Diagnosis and treatment planning


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Diagnosis and treatment planning

  1. 1. July 23, 2009<br />The ISI Complete™ , <br />TSI, and Soon Be Released ERI Immediate Load <br />Dental Implant System<br />OCO Biomedical introduced the next generation of endosseous implants:<br />Patent pending<br />
  2. 2. Diagnosis and treatment planning<br />Medical and dental history<br />How did the patient loose the tooth or teeth<br />Pano or cone-beam cat scan x-ray<br />Study models<br />Model mapping on areas to be treated if needed<br />Identify bone type and density<br />Evaluate available bone in areas to be treated<br />Inform before you perform<br />Evaluate the patient expectations<br />Can you meet those expectations<br />Can anyone achieve the expectations<br />Encourage the patient to get a second or third opinion and estimate<br />
  3. 3. Evaluate study model for ridge width, alignment of adjacent teeth, if a dental implant can be placed using uncomplicated techniques.<br />
  4. 4. Section the model through the edentulous area and after estimating gingival thickness, map it.<br />
  5. 5. Mount study models, mounted. A must for treatment planning and Case Presentation <br />
  6. 6. Mount study models, mounted. A must for treatment planning and Case Presentation<br />
  7. 7. July 23, 2009<br />Edentulous MandibleAn immediate denture placed 17 yrs ago<br />
  8. 8. Pantographic X=Ray, a must for any implant case. Is there abundance of bone?<br />
  9. 9. Model of lower, sectioned at the center and mapped<br />
  10. 10. July 23, 2009<br />Bone Densities<br />
  11. 11. Anterior Bone Qualities<br />Lekholm and Zarb’s four bone qualities for the anterior region of the jaws:<br />Quality 1: Composed of homogenous compact bone <br />Quality 2: Thick layer of cortical bone surrounding dense trabecular bone. <br />Quality 3: Thin layer of cortical bone surrounded by dense trabecular bone of favorable strength. <br />Quality 4: Thin layer of cortical bone surrounding a core of low-density trabecular bone.<br />D1<br />D2<br />D3<br />D4<br />
  12. 12. General Bone Densities<br />Bone Density Classification by Misch & Judy<br />D2<br />D1<br />D4<br />D3<br />
  13. 13. Basics for fixed: 4 Main buttresses for fixed or implant supported teeth<br />Ideal minimum<br />Implant diameter<br />Minimum implant <br />length 10 to 12 mm<br />
  14. 14. A Dental Implant is not a natural tooth root<br />Vertical tooth movement: 25 to 100 mµ<br />Vertical Implant movement: 0 to 10 mµ <br />Horizontal flex: Tooth –yes<br /> Implant - no <br />Proprioception: Tooth – yes<br /> Implant - no <br />
  15. 15. So, if not following the buttress parameters and ignoring the physical properties: <br />
  16. 16. Edentulous upper left quadrant:<br />Ideal implant placement<br />4.0mm bicuspid areas<br />5.0 mm 1st molar area<br />4 or 5mm 2nd molar<br />
  17. 17. Bi-Lateral lower edentulous: R- normal ridge, L- narrow ridge Treatment <br />R- Ideal, 5.0mm at <br />Molar, 4mm for bicuspids<br />L- Narrow ridge- compromise,<br /> 2 3.25 At molar. <br />3.25 in bicuspid<br />Areas.<br />Prosthesis, splinted crowns<br />No wider than bicuspids, <br />Lighter occlusion and no <br />Lateral interferences. <br />
  18. 18. Edentulous upper and lower Treatment: Stabilize lower denture <br />Economy: I-Mini Implants<br />4 on the floor<br />3.0mm I-Mini implants<br />Placed between mental foramina <br />X<br />X<br />FOR A SIMPLE<br />OVERDENTURE<br />NEVER PLACE<br />IMPLANTS IN THE <br />POSTERIOR REGION<br />
  19. 19. To maximise To maximize A-P place markers in the denture, take a pano and establish the location of the mental foramina <br />I O<br />O I<br />
  20. 20. Implants placed and at least 3mm anterior to the mental foramina<br />
  21. 21. Edentulous upper and lower Treatment: Stabilize lower denture <br />Or, if the residual ridge <br />Permits: moderate height, <br />Wide ridge<br />Never!<br />2 Implants in <br />Cuspid Areas<br />4 to 6 standard sized 3.25 or 4mm Implants placed between the mental foramina, <br />Crates a fulcrum<br />The denture will rock<br />2 - 4.0 mm<br />2 – 3.25 mm<br />
  22. 22. Edentulous upper and lower Treatment: Stabilize lower denture <br />Or, if the residual ridge <br />Permits: Tall, med width<br />OR:<br />5 or 6 3.25 mm implants <br />between the mental foramina <br />
  23. 23. Five implants placed comfortably in the safety zone by placing markers in denture first<br />
  24. 24. Post- Op Pano<br />
  25. 25. In less than 2 weeks the healing looks great and he’s ready for a reline and the final female attachments<br />
  26. 26. Flanges are trimmed and the size of the denture is minimized<br />
  27. 27. July 23, 2009<br />IMMEDIATE PLACEMENT PROTOCOL AND PROCEDURE<br />ISI Complete™ One-piece and <br />TSI Two-piece Dual Stabilization™ Implants<br />
  28. 28. Establishing the path of implant insertion after removing the tooth or tooth roots<br />
  29. 29. With a high speed drill, always break through the cortical bone lining the socket wall in the direction of implant alignment<br />Use a # 8 surgical or XXL straight fissure burr/ water<br />cooling only, no air<br />
  30. 30. Use the pilot drill in the surgical HP aligned to the final depth<br />
  31. 31. Select the implant diameter by placing the final drill into the socket. It must not drop more that half the selected length<br />
  32. 32. Drill with osteotomy former to the final depth established by the pilot Drill<br />
  33. 33. Implant placed with grafting material, if dual stabilization is present, ISI can be used. If not, a TSI must be used <br />
  34. 34. Q&A<br />Thank You<br />Questions?<br />OCO Biomedical is a debt-free<br />Company serving the dental <br />Implant Community since 1976<br />