUMBER AND DIAMETER OF THE IMPLANTS NEEDED </li></ul><ul><li>FACILITATE HYGIENE </li></ul>
  42. 42. AN AGING POPULATION <ul><li>THE GROUP OLDER THAN 65 IS PROJECTED TO INCREASE FROM 12% OF THE POPULATION IN 2000 TO MORE THAN 20% IN THE NEXT 25 YEARS </li></ul>
  43. 43. <ul><li>POTENTIAL IMPLANT PATIENT POPULATION IS EVER INCREASING BY 2025 NEARLY 70 MILLION PEOPLE WILL BE 65 AND OLDER </li></ul>
  44. 44. <ul><li>POTENTIAL IMPLANT PATIENT POPULATION IS EVER INCREASING BY 2025 NEARLY 70 MILLION PEOPLE WILL BE 65 AND OLDER </li></ul>
  45. 45. ACCORDING TO MISCH THE LIFE SPAN AT FAILURE OF CROWNS IS 10.3 YEARS <ul><li>REASON FOR FAILURE: DECAY, ENDODONTIC THERAPY </li></ul><ul><li>IT HAS BEEN ESTIMATED THAT A $425 CROWN FOR A 22 YEAR OLD PATIENT WILL COST $12,000 DURING THE PATIENT’S LIFETIME TO REPLACE OR REPAIR IT. </li></ul>
  46. 46. <ul><li>70% OF THE US POPULATION IS MISSING AT LEAST ONE TOOTH </li></ul><ul><li>IN 1990 MORE THAN 4 MILLION BRIDGES WERE PLACED </li></ul><ul><li>BRIDGES ACCOUNT FOR 7% OF THE ANNUAL DENTAL REIMBURSEMENT FROM INSURANCE COMPANIES AND MORE THAN $3 BILLION/YEAR </li></ul>
  47. 47. <ul><li>STUDIES SHOW THAT THERE IS A 74% 15 YEAR SURVIVAL RATE ON BRIDGES. </li></ul><ul><li>MEAN LIFE SPAN OF 9.6 -10.3 YEARS </li></ul>
  48. 48. ADVANTAGES OF SINGLE TOOTH DENTAL IMPLANTS <ul><li>HIGH SUCCESS RATES </li></ul><ul><li>DECREASED RISK OF CARIES OF ADJACENT TEETH </li></ul><ul><li>DECREASED RISK OF ENDODONTIC PROBLEMS </li></ul><ul><li>BETTER HYGIENE </li></ul><ul><li>IMPROVED ESTHETICS </li></ul><ul><li>BONE MAINTENANCE </li></ul><ul><li>ELIMINATE COLD SENSITIVITY </li></ul><ul><li>ELIMINATE NEED TO GRIND DOWN ADJACENT TEETH </li></ul>
  49. 49. AVERAGE EDENTUALISM IS 20% WORLDWIDE BY AGE 60
  50. 50. 1999-2002 TOTAL US EDENTUALISM OF BOTH ARCHES WAS 7.7% (20 MILLION PEOPLE)
  51. 51. ONE OR TWO ARCH EDENTUALISM 17% OF THE US POPULATION OR 30 MILLION PEOPLE
  52. 52. REDUCED OCCLUSAL FORCES IN EDENTULOUS <ul><li>CHEWING FORCES DECREASED TO 20-30% OF THOSE WITH NATURAL TEETH </li></ul><ul><li>NOT CHEWING PROPERLY INCREASES NEED TO MEDICATION FOR GASTROINTESTINAL PROBLEMS </li></ul><ul><li>DECREASE YOUR LIFE SPAN </li></ul>
  53. 53. <ul><li>5 YEAR SURVIVAL RATE FOR RPDS IS 60% </li></ul><ul><li>44% ABUTMENT TOOTH LOSS IN 10 YEARS </li></ul><ul><li>ACCELERATED BONE LOSS </li></ul>
  54. 54. PSYCHOLOGICAL EFFECTS <ul><li>LOW SELF ESTEEM </li></ul><ul><li>SPEECH AFFECTED </li></ul><ul><li>AVOID SOCIALIZING </li></ul>
  55. 55. MISCH BONE DENSITY CLASSIFICATION <ul><li>D1 DENSE CORTICAL BONE IN THE ANTERIOR MANDIBLE </li></ul><ul><li>D2 POROUS CORTICAL AND COARSE TRABECULAR IN THE ANTERIOR AND POSTERIOR </li></ul><ul><li>D3 POROUS CORTICAL (THIN) AND FINE TRABECULAR IN THE ANTERIOR AND POSTERIOR MAXILLA </li></ul><ul><li>D4 FINE TRABECULAR IN THE POSTERIOR MAXILLA </li></ul>
  56. 56. CRITERIA FOR IMPLANT SUCCESS <ul><li>NOT MOBILE </li></ul><ul><li>NO EVIDENCE OF PERIIMPLANT RADIOLUCENCY </li></ul><ul><li>VERTICAL BONE LOSS OF LESS THAN 0.2 MM ANNUALLY AFTER THE 1ST YEAR </li></ul><ul><li>NO PAIN, INFECTION, PARESTHESIA </li></ul><ul><li>SUCCESS RATES OF 85% AT THE END OF A 5 YEAR OBSERVATION AND 80% AFTER A 10 YEAR PERIOD </li></ul>
  57. 57. <ul><li>A PROBE PENETRATES DEEPER NEXT TO AN IMPLANT COMPARED TO A TOOTH </li></ul><ul><li>TAKE CARE NOT TO CONTAMINATE THE IMPLANT SULCUS WITH BACTERIA FROM A DISEASED PERIODONTAL SITE </li></ul>
  58. 58. TOOTH HAS CEMENTUM, BONE AND PERIODONTIUM IMPLANT IS OSSEOINTEGRATED WITH AKLYLOSIS ON IMPLANT TO BONE
  59. 59. TOOTH AND IMPLANT HAVE HEMIDESMOSOMES AND BASAL LAMINA AS ITS JUNCTIONAL EPITHELIUM
  60. 60. <ul><li>TOOTH HAS PERPENDICULAR CONNECTIVE TISSUE FIBERS WITH INCREASED FIBROBLASTS AND DECREASED COLLAGEN </li></ul><ul><li>IMPLANT HAS PARALLEL AND CIRCULAR FIBERS WITH NO ATTACHMENT TO THE IMPLANT SURFACE AND BONE AND HAS INCREASED COLLAGEN AND DECREASED FIBROBLASTS </li></ul>
  61. 61. TOOTH HAS GREATER VASCULARITY FROM THE PERIODONTAL LIGAMENT
  62. 62. NORMAL PROBING IS 3MM IN A HEALTHY TOOTH BUT 2.5-5MM IN AN IMPLANT DEPENDING ON THE SOFT TISSUE DEPTH
  63. 63. <ul><li>INSTRUMENTS TO MAINTAIN IMPLANTS MUST BE EFFECTIVE IN REMOVING BIOFILMS AND ACCRETIONS AND NOT DAMAGE THE IMPLANT BODY </li></ul>
  64. 64. <ul><li>DON’T GOUGE TITANIUM WITH ULTRASONIC AND SONIC SCALERS. USE PLASTIC OR RUBBER SLEEVES </li></ul>
  65. 65. <ul><li>NO STAINLESS STEEL TIPPED INSTRUMENTS </li></ul><ul><li>USE PLASTIC, GRAPHITE, NYLON OR TEFLON COATED INSTRUMENTS </li></ul>
  66. 66. <ul><li>USE RUBBER CAP WHEN POLISHING WITH FINE PROPHY PASTE OR TIN OXIDE </li></ul>
  67. 67. <ul><li>SIMPLY REMOVE THE PLAQUE AND CALCULUS </li></ul><ul><li>CHLORHEXIDINE GLUCONATE EFFECTIVE IN REDUCING PLAQUE. </li></ul><ul><li>USE WITH A BRUSH OR FLOSS </li></ul>
  68. 68. CONVENTIONAL DENTAL IMPLANT APPROACHES <ul><li>PLANNING </li></ul><ul><li>SURGERY </li></ul><ul><li>REMOVE SUTURES </li></ul><ul><li>RELINE PROSTHESIS </li></ul><ul><li>ABUTMENT SELECTION AND PLACEMENT </li></ul><ul><li>TRANSITIONAL PROVISIONAL </li></ul><ul><li>SOFT TISSUE MONITORING </li></ul><ul><li>FINAL IMPRESSION </li></ul><ul><li>TRY IN </li></ul><ul><li>FINAL PROSTHESIS </li></ul>
  69. 69. CAD/CAM GUIDED APPROACH <ul><li>PLANNING </li></ul><ul><li>SURGERY </li></ul><ul><li>TRANSITIONAL PLACMENT </li></ul><ul><li>FINAL PROSTHESIS </li></ul>
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