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10º Simpósio Ibérico Biomet3i - Jan. 2011
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10º Simpósio Ibérico Biomet3i - Jan. 2011

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"Minimally Invasive Surgical Procedures" - Gonçalo Seguro Dias, DDS

"Minimally Invasive Surgical Procedures" - Gonçalo Seguro Dias, DDS

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    10º Simpósio Ibérico Biomet3i - Jan. 2011 10º Simpósio Ibérico Biomet3i - Jan. 2011 Presentation Transcript

    • Minimally invasive surgical procedures Clinical Guidelines for a Successful Outcome Gonçalo Seguro Dias Oral Surgery and Oral Pathology Dept School of Dentistry, Lisbon Universityquarta-feira, 26 de Janeiro de 2011
    • Gonçalo Seguro Dias Aknowledgments: Ana Luísa Silva Teresa Casaca Vanessa Osório For a handout of this lecture please contact by email: goncalosegurodias@gsd-dentalclinics.comquarta-feira, 26 de Janeiro de 2011
    •  Less trauma for the patient than an equivalent invasive procedure. Definitionquarta-feira, 26 de Janeiro de 2011
    •  More or less expensive;  Operative time not essential; Definition  Less pain and less posoperative complications;  Faster recovery.quarta-feira, 26 de Janeiro de 2011
    • Treatment plan trendsquarta-feira, 26 de Janeiro de 2011
    • Patient’s Perspective  Less surgical steps;  Short treatment time;  Maximize comfort;  High success rate;  High esthetic and functional outcome.quarta-feira, 26 de Janeiro de 2011
    • Patient’s Perspective Clinician’s Perspective  Less surgical steps;  Less surgical steps;  Short treatment time;  Less chair time;  Maximize comfort;  High success rate.  High success rate;  High esthetic and functional outcome.quarta-feira, 26 de Janeiro de 2011
    • t’s ien e Pat tiv rspec Pe Clinici an’s Perspe ctivequarta-feira, 26 de Janeiro de 2011
    • Biologic and clinical rational for a successful outcome regarding minimally invasive surgery in treatment plan. Bone/soft No bone/soft Topics tissue Immediate implants tissue discrepancies discrepancies * * ASSUMPTION: all implants in esthetic anterior areas need bone/soft tissue graftsquarta-feira, 26 de Janeiro de 2011
    • No bone/soft Bone/soft Topics tissue Immediate implants tissue discrepancies discrepanciesquarta-feira, 26 de Janeiro de 2011
    • Brodala N. Flapless surgery and its effect on dental implant outcomes. Int J Oral Maxillofac Implants. 2009;24 Suppl:118-25. Becker W, Goldstein M, Becker BE, Sennerby L, Kois D, Hujoel P. Minimally invasive flapless implant placement: follow-up results from a multicenter study. J Periodontol. 2009 Feb;80(2):347-52. Papaspyridakos P, Lal K. Immediate loading of the maxilla with prefabricated interim prosthesis using interactive planning software, and CAD/CAM rehabilitation with definitive zirconia prosthesis: 2-year clinical follow-up. J Esthet Restor Dent. 2010 Aug;22(4):223-32. Rousseau P. Flapless and traditional dental implant surgery: an open, retrospective comparative study. Oral Maxillofac Surg. 2010 Sep;68(9):2299-306.quarta-feira, 26 de Janeiro de 2011
    • Full Arch Rehabilitationquarta-feira, 26 de Janeiro de 2011
    • Full Arch Rehabilitationquarta-feira, 26 de Janeiro de 2011
    • Full Arch Rehabilitationquarta-feira, 26 de Janeiro de 2011
    • Full Arch Rehabilitationquarta-feira, 26 de Janeiro de 2011
    • Full Arch Rehabilitationquarta-feira, 26 de Janeiro de 2011
    • Full Arch Rehabilitationquarta-feira, 26 de Janeiro de 2011
    • Single Unit Rehabilitationquarta-feira, 26 de Janeiro de 2011
    • Single Unit Rehabilitationquarta-feira, 26 de Janeiro de 2011
    • Single Unit Rehabilitationquarta-feira, 26 de Janeiro de 2011
    • Single Unit Rehabilitationquarta-feira, 26 de Janeiro de 2011
    • Single Unit Rehabilitationquarta-feira, 26 de Janeiro de 2011
    • Single Unit Rehabilitationquarta-feira, 26 de Janeiro de 2011
    • Single Unit Rehabilitationquarta-feira, 26 de Janeiro de 2011
    • Single Unit Rehabilitationquarta-feira, 26 de Janeiro de 2011
    • Treatment Plan Options Removal of the Try to remove implant and the broken screw replacement with another implantquarta-feira, 26 de Janeiro de 2011
    • Considerations Screw not loose; Only active part of screw is inside the implant; Anxious patient.quarta-feira, 26 de Janeiro de 2011
    • Changes in implant primary and secondary stability over timequarta-feira, 26 de Janeiro de 2011
    • Single Unit Rehabilitationquarta-feira, 26 de Janeiro de 2011
    • Single Unit Rehabilitationquarta-feira, 26 de Janeiro de 2011
    • Single Unit Rehabilitationquarta-feira, 26 de Janeiro de 2011
    • Single Unit Rehabilitationquarta-feira, 26 de Janeiro de 2011
    • Guided ADVANTAGES Surgery/ Reduced treatment time; Mini flaps Reduced morbility.quarta-feira, 26 de Janeiro de 2011
    • CB CT planning Guided Surgery/ Mini flapsquarta-feira, 26 de Janeiro de 2011
    • CB CT planning Guided WHEN? Surgery/ Mini flaps Nodoubts regarding the bone or soft tissue volume.quarta-feira, 26 de Janeiro de 2011
    • No bone/soft Bone/soft Topics tissue Immediate implants tissue discrepancies discrepanciesquarta-feira, 26 de Janeiro de 2011
    •  Caneva M, Botticelli D, Salata LA, Souza SL, Bressan E, Lang NP. Flap vs. "flapless" surgical approach at immediate  implants: a histomorphometric study in dogs. Clin Oral Implants Res. 2010 Dec;21(12):1314-9. Caneva M, Botticelli D, Salata LA, Scombatti Souza SL, Carvalho Cardoso L, Lang NP. Collagen membranes at Immediate immediate implants: a histomorphometric study in dogs. Clin Oral Implants Res. 2010 Sep;21(9):891-7. implants  Caneva M, Salata LA, de Souza SS, Bressan E, Botticelli D, Lang NP. Hard tissue formation adjacent to implants of various size and configuration immediately placed into extraction sockets: an experimental study in dogs. Clin Oral Implants Res. 2010 Sep;21(9):885-90.  Caneva M, Salata LA, de Souza SS, Baffone G, Lang NP, Botticelli D. Influence of implant positioning in extraction sockets on osseointegration: histomorphometric analyses in dogs. Clin Oral Implants Res. 2010 Jan;21(1): 43-9.  de Sanctis M, Vignoletti F, Discepoli N, Zucchelli G, Sanz M. Immediate implants at fresh extraction sockets: bone healing in four different implant systems. J Clin Periodontol. 2009 Aug;36(8):705-11.  Ferrus J, Cecchinato D, Pjetursson EB, Lang NP, Sanz M, Lindhe J. Factors influencing ridge alterations following immediate implant placement into extraction sockets. Clin Oral Implants Res. 2010 Jan;21(1):22-9.  Tomasi C, Sanz M, Cecchinato D, Pjetursson B, Ferrus J, Lang NP, Lindhe J. Bone dimensional variations at implants placed in fresh extraction sockets: a multilevel multivariate analysis. Clin Oral Implants Res. 2010 Jan;21 (1):30-6.  Vignoletti F, Johansson C, Albrektsson T, De Sanctis M, San Roman F, Sanz M. Early healing of implants placed into fresh extraction sockets: an experimental study in the beagle dog. De novo bone formation. J Clin Periodontol. 2009 Mar;36(3):265-77.quarta-feira, 26 de Janeiro de 2011
    • Implant Location (vertical dimension)  Botticelli, 2004; Covani, 2007; Buser, 2008; Caneva, 2010 Immediate Implants Buccal plate thickness Assessment  Araújo, 2004; Botticelli, 2004; Araújo, 2005; Botticceli, 2006; Nevins, 2006; Chen, 2007; Ferrus, 2010; Huynh-Ba, 2010; Tomasi, 2010 No flap procedures  Blanco, 2008, 2010; Sainz, 2010 Horizontal void  Araújo, 2005; Ferrus, 2009; Sanz, 2009; Huynh-Ba, 2010; Tomasi, 2010 Immediate provisionalization  Wohrle 1998; Kan 2000; Hui 2001; Saadoun 2002; Covani 2004; Cornelini 2005; Tortamano 2010; Valentini 2010quarta-feira, 26 de Janeiro de 2011
    • Upper Pre Molar Areaquarta-feira, 26 de Janeiro de 2011
    • Upper Pre Molar Areaquarta-feira, 26 de Janeiro de 2011
    • Upper Pre Molar Areaquarta-feira, 26 de Janeiro de 2011
    • Upper Pre Molar Areaquarta-feira, 26 de Janeiro de 2011
    • Upper Pre Molar Areaquarta-feira, 26 de Janeiro de 2011
    • Upper Pre Molar Areaquarta-feira, 26 de Janeiro de 2011
    • Upper Pre Molar Areaquarta-feira, 26 de Janeiro de 2011
    • Upper Pre Molar Areaquarta-feira, 26 de Janeiro de 2011
    • Upper Molar Area  Acocella A, Bertolai R, Sacco R. Modified insertion technique for immediate implant placement into fresh extraction socket in the first maxillary molar sites: a 3-year prospective study. Implant Dent. 2010 Jun;19(3):220-8.  Bersani E, Coppede AR, de Paula Pinto Prata HH. Immediate loading of implants placed in fresh extraction sockets in the molar area with flapless and graftless procedures: a case series. Int J Periodontics Restorative Dent. 2010 Jun;30(3):291-9.quarta-feira, 26 de Janeiro de 2011
    • Upper Molar Area  Acocella A, Bertolai R, Sacco R. Modified insertion technique for immediate implant placement into fresh extraction socket in the first maxillary molar sites: a 3-year prospective study. Implant Dent. 2010 Jun;19(3):220-8.  Bersani E, Coppede AR, de Paula Pinto Prata HH. Immediate loading of implants placed in fresh extraction sockets in the molar area with flapless and graftless procedures: a case series. Int J Periodontics Restorative Dent. 2010 Jun;30(3):291-9.quarta-feira, 26 de Janeiro de 2011
    • Upper Molar Areaquarta-feira, 26 de Janeiro de 2011
    • Upper Molar Areaquarta-feira, 26 de Janeiro de 2011
    • Lower Molar Areaquarta-feira, 26 de Janeiro de 2011
    • Lower Molar Areaquarta-feira, 26 de Janeiro de 2011
    • Lower Molar Areaquarta-feira, 26 de Janeiro de 2011
    • Lower Molar Areaquarta-feira, 26 de Janeiro de 2011
    • Patient Considerations  Case selection is critical for sucess: - Healing problems; thick biotypes; smokers,... Surgeon  Atraumatic extraction (root separation mandatory);  Implant placement in an ideal 3d restorative position;  Familiar with GBR procedures.  Skillfull - know what to do when things go wrong!quarta-feira, 26 de Janeiro de 2011
    • Bone/soft No bone/soft Topics tissue Immediate implants tissue discrepancies discrepancies * * ASSUMPTION: all implants in esthetic anterior areas need bone/soft tissue graftsquarta-feira, 26 de Janeiro de 2011
    • No bone reconstruction required Extraction Implant placement Timing for Abutment connection SOFT Soft TISSUES Tissues MANAGEMENT Management Bone reconstruction required Extraction Abutment connectionquarta-feira, 26 de Janeiro de 2011
    • Lateral Incisorquarta-feira, 26 de Janeiro de 2011
    • Lateral Incisor Considerations Periodontal afected tooth; Vertical bone deficiency; Soft tissue deficiency.quarta-feira, 26 de Janeiro de 2011
    • Lateral Incisor 8 weeks afterquarta-feira, 26 de Janeiro de 2011
    • Lateral Incisor 8 weeks afterquarta-feira, 26 de Janeiro de 2011
    • Lateral Incisorquarta-feira, 26 de Janeiro de 2011
    • Lateral Incisor Buser 2005quarta-feira, 26 de Janeiro de 2011
    • Lateral Incisorquarta-feira, 26 de Janeiro de 2011
    • Lateral Incisorquarta-feira, 26 de Janeiro de 2011
    • Lateral Incisor 8 weeks afterquarta-feira, 26 de Janeiro de 2011
    • Lateral Incisor 8 weeks afterquarta-feira, 26 de Janeiro de 2011
    • GBR procedures; Hard Tissue Bone blocks; Discrepancies Short/Tilted implants; Alveolar distraction; Zygomatic implants.quarta-feira, 26 de Janeiro de 2011
    • GBR procedures; Hard Tissue Bone blocks; Discrepancies Short/Tilted implants; Alveolar distraction; Zygomatic implants. How can we be minimally invasive?quarta-feira, 26 de Janeiro de 2011
    • Partial Edentulismquarta-feira, 26 de Janeiro de 2011
    • Partial Edentulismquarta-feira, 26 de Janeiro de 2011
    • Partial Edentulismquarta-feira, 26 de Janeiro de 2011
    • Partial Edentulismquarta-feira, 26 de Janeiro de 2011
    • Partial Edentulismquarta-feira, 26 de Janeiro de 2011
    • Partial Edentulismquarta-feira, 26 de Janeiro de 2011
    • Treatment Plan Options  Cyst removal and wait for healing  “Cyst elevation”quarta-feira, 26 de Janeiro de 2011
    • Partial Edentulismquarta-feira, 26 de Janeiro de 2011
    • Partial Edentulismquarta-feira, 26 de Janeiro de 2011
    • Partial Edentulismquarta-feira, 26 de Janeiro de 2011
    • Partial Edentulismquarta-feira, 26 de Janeiro de 2011
    • Partial Edentulism 6 months afterquarta-feira, 26 de Janeiro de 2011
    • Partial Edentulism 6 months afterquarta-feira, 26 de Janeiro de 2011
    • Total Edentulismquarta-feira, 26 de Janeiro de 2011
    • Total Edentulismquarta-feira, 26 de Janeiro de 2011
    • Treatment Plan Options  Bilateral sinus lift;  Short implants;  Tilted implants.quarta-feira, 26 de Janeiro de 2011
    • Total Edentulismquarta-feira, 26 de Janeiro de 2011
    • Total Edentulismquarta-feira, 26 de Janeiro de 2011
    • Total Edentulismquarta-feira, 26 de Janeiro de 2011
    • Total Edentulismquarta-feira, 26 de Janeiro de 2011
    • das Neves FD, Fones D, Bernardes SR, do Prado CJ, Neto AJ. Short implants--an analysis of longitudinal studies. Int J Oral Maxillofac Implants. 2006 Jan-Feb;21(1): 86-93. Short Grusovin MG, Coulthard P, Worthington HV, George P, Esposito M. Interventions for replacing missing teeth: maintaining and recovering soft tissue health around dental Implants implants. Cochrane Database Syst Rev. 2010 Aug 4;(8): Misch CE. Short dental implants: a literature review and rationale for use. Dent Today. 2005 Aug;24(8):64-6, 68. Morand M, Irinakis T. The challenge of implant therapy in the posterior maxilla: providing a rationale for the use of short implants. J Oral Implantol. 2007;33(5): 257-66. Raviv E, Turcotte A, Harel-Raviv M.Short dental implants in reduced alveolar bone height.Quintessence Int. 2010 Jul-Aug;41(7):575-9. Romeo E, Bivio A, Mosca D, Scanferla M, Ghisolfi M, Storelli S.The use of short dental implants in clinical practice: literature review.Minerva Stomatol. 2010 Jan-Feb;59(1-2): 23-31.quarta-feira, 26 de Janeiro de 2011
    • Severe Atrophic Maxillaquarta-feira, 26 de Janeiro de 2011
    • Severe Atrophic Maxillaquarta-feira, 26 de Janeiro de 2011
    • Bone reconstruction with autologous and xenograft (no Treatment immediate load; 8-12 months treatment lenght; no Plan Options provisional).quarta-feira, 26 de Janeiro de 2011
    • Treatment Plan Options Bilateral sinus lift (no immediate load; 6-8 months lenght).quarta-feira, 26 de Janeiro de 2011
    • Treatment Plan Options Zigomatic implants (immediate loading; shorter treatment time; less morbility).quarta-feira, 26 de Janeiro de 2011
    • Davo R.Zygomatic implants placed with a two-stage procedure: a 5-year Surgical retrospective study.Eur J Oral Implantol. 2009 Summer;2(2):115-24. Alternatives Esposito M, Worthington HV, Thomsen P, Coulthard P.Interventions for - Zygomatics replacing missing teeth: dental implants in zygomatic bone for the rehabilitation of the severely deficient edentulous maxilla.Cochrane Database Syst Rev. 2003; (3). Kuabara MR, Ferreira EJ, Gulinelli JL, Paz LG.Rehabilitation with zygomatic implants: a treatment option for the atrophic edentulous maxilla--9-year follow- up.Quintessence Int. 2010 Jan;41(1):9-12. Malevez C, Daelemans P, Adriaenssens P, Durdu F.Use of zygomatic implants to deal with resorbed posterior maxillae.Periodontol 2000. 2003;33:82-9.quarta-feira, 26 de Janeiro de 2011
    • Take home messagesquarta-feira, 26 de Janeiro de 2011
    • Treatment Plan Decision Making for No Bone/ Soft Tissue Discrepancies Cases No bone/soft CBCT evaluation Guided Surgery / Predictable tissue Outcome discrepancies Miniflapquarta-feira, 26 de Janeiro de 2011
    • Treatment Plan Decision Making for Immediate Implants 2nd No GBR surgery Predictable preservation or for Outcome* GTR implant placement Implant Placement Abort Immediate Tooth Buccal Implant Extraction Plate Primary placement Predictable Implants with/ Stability Outcome without GBR How skillful are you? Preservation 2nd No Primary GBR surgery Predictable Stability or for GTR implant Outcome placement Implant Placement Abortquarta-feira, 26 de Janeiro de 2011
    • Treatment Plan Decision Making for Bone/ Soft Tissue Discrepancies Cases Extreme bone ZYGOMATIC resorption IMPLANTS Specific Vertical Defects ALVEOLAR DISTRACTION Patient sensitive Bone/Soft Soft GBR/ Implant Predictable Bone Specific Locations Tissue Tissue Regeneration SINUS placement Outcome Discrepancies Regeneration LIFT BONE Specific Locations BLOCKS Case sensitive SHORT/ Posterior Areas TILTED Anterior bone height of IMPLANTS 10mm and width 5 mmmquarta-feira, 26 de Janeiro de 2011
    • Custom made treatment plans regarding both patient evaluation and clinician skills.quarta-feira, 26 de Janeiro de 2011
    • Do not start your treatment plan if you do not know what to do if things go wrong.quarta-feira, 26 de Janeiro de 2011
    • NO evidence to suggest that simultaneous site development and implant loading is predictable.quarta-feira, 26 de Janeiro de 2011
    • You choose your success rate!quarta-feira, 26 de Janeiro de 2011
    • Thank you very much for your attention! goncalosegurodias@gsd-dentalclinics.comquarta-feira, 26 de Janeiro de 2011