Basic dental implant surgery/ cosmetic dentistry training


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Indian Dental Academy: will be one of the most relevant and exciting

training center with best faculty and flexible training programs

for dental professionals who wish to advance in their dental

practice,Offers certified courses in Dental

implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic

Dentistry, Periodontics and General Dentistry.

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Basic dental implant surgery/ cosmetic dentistry training

  1. 1. Basic implant surgery Basic implant surgery INDIAN DENTAL ACADEMY Leader in continuing dental education
  2. 2. CONTENTS  Introduction  Preoperative measures  Operative requirements  Sterile technique  Surgical techniques for implant instillation  Surgery for abutment connection  Recent advances  Conclusion  References
  3. 3. INTRODUCTION Successful implant surgery is largely dependent upon good planning and meticulous technique. The planning requires an appreciation of the restorative requirements and visualization of the desired end result of treatment. The meticulous technique requires adequate surgical training and experience of the selected implant system.
  4. 4. The essential pre-requisites before proceeding to implant surgery are: The patient should be medically fit to undergo the surgery. Placement of one or two implants is equivalent to relatively minor oral surgery whereas placement of five or six implants increases the magnitude significantly.
  8. 8. INFORMED CONSENT 1. The patient should understand the procedure and be warned of any complications. 2. They should have agreed the treatment plan, treatment schedule, costings, and given their consent.
  9. 9.  The diagnostic set-up surgical stent and relevant radiographs should be available.  The surgeon should have a clear idea of the number, size and planned location of the implants. They should be trained in the procedure and able to cope with any unforeseen circumstances.
  10. 10. GENERAL MEDICAL CONTRAINDICATIONS 1. Age 2. Current medications 3. Metabolic disorders 4. Hematologic disorders 5. Cardiac and circulatory disorders 6. Osseous metabolic disorders 7. Pregnancy 8. Heart valve prosthesis or bacterial endocarditis
  11. 11. INTRAORAL CONTRAINDICATIONS 1. Unfavorable bone quality and quantity 2. Problematic occlusal and functional relationship 3. Pathologic conditions in alveolar bone 4. Radiation therapy in jaw region 5. Pathologic alteration of oral mucosa 6. Xerostomia 7. Poor oral hygiene
  12. 12. PSYCHOLOGICAL CONTRAINDICATIONS 1. Poor patient compliance 2. Alcohal and smoking 3. Neurosis and psychosis 4. Problem patients
  13. 13. ANAESTHESIA Most implant surgery can be carried out under local anaesthesia, although some patients will require sedation or general anaesthesia. For extremely anxious patients benzodiazepine 5- 20 mg 1 hour before operation.
  14. 14. STERILE TECHNIQUE  Every effort should be made to conduct implant surgery under sterile operating conditions.  Chlorhexidine 0.2% is used as a pre-operative mouthwash and skin preparation circumorally using broad spectrum microbicide ex: betadine.
  19. 19. Reduction gear angled handpiece system uses both internal and external irrigation
  20. 20. Operatory: sterilized, ventilated
  21. 21. Disposable plastic sleeve for motor and cord. Avoids repeated autoclaving
  22. 22. High speed hand piece to run at high torque with a speed of 1500 to 2000 RPMs, and the slow speed hand piece at high torque with speed of approximately 15 to 20 RPMs
  23. 23. Drills used for bone preparation include: guide drill, 2 mm twist drill, pilot drill, the 3 mm twist drill, and countersink
  24. 24. Irrigation unit is used to deliver an even, steady flow of sterile water to the surgical site at all times during high and low speed preparation
  25. 25. Surgical guide stent is placed in the area to project the future position of the fixture
  26. 26. FLAP DESIGN  There are many different flap designs for implant surgery. practically in all situations a mid-crestal incision can be employed.  Access and elevation of the flaps can usually be improved by the additional use of vertical relieving incisions
  27. 27. IncIsIons
  30. 30. Arcuate vestibular primary incision
  31. 31. Crestal incision with buccal reflection
  32. 32. Vestibular incision with lingual reflection
  33. 33. Primary incisions – maxilla crestal incision in edentulous maxilla
  34. 34. Palatal primary incision with buccally reflected mucoperiosteal flaps
  35. 35. Buccal primary incision with palatal reflection of mucoperiosteal flaps
  36. 36. Partially edentulous maxilla – palatal incision
  37. 37. Single tooth implant – periodontal surgery type incision technique
  38. 38. Single tooth implant – maxillofacial surgery type incision technique
  39. 39. Stage I Surgery is the procedure for installing implants into bone. This procedure demands exacting, non- traumatic preparation of the recipient site and a specific insertion protocol. Variations in this procedure mainly depends on the quality and quantity of bone and also on the load demands on the final prosthesis
  40. 40. Guide drill is the first drill used in the bone preparation process. It is designed to penetrate the cortical layer of the bone
  41. 41. Initial penetration using surgical guide stent, is initiated using high speed guide drill at 1500 RPM. Copious saline irrigation used at all times
  42. 42. 2 mm twist drill is used second in the sequence to prepare the site to 2mm in diameter
  43. 43. Site is progressively enlarged to 2mm with a 2mm twist drill at 1500 RPM
  44. 44. Pilot drill is used next. Inferior portion of the drill is to engage the 2mm prepared site and superior portion begins the enlargement of the site
  45. 45. Final orientation and inclination of the implant is done by using the pilot drill at high speed, high torque. It has an 2mm non-cutting edge and a 3mm cutting edge
  46. 46. 3 mm twist drill is fourth drill in bone preparation. Its used to prepare bone to its final destination
  47. 47. Implant site is prepared to final length and width utilizing a 3mm twist drill operating at high speed
  48. 48. Countersink is the final drill used in the high speed drilling process. It is used to create a shelf in the prepared bony site
  49. 49. Crestal bone carefully prepared using countersink. Allows superior aspect of implant to be placed crestally or sub- crestally.
  50. 50. Bone tap is the first in the series of slow speed bone preparation. Made of titanium and used to thread the bone prior to implant placement
  51. 51. Receptor site is tapped utilizing a titanium tap operating at 15 to 20 RPMs along with copious irrigation
  52. 52. Implants are composed of commercially pure titanium and range in length from 7 to 20 mm and width of range 3.75 and 4.0 mm
  53. 53. Fixture mount is connected to the implant
  54. 54. Connection to handpiece is used to connect the fixture mount to the handpiece
  55. 55. Implant is connected to the handpiece, and inserted to the pre-tapped site at 15 to 20 RPMs
  56. 56. implant is in position
  57. 57. Cylinder wrench used for final tightening of implant
  58. 58. Open end wrench to stabilize the implant during removal of fixture mount
  59. 59. Subcrestal position of the implant
  60. 60. Screwdriver, either hexagonal or slotted used to place cover screw into implant
  61. 61. Cover screws are available either a hexagonal or slotted configuration
  62. 62. Coverscrew picked up in slow handpiece and placed into the implant
  63. 63. Appearance of implant after insertion of cover screw
  64. 64. Sutures placed
  65. 65. Stage II surgery Uncovering of implants may be after 3 to 4 months of healing in mandible and 5 to 6 months in case of maxillae
  66. 66. Repositioned flaps
  67. 67.
  68. 68. Connective tissue transplant
  69. 69.
  70. 70. Free gingival graft
  71. 71. Electrosurgery
  72. 72. Excessive bone formation
  74. 74. Cover screw is exposed after removal of overlying bone or soft tissue
  75. 75. Hexagon cover screw driver used to remove cover screw from implant
  76. 76. After 4 months of healing, cover screw removed
  77. 77. Selection of proper sized abutment for transmucosal connection
  78. 78. Abutment placed into implant and secured with abutment screw
  79. 79. Small or large healing caps used to prevent debris collection in threaded portion of abutment screw
  80. 80. Surgical dressing during healing phase
  81. 81. Tissue response after two weeks
  82. 82. Hex abutment screwdriver to screw abutment into implant
  83. 83. Abutment placed with help from screwdriver
  84. 84. Abutment clamp used to prevent transfer of torque to implant while connecting abutment screw
  85. 85. Abutment clamp in use
  86. 86. Post-operative care After implant surgery, patients should be warned to expect: 1. Some swelling and possibly bruising 2. Some discomfort which can usually be controlled with oral analgesics 3. Some transitory disturbance in sensation if surgery has been close to a nerve.
  87. 87. They should be advised: 1. In most circumstances, not to wear dentures over the surgical area for at least 1 week (possibly 2 weeks) to avoid loading the implants and the possibility of disrupting the sutures 2. To use analgesics and ice packs to reduce swelling and pain 3. To keep the area clean by using chlorhexidine mouthwash 0.2% for 1 minute twice daily 4. Not to smoke.
  88. 88. ANTIBIOTIC COVER The original protocols recommended an antibiotic such as amoxicillin 250 mg 8 hourly for 5 to 7 days, unless the patient is allergic where a suitable alternative should be prescribed.
  89. 89. Recent advances : Computer Guided Implant Surgery Computer Guided Implant Surgery SIM/Plant is the recent advance in implant treatment planning. It is an interactive 3D computer imaging system that guides us in implant surgery. With SIM/Plant we can visualize the placement of simulated implants and it gives us detailed knowledge of the anatomy of the jaw in all three dimensions. It helps us locate important internal structures and also helps us measure bone quality directly from images.
  90. 90. Wand's computer controlled local anesthetic injection system: • It doesn't feel like a syringe. We know that some patients get more nervous than others at the mere site of a needle and syringe. • That's why this performs injection with a revolutionary system called the Wand, a computer controlled local anesthetic injection system. • The microprocessor inside the Wand automatically ensures a steady flow rate regardless of tissue density. The flow of anesthetic into your tissue is the source of discomfort for most injections-not the needle.
  91. 91. Conclusion Implant surgery is highly technique sensitive and requires adequate training and an understanding of the restorative requirements of the proposed treatment. However, control of these factors can produce a highly predictable, aesthetic and long-lasting result.
  92. 92. References 1. Atlas of oral implantology – A.Norman Cranin 2. Contemporary implant dentistry – Carl.E.misch 3. Implants in clinical dentistry – Richard.M.Palmer 4. Color atlas of dental implantology – Hubertius spiekermann 5. Implant prosthodontics – Stevens Friedrickson
  93. 93. 6. Atlas of tooth and implant supported prosthodontics – Lawrence.A.Weinberg 7. Principles and Practice of Implant Dentistry: Adam Weiss and Charles M.Weiss 8. Richard palmer, paul palmer and peter Floyd. Basic implant surgery. British dental journal 1999, vol 187, no 8, page 415. 9. Effect of surgical techniques on primary implant stability and periimplant bone. J Oral Maxillofacial Surgery 2007, 65, 2487. 10. A surgical guide for dental implant placement . J Prosthet Dent 2006; 96; 129.
  94. 94. Thank you For more details please visit