4. áá ááśáŻáá˝áášááźáŹá¸á áŻááášááŹáááš Implant treatment á ááŹáááŻáąááŹáášá¸áá˛áááŻáááš
- increase in bone anchored support
- prevent bone resorption
- maintain healthy teeth (áąáá¸ááźáŹá¸áĄáąááŹáášá¸áąááźááᯠbur áá˛ááááŻáášáá ášá ááŹááááŻ) á ááŹáąááź áťáá ášááŤááášá
5.
6. áĄááášá¸ (á) áąáĄáŹáášáťááášáąáᏠááŻááááĄááźááš áĄáąáťáááśáĄááşáášááşáŹá¸
áá dental implant treatment áąáĄáŹáášáťááášáááŻá good planning and meticulous technique ááá˝áááŻáááŻááŤááášá
ááŻááááżááŽá¸ááśáŻá¸áá˛áˇáĄááşááášáá˝áŹ ááášáááŻáááášáááŻááşáášááŤááá˛á áĄá˛áˇááŽáááŻááşáášáá˛áˇáááášáĄááźááš
ááááłááášáťááášááášáááĄááášáˇááášáˇ (good planning)ááŻáášáááŤááášá meticulous technique áááŻááŹá
ááźá˛á ááášááá áźáášá¸ááášáá˛á áááááĄááśáŻá¸áťááłááášáˇ implant system áĄáąážááŹáášá¸áááŻááášá¸ áąáááşáŹáąááˇááŹááŹá¸áááŤááášá
áá áá°ááŹá ááşáášá¸ááŹáąáá¸áąááŹáášá¸ááźáášáááŤáááš (The patient should be medically fit to undergo the
surgery.)á implant áá ášáąááşáŹáášá¸ááá˝á ášáąááşáŹáášá¸ááášáˇááŹá minor surgery áá˛ááá°áżááŽá¸ 5 áąááşáŹáášá¸á 6
áąááşáŹáášá¸ááášáˇááŹáá˛ááĄáá˝áş áááŻáżááŽá¸ áááŻá ááŻáášáááŻááááŻáĄáášááŤááášá ááŻááááĄáąážááŹáášá¸ áá°ááŹáááŻ
áąáááşáŹáá˝áášá¸áťáááŹá¸ááá˝áŹáťáá ášáááᯠinformed consent áá°ááŹá¸áááŻá áááŻáĄáášááŤááášá
áá surgical stent áá˛á áááŻáĄáášáá˛áˇ radiographs áąááź áąáááşáŹáťááášááášáąááˇááŹááŤá ááŻááááąáá¸ááášáˇ
ááźáŹá¸áááŹááášáĄáąááá˛á á ááŻáášááášáˇ implant áĄáąááĄááźáášá áĄááźáášáĄá áŹá¸á á ááŻáášááášáˇáąáááŹáááŻáááᯠáá˝áášá¸áá˝áášá¸ááášá¸ááášá¸
áááťááášááŹá¸áááŤááášá ááŻááááĄááźááš áąááˇááşáášáˇááŹá¸ááááá˝ááá˝áŹáťáá ášáááᯠáťáá ášááŹáááŻáášáá˛áˇ
áĄáąáťááĄáąááĄááášááášáááŻááášá¸ áąáťááá˝áášá¸áááŻáášááá˝áŹáťáá ášááŤááášá medical contraindications áąááźá intraoral
contraindications áąááźá psychological contraindications áąááźááá˝ááŤá áąáááşáŹáąááˇááŹááášá¸á á ášááśáŻá¸ááášáżááŽá¸áá˝
áááŻáĄáášáááᯠááŻááááąáá¸ááášáˇááŤááášá
áá implant surgery áĄááşáŹá¸á áŻááŻá ááśáŻáąáá¸áťááášáˇ áąááŹáášááźáášáááŻáášááŤááášá áá°ááŹáá ášááşáłáááááŻáąááŹáˇ sedation or
general anesthesia áąáá¸áżááŽá¸ ááŻááááŻáášááŤááášá áĄááášá¸á ááŻá¸áááášááášáá˛áˇáá°ááŹáąááźáááŻáąááŹáˇ áááźá˛áááš
áá ášááŹááŽáĄáááŻáá˝áŹ benzodiazepine 5 - 20 mg áąáá¸áááŻáášááŤááášá
á á ááŻááááąáá¸áááŻá ááášááá˝áášá¸ááášááášáżááŽá¸ áąááŹááŤáááŻá¸ááá°á¸á áášáááŻáášáá˛áˇ áąáááŹáá˛á áá áĽáášá¸áąááź áááŻááŤáááš (sterile
technique)á áááźá˛ááášáá˝áŹ 0.2% chlorhexidine mouthwash áá˛áááŤá¸ááŻáášááşáášá¸áąá áżááŽá¸ ááśááźáášá¸ááášááášááášáááŻ
betadine áá˛áááášááá˝áášá¸áąáá¸áááŤááášá áĄáąáťáááśáááŻáĄáášáá˛áˇáá áĽáášá¸áąááźá surgical drape kit á implant packaging á
sterile physiologic saline solution á reduction gear angled handpiece system with both external
and internal irrigation á disposable plastic sleeve for motor and cord á handpiece á drills á
irrigation unit á ááŹáąááźááᯠáąáááşáŹáťááášááášáááŤááášá
7. áá implant flap design áĄááşáłáá¸ááşáłáá¸ááá˝ááášáˇáĄáááš mid-crestal incision ááᯠáĄáąáťááĄáąááĄáŹá¸ááśáŻá¸áá˝áŹ
áĄááśáŻá¸áťááłáááŻáášááŤááášá áťááášááźáášá¸áááŻáá˝áášá¸áąáĄáŹáášá ááŻáášááᏠááşáášááşáášááášá¸ááášá¸áťáá ášáąáĄáŹááš vertical relieving
incisions ááŻáášáááŻáášááŤááášá
áá stage I surgery áááŻááŹá implant fixture ááᯠáĄáááŻá¸áᲠááášáˇáá˛áˇ procedure áťáá ášááŤááášá ááááááşááşáá˛á
áááŻáĄáášááŹáááš áááááŻáášáááááá˝áąá áᲠimplant ááᯠááášáˇáááŤáááš (exacting, non-traumatic preparation of
the recipient site, and a specific insertion protocol) á ááášáˇááźáášá¸á áĽášá¸á áŹá¸áááášáˇáĄááşáášáąááźááąááŹáˇ
quality and quantity of bone á the load demand on the final prosthesis áááŻá áťáá ášááŤááášá drill áá˛á
áąááŹáášáąáááŻáášá¸áá˝áŹ copious saline irrigation ááŻáášáááŤááášá
áá áááááĄááśáŻá¸áťááłáá˛áˇ implant system áĄá drill ááşáŹá¸ááᯠáĄá áŽá áĽášáĄáááŻáášá¸ áĄááśáŻá¸áťááłááŤá áááŻáĄáášááŤá countersink áá˛á
bone tap ááᯠáĄááśáŻá¸áťááłááŤá implant ááᯠááášáá˝áášááŹá¸áá˛áˇ 15-20 RPMs áĄáááŻáášá¸ááášáˇááŽá¸ááŤá cover screw áá˛á
áááášááŤá suture ááŻáášááŤá
áá stage II sugery ááᯠhealing ááżááŽá¸áąááŹááš mandible áá˝áŹ á ááá˝ á áá maxilla áá˝ áá áá˝ á á áĄááşááášáá˝áŹ
ááŻáášááŻááášááŤááášá
- Cover screw is exposed after removal of overlying bone or soft tissue
- cover screw driver is used to remove cover screw from implant
- Selection of proper sized abutment for transmucosal connection
- Abutment placed into implant and secured with abutment screw
- Small or large healing caps used to prevent debris collection in threaded portion of abutment
screw
- Surgical dressing during healing phase
ááá Post-operative care
After implant surgery, patients should be warned to expect:
- Some swelling and possibly bruising
- Some discomfort which can usually be controlled with oral analgesics
- Some transitory disturbance in sensation if surgery has been close to a nerve.
They should be advised:
- 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
- To use analgesics and ice packs to reduce swelling and pain
- To keep the area clean by using chlorhexidine mouthwash 0.2% for 1 minute twice daily
- Not to smoke.
ááá amoxicillin 250 mg áá ášáąáá ááśáŻá¸ááááášá á -á áááš áąáá¸áááŻáášááŤááášá amoxicillin áá˛ááááášáˇáááš
áąáá¸áąáťááŹáášá¸áąáá¸ááŤá
8.
9. áĄááášá¸ (á) dental implant imaging modalities
- - - - - - - - - - - - - - - - - - - - - - - - - - - - -
áá dental implant imaging modalities áĄááşáŻáá¸ááşáłáá¸ááá˝ááášáˇáĄáááš Cone-beam computed tomography
(CBCT) ááᯠáĄááśáŻá¸áťááłáťááášá¸áᏠáĄáąááŹáášá¸ááśáŻá¸áááŻá áááŻááŹá¸ááŤááášá
áá áąáĄáŹáášáťááášáá˛áˇááŻááááááŻáášá¸áĄááźááš áááŻáĄáášááŹáąáá¸áąááźá - The successful outcome of any implant
procedure depends on a series of patient-related and procedure dependent parameters,
including general health conditions, biocompatability of the implant material, the feature of the
implant surface, the surgical procedure, and the quality and quantity of the local bone.
(Turkyilmaz et al., 2007)
áá áĄááášáąááášááąááŹáˇ periapical radiographs áá˛á panoramic images áąááŹáášáá˛ááśáŻá¸ááŽá¸ implant
treatment áąáá¸áá˛áˇážáááŤááášá CT, CBCT áąááźáąááááŹáąááŹáˇ áĄá˛áˇááŤáąááźááśáŻá¸áżááŽá¸ treatment plan ááźá˛áá˝
treatment áąáá¸áá˝ áááŻáááŻááááşáĄááąááŹáášááášá¸áąážááŹáášá¸ ááśáŻá¸ááášááŹážáááŤááášá áĄáá°á¸ááťááášáˇ complex
reconstruction case áąááźáá˝áŹ CT, CBCT áąááźááᯠááśáŻá¸ááášáˇááŤááášá
áá ideal imaging technique áááŻááášáá˝áŹ - The ideal imaging technique for dental implant care
should have several essential characteristics, including the ability to visualize the implant site in
the mesiodistal, buccolingual and superioinferior dimensions; the ability to allow reliable,
accurate measurements; a capacity to evaluate trabecular bone density and cortical thickness;
reasonable access and cost to the patient and minimal radiation risk (Benson & Shetty, 2009).
10. á á imaging techniques áĄáŹá¸ááśáŻá¸áá˝áŹ áąááŹáášá¸ááşáłáá¸á áááŻá¸ááşáłáá¸áąáá¸áąááź ááá˝ááášáááŻááááŻááŤááášá The objectives
of the preoperative implant imaging include all necessary surgical and prosthetic information to
determine the quantity, quality and angulations of bone; selection of the potential implant sites,
and to verify absence of pathology. However, there is no ideal imaging technique in the field of
oral implantology that would be acceptable for all patients. All imaging techniques have
inherent advantages and disadvantages (Resnik et al. 2008).
áá ááášáˇáąááŹášáá˛áˇ radiographic modality áąáĄáŹáášááŤáĄááşáášáąááźááᯠážááášáˇááŽá¸ áąááźá¸ááşáášááŤááášá
- áĄááášá¸ááśáŻá¸ ááŤáášáąááŹáášáťááášáááŹá
- ááŻáášááşá áááášáĄááášá¸ááśáŻá¸
- sufficient diagnostic information for treatment planning
áá áĄááśáŻá¸ááşáŹá¸áá˛áˇ imaging technique áąááźááąááŹáˇ
- Intraoral radiography
- Panoramic radiography
- Computed tomography (CT)
- Cone-beam computed tomography (CBCT) áááŻááťáá ášážáááŤááášá
CBCT
11. áĄááášá¸ (á) Assessment of bone quality and quantity in implant treatment
áá áĄáááŻá¸áá˛á quality and quantity ááᯠáááááŻá áĄááźáášáĄáąáá¸áááŽá¸ááŤááášá Several factors, such as implant
geometry, preparation technique, and quality and quantity of local bone influence primary
stability; primary implant stability is one of the main factors influencing implant survival rates.
(Friberg et al., 1991; Meredith, 1998, Turkyilmaz & McGlumphy, 2008).
12.
13. áĄááášá¸ (á ) Theories about Dental Implant
áá Theory of osseointegration = dental implant áá˛áááşáášáá˝áŹáťááášáá˝áŹááá˝áá˛áˇ titanium oxide áá˛á áĄáááŻá¸ááŹ
connective tissue áĄááᏠážááŹá¸áááśáᲠáááŻáášáááŻáášáąááŤáášá¸á áášáááŻáášááášáááŻá ááá á áá˝á ášááşáŹá¸áá˝áŹ áááŹáá˝áášPer-Ingvar
BrĂĽnemark áááŻáá˛áˇááŤááášá A direct structural and functional connection between ordered, living
bone and the surface of a load-carrying implant (BrĂĽnemark, 1985)
áá Weiss theory of fibro-osseous integration = Weiss theory states that there is a fibro-osseous
ligament formed between the implant and the bone and this ligament can be considered as the
equivalent of the periodontal ligament. He defends the presence of collagen fibres at the bone-
implant interface. He interpreted it as the peri-implantal ligament with an osteogenic effect. He
advocates the early loading of the implant.
áá Complementary procedures
1.BONE GRAFTING FOR IMPLANTS = Bone grafting is done when the bone is too narrow or too
short to place an adequate sized implant. Bone grafting helps to increase the width and/or
height of bone.
14. 2.SINUS LIFT = Our sinuses are located in close proximity to the upper posterior jaw bone. In
some cases, the sinus floor "dips" down, causing that area to lose bone height. If the bone
height is not adequate for an implant, then a "sinus lift" procedure is necessary in order to
increase bone height.
áá áááŹááášáá ášááŻáąááˇááŹááŹáá˝áŹ principles and practice áá ášáťáááłáášáááš áąááˇááŹáááŻáášááášáąááŹáˇ áááŻáááąááŹáášáá
ááá˝ááŤááááˇášááášá ááśáŻáá˝ááš implant á ááŻáášááášáˇ ááźáŹá¸áááŹááášáá ášáąááŹáášáĄáąááá˛ááááŻáášáᲠdental implant áááŻ
áĄáá°á¸áťááłáąááˇááŹááášáˇáááŹáá˝áášáťáá ášááşáášááášáááŻááášáąááŹáˇ áąááˇááŹá ááŹáąááźá áĄááşáŹá¸áááŽá¸ááá˝áąáááŤááášá
á á osseointegration process áĄáąážááŹáášá¸ áąááˇááŹáąá ááşáášááŤááášá áĄáąáá¸á ááášáááŻáášáąáááášáˇ
áĄážááášá¸ááşáášá¸áąáááťááąáá¸áááŻáášááŤááášá
Stages of Bone Healing and Osseointegration: Cell Kinetics and Tissue Remodeling
- The osseointegration process observed after implant insertion can be compared to bone
fracture healing.
- In the case of a bone fracture, any bone wounding leads to an inflammatory reaction with
bone resorption and subsequently the activation of growth factors and attraction by chemotaxis
of osteo- progenitor cells to the site of the lesion.
15. - The differentiation toward osteoblasts will lead to a reparative bone formation, will lead to
fusion of both ends.
- In the case of an implant insertion into a prepared hole, this will lead to bone apposition onto
the implant surface if the latter is nontoxic.
- Logically, a certain immobility of the implant surface toward the bone should be maintained.
- A mild inflammatory response, as triggered by movements or appropriate electrical stimuli,
may enhance the bone-healing response, but above a certain threshold, this is detrimental.
- Micromotion at the bone-implant interface beyond 150 Îźm results in fibrous encapsulation
instead of osseointegration (Szmukler-Moncler et al. 1998)
áá Steps of osseointegration
- First, woven bone is quickly formed in the gap between the implant and the bone.
- Second, after several months this is progressively replaced by lamellar bone under the load
stimulation.
- Third, a steady is reached after about l.5 years.
- Woven bone grows fast, up to 100 um per day, and in all directions. It is characterized by a
random orientation of its collagen fibrils, high cellularity which means that the bone is low
biomechanical capacity, and thus occlusal load should be controlled.
- After 1 to 2 months, under the effect of load, the woven bone surrounding the implant will
slowly transform into lamellar bone.
16. áĄááášá¸ (á) Loading protocols in Implant Dentistry
áá áá°ááŹáĄáŹá¸ááśáŻá¸ ááźáŹá¸ááŻáááááśáá°áá˛áˇáĄá፠áĄáťááášáżááŽá¸áąášáťááŹáášááşáášážáááŤááášá áťáá ášáááŻáášáááš áąážááŹášáťááŹáąááźáá˛áá˝áŹ
áąááźááááᯠáá ášááášááášá¸áá˛á áĄááşáááš ááášáá˝á ášááŹááŽáąááŹáášáá˛á ááŽá¸áąáĄáŹáášááŻáášáąáá¸áááŻááááá°á¸ááŹá¸áááŻááŽá¸
áąááŹáášá¸áááŻááášážáááŤááášá
áá immediate loading ááᯠrestoring the implant in occlusal contact within 48 hours of implant
placement áááŻááŽá¸ ááášáá˝áášááŹá¸ááŤááášá áá°ááŹáĄááźááš áąááŹáášá¸ááşáłáá¸áąááźááąááŹáˇ
- reduced overall treatment time
- reduced number of visits to clinicians
- comfort during the healing period
- improved esthetic and phonetic aspects áááŻá ááá˝ááŹááášáááŻá áááŻááŤááášá
áá immediate restoration or immediate provisionalization áááŻááŹá immediate loading áá˛á
ááášáá°ááááŻááá˝ááŤááášá ááŤáąáááášáˇ functional occlusion ááťáá ášáąáĄáŹááš ááŹá¸ááášáˇááášáááŻá áááŻážáááŤááášá
áĄá˛áˇááŽáá˝á ášááŻááᯠáĄáá°áá°ááźá˛ááŽá¸ áąáťááŹáąááˇááá˝áąáááášáˇ ááŽá¸áťááŹá¸á áĽášá¸á áŹá¸áżááŽá¸ áá°ááŹááᯠááŻááááąáá¸áááŤááášá
áá (áá)ááŹááŽááąá (á)ááĄááźáášá¸áááŻáááš Early loading áááŻá ááášáá˝áášááŤááášá áá°ááŹáá ášáąááŹáášááşáášá¸á áŽáá˛á
áĄáąáťááĄáąááĄáŹá¸ááśáŻá¸ááᯠááśáŻá¸ááášááŽá¸ loading protocol ááŻá ááášáá˝áášááá˝áŹáťáá ášááŤááášá
á á esthetically critical areas áąááźáá˝áŹ immediate loading áááš conventional and early loading
protocols áąááźá áááŻáąááŹáášá¸ááášáááŻá áááŻážáááŤááášá
áá áá°ááŹáá ášáĽáŽá¸ááşáášá¸á áŽáá˛á occlusal funcation and parafunctional forces áąááźááᯠáąáááşáŹááśáŻá¸ááášáżááŽá¸
ááŻááááąáá¸áááŤááášá
áá Successful osseointegration depends on several factors:
- Suitability of the implant material
- Careful site preparation
- Adequate stabilization of the implant
áá shortened loading protocols áąááźááᯠá áĽášá¸á áŹá¸áá˛áˇáĄá፠áááááŹá¸ááá˝áŹáąááźá
- Amount of primary bone contact/primary stability
- Quantity and quality of bone at the implant site
- Pace of bone formation around the implant
áá ááŻáąááááąááźááąááŹáˇ áąáĄáŹáášáťááášáááĄáááŻáášá¸áĄááŹááᯠáĄááşáłáá¸ááşáłáá¸ááášáťááąáážááá˝áŹáťáá ášáááŻá
áááááááŻáááŻááááąáá¸áááášáˇáá°ááŹáĄáąáťááĄáąáá hard and soft tissue áĄáąáťááĄáąááąááźááᯠáąáááşáŹááśáŻá¸ááášáżááŽá¸áá˝
ááŻááááĄááźááš loading protocol ááᯠááśáŻá¸áťááášáááŻáášážááá˝áŹáťáá ášááŤááášá ááźáŹá¸áááŹááášáá˛á áá˝áźáášá¸ááşáášáááááášá¸
áĄáąáá¸ááŤáá˝ááŤááášá
17.
18. áĄááášá¸ (á) Cement retention Vs Screw retention
áá implant crown prosthesis ááᯠcement retention áááŻááááŻááš screw retention ááŻáášááŹáá˝áŹ ááášááŹ
áááŻáąááŹáášá¸áá˛áááŻá áąáá¸áąááˇááá˝ážáááŤááášá áąááąáááşáŹááşáŹ áĄááśáŻá¸áťááłááášáááŻááášáąááŹáˇ áĄá˛áˇááŽáá˝á ášááŻáá˛á ááááłáášááŹáááŻ
áĄááśáŻá¸áťááłáááŻááááŤááášá
áá cement retained prostheses áá˛á áąááŹáášá¸ááşáłáá¸áąááźááąááŹáˇ áąáĄáŹáášááŤáĄáááŻáášá¸áťáá ášááŤááášá
- Simplicity
- Familiarity
- Idealize occlusal contacts (Occlusal contacts are not affected by the screw access channel.)
- Esthetics (Porcelain occlusal surfaces can be developed.)
- Reduces risk of porcelain chipping and fractures associated with the screw access channel.
áá cement retained prostheses áá˛á ááąááŹáášá¸áá˛áˇáĄááşáášáąááźááąááŹáˇ áąáĄáŹáášááŤáĄáááŻáášá¸áťáá ášááŤááášá
- requires precise margin placement
- requires a meticulous technique
- prosthesis is not easily retrieved
- recurrent loss of retention when retention and resistance form the abutment is suboptimal.
áááŻááťáá ášááŤááášá áĄáá°á¸ááťááášáˇ áááŻáąááá˛áˇ cement áąááźááᯠáąáááşáŹááášáááŻáášááááášá ááŤáá˝áááŻááš cement áąážááŹáášáˇ
incomplete seating of the crown áťáá ášáááŻáášáżááŽá¸ áĄááşáłáá¸ááášáĄáąááá˛á peri-implant mucositis; peri-
implantitis á ááŹáąááź áťáá ášáááŻáášááŤááášá
19. áá áĄááááťáááᏠ(á)áá˝á ášááŻááąááŹáˇ
- impaction of cement subgingivally during cementation
- incomplete seating of the crown áááŻááťáá ášáżááŽá¸ áĄá˛áˇááŽáá˝á ášááŻáąážááŹáášáˇ peri-implantitis áťáá ášáąá áááŻáášááŤááášá
Peri-implantitis = An inflammatory process affecting the tissues around an osseointegrated
implant in function, accompanied by bone loss.
á á peri-implantitis áťáá ášááťááášá¸áá˛á 80 ááŹáááŻášáášáááášá¸áᏠsubgingival accumulation of cement áąážááŹáášáˇááŻáá
áááŻááŹá¸ááŤááášá 80% of cases of peri-implantitis are secondary to subgingival cement
accumulations. (Wilson, 2009) á ááášááŹá cement margin á subgingival áá˝áŹáááŻáááš áááŻáąááá˛áˇ
cement áąááźááᯠááášááŻáášáááŻáá ááťáá ášáááŻáášáąááŹáášáąáĄáŹáášááŤáá˛á If the cement margin is subgingival, it is
not possible to remove all the cement (Linkevicius et al, 2013) á implant surface áá˝áŹ cement á
ááášáąáááŽáááŻáááš ááášááŻáášáááŻá áąááŹášáąááŹášááášááŤááášá
áá áĄá˛áˇááŽáąááŹáˇ cement ááᯠáĄááśáŻá¸áťááłááášáááŻáááš
- cement ááᯠáááŻááąááŹáášáᲠáĄááśáŻá¸áťááłááŤá áĄááşáŹá¸áááŽá¸ áááášáˇááŤáá˛áá
- prefabricated abutment áąááźááᯠáááśáŻá¸ááŤáá˛áá
- Use customized abutments with supra-gingival margins in the posterior quadrants, especially
when there are signiďŹcant undercuts and concavities associated with the abutment.
áá screw retained prosthesis áąááź áĄáąááá˛áááąááŹáˇ
- Retrievability (áťááášááśáŻá¸ áťááášáťááášáááŻá ááááŻáášááŤáááš)á
- Avoid trapping cement subgingivally (cement áááśáŻá¸áąááŹáˇ cement ááşáášáąááá˝áŹ ááá°ááąááŹáˇááŤá peri-
implantitis áťáá ášáááŻá ááášá¸ááźáŹá¸ááŤáááš)
- Carry restoration more subgingivally ( ideal emergence profile and contour ááááŻáášáżááŽá¸
áąáá˝áááźáŹá¸áąááźáá˝áŹáááŻáááš áááŻáá˝áąáĄáŹááš ááŻáášáąáá¸áááŻáášááŤáááš) You can extend the porcelain margins deeper
subgingivally.
20. áĄááášá¸ (á) Implant therapy in the Esthetic Zone
áá bone and soft tissue loss ááşáŹá¸áąááąá ideal esthetic result ááááŻá ááášáąááąáááŤáá˛á gingival and
papillary architecture áĄáąááŹáášá¸ááśáŻá¸áťáá ášáááŻá áĄááášááášá á áĽášá¸á áŹá¸ááŽá¸ ááŻááááąáá¸ááá˝áŹáťáá ášááŤááášá
áá Factors affecting aesthetic outcome áąááźááąááŹáˇ
- patient selection and smile line
- tooth position
- root position of the adjacent teeth
- biotype of the periodontium and tooth shape
- bone anatomy of the implant site
- position of the implant áááŻá áťáá ášááŤááášá
áá áąáá˝áááźáŹá¸áá ášáąááşáŹáášá¸áá˛á ááŻáášáá˛áˇáĄá፠ááźáášááášáąáááŹááźáášá ááşáášááźáášá¸áąááááš implant áá˛á crown á
ááá˝ááášáˇááŹáááš ááŻááááŽá¸ááźáŹá¸áá˝áŹáťáá ášáááŻá áá˝áá˝áŹ áááŻáášáąááŹáˇááŤáá°á¸á (excessive mesiodistal space in the
region requiring implant restoration)
áá ááááá ááŻáášááášáˇ ááźáŹá¸áá˛á áąáá¸áá ášááášáá ášááşáášáá˝áŹááá˝áá˛áˇ ááźáŹá¸áĄáťáá ášáąááźáá˛á ááášááá˝ááśáŻáąážááŹáášáˇ implant ááášáˇáááŹ
ááášááźáŹá¸ááŹá ááášáˇááááŹááášá¸ áťáá ášááášááŤááášá
21. á á biotype of periodontium á ááŤá¸ááźáášá¸áąááááš implant ááŻá palatal ááášáááŻá¸ááŽá¸ ááášáˇáąááˇááá˝ááŤááášá
áá implant ááášáˇáá˛áˇáąáááŹá free gingival margin á apical migration áťáá ášááášáááŻá
áááááŹá¸áááŻááááŻááŤááášá
áá áááŻáĄáášáááš bone graft ááášá¸ ááášáˇááŤá
áá implant ááášáˇáá˛áˇáĄá፠áąáá¸ááźáŹá¸áąááźááąá 1.5 - 2 mm ááźáášáąáááášáˇááŤááášá facio-lingual bone
ááąááŹáˇ á ááŻáášááášáˇ implant áá˛ádiameter áááš áĄááášá¸ááśáŻá¸ 1mm áááŻááá˝áąááááŤááášá
áá á ááášáá°á¸áá˛á crown áá˛á curvature áąáá¸ááᯠáťááášážááášáˇáżááŽá¸ implant ááᯠpalatal ááášáááŻá¸ááŽá¸ ááášáˇááŤá
ááá facial bone wall áá˛á height and thickness; interproximal area áá˝áŹááá˝áá˛áˇ alveolar crest áá˛á bone
height áąááźá free gingival margin áá˛á peri-implant papillae áĄáąáááá˝áŹ áĄááşáłáá¸ááášáąááŹáášááááá˝ááŤááášá
ááá buccal ááášáá˝áŹ dehiscence ááťáá ášáąáĄáŹáášá palatal ááášáá˝áŹ ridge lap ááťáá ášáąáĄáŹááš áááŻá ááŻáášáááŤááášá
ááá mesio-distal áĄáąááá˛á á áĽášá¸á áŹá¸ááášáááŻáááš áťáá ášááášááŹáąááźá
- decreased papillary height
- restoration problems
- poor embrasure form and emergence profile
- long contact zone áááŻááťáá ášááŤááášá
ááá Apico-coronal implant placement áá˝áŹ áááŻááŹá áááŻááŹáąááźáĄááźáášáąážááŹáášáˇ
- restoration á free gingival margin áá˛á áĄáťááášááášáąááŹáášáąáááŹ
- difficulty in impression making
- difficulty in instrumentation
- tissue impengingment áąááźáťáá ášáááŻáášááŤááášá
22. áĄááášá¸ (á) dental implant surface áĄáąážááŹáášá¸ áááąááŹáášá¸á ááŹááşáŹá¸
áá dental implant surface ááᯠáĄááşáłáá¸ááşáłáá¸á áášá¸ááášááŻáášááŻáášáąááᏠáąááźááááŤááášá áĄááááĄáąááá˛áááąááŹáˇ
Osseointegration áááŻáąááŹáášá¸ááŹáąá áááŻááťáá ášááŤááášá smooth; machined; acid-etched áá˛á coated áááŻááŽá¸
(á)ááşáłáá¸ááźá˛áťááŹá¸ááŹá¸áᏠáąááźááááŤááášá
áá smooth surface ááá˝áá˛áˇ implant áááš active or rough surface ááá˝áá˛áˇ implant á osseointegration
rate áááŻáąááŹáášá¸áąá ááášáááŻá ááŻáąááááąááźá áąáááťáážáááŤááášá áááŻáąááŹáášáááŻáášá¸ hydroxyapatite coated
surface áĄááşáłáá¸áĄá áŹá¸áąááź áĄááśáŻá¸ááşáŹá¸ááŹáᏠáąááźááááŤááášá
áá bone áĄááşáłáá¸áĄá áŹá¸áąááźáá˛á human low density bone áá˛áá˝áŹ surface modification ááŻáášááŹá¸áá˛áˇ
implant ááᯠááášáˇáťááášá¸áťááášáˇ bone-implant-contact(BIC)ááᯠáááŻáááŻáąááŹáášá¸áąá áąážááŹáášá¸ áąááźáááá˝áááŤááášá
ááŤáąáááášáˇ healing period áĄááźáášá¸áá˝áŹ implant ááášááášááášááá˝áá˛áˇ bone density
áááŻá¸ááášááŹáťááášá¸áááášáááá˝áááŻá áąááá˝áášáá˝áŹ áąáĄáŹáášáťááášáááŻáášááŤáˇáááŹá¸áááŻáżááŽá¸ áąáá¸ááźáášá¸ááŻáášáąáážáááŤááášá
áá large porous-coated surface ááá˝áá˛áˇ implant áąááźááśáŻá¸áááš bone penetration into the implant surface
áąážááŹáášáˇ áááŻáąááŹáášá¸áááŹá¸áááŻááŽá¸ á áášá¸ááášáąáážáááŹááášá¸ áąááźááááŤááášá
á á cell adherence and proliferation áąááŹáášá¸áááŻááĄááźáášááášá¸ sand blasted and acid-etched
ááŻáášááŹá¸áá˛áˇ implant surface ááᯠááŻáášááŹá¸áᏠáąááźááááŤááášá
23. áá low density bone; short implants in posterior areas; overloading in hard-biters áąááźáá˝áŹ
loosening of implants áááŻáťáá ášáááŻáášáá˛áˇáĄááźááš áááŻáááŻáááŻáťááłáąá áááŻááŤááášá
áá implant áąáĄáŹáášáťááášáááŻá áááŻá ááŻáášáááášáĄááşáášáąááź áĄááşáŹá¸áááŽá¸ááá˝áá˛áˇáĄáááš ááááááśáŻá¸áááš implant áá˛á surface
áĄáąážááŹáášá¸ áááŻáááŻááááá˝ááŹá¸ááŤá ááşáŹá¸á áźáŹáĄááşáłáá¸ááá˝áááŻáášááŤááášá
áá ááśáŻáąáá¸áąááźááᯠážááášáˇáááŻáášáááš implant surface áĄáąážááŹáášá¸ áááŻáááŻááŹá¸ááášááąááŹáąááŤáášááŹáá˝áŹááŤá
áá dental implant áĄáąáááá˝áŹ negative effect ááášáąááŹáášáąá áááŻáášáá˛áˇ áĄááşáášáąáá¸áąááźááášá¸
áĄááášá¸ááášáąáááťáááşáášááŤáááš
- compromised blood supply
- compromised oxygen supply (e.g. after radiotherapy, hyperbaric oxygen therapy
- loss of blood clot stability
- microbial contamination of the surgical site
- temperature of more than 47 degree Celsius for a minute áááŻááťáá ášááŤááášá
ááá Profilometer áááŻááŹááąááŹáˇ dental implant áá˛á surface roughness áááŻáášá¸áá˛áˇááááááŹáťáá ášááŤááášá
ááá implant biomechanics-rigidity of bone-implant interface áááŻáášá¸áááŻá
áĄááśáŻá¸áťááłáá˛áˇááááááŹáąáá¸áąááźááąááŹáˇ Periotest áá˛á Ostell áááŻááŽá¸ áąá áşá¸ááźáášáá˝áŹ áąááźááááŤááášá
24. áĄááášá¸ (áá) immediate implant placement áĄáąážááŹáášá¸
Immediate implant placement áĄáąážááŹáášá¸
áá ááźáŹá¸áááášááŽá¸áááš áąáá¸áááŻá¸áĄááźáášáĄá áŹá¸ (height & width) á ááźáŹá¸áááášáááŻáášáá˛áˇáąáááŹáá˝áŹ áááŻáąáá¸ááášááźáŹá¸ááŹ
áąááźááááŤááášá bone resorption rate áᏠááááá ášáá˝á ášáĄááźáášá¸áá˝áŹ áĄááşáŹá¸ááśáŻá¸áťáá ášááášáááŻá áááŻážáááŤááášá
áááášáááŻáášááá˛áˇááźáŹá¸áąáááŹá áĄáááŻá¸áá˛á annual resorption rate áᏠáá˝á ášá áĽáš 0.5% to 1%
ááá˝ááášáááŻááááŻááŤááášá ááźáŹá¸áááášáżááŽá¸ ááá (á)ááĄááźáášá¸áá˝áŹ extraction socket á
ááášáˇááášáˇáá˛áˇáĄáááŻá¸áááŹááááá˝ááŤááášá
- Following an extraction there is a 25% decrese in the width of the alveolar bone during first
year and an average 4mm decrease in height during the first year following multiple extractions
(Carlson 1967)
- Tatum and Misch have observed a 40%â60% decrease in alveolar bone width after the first
2-3 years post extraction.
áá Traditional Branemark Protocols áá˝áŹáąááŹáˇ ááźáŹá¸áááášááŽá¸ áá ášáá˝á ášáąááŹáášáąá áŹáášáˇá ááŽá¸áá˝ implant
treatment á ááŻáášá implant fixture ááášáˇááŽá¸ á á - á á áąááŹáášáąááá˝ restoration á ááŻáášá áááŻáąááŹáˇ
áá°ááŹáĄáąááá˛á ááźáŹá¸áááá˝áá˛áąáááŹáá˛áˇáĄááşááášá á áá˝á ášá á áá˝á ášáąááŹááš ážááŹááźáŹá¸ááášááŤááášá
áá ááąáá ááŻááááąáá¸ááŹáá˝áŹ ááźáŹá¸áááášááŽá¸ ááášáĄááşááášáá˝áŹ implant ááášáˇááášáˇáá˛áááŻááŹááᯠextraction socket áá˛á
hard and soft tissues áĄáąáťááĄáąáá implant ááŻáášááášáˇ áąáááŹá áá°ááŹáá˛á áĄáąáťááĄáąááá˛ááááľáąáááá˝áŹ áá°ááášáżááŽá¸
ááśáŻá¸áťááášážááᏠáąááźááááŤááášá áĄá˛áˇááŽáąááŹáˇ treatment ááŻá ááźáŹá¸áááášááŽá¸ááŽá¸ááşáášá¸ ááŻáášááŹááá˝ááááŻá soft tissue
healing ááá˝ (áááŻá) hard tissue healing ááá˝ááášá¸ ááŻáášážáááŤááášá
áá ááźáŹá¸áááášááŽá¸ immediate implant placement ááŻáášáᏠááŹáąááźáąááŹáášá¸áá˛áááŻáááš
- Patients acceptability
- Reduces treatment time
- Socket as a guide for determination of parallelism and alignment
25. - Surgeon can position the implant more favorably than the original position
- Facilitates final restoration and minimizes need for severely angled abutments
- Implants in extraction sites can be placed in the same position as the extracted teeth
á á ááášáááŻáĄáąááĄááŹá¸ááşáłáá¸áá˝áŹ ááşáášááşáášá¸ááŻáášááášáˇáá˛áááŻáąááŹáˇ ááźáŹá¸áááášáá˛áˇáĄááşááášáá˝áŹ little or no bone loss
áťáá ášáááášá áąáá˝áŹáášáááášáˇáĄáąááĄááŹá¸áąááźááąááŹáˇ
- Presence of pus
- lack of bone beyond the apex
- close proximity to anatomical vital structures
- clinical conditions preventing primary closure
áá Treatment sequence and planning protocol
- clinical examination
- radiographic examination
- fabrication of surgical guide
- surgical and prosthetic phase
- maintenance
26. áĄááášá¸ (áá) Maxillary sinus lift surgery áĄáąážááŹáášá¸ áááąááŹáášá¸á ááŹááşáŹá¸
áá posterior edentulous maxilla áá˝áŹ implant á ááŻáášáąááŹáˇááášáááŻáááš áĄáá°á¸ááááťááłááá˝áŹá maxillary sinus
áá˛á ááášááşááš áąáá¸áááŻá¸áááŹááťáá ášááŤááášá áĄáá°á¸ááťááášáˇ alveolar bone height áᏠ10 mm ááášááášá¸áá˛áˇáááš
- inlay type ridge augumentation
- direct OR indirect sinus lift procedure áááŻááá˛á áá ášááŻááŻáá˛á ááŻááááąáá¸áááŻáášááŤááášá
áá áááá ááŻáá˝á ášáá˝áŹ Mr. Tatum á modified caldwell luc approach áááŻááŽá¸ maxillary sinus lift surgery
ááᯠimplant treatment áĄááźááš áĄááśáŻá¸áťááłáá˛áˇááŤááášá áĄá˛áˇááŤááᯠdirect sinus lift procedure ááŻáááąááááŤááášá
áá osteotome ááᯠáĄááśáŻá¸áťááłáżááŽá¸ crest of the alveolar ridge ááąá sinus lift ááŻáášááŹááᯠindirect sinus lift
procedure ááŻáááąááááŤááášá
áá maxillary sinus áá˛á anatomy ááᯠáąáá¸ááŹá¸áá˛áˇááśáŻáąáá¸áąááźáá˝áŹ ážááášáˇááááááŻáášááŤááášá
- U shaped osteotomy of the maxillary sinus
á á partially freed-up bone segment áąáá¸ááᯠmaxillary sinus áᲠáťááášá¸áťááášá¸ááşáášá¸ áĄááŹáĄááŹ
áááášáááŻáášáżááŽá¸ áťáá ášáąááááŹáá˛áˇ áąáááŹááźáášáá˛ááŻá bone graft áąááźáá˛á áťááášáˇááŤááášá ááśáŻáá˝áášáááŻááášáąááŹáˇ á á
ážááŹáżááŽá¸áąááŹááš implant á ááŻáášááŤááášá sinus lift surgery áá˛ááĄáá° implant ááᯠáá ášááŤááášá¸á ááŻáášááášáááŻááášáąááŹáˇ
bone height áᏠáĄááášá¸ááśáŻá¸ 4 - 5 mm ááá˝áááŤááášá
27. áá áĄááśáŻá¸áťááłáááŻáášáá˛áˇ bone graft áĄááşáłáá¸áĄá áŹá¸áĄáąááźááąááŹáˇ
- autologous
- autogenous
- xenograft
- allograft
áá sinus lift surgery áĄááźááš áąáá˝áŹáášááášáˇáá˛áˇáĄáąáťááĄáąááąááźááąááŹáˇ
- sinus infection
- tumors or pathologic growth in sinus
- severe allergic rhinitis
- chronic topical steroid use
- radiation therapy
- excessive tobacco use
- psychologic/mental impairment áááŻááťáá ášááŤááášá
áá ááášááá˝ááŻáąááááąááźááąááŹáˇ bone graft áĄááşáłáá¸ááşáłáá¸á growth factors áĄááşáłáá¸ááşáłáá¸ááᯠáĄááśáŻá¸áťááłáżááŽá¸
á áášá¸ááášáąáážááááᯠstem cell áĄááśáŻá¸áżááłáżááŽá¸ bone regeneration ááᯠáááŻáąááŹáášá¸áąáĄáŹáášááŻáášáááŻáášáááŹá¸áááŻááŽá¸
á áášá¸ááášáąáážáááŹááášá¸ áąááźááááŤááášá
29. áá Mandible áá˝áŹáááŻáááš
(á) Mandibular arch morphology
- maxilla ááášáááŻáżááŽá¸ ááŹááŤáááš
- The palpation of this region is necessary before implant placement to determine shape of
ridge and extent of submandibular fossa.
(á) Mandibular canal
- first molar áá˛á distal áá˝áŹ canal á áĄáááášáˇááśáŻá¸áąáááŹáá˝áŹ ááášááá˝áąááááŻá implant ááášáˇáááŻá á ááášááşááá˛áˇáąáááááŻá
áąáťááŹáááŻáášááŤááášá
(á) Symphysis region
(á) Muscle attachments
- muscle áąááźááᯠááááąáĄáŹááš áááŻá ááŻáášáááŤááášá
- genioglossus muscle ááᯠtubercles ááąá ááźáŹáááááš complete retrusion of tongue áťáá ášáżááŽá¸ airway
obstruction ááááŻáášááŤááášá
(á) Innervation of Mandible
(á ) Blood supply
- During implant placement procedures, one must avoid injury to the arteries and specially
should be careful in the anterior region as there is anatomosis from the opposite site.
áá anatomical structures áąááźáá˛á ááášááášáżááŽá¸ áąááąáááşáŹááşáŹááááŹá¸áááš implant placement áááŻ
áĄááášáĄáá˛áááá˝ááŻáášáááŻáášáąá ááŤááááˇášááášá flap áá˝áášáááŻáášá¸ áąáááşáŹáááŻá ááŻáášááŤá No uncontrolled forces should be
applied. Clean and patient surgery is the key to success.
30. áĄááášá¸ (áá) Dental Implants áĄááşáłáá¸áĄá áŹá¸ááşáŹá¸ ááźá˛áťááŹá¸áťááášá¸
áá based on Implant Designs
- endosteal (ramus frame; root form; blade form) áĄááśáŻá¸áĄááşáŹá¸ááśáŻá¸ááąááŹáˇ root form áťáá ášááŤááášá
- subperiosteal
- transosteal
- intramucosal
áá based on attachment mechanism of the implants
- osseointegration (described by Branemark) *Direct contact between the bone and the surface
of the loaded implant *Bio-active material that stimulates the formation of bone can also be
used
- fibro-integration (proposed by Dr. Charles Wiess) *Complete encapsulation of the implant with
soft tissues *Soft tissue interface could resemble the highly vascular periodontal fibers of
natural dentition
31. áá based on macroscopic body design of the implant
- cylinder
- thread
- plateau
- perforated
- solid
- hollow or vented
áá based on the surface of the implant
- smooth
- machined
- textured
- coated (ááŻáąááá áĄááşáŹá¸áĄáťááŹá¸ááŻáášááŽá¸ áąááˇááŹáąááᏠáąááźááááŤáááš)
50. áĄááášá¸ (áá) Failures in Implants áĄáąážááŹáášá¸
Table 1: Various complications occurring in implant placement
Table 2: Various factors associated with increased failure rates
51. áĄááášá¸ (áá) One stage Vs Two Stage Treatment in Dental Implant áĄáąážááŹáášá¸
áá áá°ááŹáąááźááąááŹáˇ áťááášáťááášáá˛ááąááŹáášá¸áąááŹáášá¸ ááŻáááááᯠááśáá°ááşáášážáááŤááášá ááŻááááąáá¸ááášáˇ áááŹááášáąááź
áĄáąááá˛áááąááŹáˇ áąáĄáŹáášáá˝áŹ áąáááťáááŹá¸áá˛áˇ áąááŹáášá¸ááşáłáá¸ááááŻá¸ááşáłáá¸ááşáŹá¸áĄáąáááá°ááášáżááŽá¸ ááŻááááąáá¸ááŹ
áąááźááááŤááášá
52. áĄááášá¸ (áá) ááášáąááźááąááˇááşáášáˇááášáąáťááŹáášáááášáˇ áĄáąáťáááśááşáŹá¸
áá soft tissue flap ááşáŹá¸ áá˝áášáťááášá¸á suture ááŻáášáťááášá¸á
áá intra-oral and extra-oral auto autogenous grafts ááşáŹá¸ áá°áťááášá¸á áááŻáĄáášááŤá bone grafts and
membrance ááşáŹá¸ áĄááśáŻá¸áťááłáťááášá¸á
áá áááááĄááśáŻá¸áťááłááášáˇ implant system áĄáááŻááš drills ááşáŹá¸ áĄááášáˇááášáˇáĄááśáŻá¸áťááłáżááŽá¸ implant ááášáˇáťááášá¸á
áá impression taking procedures
á á prosthesis delivery
áá áááŻáááŻáááášáąááźá¸ááášáá˛áąáᏠcase ááşáŹá¸ááᯠáááášáˇááášááŻáášáááŻáášáąá áááš áááŻáĄáášáąááŹáá˝áźáášá¸ááşáášááááşáŹá¸áááŻ
áĄáťáá˛áąááˇááŹáąááˇááşáášáˇáąáááášá áááŻáĄáášááŤá team approach áťááášáˇ áąááŹáášááźáášááášá
áĄááášá¸ (áá ) Soft tissue management in Dental Implant áĄáąážááŹáášá¸
áá soft tissue grafts áá˛á management áĄáąážááŹáášá¸ áąááˇááŹááášá
áĄááášá¸ (áá) Removal of failed implant áĄáąážááŹáášá¸