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Recent advances in implants.

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Recent advances in implants.

  1. 1. GOOD MORNING
  2. 2. Recent Advances in Implants Dr. Sanket Rane
  3. 3. Contents • Introduction • Advanced diagnostic methods • Advances in implant materials. • Advanced surgical techniques. • Changing concepts in implant dentistry. • Conclusion.
  4. 4. INTRODUCTION • The idea of permanently being able to replace teeth has been a desire of civilizations since the days of the Egyptians. • First implant- copper peg- 3000 yrs ago. • Central America- Replacing lost teeth with animal ones. • Finally, in the mid-1960's, Dr. Branemark in Sweden discovered that titanium would fuse to bone….. • Advent of computerized tomography (CT).
  5. 5. Classification • Advances in diagnostic imaging – Zonography – Cone beam Computed tomography(CBCT) – Microtomograph – Multi slice helical CT – Dentascan – Interactive CT
  6. 6. • Advances in implant design – Mini implants – Transitional implants – One-piece implants. • Advances in Implant materials -Ceramics -Carbon and polymers - Hyrdoxyapatite - Bone morphogenic proteins - Plasma spraying
  7. 7. • Advances in implant design and surface in commerically available brands: – Biohorizon – Nobel biocare – Astra tech – Straumann
  8. 8. • Softwares simplifying treatment planning and surgical procedures – Simplant – NobelGuide – NobelClinician – Image guided surgeries CAD/CAM in implant dentistry. Changing concepts in implant dentistry -All on 4 concept -Tooth in an hour concept -Rescue implant concept
  9. 9. ADVANCES IN IMAGING/ DIAGNOSTIC MODALITIES • ADVANCES IN PANORAMIC IMAGING • ZONOGRAPHY • A modification of the panoramic x-ray machine for making cross sectional images of the jaws. • The tomographic layer is approximately 5mm. • For appreciation of spatial relationship between the critical structures and the implant site.
  10. 10. Zonography • Limitations: • Tomographic layers relatively thick . • Adjacent structures blurring and superimposition. • Not useful for determining the differences in bone density or for identifying disease at implant site.
  11. 11. Tomography • Tomography is the generic name formed by the greek words ‘tomo’(slice) and ‘graphy’(picture). • Enables visualization of a section of patient’s anatomy by blurring other regions above and below the site of interest. • For dental implant patients, high quality complex motion tomography is required.
  12. 12. Computed tomography (CT) • Computed tomography (CT) is a digital and mathematical imaging technique that creates tomographic sections. • With latest CT scanners, images with sectional thickness of 0.25 mm can be obtained . • This can be useful for determining the implant site in terms of bone density, and location to adjacent anatomic structures.
  13. 13. Recent advances in Computed Tomography(CT) • Cone beam CT: • It uses a cone beam and reconstructs the image in any direction using special software. • It gives all the information of a CT but, at 1/8th the radiation dose and at a lower cost.
  14. 14. • Software is used to display and visualize the anatomy in a way that is clinically meaningful. • The manufacturers of CBCT scanners offer software that is capable of multiplanar reformations . • Third-party software ……. Simplant……..
  15. 15. SAGGITAL CT AXIAL CT CROSS SECTIONAL VIEW OF MAXILLA AND MANDIBLE
  16. 16. Recent advances in Computed Tomography(CT) • Microtomograph: • Modification of CT, it is specially useful in acquiring serial sections of bone implant interface. • Multi slice helical CT: • The rapid volumetric data acquisition. The speed was further increased by multislice CT, and offers higher accuracy of images as compared to CT.
  17. 17. Dentascan • DentaScan imaging provides programmed reformation, organization and display of the imaging study.
  18. 18. • The radiologist simply indicates the curvature of the mandibular or maxillary arch • The computer is programmed to generate referenced cross sectional and tangential/panoramic images of the alveolus along with 3-D images of the arch. • The cross sectional and panoramic images are spaced 1mm apart and enable accurate preprosthetic treatment planning.
  19. 19. Limitations • 1. Images may not be of true size and require compensation for magnification. • 2. Determination of bone quality requires use of the imaging computer or workstation. • 3. Hard copy dentascan images only include a limited range of the diagnostic gray scale of the study. • 4. Tilt of the patients head during the examination is critical
  20. 20. Interactive computed tomography(ICT) • This technique enables transfer of the imaging study to the clinician as a computer file…. • The clinician’s computer becomes a diagnostic radiologic workstation with tools……….
  21. 21. • An important feature of ICT is that the clinician and radiologist can perform “electronic surgery” (ES)…… • With an appropriately designed diagnostic template, ES can be performed to develop the patient’s treatment plan electronically in 3 dimensions. • ES and ICT enable the development of 3 dimensional treatment plan…..
  22. 22. • Transfer of the plan to the patient at the time of surgery can be accomplished by…… • It can also be accomplished by the production of the computer generated, three-dimensional stereotactic surgical templates from the digital ICT and ES data.
  23. 23. Limitations of ICT: • Refinement and exact orientation of the implant positions is difficult and cumbersome. • Executing the plan may be difficult for the surgical team.
  24. 24. ADVANCES IN IMPLANT MATERIALS, FORM, SHAPE AND SURFACE TOPOGRAPHY • Mini implants/transitional implants. • One -piece implants • Modifications in surface topography(coatings) • Materials used for fabrication of implants.
  25. 25. MINI IMPLANTS • Mini dental implants (MDIs) are small diameter dental implants. • Are sometimes referred to as SDIs (small diameter implants), as well as NDIs (narrow body implants). • Diameter less than three millimetres (3mm.)
  26. 26. MINI IMPLANT DESIGN • Diameter of 1.8mm to 2.9mm. • Various lengths. • Multiple tip, thread, body and head designs are available • Thread designs vary from thin to thick and thread spacing is also variable. • Square, rectangular, or o-ball heads are common.
  27. 27. MINI IMPLANT -indications • Endentulous patients that have loose lower dentures. • Where extensive surgery required for conventional implants is contraindicated due to medical or age constraints. • Healing time is decreased. • Lower costs
  28. 28. • Fixed crown and bridge…. • Proper case selection is critical but the available literature has demonstrated success that rivals standard implants. • Transitional stabilization
  29. 29. PROCEDURE • Available in 6 lengths: 6, 8, 10,13, 15 & 18 • Typically inserted directly through the overlying gums and into the bone beneath • No need to surgically cut and raise flap • A single minimally invasive surgery is needed for insertion of MDI implants • Immediate loading done due to self tapping design.
  30. 30. PROCEDURE • Each of the tiny implants is held in finger driver that inserts the implant and also acts as screw driver. • Next a winged wrench is used to tighten the implant • Possible to provide mini implant treatment in single dental office visit.
  31. 31. TRANSITIONAL IMPLANTS • Diameter ranges -1.8 to 2.8 mm • Length -7mm to 14mm. • Fabricated with pure titanium in a single body with treated surface. • Primary function is to absorb masticatory stress during healing phase
  32. 32. Advantages • Provisionalisation of fully and partially edentulous jaws • Undisturbed healing of bone grafts • Immediate loading not possible but patient insists for fixed transitional prosthesis • Effective way to generate aesthetic transitional appliances • Allows evaluation of phonetics and function. • Cost effective.
  33. 33. Contraindications • Depth of supporting bone is less than 10mm with insufficient cortical bone to provide implant stabilization. • Patients with excessive bruxism. • When placement of sufficient number of transitional implants is not possible….. • Should be used with caution : Placed 1.5 to 2.5 mm from definitive implants….
  34. 34. COMMERCIALLY AVAILABLE TRANSITIONAL IMPLANT SYSTEMS • Immediate Provisional Implant System –IPI (Nobel Biocare) • Modular Transitional Implant System -MTI (Dentatus) • TRN/ TRI Implants (Hi Tec implants)
  35. 35. ONE PIECE IMPLANTS • Abutment and implant body in one piece and not separate • Material: Titanium Alloy – Ti-6Al-4V • Diameter: 3.0mm Lengths: 12, 15 and 18mm. • Maximum Strength - Minimum Profile. • Minimal Surgery - Maximum Esthetics. • Availability : Biohorizon 3.0 , Nobel direct , Zimmer’s one piece implant.
  36. 36. INDICATIONS • The long-term treatment of missing maxillary laterals and mandibular incisors. • For treatment of spaces that cannot be handled with larger two-piece implants…. • Also used for overdentures.
  37. 37. Biologic width Around One- And Two-Piece Titanium Implants. Hermann J. S, Cochran D. L., Buser D., Schenk R. K. and Schoolfield J. D • Histometrically examined peri-implant soft tissue dimensions • Conclusion: Gingival margin (GM) is located more coronally and Biologic Width (BW) dimensions are more similar to natural teeth around one-piece nonsubmerged implants compared to either two-piece nonsubmerged or two-piece submerged implants. Clinical Oral Implants Research 2001, 12: 559–571.
  38. 38. SURFACE MODIFICATIONS • Increase possibility of rigid fixation • Promote higher percentage of bone – implant contact • Proven to increase bone bonding strength Three general techniques used to modify surfaces: - Add material, - Remove material - Change the material already present.
  39. 39. Addition • Thick coatings - sol-gel and plasma-spraying • Thin film coatings (sub-micron) - vapor deposition techniques, where the coating material condenses onto a surface from a vapor. • The three basic vapor deposition techniques are: i. evaporation, ii. sputtering and iii. chemical vapor deposition.
  40. 40. Removal of material from surfaces • Glow discharge treatment • Sputter-etching.
  41. 41. • Changed without addition or removal of material by use of laser and electron beam thermal treatments. • Ion implantation can be used to add material to surfaces, modify coatings, and change microstructures
  42. 42. Surface modification for metallic implants • These treatments include passivation, anodization, ion implantation, and texturing.
  43. 43. PASSIVATION • Purpose: enhancing the oxide layer present and creating a surface less likely to break down and release metallic ions in service. • Passivation of a surface with the action of an electric current is known as ANODIZATION….resulting in much thicker oxide layers….. • IMPORTANT for highly roughened surfaces, since the increased surface area has the potential for greater release of metallic ions into the surrounding tissue.
  44. 44. • Surface texturing of an implant is done to increase the surface area and provide a greater potential for interlocking with bone. • Blasting with aluminum oxide or other ceramic particulate materials, plasma spraying with titanium and acid etching. • Recently, a resorbable ceramic-blasting material has been developed…….
  45. 45. Ceramic implant surface • High-strength ceramics used for implants are very inert in the body and exhibit minimal ion release. • Aluminum oxide is regarded by many as the standard inert material……..
  46. 46. • The ionic ceramic surface is in a high oxidation state, thermodynamically stable and hydrophilic • Minimal ion release has been noted for aluminum oxide or zirconium oxide under normal conditions. • Coatings may also include biologic coatings such as proteoglycans, bone morphogenic proteins and growth factors
  47. 47. Zirconia • Zirconia (Zr02) is a ceramic material used in implantology because: • Biocompatibility(bio inert) • Esthetics (because its colour is similar to the teeth), and • Mechanical properties, which are better than alumina. • High resistance to corrosion, flexion, and fracture • Contact with bone and soft tissue similar to that observed in titanium implants • It can be used to produce a entire implant or as a coating.
  48. 48. Carbon and Polymeric implant surfaces • Carbon has been shown to exhibit an inert and biocompatible surface when exposed to blood or tissue. • The carbon structure used for dental implants is known as turbostratic and is a modified graphite structure. • Polymeric surfaces are not commonly seen for dental implants. • Designed to act as a shock absorber, but this polymeric element requires periodic replacement due to wear.
  49. 49. Surface enhancers • Bioactive surface coating Plasma spray - titanium - hydroxyapatite • Sand blasted • Acid etched
  50. 50. Hydroxyapatite • Properties of HA composites is highly dependent on the particle size and morphology of the HA filler. • HA of sufficient fineness should be developed. • RF induction suspension plasma spraying with a wet suspension of HA.
  51. 51. NanoTite ion beam modification of titanium surface • Modified with a thin 1 micron thickness of calcium phosphate with HA- like chemistry for bone enhancement Ion beam deposition
  52. 52. Loaded HA Coated And Grit Blasted Titanium Implants Block MS, Finger IM, Fontenot MG, Kent JN • Comparative study of bone response to HA-coated titanium surface and two titanium surfaces. • He found that bone formation and maturation clearly occurred at a faster rate and earlier periods on HA coated implants than on non-coated implants, they are stable both in vivo and in vitro. • He concluded that HA-coated dental implant results in superior bone bonding, earlier biointegration, and better maintenance of crestal bone than titanium surfaces. Int J Oral Maxillofac Implants 1989,4:219-225
  53. 53. Red Blood Cell And Platelet Interaction With Titanium Implant Surfaces • The influence of the micro-roughened surface, produced by dual acid-etching (DAE) of machined commercially pure titanium, on initial blood cell/implant interactions . • Micro-roughened DAE implant surfaces showed, qualitative, more platelets than machined surfaces, while the textured glass surfaces demonstrated increased platelet aggregation. • They believed that these early blood cell/implant interactions may play a key role in the osteoconduction stage of peri-implant bone healing response to micro-roughened implants. Clini Oral Implants Res 2000,Dec 11(6);530-9 Park JY, Davies JE
  54. 54. The Advantages Of Coated Titanium Implant Prepared By Radiofrequency Sputtering From Hydroxyapatite David R. Cooley, Adrian F. Van Dellen DVM, John O. Burgess and A. Stewart Windele • Investigated and compared the healing rates of bone around commercially pure titanium implants and titanium implants sputter-coated from a hydroxyapatite target. • Histologic analysis of the bone-implant interface demonstrated that coated implants had nearly twice the percentage of direct bone contact compared with non coated implants. • Accelerate the healing of bone at the implant interface. J Prosth Dent 1992(1);93-100
  55. 55. Bone Reaction Adjacent To Microplasma Sprayed Capo4 Coated Oral Implants Subjected To Occlusal Load, An Experimental Study In The Dog ; Short Term Results R. Junker , P. J. D. Manders , J.Wolke , Y. Borisov and J. A. Jansen • Investigated, in a mandibular dog model, bone biological properties and the occlusal loading effects of titanium implants provided with newly developed microplasma-sprayed CaP coatings. • Functional loading of MPS CaP coatings induces a favorable bone response. Clinical Oral Implants Res 2010
  56. 56. Bone Formation Of Titanium Porous Oxides (TiUnite ) Oral Implants In Type IV Bone Huang YB, Xiropaidis AV, Sorensen RG, Albandar JM, Hall J, Wikesjo UM • Evaluated the local bone formation and osseointegration at TPO- modified implants in type IV bone. Result- TPO surface possesses a considerable osteoconductive potential promoting a high level of implant osseointegration in type IV bone in the posterior maxilla Clinical Oral Implant Res 2005, Vol 16 Issue 1 ;105-111
  57. 57. TO BE CONTINUED.....
  58. 58. Advances in commercially available implant systems • Biohorizon • Nobel biocare • Astra tech • Straumann
  59. 59. BIOHORIZON IMPLANT SYSTEM • LASER- LOK TECHNOLOGY • Unique surface characteristics • Laser-Lok microchannels is a series of cell-sized circumferential channels that are precisely created using laser ablation technology. • Extremely consistent microchannels that are optimally sized to attach and organize both osteoblasts and fibroblasts. • Includes a repeating nanostructure that maximizes surface area and enables cell pseudopodia and collagen microfibrils to interdigitate with the Laser-Lok surface.
  60. 60. • Biologic response : • The inhibition of epithelial downgrowth and the attachment of connective tissue (unlike Sharpey fibers). • This physical attachment produces a biologic seal around the implant that protects and maintains crestal bone health. • More effective than other implant designs in reducing bone loss.
  61. 61. • Different than other surface treatments • Virtually all dental implant surfaces on the market are grit-blasted and/or acid-etched. • These manufacturing methods create random surfaces that vary from point to point on the implant…….. • The clinical advantage • The Laser-Lok surface has been shown in several studies to offer a clinical advantage over other implant designs to reduce bone loss by 70% .
  62. 62. • Latest discoveries • Laser-Lok abutments • Create a biologic seal.
  63. 63. NOBEL BIOCARE SYSTEM NobelReplace™ Tapered Groovy implant • NobelReplace™ Tapered Groovy implant is shaped to resemble a tooth root. • New and unique grooved threads implant. • Since bone forms more rapidly in the grooves, the Groovy implants integrate faster • Tapered design makes surgical procedure exceptionally simple and predictable – especially for immediate placement after extraction.
  64. 64. INDICATIONS • For immediate placement after extraction. • Whenever immediate or early loading is applied. • The Groovy implants are preferred over models without the groove in soft bone conditions.
  65. 65. Advantages of groove pattern • Faster integration with grooves • Bone formed preferentially within the grooves, compared to other parts of the implant • Enhanced osseoconductive properties of the grooves and a guiding effect on bone forming cells • Up to 30% increase in stability…… Scanning electron microscopic images of TiUnite® implant with a groovy at the thread flank.
  66. 66. NobelReplace™ Tapered Groovy implant on the collar • Grooves extended to the collar of most new implants so they: • Increase surface area • Increase area for bone to-implant contact
  67. 67. The NobelSpeedy™ implant • Features: • Parallel walled implant • Slightly tapered design • TiUnite® surface provides accelerated osseointegration over machined surface implants . • Narrow tip makes it perfect for flapless surgery • Primary stability at time of implant placement. • Shortening treatment time and speeding recovery.
  68. 68. • NobelSpeedy™ implant for flapless surgery • The innovative head design makes this implant ideal for flapless surgery. • Head is the same diameter as the implant body… • Inspection of the bone margin is impossible when working flapless…… • Preventing the use of countersinks preserves cortical bone.
  69. 69. • NobelSpeedy™ implant for Immediate Function • The innovative implant tip is sharp so the implant works as an osteotome……. • This feature allows variable, and if needed, extensive under-preparation of the site. • The resulting higher initial stability, especially in soft bone, supports immediate function. • The sharp tip also secures a smooth insertion…….
  70. 70. • Since the implant cuts through any bone quality it's especially suitable for grafted bone. • The bone graft can be of various density levels, and the ability to under-prepare gives the necessary flexibility when preparing the grafted site. • The implant will cut even in under-prepared block graft sites.
  71. 71. • NobelSpeedy™ implant -esthetics • The parallel-walled body and innovative head of NobelSpeedy™ secures flexibility in the final vertical position of the implant, which is important for the emergence profile. • It provides the possibility to increase torque and place the implant further down without repeating the drilling procedure. • Especially important when working with internal connection implants where only 3 positions allow optimal esthetics.
  72. 72. NobelSpeedy™ Replace • Narrow Tip ,Sharper Chamfers • Internal Abutment Connection • Slightly Tapered • TiUnite® all the way up • Extremely Short Drill Protocol • Grooves on threads • Increased initial stability in soft bone
  73. 73. NobelSpeedy™ Groovy • Same benefits as NobelSpeedy™ Replace. In addition: • External Abutment Connection • Including Shorty implant NobelSpeedy™ Shorty (7mm)
  74. 74. NobelActive™ Implant • NobelActive™ implants don't cut through bone like conventional implants, they gently press through it like a corkscrew. • This bone condensing capability delivers high initial stability. • The narrow neck is designed to preserve marginal bone and promote long-lasting soft tissue stability.
  75. 75. • The self-drilling ability of NobelActive™ implants allows it to be inserted into sites prepared to a reduced depth. • This is useful where sites are close to vital anatomical structures: the mandibular nerve canal or the maxillary sinus, and nose cavity. • Operator can be confident of accurate placement while having a minimally invasive procedure.
  76. 76. NobelActive™-Advantages • Potentially fewer drilling protocol steps, depending on bone density and quantity . • Minimal osteotomy with minor trauma to bone and surrounding tissues . • High stability in fresh extraction sites and sites with thin sinus floors. • Immediate placement in the esthetic region, even when buccal bone plate is very thin • Excellent stabilization in wide sockets…..
  77. 77. • Excellent stabilization in soft bone… • Adjustment to small changes for parallelism – using the self-drilling capacity….. • A narrow neck designed to preserve marginal bone. • Grooves on threads and scientifically proven Tiunite™ surface
  78. 78. NobelSpeedy™ Shorty • Shorty implant (7mm) • Narrow Tip • Slightly Tapered • Grooves on threads • The implant for flapless surgery • Extremely Short Drill Protocol • Immediate Function • Increased initial stability in soft bone • Optimal Emergence Profile and Esthetics • TiUnite® 'all the way up'
  79. 79. NobelPerfect™ • NobelPerfect™ is a unique, anatomically designed implant for esthetically demanding areas from premolar to premolar. • The interproximal bone may be preserved …………… height discrepancy between the facial and interproximal… • The anatomic design and the unique implant surface, TiUnite™, give esthetic support and an effective barrier against the oral cavity.
  80. 80. • Scalloped bone apposition area follows three-dimensional osseous contours. • Scalloped soft tissue apposition area allows for the development of the biologic width around the entire neck of the implant. • Scalloped prosthetic table follows three-dimensional soft tissue topography.
  81. 81. The NobelPerfect™ One-Piece implant • The NobelPerfect™ One-Piece implant is machined from a single piece of titanium….. • The scalloped TiUnite surface contour at the implant neck follows the same principles as for the original NobelPerfect™. • The One-Piece design allows placement flexibility of the implant… • With this design, the soft tissue is supported entirely by the implant body, irrespective of the shape of the osseous ridge.
  82. 82. NobelDirect Implant • The NobelDirect Groovy implant features a revolutionary new one-piece design that is • user-friendly, • cost-effective, • biologically sound and • esthetically stable. • The implant is machined from a single piece of titanium, incorporating both the implant body and an integral fixed abutment.
  83. 83. NobelGuide™ Zygoma Implant • Using Brånemark System® Zygoma implants with NobelGuide™ enables use of CT scan data as the basis for surgical planning in a 3D computer environment. • From computer-based planning…one or two Surgical Templates, depending on the nature of the case….flapless surgery. • Immediate Function
  84. 84. Astra Tech implant system • OsseoSpeed™ -chemically modified titanium surface, • Providing unique nano scale topography, • Stimulates early bone healing and speeds up the bone healing process. • The result of the micro-roughened titanium surface treated with fluoride is increased bone formation and stronger bone-to- implant bonding.
  85. 85. Astra Tech implant system • MicroThread™ • The neck of Astra Tech implants are designed with MicroThread that has minute threads that offer optimal load distribution and lower stress values.
  86. 86. Astra Tech implant system • Conical Seal Design™ a strong and stable fit • Conical connection below the marginal bone level transfers the load deeper down in the bone……. • Reduces peak stresses and thereby preserves the marginal bone. • Seals off the interior of the implant from surrounding tissues, minimizing micro-movements and micro-leakage.
  87. 87. • Simplifies maintenance and ensures reliability in all clinical situations. • The tight and precisely fitting implant-abutment relation...... • The abutment is self-guiding and the installation procedure is non-traumatic, eliminating the risk of bone damage.
  88. 88. • Connective Contour • The Connective Contour™ is the unique contour that is created when you connect the abutment to the implant. • This contour allows for an increased connective soft tissue contact zone both in height and volume… • Sealing off and protecting the marginal bone.
  89. 89. Straumann SLActive implant • Chemical modification to a sandblasted, large-grit, acid-etched (SLA) implant surface. • Hyrdophilicity • Protein adsorption
  90. 90. • Enhanced osteoblast activity within the first weeks • Enhanced angiogenesis and bone healing within the first days after contact with the new surface.
  91. 91. • More bone apposition on surface • Higher implant stability .
  92. 92. Advantages • This surface reduced the average healing time from 12 weeks (TPS surface) to only 6-8 weeks. • Molecular optimization and the substantial reduction of the average healing time from 6-8 weeks to 3-4 weeks,
  93. 93. Straumann Roxolid Implant • Roxolid® is a homogenous metallic alloy composed of the elements titanium and zirconium. • Higher tensile strength compared to pure titanium. • Important when small diameter implants are chosen due to their reduced size. • Roxolid® and SLActive® combine high strength with excellent osseointegration. • Roxolid® implants have been used where 3.3mm titanium implants previously were not suitable.
  94. 94. SURGICAL GUIDES • Surgi Guides are computer-generated drilling guides that are fabricated through the process of stereolithography. • The SurgiGuide concept is based on the presurgical treatment planning using SimPlant software for ideal implant positioning. • These successive diameter surgical osteotomy drill guides may be either bone, teeth, or mucosa-borne.
  95. 95. • Surgi Guides have metal cylindrical tubes that correspond to the number of desired osteotomy preparations and specific drill diameters. • The diameter of the drilling tube is usually 0.2mm larger than the corresponding drill, thus making angle deviation highly unlikely.
  96. 96. Steps in using SIMPLANT software Step 1 The scan • Connect to the Dental Planit button in your SimPlant GO software to start a case. • A radiolucent bite index used to stabilize jaws at the time of scanning. • Create an open bite with no overlap in the horizontal plane.
  97. 97. Steps in using SIMPLANT software Step 1 The scan • Digital information on the desired tooth-setup is obtained via the wax-up created on the plaster model. • When your patient has been scanned, your image conversion provider takes an optical scan of the plaster model and wax-up and integrates them with the scanning images.
  98. 98. Steps in using SIMPLANT software • The image conversion saves you valuable time and ensures that the CT images are easy to read. • Exact tooth information – no scatter artefacts. • Desired tooth setup – via the plaster model wax-up (optional). • Soft tissue information – be able to measure mucosa thickness. • Indication of the alveolar nerve –result is EASY verification. • Exact sinus information – 3D representations included.
  99. 99. Steps in using SIMPLANT software • Step 2 • The planning in SimPlant® • SimPlant file. • 3D representations of patient’s anatomy, alveolar nerve, sinuses, plaster model and desired tooth setup. • Plan and communicate
  100. 100. Steps in using SIMPLANT software • Step 3 • The SurgiGuide®online order • The high resolution optical scan of the plaster model in SimPlant is used to design a perfectly fitting SurgiGuide. • Specialized design team reviews and designs a custom made SurgiGuide which is fabricated with high precision 3D printing process.
  101. 101. Steps in using SIMPLANT software • Step 4 • Surgery • SurgiGuide is delivered with the drilling and installation protocol. • Disinfect the SurgiGuide before surgery
  102. 102. NobelGuide • NobelGuide is a complete treatment concept for • Diagnostics, • Prosthetic-driven treatment planning and • Guided implant surgery – for a single missing tooth to an edentulous jaw.
  103. 103. NobelClinician Software • NobelClinician Software is the next generation software for • Digital diagnostics and • Treatment planning. • Through various pre-defined workspaces any DICOM file can be reviewed and analyzed. • NobelClinician Software facilitates team collaboration and comes with an unparalleled ease of use.
  104. 104. • NobelClinician Software supports the NobelGuide concept. • 3D radiographic data
  105. 105. CAD/CAM in implant dentistry • Uses • Used in designing of prosthesis • Used in milling /fabrication of prosthesis(framework) • For milling of abutments. • Advantages: • Superior fit • Less degree of rotational freedom so more accurate implant abutment connection.
  106. 106. CAD/ CAM system Provider Implant restoration type Restoration material Procera Nobel Biocare Abutments Fixed partial denture frameworks Milled bars Titanium Alumina Zirconia Atlantis Astra Tech Abutments Titanium Titanium with gold coating Zirconia Encode Biomet 3i Abutments Titanium Titanium with gold coating
  107. 107. CAM StructSURE Biomet 3i Milled bars Titanium CARES Straumann Abutments Titanium Zirconia Etkon Straumann Frameworks Abutments Zirconia Titanium BioCad BioCad Medical Abutments Milled bars Titanium
  108. 108. CAD/CAM Custom Implant Abutment Systems • The Procera system (Nobel Biocare) : • Custom abutments in titanium, alumina, and zirconia. • A master cast is developed after making an implant-level impression. • Scanned and the custom abutment is designed by a 3d cad pro-gram.
  109. 109. • A machined base cylinder is screwed to the implant analog and the abutment is waxed up. • The pattern is then removed from the master cast and scanned by the Procera scanner. • The design is sent to the production facility for the abutment fabrication. • The abutment can be further digitized, and finally a titanium or ceramic coping is produced using the same system.
  110. 110. CAD/CAM Custom Implant Framework System • Procera implant partial prostheses are available in zirconia or titanium. • CAD/CAM custom Procera partial prostheses are screw-retained implant-supported restorations that can be used with a wide range of implant systems.
  111. 111. • The zirconia implant prosthesis is available at the implant level, while the titanium implant prosthesis is available at the implant and abutment levels . • Using acrylic resin, a framework pattern is fabricated directly on temporary implant cylinders. • The acrylic resin framework pattern is then laser scanned, and the framework is milled in a CNC-milling machine with 5 degrees of freedom.
  112. 112. • CAM StructSURE precision milled bars (Biomet 3i) • Hader and Dolder designs for over-denture bars and primary bars and in fixed hybrid designs. • Technician does not need to wax or resin design the framework; instead, the design is made on-screen with a sophisticated software program.
  113. 113. • The Etkon system can produce frameworks up to16 units from a variety of materials, such as zirconia and titanium.
  114. 114. Newer concepts in implant dentistry • All on four • Rescue implant concept • Teeth in an hour concept
  115. 115. ALL ON FOUR -Maxilla and mandible • The All-on-4 for edentulous jaws has been developed to maximize the use of available bone and to allow for Immediate Function • Using only four implants in edentulous jaws…..
  116. 116. • All-on-4 using conventional flap procedure with traditional planning and a standardized All-on-4 Guide for predictable and optimal positioning of the implants.
  117. 117. • All-on-4 with NobelGuide using flapless technique, computer-based planning and a customized Surgical Template to correctly drill and position the implants.
  118. 118. Zygoma implants • The zygomatic implant is an alternative to bone grafting in extremely resorbed maxilla. • With extremely resorbed maxillas, fixed prosthesis can be provided with four zygomatic implants. • Either a conventional two stage procedure or a one-stage surgical procedure or flapless guided surgery with Nobelguide and immediate function.
  119. 119. Zygoma implants • The four zygomatic implants procedure results in • Less morbidity, • Shorter delays between anatomical reconstruction and functional rehabilitation • Provide immediate or early loading with immediate function. • Four zygomatic implants and a fixed bridge seem to be a valuable technique for the rehabilitation of extremely resorbed maxillas.
  120. 120. Teeth in an hour concept • With conventional treatment….. • Teeth-in-an-Hour™ allows the possibility to provide patients fixed, well-functioning, and esthetic prostheses on implants in less than an hour. • With flapless technique…..with greatly reduced healing time, no temporaries and no significant pain or swelling. • With the NobelGuide system, allows replacing missing teeth with permanent dental implants – easily, quickly and comfortably.
  121. 121. CONCLUSION
  122. 122. References • 1. Griffitts, TM; Collins CP, Collins PC . "Mini dental implants: An adjunct for retention, stability, and comfort for the endentulous patient". Oral Surg Oral Med Oral Pathol Oral Radiol Endod 100 (5): E81–84. • 2. English, CE; Bohle GC . "Diagnostic,k procedural, and clinical issues with the Sendax mini dental implants". Compendium. supplement 1 24: 1– 23. • 3. Block, MS; Delgado A, Fontenot MG . "The effect of diameter and length of hydroxyapatite-coated dental implants on ultimate pullout force in dog alveolar bone". Journal Oral Maxillofac Surgery 48 (2): 174–178. • 4. Binon, PP . "The effect of implant/abutment hexagonal misfit on screw joint stability". Int Journal of Prosthodontics 9: 149–160. • 5. Shatkin, TE; Shatkin S, Oppenheimer BD, Oppenheimer AJ . "Mini dental implants for long term fixed and removable prosthetics: A retrospective analysis of 2514 implants placed over a five year period.". Compendium 28: 36–41.
  123. 123. References • 6. Christensen, GJ; Swift, Edward J. (2008). "Mini implants: Good or bad for long term service?". J Esthetic Dentistry 20 (5): 343–348. • 7. Gibney, JW (2001). "Minimally invasive implant surgery". J Oral Implantology 27 (2): 73–76 • 8. Campelo, LD; Camara JR (2002). "Flapless implant surgery: A 10 year clinical retrospective analysis". Int Journal Maxillofac Implants 17: 271– 276. • 9. Ahn, M-R; An K-A, Choi J-H, Sohn D-S (2004). "Immediate loading with mini dental implants in the fully edentulous mandible". Implant Dent 13 (4): 367–372. • 10. Mazor, Z; Steigmann M, Leshern R, Peleg M (2004). "Mini-implants to reconstruct missing teeth in severe ridge deficiency and small interdental space: A five year case series". Implant Dentistry 12: 336–341. • 11. Shatkin, TE; Shatkin S, Oppenheimer AJ (2007). "Mini dental implants for long term fixed and removeable prosthetics: A retrospective analysis of 2514 implants placed over a five year period.". Compendium 28: 36–41. • 12. Christensen, GJ; Swift, Edward J. (2008). "Mini implants: Good or bad for long term service?". J Esthetic Dentistry 20 (5): 343–348.
  124. 124. References • 13. Sendax, VI (1996). "Mini-implants as adjuncts for transitional prostheses". Dental Implantol Update 7: 12–15. • 14. Almeida EO, Filho HG, Goiatto MC.The use of transitional implants to support provisional prostheses during the healing phase: a literature review. Quintessence Int. 2011 Jan;42(1):19-24. • 15. Hermann J. S, Cochran D. L., Hermann J. S., Buser D., Schenk R. K. and Schoolfield, J. D.Biologic Width Around One- And Two-Piece Titanium Implants. Clinical Oral Implants Research 2001, 12: 559–571. • 16.Simunek A et al Evaluation Of Stability Of Titanium And HA Coated Osseointegrated Dental Implants : A Pilot Study , Clin Oral Implants Res 2002 Feb , 13(1);75-9. • 17. Hahn J One-Piece Root-Form Implants: A Return To Simplicity. J Oral Implantol: April 2005, 31, 77-84 • 18. Block MS, Finger IM, Fontenot MG, Kent JN Loaded HA Coated And Grit Blasted Titanium Implants ,Int J Oral Maxillofac Implants 1989,4:219-225 • 19. Park JY, Davies JE Red Blood Cell And Platelet Interaction With Titanium Implant Surfaces, Clini Oral Implants Res 2000,Dec 11(6);530-9
  125. 125. References • 20. David R. Cooley, Adrian F. Van Dellen DVM, John O. Burgess and A. Stewart The Advantages Of Coated Titanium Implant Prepared By Radiofrequency Sputtering From Hydroxyapatite , J Prosth Dent 1992(1);93-100 • 21. Ivanoff CJ, Hallgren C, Widmark G, Sennerby L, Wennerberg A Histologic Evaluation Of Bone Response To Oxidised And Turned Titanium Micro Implants In Human Jaw Bone , Int J Oral Maxillofac Implants 2003 ,May-June 18(3); 341-8 • 22. Junker R et al.Bone Reaction Adjacent To Microplasma Sprayed Capo4 Coated Oral Implants Subjected To Occlusal Load, An Experimental Study In The Dog ; Short Term Results , Clinical Oral Implants Res 2010 • 23. Huang YB, Xiropaidis AV, Sorensen RG, Albandar JM, Hall J, Wikesjo UM Bone Formation Of Titanium Porous Oxides (TiUhite ) Oral Implants In Type IV Bone ,Clinical Oral Implant Res 2005, Vol 16 Issue 1 ;105-111 • 24. Deporter DA, Caudry S, Kermalli J, Adegbembo Further data on A Predictable Procedure For Managing The Resorbed Posterior Maxilla With Short, Sintered Porous-Surfaced Dental Implants, Int J Periodontics Restorative Dent. 2005 Dec;25(6):585-93. • 25. Int J Oral Maxillofac Surg. 2010 Apr;39(4):358-63
  126. 126. Thank you

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