single tooth implant ppt

1. Single Tooth Implant
Placement
Presented by
Dr. Shalin khatri

2. Case Study
Patient Name – Vandana Shingare
Age - 20 yrs
Sex - Female
Marital Status - Married
Occupation - Employed

3. Chief Complaint
Patient wants to replace her missing tooth in lower right
back region of mouth.

4. History
 Extraction of tooth right side 4 and half months back.
 Extraction was uneventful on right side.
 Reason for extraction was tooth decayed.

5. Medical & Dental History
No h/o of DM/HTN/TB/Bleeding disorders.
No h/o of hospitalization last 6 months.
No h/o regular intake of medication for any systemic illness.
She has visited dental college few times for restorations and extractions of the same missing
teeth.
She uses a tooth brush and paste to brush her teeth once a day.
She does not use any other oral hygiene aids.
she has mixed diet.

6. General Physical examination
An adolescent well built, moderately nourished female well oriented to time place and person.
Gait unaltered.
Facial examination
No deviation of mandible on opening and closing.
No clicking sounds.
No regional lymphadenopathy.

7. Clinical Evaluation of Implant Site
Space Evaluation –
Mesio – Distal length – 10 mm
Bucco – Lingual Width – 7 mm
Occlusal Height - 10 mm
Radiographic Evaluation –
Available Bone Height – 11.5 mm

8. Treatment Options
Removable partial denture
Tooth retained fixed prosthesis (Dental Bridge)
Screw retained fixed prosthesis (Dental Implant)
Patient was willing for Implant in 46 region

9. Treatment Plan
According to clinical and radiographic evaluation, root form endosteal
implant 4.6 x 9 mm planned for 46 region.
Two stage surgical technique planned.
Indirect technique for implant impression.

10. Procedure
(1) Incision
Crestal Incision was made, at mid crestal region
Coronal incision given on buccal aspect to increase visibility and
instrumentation.
Periosteal elevator used for soft tissue reflection.

11. (2) Implant Osteotomy –
 A round bur was used for dimple preparation (center of M-D, B-L area) at planned
osteotomy site.
 2 mm diameter end cutting bur (Pilot drill) used to start drill up to half of the length.
 Guide pin placed in osteotomy and radiograph taken to check location, angulation and
distance from nearest anatomical landmark (Adjacent teeth & Mandibular Canal).

12.  Osteotomy depth to 9 mm from the crest was made.
 800 RPM speed and 40 Nm torque used for drilling with saline.
 A 2.5 mm drilling bur is used up to 9 mm.
 Sequential drilling done by side cutting twist drilling bur.
 4.6 x 9 mm Implant placement was done into the final osteotomy site with hand
driven torque control ratchet.
 35 nm torque used for primary stability of implant.
 Radiograph was taken to verify the final position
of the implant.
 Cover screw placed over implant.

13. Tension free interrupted sutures given.
Recall the patient after 10 days for suture removal.

14. (3) SECOND STAGE SURGERY
 After 3 months, patient recalled for second stage
surgery.
 Infiltration anesthesia given buccally and lingually.
 Slight lingual incision given and flap raised.
 A 5 mm collar height gingival former placed on
implant body.
 Suture the tissue around gingival former.

15. (4) Prosthetic Phase
Remove healing collar and check gingival healing.
3 mm gingival cuff was formed around the crest module/shoulder.
A transfer coping placed over implant body to transfer implant location and
angulation on cast.
Closed tray indirect impression technique used and impression made with putty
and light body.
Lab analog placed on transfer coping and impression was sent to lab for crown and
abutment preparation.
Gingival former replaced on implant body.

16. Transfer Coping Placement

17. Recalled patient after fabrication of crown.
Abutment placed on implant body and initial screw tightening done with hex.
After Crown trial, final abutment tightening done.
Key hole of abutment covered with cotton and composite.
Final cementation of crown done with zinc phosphate cement.
Extra amount of cement removed with help of instrument and
dental floss.
Final radiograph taken to check crown seating on abutment and
presence of cement below the crown.
Post cementation and implant maintenance instructions given
to patient.

18. Abutment radiograph Post cementation Radiograph

19. Instructions
Soft diet for few days.
Then move on semisolid and normal diet.
Flossing and brushing techniques.
Oral hygiene maintenance procedures.
Routine check-up after every 3 months up to one year.

20. Before Treatment
After Treatment

21. Thank you