Mini Dental Implants  A Presentation        by     Tariq Idris         .                       Menu   <
Topics•   History of Dental Implants•   Role of Mini Implants•   Cases•   Complications                                 Me...
Topics• Future trends• Medico-legal issues• Practicals: Surgical and Prosthetic                                 Menu   <
Aims/ Objectives• To appreciate the choices available   to the patient• To understand the scope of mini implants• To under...
Aims/ ObjectivesTo gain an insight into the techniques                employed                                   Menu   <
Current Options for the Edentulous         Complete Dentures                                 Menu   <
Current Options for the EdentulousOverdentures Retained by Implants                               Menu   <
Current Options for the EdentulousBridgework Supported by Implants                               Menu   <
Option 1:A Denture.• Low cost/Simplicity but difficulties    when faced with:• Little/ no ridge• No retention/ resistance ...
Option 1:A Denture.• Sore spots/ constant Easing• Aesthetic Compromise                                Menu   <
Consequently:• Looseness• Pain/ ulceration• Lack of Confidence• Difficulty with eating                           Menu   <
• “ It makes me gag”• “ It hurts when I chew”• “ I can’t taste my food”• “ I hate it !”• “ I take it out to eat”          ...
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Anti-Ageing              Menu   <
Mini Dental Implants(MDI’s)• Over 20 year history• No long term studies• Some early studies:                          Menu...
Mini Dental Implants(MDI’s)   Currently 4 years of Data   showing only 2.1% loss.                               Menu   <
Mini Dental Implants(MDI’s)   Historically used as temporary or      transitional implants to secure   Temporaries whilst ...
Mini Dental Implants(MDI’s)       Now some FDA approvedfor long term use for fixed and removable                  prothese...
MDI Features•    Implants are Surfaced Etched•    Self-tapping Thread Design•    High-Strength Titanium Alloy Material•   ...
MDI Features            (at the moment!)•    1.8 – 2.2 mm diameter•    Available in 10 to18 mm lengths•    Implant and abu...
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Current Designs                  Menu   <
Titanium Alloy (Titanium, 6Aluminum, 4Vanadium)62.5% Higher tensile strength thanthe strongest commercially pure,  Grade I...
Advantages of Mini Implants • Minimally invasive surgery • Cost effective • Immediate loading • Suitable for Resorbed Ridg...
Advantages of Mini Implants• Minimal post-op Discomfort• Can be used on almost all ridges•Can be performed by the patients...
Is this the Endof Conventional Implants?                            Menu   <
NO!!!!MDI’s are an alternative to dentures, bridges and conventional implants         in certain situations               ...
NO!!!!     They are often a third way        in between denturesand more complex implant treatments                       ...
NO!!!!The Patient will end up with a different                productcompared with conventional implants                  ...
The most important thingis to give the patient the Choice                                Menu   <
Many patients who would not            consider  conventional implant treatment due to:• Fear of complex surgery• Timescal...
• Limited bone availability: do not want                grafting• may proceed with mini dental implants                   ...
Mini Dental Implants• They are ‘consumer friendly’• They widen the market of prospective    patients• They require less in...
Patient Selection Criteria• Who is a candidate for  MDI?• Difficulty wearing  lower denture!!! etc.                       ...
Patient Selection Criteria• Cannot tolerate a palate on upper• Anatomically   compromised• Patient wants to feel   more co...
Are MDI’s Good for everyone?• Medically Compromised ?• A wider range of Patients can be treated• No incision in most cases...
Are MDI’s Good for everyone?• Low morbidity• Low infection• Non-invasive                          Menu   <
Are MDI’s Good for everyone?• What about patients taking steroids?• Contraindicated for most implants,  but can be done wi...
Are MDI’s Good for everyone?• What about patients taking blood  thinners?• Less of a problem unless a flap is needed• Cons...
Are MDI’s Good for Everyone?     • Anatomically      Compromised ? • Many patients do not    have adequate bonesupport to ...
Are MDI’s Good for Everyone?     • Anatomically      Compromised ?• MDI’s can be used in  almost any ridge and on  patient...
Are MDI’s Good for Everyone?• Fewer visits to the dental surgery• Can be performed by the General Dentist                 ...
Are MDI’s Good for Everyone?       Financially Compromised ?• Fewer visits to the dental surgery• Can be performed by the ...
Mini Dental Implants    Their biggest application is in thestabilisation of Complete lower dentures.                      ...
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Mini Dental Implant Diagnosis   and Treatment Planning                           Menu   <
Treatment Plan•   Occlusal Dynamics•   Oral Hygiene•   General health/ medical history•   Psychological/ social status•   ...
Anatomy          Menu   <
Anatomical Considerations• Mandibular Nerve• Mental Nerve• Sub- mental artery                            Menu   <
Anatomical Considerations• Maxillary Sinus• Nasal Sinus• Other teeth/ roots                            Menu   <
Bone Quality and Quantity• Rate Density - 1,2,3,4• 1 - Very dense bone: difficult surgically• 2 - Moderately dense bone   ...
Bone Quality and Quantity• 3 - Low density bone    Maxillary bone or soft mandibular    spongy bone: modify protocol• 4 - ...
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Assess the Bone•   Height•   Width•   Shape•   Angulation                         Menu   <
Assess The Bone• Using Ridge Mapping, Radiographs,    CT scans,• Sectional Radiographs, Scanora,etc                       ...
1 - Radiographic Planning  Panoramic X-RayAssists in planning Implant placement                            Menu   <
1 - Radiographic PlanningPencil radiograph in region of canineand 1st premolaranterior to mental nerve canal              ...
1 - Radiographic PlanningPencil radiograph and in region of  lateral incisor      Region                          Menu   <
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Implant Placement Procedure                          Menu   <
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2 - Mark Denture and Transfer• Using the pencil  marks made on  the radiograph as  a guide, mark  DRY denture  heavily wit...
2 - Mark Denture and TransferNext DRY Patient’sarch and place denture       in mouth.                                Menu ...
2 - Mark Denture and TransferYou may darken transfer  spots with marker for    APPROXIMATE placement of implants.         ...
3- Assess Vertical Bone Height :• MDIs are 10mm. - 18mm. Long• Less than 10 mm = Poor Candidate for    MDI• Use longest im...
4 - Create Pilot HoleFirst Palpate to assess   the Angulation of       the Ridge.                           Menu   <
4 - Create Pilot Hole After measuring depth, drill pilothole with a tappingmotion using saline    irrigation.             ...
4 - Create Pilot HoleDrill depth according    to bone density       evaluation.                           Menu   <
5 - Implant InsertionDo not contaminate the implant surface                           Menu   <
5 - Implant InsertionInsert implant into    pilot opening through gingiva to bone: take care not    to trap tissue        ...
5 - Implant InsertionRotate clockwise with downward     pressure                         Menu   <
6 - Finger DriverContinue insertion of implant with fingerdriver until firm bony  resistance is again       met. met.     ...
6 - Finger Driver Then follow with   winged thumb wrench SLOWLY,again until firm bony  resistance is met.                 ...
7 - Ratchet WrenchIf bone is extremely  dense use of ratchet  wrench is needed.                            Menu   <
7 - Ratchet WrenchSLOW incrementalturns will allow full  insertion without   snapping of the      implant.                ...
7 - Ratchet WrenchPressure should be applied downwardon the ‘head’ of the   ratchet during     insertion.                 ...
7 - Ratchet Wrench If VERY HEAVYresistance is noticed,   back implant out                           Menu   <
7 - Ratchet Wrenchand make pilot hole deeper. DO NOT   force ratchet orimplant may snap at        neck.                   ...
8 - Complete InsertionComplete the insertion   of all implants.                                Menu   <
8 - Complete Insertion  Insert implantscompletely so that no     threads are   supragingival.                             ...
8 - Complete InsertionCheck primary fixation  with torque wrench                                Menu   <
Postoperative X-ray                      Menu   <
Denture Placement and Prosthetic Technique Phase 3                                Menu   <
Denture Placement and          Prosthetic TechniquePositioning should be close to original plan,make holes in denture    w...
Denture Placement and        Prosthetic Technique   Place housingabutments on implant       o-balls.                      ...
Denture Placement and         Prosthetic TechniqueTry-in denture for full        seating.   Use fit checker               ...
Denture Placement and Prosthetic       Technique, (cont.)Fill holes in denturewith implant housing  attachment resin.     ...
Denture Placement and Prosthetic         Technique, (cont.)Protect exposed implant     head to prevent   engaging undercut...
Denture Placement and Prosthetic          Technique, (cont.)Place denture on o-ringhousings and have patientbite gently us...
Denture Placement and     Prosthetic Technique, (cont.)Remove denture and assess security of housing in denture..         ...
Denture Placement and     Prosthetic Technique, (cont.)Add flowable resin (light cured), cold cured acrylic or cyanoacryla...
Denture Placement and      Prosthetic Technique, (cont.)Trim excess material  and smooth tissue  surface of denture to  av...
Denture Placement and     Prosthetic Technique, (cont.)Also shorten boarders of denture.                               Men...
Post Operative Instructions•   Prescribe analgesics•   Ice Applications•   Warm saltwater•   Wear Denture for 24 hours•   ...
24 Hours Later• Adjust denture• Most likely there will be adjustments• Some will have denture sores   developing• Adjust s...
24 Hours Later• Instruct to wear denture as much as     possible over next week     and to call if there is a problem.• Se...
Case Presentations                     Menu   <
Case 1         Menu   <
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Case 2         Menu   <
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Lateral Case               Menu   <
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Immediate Loading•   Introduced by Linkow in the 60’s•   Well established in the mandible•   Not yet in the maxilla•   Pri...
MDI’s aren’t Voodoo• Its what yoodoo that counts.• How many implants do you need to   restore a full jaw?• The principles ...
MDI’s aren’t Voodoo• Primary fixation• Oral health• No/ limited micro movement• Biomechanics                              ...
Other Applications?• Transitional – during the healing phase    of conventional implants• Salvage cases• Retention of Part...
Other Applications?• Distal abutment - Free end saddle  replacement of removable partial  dentures???• One implant per roo...
Partial Cases                Menu   <
Complications•   Fracture: instruments/ implants•   Lateral forces•   Pain/swelling•   Fracture of prosthesis•   Housing l...
Broken Drill               Menu   <
Broken Drill               Menu   <
Broken Drill               Menu   <
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Consent• Principles• A process- not a  form• Clear and honest• Documented• Avoid jargon                        Menu   <
Consent IssuesNo/ limited data/ studies: History   New to UK: New to you.                                Menu   <
Risks•   Surgical and Prosthetic:•   Non-integration,•   Fracture,•   Infection,                               Menu   <
Risks• Damage to nerves (paraesthesia)   and adjacent teeth• Sinus perforation• Case abandonment• Bone loss               ...
Risks• Fracture of Prosthesis,• Oral Hygiene issues• Need for maintenance / check up’s.• No Assurances of Success/ Longevi...
Consent: Operator Issues• Suitable training• Suitable experience• Competence                              Menu   <
Implant Efficacy as a Function of Chronology of Implant                                     Placement                100% ...
Future Trends• More research, more research, more   research• Greater range of sizes                                Menu   <
Future Trends• Development of design for individual    crowns• Orthodontic Applications                                 Me...
24 Hours Later•   Adjust denture•   Most likely there will be adjustments•   Some will have denture sores developing•   Ad...
24 Hours Later• Instruct the Patient to wear denture    as much as possible over next week    and to call if there is a pr...
SummaryPatient arrives with a loose lower denturePatient leaves 2 hours later with a stable                 prosthesis    ...
Summary    No flap   No suturesImmediately loaded                     Menu   <
Other Applications?• Transitional – during the healing phase    of conventional implants• Salvage cases• Retention of Part...
Concerns with the following issues: • Insufficient fixation in Type 2, 3 and 4     bone • The marginal overhang? • Potenti...
Address concerns/ difficulties•   Fracture•   Durability•   Surface Area•   Emergence Profile/ Overhang•   Poor Quality Bo...
Range of Larger SizesAll self tapping.    • 2.3mm    • 2.8mm    • 3.3mm    • 3.8mm    • 4.3mm                            M...
Improved Abutment for CrownsWith a Hygienic Crown Margin                           Menu   <
The New Mini/ Midi Implant• Increased Surface Area: comparable  with conventional implants• Improved Strength• Improved Re...
Assess the Bone•   Height•   Width•   Shape•   Angulation                          Menu   <
Assess The Bone•   Using ridge mapping, radiographs,               CT scans,•   Sectional radiographs, Scanora,etc        ...
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Auto Advancing Technique• Similar Effect to Using Osteotomes• Implant is creating a channel by pushing    spongious bone t...
Ridge Expansion/ Compression• Established over 30 years ago• Scientifically valid• Involves opening the ridge and    displ...
• Creates a Series of microfractures• Heal readily especially if stable   and with periosteum intact                      ...
Expansion and Compression      Phenomenom  TM                            Menu   <
Simultaneous Expansion and Compression     Producing Improved Primary StabilityParticularly Suitable for Type 2 and 3 Bone...
Expansion and Compression• Smooth and Progressive• Improves surrounding bone quality• Creates a wall of dense bone around ...
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Aseptic Technique                    Menu   <
Missing laterals                   Menu   <
A Denture had Been In place for over 20 years.   Ridge Mapping revealed 2mm Width                                        M...
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The Finished Restorations                            Menu   <
Measured Ridge ExpansionPre-op 2mm         Post op 4mm                              Menu   <
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Deciduous Teeth                  Menu   <
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Implants Placed                  Menu   <
Crowns in Place                  Menu   <
Natural Contours                   Menu   <
Lower Incisor                Menu   <
Implant Insertion                    Menu   <
Implant in Site                  Menu   <
Fixation Checked 30Ncm                         Menu   <
The Post is Prepared                       Menu   <
Crown Fitted               Menu   <
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Scientific Principles•   Biocompatibility•   Implant Surface•   Implant Site•   Surgical Technique                        ...
Scientific Principles• Undisturbed healing phase• Biomechanics• Prosthetic Success                              Menu   <
Principles Examined         Biocompatibility:Titanium Alloy well established as a    biocompatible implant material       ...
Principles Examined           Implant Surface:Implant is a threaded screw etched and                  blasted             ...
Principles Examined           Implant Site:Placement site is always improved by        ‘Osteo- Expression’                ...
Simultaneous Expansion and Compression  Producing Improved Primary StabilityParticularly Suitable for Type 2 and 3 Bone i....
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Advantages of the Self Tapping          Tapered Design• Avoids drilling the bone/ minimal risk    of overheating• Progress...
4. The Surgical Technique           Flapless Surgery• In use for over 30 years by many     surgeons: Tatum, Hahn, Roberts,...
4. The Surgical Technique            Flapless Surgery• Maintains keratinised tissue which act   as a physical barrier to p...
5. Undisturbed Healing/         Immediate Loading• Dependent on good fixation > 25Ncm• Micromovement less than 100 microns...
Related research•Immediate Load Of Single Tooth Implants   in the Anterior Maxilla: 100% success     attributed to good fi...
Related Research:  ‘ A delayed healing process can cause psychological, social, and speech and/ or            function pro...
Related Research:  ‘One method for decreasing the risk ofsurgical trauma is to have more vital bone       in contact with ...
Related Research     Testori: BIC at 4 months 64% for immediately loaded compared with 39%  Piatelli: Early loaded implant...
Related ResearchG. E Romanos Journal of Oral implantology              vol30.no 3.2004.  ‘Present status of Immediate Load...
Related Research      Several Conditions       Primary Stability   Sufficient Bone QualityElimination of Micromovement    ...
Related Research ‘Implant design makes a significant  contribution to the initial stability’‘A screw threaded design with ...
Related Research3.5mm by 14mm implant equivalent    surface to multirooted teethRecommended techniques to improve         ...
6. Biomechanics•   Avoid Bruxists•   Avoid Molars•   Splinting to other implants•   Occlusal Protection•   Controlled Diet...
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Prosthetic Factors• Ultimate simplicity: no extra components• Conventional impression techniques• Conventional Crown fabri...
Stable Gap Free Interface     1Year Post Op                            Menu   <
Simple Reconstruction                        Menu   <
Factors Contributing to Success•   Minimal Surgical Trauma•   Improved Bone to Implant Contact•   Improved Fixation•   Imp...
Personal Experience: Fixed Restorations • 18 months • Over 180 Placed following Protocols • Only 3 Lost: 2 Overloaded, 1 p...
Using MDI in your practice• Patient Satisfaction• Your Satisfaction• Staff Involvement• Financially Accepted• Financially ...
How can MDIs affect my Practice?• Emotional Satisfaction• Patient Relationships and Referrals• Financial Freedom• Personal...
Pitfalls and Limitations• Do not over-promise• Do not overload• Not an excuse for an ill fitting denture• Beware with fixe...
The End          Menu   <
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Mini Dental Implants A Presentation by Tariq Idris .

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  • gud one sir,,,,,,,,
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  • A very informative presentation about mini dental implants.It's an extraordinarily simple solution for anchoring an existing or new denture into place. No incision is required, and there is very little post placement discomfort and down time.I think it provides a good time consuming solution through implant,within budget.Claps for your effort.
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Mini Dental Implants A Presentation by Tariq Idris .

  1. 1. Mini Dental Implants A Presentation by Tariq Idris . Menu <
  2. 2. Topics• History of Dental Implants• Role of Mini Implants• Cases• Complications Menu <
  3. 3. Topics• Future trends• Medico-legal issues• Practicals: Surgical and Prosthetic Menu <
  4. 4. Aims/ Objectives• To appreciate the choices available to the patient• To understand the scope of mini implants• To understand their limitations and Pitfalls Menu <
  5. 5. Aims/ ObjectivesTo gain an insight into the techniques employed Menu <
  6. 6. Current Options for the Edentulous Complete Dentures Menu <
  7. 7. Current Options for the EdentulousOverdentures Retained by Implants Menu <
  8. 8. Current Options for the EdentulousBridgework Supported by Implants Menu <
  9. 9. Option 1:A Denture.• Low cost/Simplicity but difficulties when faced with:• Little/ no ridge• No retention/ resistance Menu <
  10. 10. Option 1:A Denture.• Sore spots/ constant Easing• Aesthetic Compromise Menu <
  11. 11. Consequently:• Looseness• Pain/ ulceration• Lack of Confidence• Difficulty with eating Menu <
  12. 12. • “ It makes me gag”• “ It hurts when I chew”• “ I can’t taste my food”• “ I hate it !”• “ I take it out to eat” Menu <
  13. 13. Menu <
  14. 14. Menu <
  15. 15. Anti-Ageing Menu <
  16. 16. Mini Dental Implants(MDI’s)• Over 20 year history• No long term studies• Some early studies: Menu <
  17. 17. Mini Dental Implants(MDI’s) Currently 4 years of Data showing only 2.1% loss. Menu <
  18. 18. Mini Dental Implants(MDI’s) Historically used as temporary or transitional implants to secure Temporaries whilst conventionalimplants were undergoing healing phase Menu <
  19. 19. Mini Dental Implants(MDI’s) Now some FDA approvedfor long term use for fixed and removable protheses. Menu <
  20. 20. MDI Features• Implants are Surfaced Etched• Self-tapping Thread Design• High-Strength Titanium Alloy Material• Integrated Abutment Menu <
  21. 21. MDI Features (at the moment!)• 1.8 – 2.2 mm diameter• Available in 10 to18 mm lengths• Implant and abutment are a single unit• O-Ball and Square Head abutment designs Menu <
  22. 22. Menu <
  23. 23. Current Designs Menu <
  24. 24. Titanium Alloy (Titanium, 6Aluminum, 4Vanadium)62.5% Higher tensile strength thanthe strongest commercially pure, Grade IV CP Titanium 70 60 50 40 30 20 10 0 Titanium CP Titanium Alloy Menu <
  25. 25. Advantages of Mini Implants • Minimally invasive surgery • Cost effective • Immediate loading • Suitable for Resorbed Ridges Menu <
  26. 26. Advantages of Mini Implants• Minimal post-op Discomfort• Can be used on almost all ridges•Can be performed by the patients general dentist Menu <
  27. 27. Is this the Endof Conventional Implants? Menu <
  28. 28. NO!!!!MDI’s are an alternative to dentures, bridges and conventional implants in certain situations Menu <
  29. 29. NO!!!! They are often a third way in between denturesand more complex implant treatments Menu <
  30. 30. NO!!!!The Patient will end up with a different productcompared with conventional implants Menu <
  31. 31. The most important thingis to give the patient the Choice Menu <
  32. 32. Many patients who would not consider conventional implant treatment due to:• Fear of complex surgery• Timescale of treatment: up to 2 years• Cost Menu <
  33. 33. • Limited bone availability: do not want grafting• may proceed with mini dental implants Menu <
  34. 34. Mini Dental Implants• They are ‘consumer friendly’• They widen the market of prospective patients• They require less investment of time and money from the Dentist due to their relative simplicity Menu <
  35. 35. Patient Selection Criteria• Who is a candidate for MDI?• Difficulty wearing lower denture!!! etc. Menu <
  36. 36. Patient Selection Criteria• Cannot tolerate a palate on upper• Anatomically compromised• Patient wants to feel more confident, etc. Menu <
  37. 37. Are MDI’s Good for everyone?• Medically Compromised ?• A wider range of Patients can be treated• No incision in most cases Menu <
  38. 38. Are MDI’s Good for everyone?• Low morbidity• Low infection• Non-invasive Menu <
  39. 39. Are MDI’s Good for everyone?• What about patients taking steroids?• Contraindicated for most implants, but can be done with MDI Menu <
  40. 40. Are MDI’s Good for everyone?• What about patients taking blood thinners?• Less of a problem unless a flap is needed• Consult with Patient’s Physician Menu <
  41. 41. Are MDI’s Good for Everyone? • Anatomically Compromised ? • Many patients do not have adequate bonesupport to accept the large size of conventional implants.. Menu <
  42. 42. Are MDI’s Good for Everyone? • Anatomically Compromised ?• MDI’s can be used in almost any ridge and on patients with severe alveolar ridge resorption. Menu <
  43. 43. Are MDI’s Good for Everyone?• Fewer visits to the dental surgery• Can be performed by the General Dentist Menu <
  44. 44. Are MDI’s Good for Everyone? Financially Compromised ?• Fewer visits to the dental surgery• Can be performed by the General Dentist Menu <
  45. 45. Mini Dental Implants Their biggest application is in thestabilisation of Complete lower dentures. Menu <
  46. 46. Menu <
  47. 47. Mini Dental Implant Diagnosis and Treatment Planning Menu <
  48. 48. Treatment Plan• Occlusal Dynamics• Oral Hygiene• General health/ medical history• Psychological/ social status• Aesthetics: smile line• Anatomy Menu <
  49. 49. Anatomy Menu <
  50. 50. Anatomical Considerations• Mandibular Nerve• Mental Nerve• Sub- mental artery Menu <
  51. 51. Anatomical Considerations• Maxillary Sinus• Nasal Sinus• Other teeth/ roots Menu <
  52. 52. Bone Quality and Quantity• Rate Density - 1,2,3,4• 1 - Very dense bone: difficult surgically• 2 - Moderately dense bone Classic Mandibular Bone Menu <
  53. 53. Bone Quality and Quantity• 3 - Low density bone Maxillary bone or soft mandibular spongy bone: modify protocol• 4 - Very low density bone Poor candidate for MDI Menu <
  54. 54. Menu <
  55. 55. Assess the Bone• Height• Width• Shape• Angulation Menu <
  56. 56. Assess The Bone• Using Ridge Mapping, Radiographs, CT scans,• Sectional Radiographs, Scanora,etc Menu <
  57. 57. 1 - Radiographic Planning Panoramic X-RayAssists in planning Implant placement Menu <
  58. 58. 1 - Radiographic PlanningPencil radiograph in region of canineand 1st premolaranterior to mental nerve canal Menu <
  59. 59. 1 - Radiographic PlanningPencil radiograph and in region of lateral incisor Region Menu <
  60. 60. Menu <
  61. 61. Menu <
  62. 62. Menu <
  63. 63. Menu <
  64. 64. Menu <
  65. 65. Implant Placement Procedure Menu <
  66. 66. Menu <
  67. 67. Menu <
  68. 68. 2 - Mark Denture and Transfer• Using the pencil marks made on the radiograph as a guide, mark DRY denture heavily with skin marker. Menu <
  69. 69. 2 - Mark Denture and TransferNext DRY Patient’sarch and place denture in mouth. Menu <
  70. 70. 2 - Mark Denture and TransferYou may darken transfer spots with marker for APPROXIMATE placement of implants. Menu <
  71. 71. 3- Assess Vertical Bone Height :• MDIs are 10mm. - 18mm. Long• Less than 10 mm = Poor Candidate for MDI• Use longest implant possible Mandibular – 2/3 total height• Maxillary - 90% Menu <
  72. 72. 4 - Create Pilot HoleFirst Palpate to assess the Angulation of the Ridge. Menu <
  73. 73. 4 - Create Pilot Hole After measuring depth, drill pilothole with a tappingmotion using saline irrigation. Menu <
  74. 74. 4 - Create Pilot HoleDrill depth according to bone density evaluation. Menu <
  75. 75. 5 - Implant InsertionDo not contaminate the implant surface Menu <
  76. 76. 5 - Implant InsertionInsert implant into pilot opening through gingiva to bone: take care not to trap tissue Menu <
  77. 77. 5 - Implant InsertionRotate clockwise with downward pressure Menu <
  78. 78. 6 - Finger DriverContinue insertion of implant with fingerdriver until firm bony resistance is again met. met. Menu <
  79. 79. 6 - Finger Driver Then follow with winged thumb wrench SLOWLY,again until firm bony resistance is met. Menu <
  80. 80. 7 - Ratchet WrenchIf bone is extremely dense use of ratchet wrench is needed. Menu <
  81. 81. 7 - Ratchet WrenchSLOW incrementalturns will allow full insertion without snapping of the implant. Menu <
  82. 82. 7 - Ratchet WrenchPressure should be applied downwardon the ‘head’ of the ratchet during insertion. Menu <
  83. 83. 7 - Ratchet Wrench If VERY HEAVYresistance is noticed, back implant out Menu <
  84. 84. 7 - Ratchet Wrenchand make pilot hole deeper. DO NOT force ratchet orimplant may snap at neck. Menu <
  85. 85. 8 - Complete InsertionComplete the insertion of all implants. Menu <
  86. 86. 8 - Complete Insertion Insert implantscompletely so that no threads are supragingival. Menu <
  87. 87. 8 - Complete InsertionCheck primary fixation with torque wrench Menu <
  88. 88. Postoperative X-ray Menu <
  89. 89. Denture Placement and Prosthetic Technique Phase 3 Menu <
  90. 90. Denture Placement and Prosthetic TechniquePositioning should be close to original plan,make holes in denture with lab bur on premarked locations. Menu <
  91. 91. Denture Placement and Prosthetic Technique Place housingabutments on implant o-balls. Menu <
  92. 92. Denture Placement and Prosthetic TechniqueTry-in denture for full seating. Use fit checker Menu <
  93. 93. Denture Placement and Prosthetic Technique, (cont.)Fill holes in denturewith implant housing attachment resin. Menu <
  94. 94. Denture Placement and Prosthetic Technique, (cont.)Protect exposed implant head to prevent engaging undercut. Menu <
  95. 95. Denture Placement and Prosthetic Technique, (cont.)Place denture on o-ringhousings and have patientbite gently using previous registration to seat denture and hold for setting of resin/acrylic. Menu <
  96. 96. Denture Placement and Prosthetic Technique, (cont.)Remove denture and assess security of housing in denture.. Menu <
  97. 97. Denture Placement and Prosthetic Technique, (cont.)Add flowable resin (light cured), cold cured acrylic or cyanoacrylate if loose. . Menu <
  98. 98. Denture Placement and Prosthetic Technique, (cont.)Trim excess material and smooth tissue surface of denture to avoid sore spots.. Menu <
  99. 99. Denture Placement and Prosthetic Technique, (cont.)Also shorten boarders of denture. Menu <
  100. 100. Post Operative Instructions• Prescribe analgesics• Ice Applications• Warm saltwater• Wear Denture for 24 hours• See patient next day Menu <
  101. 101. 24 Hours Later• Adjust denture• Most likely there will be adjustments• Some will have denture sores developing• Adjust spots and check occlusion Menu <
  102. 102. 24 Hours Later• Instruct to wear denture as much as possible over next week and to call if there is a problem.• See patient in three days and one week post-op. Menu <
  103. 103. Case Presentations Menu <
  104. 104. Case 1 Menu <
  105. 105. Menu <
  106. 106. Menu <
  107. 107. Menu <
  108. 108. Menu <
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  115. 115. Case 2 Menu <
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  124. 124. Lateral Case Menu <
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  131. 131. Immediate Loading• Introduced by Linkow in the 60’s• Well established in the mandible• Not yet in the maxilla• Primary stability greater than 30 Ncm• Micro movement 50-150 microns Menu <
  132. 132. MDI’s aren’t Voodoo• Its what yoodoo that counts.• How many implants do you need to restore a full jaw?• The principles of Osseointegration still apply: Menu <
  133. 133. MDI’s aren’t Voodoo• Primary fixation• Oral health• No/ limited micro movement• Biomechanics Menu <
  134. 134. Other Applications?• Transitional – during the healing phase of conventional implants• Salvage cases• Retention of Partial Dentures• Fixed Crown and Bridge? BEWARE!• Single tooth - Lateral incisors with mild occlusal forces. Lower incisors. Menu <
  135. 135. Other Applications?• Distal abutment - Free end saddle replacement of removable partial dentures???• One implant per root if possible• 2 for each molar (minimum)• 1 for each anterior tooth Menu <
  136. 136. Partial Cases Menu <
  137. 137. Complications• Fracture: instruments/ implants• Lateral forces• Pain/swelling• Fracture of prosthesis• Housing loosening• Wear: O ring; implant head Menu <
  138. 138. Broken Drill Menu <
  139. 139. Broken Drill Menu <
  140. 140. Broken Drill Menu <
  141. 141. Menu <
  142. 142. Consent• Principles• A process- not a form• Clear and honest• Documented• Avoid jargon Menu <
  143. 143. Consent IssuesNo/ limited data/ studies: History New to UK: New to you. Menu <
  144. 144. Risks• Surgical and Prosthetic:• Non-integration,• Fracture,• Infection, Menu <
  145. 145. Risks• Damage to nerves (paraesthesia) and adjacent teeth• Sinus perforation• Case abandonment• Bone loss Menu <
  146. 146. Risks• Fracture of Prosthesis,• Oral Hygiene issues• Need for maintenance / check up’s.• No Assurances of Success/ Longevity Menu <
  147. 147. Consent: Operator Issues• Suitable training• Suitable experience• Competence Menu <
  148. 148. Implant Efficacy as a Function of Chronology of Implant Placement 100% 90% 80% 70% 60% %Implant Efficacy 50% 91.8 % 92.9% 100.0 98.8% 40% Loss 30% Success 20% 10% 0% 1-85 86-170 171-255 256-340 Chronology of Implant Placement Implant Placement 1-85 86-170 171-254 255-340 T otals Order Successes 78 79 85 84 326 Losses 7 6 0 1 14* Percent 91.8% 92.9% 100.0% 98.8% 95.9% Success Menu <
  149. 149. Future Trends• More research, more research, more research• Greater range of sizes Menu <
  150. 150. Future Trends• Development of design for individual crowns• Orthodontic Applications Menu <
  151. 151. 24 Hours Later• Adjust denture• Most likely there will be adjustments• Some will have denture sores developing• Adjust spots and check occlusion Menu <
  152. 152. 24 Hours Later• Instruct the Patient to wear denture as much as possible over next week and to call if there is a problem.• See patient in three days and one week post-op. Menu <
  153. 153. SummaryPatient arrives with a loose lower denturePatient leaves 2 hours later with a stable prosthesis Menu <
  154. 154. Summary No flap No suturesImmediately loaded Menu <
  155. 155. Other Applications?• Transitional – during the healing phase of conventional implants• Salvage cases• Retention of Partial Dentures Menu <
  156. 156. Concerns with the following issues: • Insufficient fixation in Type 2, 3 and 4 bone • The marginal overhang? • Potential overloading • Long term durability • Retention Menu <
  157. 157. Address concerns/ difficulties• Fracture• Durability• Surface Area• Emergence Profile/ Overhang• Poor Quality Bone Menu <
  158. 158. Range of Larger SizesAll self tapping. • 2.3mm • 2.8mm • 3.3mm • 3.8mm • 4.3mm Menu <
  159. 159. Improved Abutment for CrownsWith a Hygienic Crown Margin Menu <
  160. 160. The New Mini/ Midi Implant• Increased Surface Area: comparable with conventional implants• Improved Strength• Improved Retention• Improved Fixation Menu <
  161. 161. Assess the Bone• Height• Width• Shape• Angulation Menu <
  162. 162. Assess The Bone• Using ridge mapping, radiographs, CT scans,• Sectional radiographs, Scanora,etc Menu <
  163. 163. Menu <
  164. 164. Auto Advancing Technique• Similar Effect to Using Osteotomes• Implant is creating a channel by pushing spongious bone to the side• Implant is intimately in contact with the bone Menu <
  165. 165. Ridge Expansion/ Compression• Established over 30 years ago• Scientifically valid• Involves opening the ridge and displacing it Menu <
  166. 166. • Creates a Series of microfractures• Heal readily especially if stable and with periosteum intact Menu <
  167. 167. Expansion and Compression Phenomenom TM Menu <
  168. 168. Simultaneous Expansion and Compression Producing Improved Primary StabilityParticularly Suitable for Type 2 and 3 Bone i.e. Maxilla Menu <
  169. 169. Expansion and Compression• Smooth and Progressive• Improves surrounding bone quality• Creates a wall of dense bone around the implant• Improves the fixation ( torque check) Menu <
  170. 170. Menu <
  171. 171. Aseptic Technique Menu <
  172. 172. Missing laterals Menu <
  173. 173. A Denture had Been In place for over 20 years. Ridge Mapping revealed 2mm Width Menu <
  174. 174. Menu <
  175. 175. The Finished Restorations Menu <
  176. 176. Measured Ridge ExpansionPre-op 2mm Post op 4mm Menu <
  177. 177. Menu <
  178. 178. Deciduous Teeth Menu <
  179. 179. Menu <
  180. 180. Implants Placed Menu <
  181. 181. Crowns in Place Menu <
  182. 182. Natural Contours Menu <
  183. 183. Lower Incisor Menu <
  184. 184. Implant Insertion Menu <
  185. 185. Implant in Site Menu <
  186. 186. Fixation Checked 30Ncm Menu <
  187. 187. The Post is Prepared Menu <
  188. 188. Crown Fitted Menu <
  189. 189. Menu <
  190. 190. Scientific Principles• Biocompatibility• Implant Surface• Implant Site• Surgical Technique Menu <
  191. 191. Scientific Principles• Undisturbed healing phase• Biomechanics• Prosthetic Success Menu <
  192. 192. Principles Examined Biocompatibility:Titanium Alloy well established as a biocompatible implant material Menu <
  193. 193. Principles Examined Implant Surface:Implant is a threaded screw etched and blasted Menu <
  194. 194. Principles Examined Implant Site:Placement site is always improved by ‘Osteo- Expression’ Menu <
  195. 195. Simultaneous Expansion and Compression Producing Improved Primary StabilityParticularly Suitable for Type 2 and 3 Bone i.e. Maxilla Menu <
  196. 196. Menu <
  197. 197. Advantages of the Self Tapping Tapered Design• Avoids drilling the bone/ minimal risk of overheating• Progressive expansion and condensation more controlled than using osteotomes• Less need to sedate the patient Menu <
  198. 198. 4. The Surgical Technique Flapless Surgery• In use for over 30 years by many surgeons: Tatum, Hahn, Roberts, etc• Maintains the periosteum which provides the blood supply• Chanavaz J Oral Implantol 1995;21:214-219 Menu <
  199. 199. 4. The Surgical Technique Flapless Surgery• Maintains keratinised tissue which act as a physical barrier to plaque invasion• Lower incidence of surgical complications Menu <
  200. 200. 5. Undisturbed Healing/ Immediate Loading• Dependent on good fixation > 25Ncm• Micromovement less than 100 microns• Controlled Load Menu <
  201. 201. Related research•Immediate Load Of Single Tooth Implants in the Anterior Maxilla: 100% success attributed to good fixation 32Ncm.•Maintenance of Crestal Bone and excellent soft tissue contours attributed to lack of second stage surgery. Lorenzoni Menu <
  202. 202. Related Research: ‘ A delayed healing process can cause psychological, social, and speech and/ or function problems’Eliminate discomfort and inconvenience of 2nd surgery: sutures, infection, etc Menu <
  203. 203. Related Research: ‘One method for decreasing the risk ofsurgical trauma is to have more vital bone in contact with the implant’ Proposed Protocol 45 to 60 Ncm for placement Misch et al Menu <
  204. 204. Related Research Testori: BIC at 4 months 64% for immediately loaded compared with 39% Piatelli: Early loaded implants showedbetter quality of bone although similar BIC for the 2 groups Menu <
  205. 205. Related ResearchG. E Romanos Journal of Oral implantology vol30.no 3.2004. ‘Present status of Immediate Loading of Oral Implants’ Menu <
  206. 206. Related Research Several Conditions Primary Stability Sufficient Bone QualityElimination of Micromovement Menu <
  207. 207. Related Research ‘Implant design makes a significant contribution to the initial stability’‘A screw threaded design with a rough surface is recommended’ Menu <
  208. 208. Related Research3.5mm by 14mm implant equivalent surface to multirooted teethRecommended techniques to improve bone density Menu <
  209. 209. 6. Biomechanics• Avoid Bruxists• Avoid Molars• Splinting to other implants• Occlusal Protection• Controlled Diet/ Bone Training Menu <
  210. 210. Menu <
  211. 211. Prosthetic Factors• Ultimate simplicity: no extra components• Conventional impression techniques• Conventional Crown fabrication• No internal joints/ screws• Conventional cementation Menu <
  212. 212. Stable Gap Free Interface 1Year Post Op Menu <
  213. 213. Simple Reconstruction Menu <
  214. 214. Factors Contributing to Success• Minimal Surgical Trauma• Improved Bone to Implant Contact• Improved Fixation• Improved Peri implant Bone quality• Controlled Occlusal Load Menu <
  215. 215. Personal Experience: Fixed Restorations • 18 months • Over 180 Placed following Protocols • Only 3 Lost: 2 Overloaded, 1 post extraction • Expansion Measured Routinely • High degree of Satisfaction Menu <
  216. 216. Using MDI in your practice• Patient Satisfaction• Your Satisfaction• Staff Involvement• Financially Accepted• Financially Rewarding• Minimal Outlay Menu <
  217. 217. How can MDIs affect my Practice?• Emotional Satisfaction• Patient Relationships and Referrals• Financial Freedom• Personal and Family time Menu <
  218. 218. Pitfalls and Limitations• Do not over-promise• Do not overload• Not an excuse for an ill fitting denture• Beware with fixed crowns:forces, cosmetics• New Generation Mini Implants Menu <
  219. 219. The End Menu <

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