Endodontic implants /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.


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Endodontic implants /certified fixed orthodontic courses by Indian dental academy

  1. 1. INDIAN DENTAL ACADEMY Leader in Continuing Dental Educationwww.indiandentalacademy.com
  2. 2. CONTENTS • INTRODUCTION • DEFINITIONS • HISTORY • MATERIALS • INDICATIONS • CONTRAINDICATIONS • SUCCESS AND FAILURE • TECHNIQUE • REFERENCES • CONCLUSION www.indiandentalacademy.com
  3. 3. INTRODUCTION
  4. 4. DEFINITIONS1) An endodontic implant is a metallic extension of the root with the object of increasing the root-to-crown ratio, to give the tooth better stability in the arch. GROSSMAN.2) A metallic extension of the root of a tooth, usually a vitallium pin or post prepared for that purpose, extending beyond the root apex and inserted into the previously prepared channel in the bone above the root. WALTON & TORABINAJAD. www.indiandentalacademy.com
  5. 5. 3) An endodontic implant refers to the stabilization of the root with an inert metallic implant that extends through the apex into the periapical bone. ALFRED L. FRANK4) An endodontic endosseous implant consists of a metallic extension beyond the root apex in order to improve the crown-root ratio and thus stabilize an inadequately supported tooth. F J HARTYTHEY ARE ALSO CALLED AS:- DIODONTIC IMPLANTS- STABILIZERS -OR-- ENDODONTIC STABILIZERS www.indiandentalacademy.com- ENDODONTIC ENDOSSEOUS IMPLANTS.
  6. 6. Souza (1953) Orlay (1960) Frank (1967)www.indiandentalacademy.co m
  7. 7. www.indiandentalacademy.com
  8. 8. • When metals are implanted into the human tissues, they should be biocompatible (nontoxic and nonantigenic), resist corrosion, resist stress, and be easily fabricated.• FERGUSON (1959)…• METALS USED FOR ENDODONTIC IMPLANTS INCLUDE: Cobalt-chrome alloys (Vitallium) and Titanium. www.indiandentalacademy.com
  9. 9. TISSUE RESPONSES TO IMPLANTED MATERIALS: 41) Tissue death if the material is toxic2) Replacement by the surrounding bone if the material is nontoxic .3) Formation of fibrous capsule of variable thickness if the material is biologically inactive, and4) Formation of an interfacial bond if the material is nontoxic and biologically active. www.indiandentalacademy.com
  10. 10. VITALLIUM IMPLANTS• VITALLIUM is an alloy consisting of: - 62 – 65% Cobalt - 27 – 30% Chromium - 5% Molybdenum - 2 – 3% Nickel• It has been extensively used as an implant material in the human body.• Venable et al. (1937) … earlier claims: electro passive, inert and non irritating to the human tissues.• VENABLE et al. (1939), BERNIER & CANBY (1943) – Vitallium implants were well tolerated by the bony tissue unless infection supervened. www.indiandentalacademy.com
  11. 11. • Several studies have shown that the alloy corrodes.• SEM – pitting corrosion of Vitallium implants.• LAING (1959), FERGUSON (1959) – corrosion products are released to the surrounding tissues and metallosis results.• HERCHFUS (1954), FITZPATRICK (1968) – concentrations of chromium ions were found dispersed through out the body tissues, often at some distances from the implants. www.indiandentalacademy.com
  12. 12. • SELTZER et al. (1973) – vitallium implants corroded in the teeth and these corrosion products were cytotoxic to the periapical tissues.• ZMENER & DOMINQUEZ (1982) – by electron microscopy and electron microprobe analysis, found extensive corrosion of vitallium implants and these corrosion products were detected in the surrounding bone. Thus, Vitallium is not inert, nor does it resist corrosion when implanted in human body. www.indiandentalacademy.com
  13. 13. TITANIUM IMPLANTS• A desirable, biocompatible material for use as an endodontic implant, based on reported corrosion and tissue toxicity studies.• CORROSION PRODUCTS of titanium – oxides such as Ti2O3. 5TiO2. TOMASHOV et al. (1972).• MILLER & GREENER (1970) – corrosion rate of titanium appears to be lower than that of most other metals. www.indiandentalacademy.com
  14. 14. • Well tolerated …..• ALBREKTSSON et al. (1985) – titanium implants in rabbit tibias became osseointegrated.• SELTZER et al. (1970) – presence of severe periapical and lateral inflammatory lesions.• “PIER EFFECT” www.indiandentalacademy.com
  15. 15. Indicationswww.indiandentalacademy.com
  16. 16. 1) Periodontally involved teeth requiring stabilization. STABILIZATION OF PERIODONTALLY INVOLVED TOOTH Radiograph of Periodontally Involved lower incisor Endodontic implant was Placed to reduce tooth mobility. 14 year recall radiograph showing No further bone loss. www.indiandentalacademy.com
  17. 17. )Transverse root fracture involving loss of the apical fragment orhe presence of two fragments that cannot be aligned. HORIZONTAL FRACTURE OF THE ROOT Placement of an endodontic implant following the removal of an apical fragment 15 year recall radiograph www.indiandentalacademy.com
  18. 18. 3) Pathological resorption of the root apex incident to achronic abscess.APICALRESORPTION Endodontic implant Placed to improve the crown – root ratio 15 year recall radiograph www.indiandentalacademy.com
  19. 19. 4) A pulpless tooth with unusually short root 5) Internal resorption affecting the integrity and strength of the root.6) A tooth in which additional root length is desired for improving its alveolar support. www.indiandentalacademy.com
  20. 20. 7) When it is necessary for a tooth to have additional root lengthto serve as a satisfactory bridge abutment or support for anoverdenture. ADDITIONAL TOOTH LENGTH TO SERVE AS ABUTMENT FOR OVERDENTURE 9 year recall radiographs Photograph of overdenture www.indiandentalacademy.com With endodontic implants
  21. 21. 8) EXCESSIVE MOBILITY DUE TO ABSENCE OF BONE SUPPORT OR THE ROOT LENGTH Absence of bone support Inadequate root length www.indiandentalacademy.com
  22. 22. 9) Previous apical surgery, or where the elimination by apical surgery of a perforation in the coronal or middle part of the root would lead to undue mobility.10) The technique is useful in teeth that have lost bony support in either the coronal or the apical half of the root. www.indiandentalacademy.com
  23. 23. Contraindications www.indiandentalacademy.com
  24. 24. 1. Active progressive periodontal disease associated withthe tooth.
  25. 25. 2. Periodontal communication (probing defect)near the apex of the tooth
  26. 26. 3. Anatomical structures in close proximity of the apex of the tooth.
  27. 27. 4. The buccolingual alignment of the tooth and configuration of the cortical plate are such that the stabilizer would project into soft tissues.
  28. 28. SUCCESS & FAILURE www.indiandentalacademy.com
  29. 29. • High failure rate.• Success depends on proper case selection & on close adherence to the following criteria:1) Routine endodontic treatment can be carried out without difficulty.2) Alveolar bone is sufficient for the retention & stability of both tooth and the implant. www.indiandentalacademy.com
  30. 30. • Endodontic implants have the histological advantage of being totally intraosseous, without communication into the oral cavity.CRITERIA FOR SUCCESS:1) There must be no communication to the oral cavity, as demonstrated by probing.2) There must be no radiographic evidence of apical pathosis.3) There must be no gingival suppuration.4) The patient should be experiencing no discomfort. www.indiandentalacademy.com
  31. 31. SIGNS OF FAILURE OF IMPLANTSRadiograph taken 17 years following endodontic Implantation.Note apical radiolucencies. There was a draining sinus tractassociated with the tooth www.indiandentalacademy.com
  32. 32. THE ACHILLES HEEL OF THE ENDODONTIC IMPANT IS ITS APICAL SEAL• HOLLAND & COLLEAGUES (1977) – attributed failure to a defective seal between the implant and the root apex.• SILVER BRAND & ASSOCIATES (1979) – claimed 90% success rate for endodontic implants, despite the presence of periapical lesions in 18% of their cases.• OHNO & CO-WORKERS (1977) – implant and the sealer were found to be encapsulated by fibrous connective tissue.• SIMON & FRANK (1980) – Evidence of resorption of dentin and cementum at the root apex because of the faulty seal. www.indiandentalacademy.com
  33. 33. SOUND CLINICAL CRITERIA FOR ASUCCESSFUL ENDODONTIC IMPLANT:1) A normal gingival crevice containing a normal epithelial attachment.2) A radiographically normal attachment apparatus including the bone, cementum and dentin.3) A stabilized, functional and symptom less tooth. www.indiandentalacademy.com
  34. 34. ENDODONTIC IMPLANTS, WHICH CAN RESULT IN FAILURE :1) Poor apical seal resulting in periapical rarefaction around the root apex.2) Extrusion of the excessive sealer through the apical foramen into the periapical tissues, with resulting irritation.3) Limitation in the length of the osseous portion of implant by local anatomic factors in the maxilla or mandible such as maxillary sinus, nasal fossa, and mandibular canal, or labio- or linguoversion of the tooth in the jaw.4) Perforation of the lateral surface or perforation of a curved root near the root apex.5) A structurally weakened tooth, instrumented to a much larger size than usual, to receive an inflexible implant, which may fracture during function. www.indiandentalacademy.com
  35. 35. ERRORS IN CASE SELECTION AND DIAGNOSIS.www.indiandentalacademy.com
  36. 36. ERRORS IN CASE SELECTION1) TERMINAL PERIODONTAL PROBLEMS.2) ANATOMICAL FACTORS. www.indiandentalacademy.co
  37. 37. ANATOMICAL FACTORS www.indiandentalacademy.co
  38. 38. TREATMENT ERRORS1) APICAL DISTORTION DURING CANAL PREPARATION.2) INADEQUATE FIT OF THE ENDODONTIC IMPLANT.- Over preparation of the root canal3) INADEQUATE INTRA CANAL LENGTH OF THE IMPLANT. www.indiandentalacademy.co
  39. 39. Over preparation of the canal resultingin a lateral perforation www.indiandentalacademy.co
  40. 40. Pre- & post treatment photographs INADEQUATE LENGTHLeft bicuspid was successful Right bicuspid failed onlyFor 12 years. after 2 years. www.indiandentalacademy.co
  41. 41. TECHNIQUE
  42. 42. oTo ensure satisfactory retention within the root, thestabilizer should extend at least 5 to 6 mm into the tooth and should make close contact with the walls of the prepared canal for as great a distance as possible. oPreparation is done entirely with reamers.oAnterior teeth should whenever possible be enlarged to atleast 70.oAccess to the pulp cavity of an anterior tooth has to be through the incisal edge, or close to it. www.indiandentalacademy.com
  43. 43. oTo avoid unnecessary pressure and irritation and toensure that it is completely seated with in the preparedcanal, the apical end of the stabilizer should be clear of bone.oFollowing insertion, sufficient room should be left in the coronal part of the root to allow post crown construction should this be necessary later.oThe stabilizer is used to root fill the tooth in the same way that a sectional silver filling is performed. www.indiandentalacademy.com
  44. 44. 3 different techniques: 1) TECHNIQUE WITH PERIAPICAL SURGERY. 2) TECHNIQUE WITHOUT PERIAPICAL SURGERY.3) ALTERNATIVE TECHNIQUE FOR FRACTURED ROOTS. www.indiandentalacademy.com
  45. 45. TECHNIQUE WITH TECHNIQUE 1PERIAPICAL SURGERY
  46. 46. • This technique is used where surgical removal of the apical part of the root is necessary because of root fracture or perforation, or where an existing filling can only be removed by a surgical approach. www.indiandentalacademy.co
  47. 47. 1) Preliminary root canal preparation to a level just short of the root apex.2) Periapical surgery is then performed and the apical part of the root removed.3) Root canal preparation is now completed with reamers to the level of the root apex. www.indiandentalacademy.co
  48. 48. 4) The appropriate stabilizer is tried in the tooth and the fit and the apical extension checked.5) Cement is applied to the walls of the prepared canal and to the coronal part of the stabilizer, and the latter seated firmly in position.6) Excess cement is removed and the wound is closed with sutures. www.indiandentalacademy.co
  49. 49. TECHNIQUE 2TECHNIQUE WITHOUTPERIAPICAL SURGERY
  50. 50. • This technique is used when the tooth mobility is the result of periodontal disease. Periapical bone is removed by way of the root canal using reamers 40mm in length.• The removal of periapical bone will necessitate local anesthesia lingually as well as bucally.• Equipment:Same as for endodontic treatment, with the addition of extra-long reamers, 40mm in sequential sizes and implants of the corresponding size www.indiandentalacademy.co
  51. 51. • Tapered cobalt – chrome endodontic stabilizer• Matching 40 mm hand reamer• Engine driven drill for apex preparation. www.indiandentalacademy.co
  52. 52. ST P IN T CH ES E NIQUE1) Anesthetize the tooth and involved area with local anesthesia.2) With the rubber dam in place, aseptically complete the usual treatment of access preparation, enlargement and irrigation of the root canal.3) A marker is then set on the 40mm reamers at the level equivalent to the length of the tooth plus the number of millimeters the implant will extend beyond the root apex. www.indiandentalacademy.co
  53. 53. 4) Osseous preparation is performed.5) This channel is widened with progressively larger instruments until the root canal preparation and the periapical preparation form a continuous taper, with simultaneous cutting of dentin and bone.6) Select an implant of equivalent size to the last instrument used, score it lightly to indicate the desired length, that is from the occlusal tip to through the root canal to the exact length cut into the cancellous bone, and insert it into the root canal and bone. See for the fit and extent. www.indiandentalacademy.co
  54. 54. www.indiandentalacademy.co
  55. 55. 7) Dry the root canal again. Shorten the implant at its apical tip by 1mm, to ensure that it will seat snuggly and will not bind in the cut osseous bed.8) Insert a plugger into the access opening until it binds, and measure the exact length it can be inserted unimpeded into the canal. the plugger will be used to seat the implant during cementation. www.indiandentalacademy.co
  56. 56. ALTERNATIVE TECHNIQUE 3TECHNIQUE FORFRACTURED ROOTS
  57. 57. www.indiandentalacademy.co
  58. 58. www.indiandentalacademy.co
  59. 59. • Drilling is continued for a further 2-3 mm into the bone, and this forms a base into which the endosseous implant can be firmly seated.• Try – in of the implant done.• When the post core implant is seen to fit correctly at both ends, it is removed, washed in sterile saline and dried. The apical bone cavity is irrigated and the root canal is dried.• A root canal cement is now introduced in to the deeper portions of the root canal. www.indiandentalacademy.co
  60. 60. • Post is now coated with an EBA cement.• The post is placed into the root canal so that it seats correctly in its apical end and also at the root face. The jacket crown may now be cemented on to the core and the post – core jacket held in position until the cement sets hard.• The apical end is now examined and any excess cement removed.• The flap is repositioned and sutured. www.indiandentalacademy.co
  61. 61. www.indiandentalacademy.co
  62. 62. • Splinting is generally not necessary, but the occlusion should be checked and freed of any contact with the opposing teeth.• The patient must also be instructed not to chew in the area for 2- 3 weeks.• Sutures are removed 4 – 7 days later. www.indiandentalacademy.co
  63. 63. REFERENCES:1. ENDODONTIC ENDOSSEOUS IMPLANTS : CASE REPORTS & UPDATE OF MATERIALS. J.O.Endo,1989;15(10):496-5002. APPLICATION OF TITANIUM-ALLOY ENDODONTIC IMPLANTS IN CONJUNCTION WITH PERIRADICULAR SURGERY. OOO,1999;88:484-73. CUSTOM-FABRICATED ENDODONTIC IMPLANTS : A REPORT OF TWO CASES. J.O.Endo,2000;26(5):301-3 www.indiandentalacademy.com
  64. 64. CONCLUSIONTHE USE OF ENDODONTIC IMPLANTS HAS DROPPED SIGNIFICANTLYIN RECENT YEARS. THIS IS UNFORTUNATE DUE TO THE MANYVARIED SITUATIONS IN WHICH THEY CAN BE USED EFFECTIVELYTO IMPROVE THE PROGNOSIS OF MOBILE TEETH. FOR VARIOUSREASONS, INCLUDING POOR CASE SELECTION, IMPROPER USE OFMATERIALS, & INADEQUATE APICAL SEAL OF THE IMPLANT, A HIGHNUMBER OF FAILURES OCCURRED. HOWEVER, BECAUSEOSSEOINTEGRATED ENDOSSEOUS IMPLANTS ARE NOW REPLACINGEXTRACTED TEETH, LITTLE ATTENTION IS NOW FOCUSED ON THEUSE OF ENDODONTIC ENDOSSEOUS IMPLANTS FOR TOOTHSTABILIZATION.
  65. 65. Thank Youwww.indiandentalacademy.com

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