Indian Dental Academy: will be one of the most relevant and exciting
training center with best faculty and flexible training programs
for dental professionals who wish to advance in their dental
practice,Offers certified courses in Dental
implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic
Dentistry, Periodontics and General Dentistry.
Failures in Fixed Partial Denture
(Prosthodontics FPD- Dental science)
Various types of failures in the fabrication of fixed partial denture
Dr.Sachin Sunny Otta
St.Gregorios Dental College,Kothamangalam,Ernakulam
Failure of the Prosthetic part of an Implant Treatment is viewed as a catastrophic failure altogether by the patients and some clinicians. We break them down to 3 PROBLEMS and how to prevent/avoid these failures.
Esthetic considerations in implant placement Esthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placement
Screw vs cement retained implant prosthesisApurva Thampi
This is a journal club presentation featuring a recent article regarding a screw and cement retained implant prosthesis.
the presentation and all its related material is available on request. Mail me at apurvathampi@gmail.com
Failures in Fixed Partial Denture
(Prosthodontics FPD- Dental science)
Various types of failures in the fabrication of fixed partial denture
Dr.Sachin Sunny Otta
St.Gregorios Dental College,Kothamangalam,Ernakulam
Failure of the Prosthetic part of an Implant Treatment is viewed as a catastrophic failure altogether by the patients and some clinicians. We break them down to 3 PROBLEMS and how to prevent/avoid these failures.
Esthetic considerations in implant placement Esthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placement
Screw vs cement retained implant prosthesisApurva Thampi
This is a journal club presentation featuring a recent article regarding a screw and cement retained implant prosthesis.
the presentation and all its related material is available on request. Mail me at apurvathampi@gmail.com
the dental implant design from the point of view of dental biomaterials and the effect of force factors on choice of implant design in correlation with bone defects and anatomical anomalies
Description :
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
failures of dental implants /certified fixed orthodontic courses by Indian de...Indian dental academy
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.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
8.implantology biologic and clinical aspectscertified fixed orthodontic cours...Indian dental academy
Description :
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.for more details please visit
www.indiandentalacademy.com
the dental implant design from the point of view of dental biomaterials and the effect of force factors on choice of implant design in correlation with bone defects and anatomical anomalies
Description :
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
failures of dental implants /certified fixed orthodontic courses by Indian de...Indian dental academy
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.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
8.implantology biologic and clinical aspectscertified fixed orthodontic cours...Indian dental academy
Description :
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.for more details please visit
www.indiandentalacademy.com
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.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
implantology biologic and clinical aspects / academy of fixed orthodonticsIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Implants in orthodontics /certified fixed orthodontic courses by Indian dent...Indian dental academy
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.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
Implant supported maxillofacial prosthesis./ lingual orthodontics coursesIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Implant surgeries to overcome anatomic difficulties/certified fixed orthodont...Indian dental academy
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.for more details please visit
www.indiandentalacademy.com
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Implant supported maxillofacial prosthesis/cosmetic dentistry coursesIndian dental academy
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.for more details please visit
www.indiandentalacademy.com
Implant surgeries to overcome anatomic difficulties ii / dental implant cour...Indian dental academy
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.for more details please visit
www.indiandentalacademy.com
Implant surgeries to overcome anatomic difficulties / implant dentistry cour...Indian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Indian Dental Academy: will be one of the most relevant and exciting training
center with best faculty and flexible training programs for dental
professionals who wish to advance in their dental practice,Offers certified
courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry,
Prosthetic Dentistry, Periodontics and General Dentistry.
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.for more details please visit
www.indiandentalacademy.com
What can go wrong in dental implants | Complication of Dental ImplantsDr. Rajat Sachdeva
An inert post placed within bone for the prosthesis placement is best tooth replacement option.
Sometimes Implants go failure due to many reason like infection, failed osseointegration, loose dental Implants, Nerve Damage, Maxillary Sinusitis.
Call us regarding Dental Implants:-
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+919818894041,01142464041
drrajatsachdeva@gmail.com
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Opportunity for Dentists (BDS/MDS )to relocate to United kingdom -Register as a DENTAL HYGIENIST/ DENTAL THERAPIST without Board exams and after approval you can register in GDC as a DH/DT and start working as a DH/DT Immediately and get paid.
You can complete the whole process in 3-4 months.Salary range for DH/DT is around 2500-3500 Pounds per month.
Eligibility / requirements-
1. An International English Language Testing System (IELTS) certificate
at the appropriate level.(Within 2 yrs of application date )
2: A recent primary dental qualification that has been taught and examined in English..(Within 2 yrs of application date )
3: A recent pass in a language test for registration with a regulatory authority in a country where the first language is English.
If you are interested Please contact us for more details.
1ST, 2ND AND 3RD ORDER BENDS IN STANDARD EDGEWISE APPLIANCE SYSTEM /Fixed ort...Indian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals
who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry,
Periodontics and General Dentistry.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
I –Aligners are made with FDA approved transparent thermoplastic materials using 3D scanning, 3D Printing and finally Trays with Pressure vacuum formers.
Dear Doctor,
Indian Dental Academy Now offers comprehensive online Orthodontics course.
Course includes:
1.whiteboard lecture presentations
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Thanks & Regards
Indian Dental Academy
--
Indian Dental Academy
Leader in continuing dental education
www.indiandentalacademy.com
skype:indiandentalacademy
+919248678078
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
Cytotoxicity of silicone materials used in maxillofacial prosthesis / dental ...Indian dental academy
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.for more details please visit
www.indiandentalacademy.com
Diagnosis and treatment planning in completely endntulous arches/dental coursesIndian dental academy
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.for more details please visit
www.indiandentalacademy.com
Properties of Denture base materials /rotary endodontic coursesIndian dental academy
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.for more details please visit
www.indiandentalacademy.com
Use of modified tooth forms in complete denture occlusion / dental implant...Indian dental academy
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Complication & failure of dental implants / cosmetic dentistry training
1. 1
By
PUSHKAR GUPTAPUSHKAR GUPTA
PG Student,
Dept. of Prosthodontics
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.com
2. 2
INTRODUCTION
The use of dental implants has enabled the
fabrication of highly functional and esthetic
restorations and improved the predictability of
treatment. However, at any point during rehabilitation
and maintenance complications and failure can occur.
www.indiandentalacademy.com
4. 4
IMPROPER PATIENT SELECTION
The critical selection of patients and the critical
application of dental implants are the two most
important pre requisites for the treatment success we
all desire (Lanney 1986)
www.indiandentalacademy.com
5. 5
BONE DENSITY
A key determinant for clinical success
Highest clinical failure rates have been reported
in posterior maxilla
Linkow in 1970 classified bone density into three
categories.
www.indiandentalacademy.com
6. 6
Class I : Consist of evenly spaced trabeculae
with small cancellated spaces.
Class II : Consist of slightly larger
cancellated spaces with less
uniformity of the osseous pattern
Class III : Large marrow filled spaces exist
between bone trabeculae
www.indiandentalacademy.com
7. 7
In 1988 Misch classified bone density into
D1 Dense cortical bone
D2 Thick dense to porous cortical bone on crest
and coarse trabecular bone within
D3 Thin porous cortical bone on crest and fine
trabecular bone within
D4 Fine trabecular bone
D5 Immature, nonmineralized bone
www.indiandentalacademy.com
8. 8
As the bone density decreases the strength of
the bone also decrease.
Stress can be reduced by :
A. decreasing the cantilever length
B. Narrowing the occlusal table design.
C. Wider implants
D. HA Coatings
0.5mm increase in width – 10% - 15% increase in
surface area.
www.indiandentalacademy.com
9. 9
AVAILABLE BONE
As a general guideline 1.5mm of surgical error is
maintained between the implant and any adjacent
landmark.
The height of the available bone is measured
from the crest of the edentulous ridge to the
opposing landmark such as the maxillary sinus or
mandibular canal in the posterior region.
The anterior region are limited by the maxillary
nares or the inferior border of the mandible.
www.indiandentalacademy.com
10. 10
After estimating the available bone height by
panoramic radiograph, the implant is selected
accordingly.
www.indiandentalacademy.com
11. 11
Another criteria is bone width, which is
measured between the facial and lingual plates at the
crest of the implant site.
Root form implant of 4.0mm crestal diameter
usually require more than 5.0mm of bone width to
ensure sufficient bone thickness and blood supply
around the implant for long term success.
www.indiandentalacademy.com
12. 12
Placing implant of 10mm length in division D bone
without bone augmentation will lead to perforation of
anatomical landmarks or impingement of nerves leading
to parasthesia.
Hence selection of implant after estimating the
available bone is one of the way of reducing
complication and implant failure.
www.indiandentalacademy.com
13. 13
DIABETES MELLITUS
More prone to infection
Slow healing tissue necrosis
A ten day regime of broad spectrum antibiotics
should be begun on the day of surgery to reduce the
risk of infection.
High success rate is reported when dental
implants are placed in diabetic patients whose disease
is under control.
www.indiandentalacademy.com
14. 14
Kapur et al in 1998 compared 37 diabetic
patients who received conventional removable
mandibular overdentures versus 52 who were fitted
with implant supported ones and concluded that
implants can be successfully used in diabetic patients
under control.
www.indiandentalacademy.com
15. 15
SMOKING
Nicotine 50% reduction in oxygen to the bone
Have greater risk of developing peri implantitis.
Increased resorption of peri implant bone
If untreated
Implant Failure
www.indiandentalacademy.com
16. 16
Failure rate of 11.28% for smokers compared to
4.76% for non smokers have been reported. (Senerby
and Roos).
Smoking cessation will results in improved
periodontal health and improve a patient chance of
successful implant osseointegration.
www.indiandentalacademy.com
17. 17
BRUXISM
The most common cause of early loss of rigid
fixation is parafunctional habits.
Such complications occur with greater frequency
in the maxilla because of decreased bone density.
A 37 – year old patient with a long history of
bruxism recorded a maximum bite force of more than
990 Psi (4-7 times normal).
www.indiandentalacademy.com
18. 18
The best and easiest way to diagnose bruxism is
to evaluate the wearing of teeth.
It is not a contraindication for implant dentistry,
but once the source of additional force on the implant
system is identified, the treatment plan is altered to
lower the negative impact on the implant, bone and
final restoration.
www.indiandentalacademy.com
19. 19
PATIENT UNMOTIVATED TO CONTROL PLAQUE
Not good candidates for dental implant
Accumulation of plaque on the implant surface (if
not treated) will lead to peri-implantitis.
Management includes patient motivation to oral
hygiene procedure and regular follow up.
www.indiandentalacademy.com
20. 20
OSTEOPOROSIS
It is age – related disorder characterized by
decreased bone mass and susceptibility to fracture.
Placement of implant in patient with osteoporosis
will significantly effect the success rate.
Implant design should be greater in width and
coated with HA to increase bone contact.
www.indiandentalacademy.com
22. 22
HEMORRHAGE
Bleeding may result from
Soft dissection Intraosseous surgery
Managed by applying Managed by forcing
pressure for 5-10mins sterile bone wax into
bleeding site.
Placement of implant itself in the final prepared
osteotomy ceases bleeding .
www.indiandentalacademy.com
24. 24
Perforation on the lingual aspect of the alveolar
process in the distal segment of the jaw causes lingual
artery injury.
This may lead to life threatening airway
obstruction.
www.indiandentalacademy.com
25. 25
INFERIOR ALVEOLAR NERVE INJURY
When an instrument or the implant contacts the
nerve, the patient experiences a pain sensation even
under anesthesia.
Implant installation should postponed and a
shorter implant should be placed at a later date.
www.indiandentalacademy.com
26. 26
LINGUAL NERVE INJURY
Damage to the lingual nerve leads to loss of
sensitivity in the anterior two thirds of the tongue.
This can be prevented by avoiding any type of
release incision in the lingual direction.
Incisions must always be crestal, with vestibular
release incisions.
Flaps on the lingual side must be elevated
carefully, in tight contact with the bone.
www.indiandentalacademy.com
27. 27
OPENING THE NASAL OR MAXILLARY SINUSES
After completion of implant bed preparation the
bed should be carefully probed, to identify any possible
perforation.
If an oro-antral or an oro-nasal tract is
detected radiographs must be taken immediately.
If perforation is minor, a shorter implant is
placed and the patient is completely informed.
Antibiotic coverage prescribed.
www.indiandentalacademy.com
29. 29
BROKEN BUR
Occurs when the bur gets bind to the bone and
an effort is made to remove it by wriggling the
handpiece shank.
Prevention grasp the handpiece beneath its
head at the point of bur emission with the thumb and
fore finger and press the fingers together.
The bur is pinched between its head and the
bone, and forced it vertically upward and out of the
bone in a non-torque influenced movement.
www.indiandentalacademy.com
30. 30
If broken bur occur radiograph taken
Usually broken bur is deep in the osteotomy
Patient informed
Aggressive attempts to remove the bur should
be avoided
If bur is not in a critical location it is best to
leave it untouched.
www.indiandentalacademy.com
31. 31
OVERSIZED OSTEOTOMYOVERSIZED OSTEOTOMY
Cause
Lack of experience
Prevention
Bone tapping and implant seating ultra low
speed handpiece
Using a mark on the rotary instrument to dictate
the exact moment to reverse the motor direction.
Safer approach – stop the motor at a point four
to five rotations from final seating and complete the
procedure with the hand held ratchet wrench.www.indiandentalacademy.com
32. 32
Treatment
Large diameter implant
If osteotomy becomes oversized, for an implant
system where there is no larger diameter implants
then remove the implant and place some particulate
hydroxyapatite graft material and then place the
implant.
www.indiandentalacademy.com
33. 33
FETAL AIR EMBOLISMFETAL AIR EMBOLISM
Cause
Injection of a mixture of air and water through
the hollow dental drill directly into the mandible, into
the facial and pterygoid plexus veins, and hence the
superior vena cava and right atrium.
Death occur from improper use of a cooling
spray of compressed air and water for apical internal
irrigation.
www.indiandentalacademy.com
34. 34
Prevention
High speed turbine drill with lateral escape
route
Suction placed closed to the cutter creates a
negative local pressure that eliminates any risk of air
embolism.
www.indiandentalacademy.com
35. 35
ACCIDENTAL SWALLOWINGACCIDENTAL SWALLOWING
Many implant components are small, when coated
with saliva escape clinicians grip and fall into
oropharynx.
If this occurs, patient should be placed
immediately with head down position to recover the
lost component.
If this proves impossible, transported with head
low position to the hospital for endoscopic examination.
www.indiandentalacademy.com
36. 36
PreventionPrevention
Use of manual screw drivers and similar
instruments equipped with safety wire of dental floss
(min.10cm long)
Correction
Specially trained medical team needed for non-
invasive endoscopic removal of large components.
Very small components – High fiber diet for
patient.
www.indiandentalacademy.com
37. 37
FRACTURED CORTICAL PLATESFRACTURED CORTICAL PLATES
Cause – misdirection of a drill
Presence of an unexpected anatomic irregularity
If periosteum is attached to cortical plate- good
prognosis.
If the fragment becomes detached, it can be
wedged back into position, but the prognosis is
guarded.
www.indiandentalacademy.com
38. 38
MANDIBLE FRACTUREMANDIBLE FRACTURE
Manson et al 1990 – said that fracture of
mandible in connection with the placement of dental
implants is relatively rare.
Fracture can occur
During bone Excessive stress
site preparation during mouth opening
www.indiandentalacademy.com
39. 39
Factors responsible for fracture
Atrophic thin mandible Multiple implant placements
Increased vulnerable Mechanical strength is
To thermal injury Decreased
www.indiandentalacademy.com
40. 40
PreventionPrevention
Limited stress to jaw during healing period
Avoid over tightening of screws
Do not use wide diameter implants with large
threads
Management
Immediate implant retrieval from fractured
bone
Rigid connection of osseointegrated implants
with rigid external fixation in order to obtain
immediate stability.
Soft diet for 45 days
www.indiandentalacademy.com
42. 42
HEMATOMAHEMATOMA
Prevented by
Proper intraoperative hemorrhage control
Careful post operative compression of the
mucosa flaps covering the implants
Immediate application of cold
packs
In case of extensive hematoma – antibiotics are
prescribed to prevent secondary infection.
www.indiandentalacademy.com
43. 43
INCISION LINE OPENINGINCISION LINE OPENING
It is the most common post operative
complication
If the design of the removable interim
prosthesis is involved, it is corrected
The patient is instructed to rinse 2-3 times daily
with chlorhexidine and gently debride the incision line
with a soft brush
Within few days to weeks the soft tissue will
granulate into the opening.
Resuturing is contraindicated.
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45. 45
CHRONIC PAINCHRONIC PAIN
Implant placed close to mandibular canal may
cause irritation of the inferior alveolar nerve
Such patients may experience chronic pain
Even in the advanced stages of peri-implantitis,
the inferior alveolar nerve may become effected.
Antibiotics are prescribed followed by removal
of the implant as soon as the acute symptoms subside.
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RADIOLUCENCIESRADIOLUCENCIES
If, at 4 or 8 weeks postoperative examination,
the radiographs shows periimplant lucency,
osseointegration will not occur.
The patient is informed and
the implant is removed.
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INFECTIONINFECTION
Characterized clinically by
- Pain
- Swelling
- Suppurative exudate from the wound
1 or 2 sutures are removed for drainage of pus
If the patient experiences fever, an antibiotic
regimen is indicated.
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IMPLANT EXPOSUREIMPLANT EXPOSURE
Cause
- Suturing the flaps under tension
- Pressure from soft tissue borne
prosthesis
The wound is left open
The denture is modified so as no to exert force
on the area of implant exposure.
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Patient is instructed to use dry cotton – tipped
applicator to keep it free of material alba.
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IMPLANT MOBILITYIMPLANT MOBILITY
Due to
- Bone necrosis
- Implant movement
- Infection
Patient should be informed about the situation
and the implant should be removed to prevent further
damage.
Infection
(+) (-)
Implant installation is Larger diameter implant
postponed placed
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LACK OF OSSEOINTEGRATION
Osseointegration is a contact established
between normal and remodeled bone and an implant
surface without the interposition of non bone or
connective tissue.
Three are two ways of implant retention (de
Putter et al 1985).
Mechanical Bioactive
Metallic substrate system HA
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Causes (Meffert)
Premature loading, earlier than initial healing
phase
Apical migration of junctional epithelium
Placing the implant with too much pressure
Over heating the bone during site preparation
Implant not fitting the site exactly.
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Carlsson et al created bone to implant gap of
0mm, 0.35mm, and 0.85mm respectively in rabbit
tabiae. Those with a gap of 0mm had direct bone to
implant contact. A 0.35mm gap resulted in few areas
of direct bone to implant contact and 0.85mm gap
resulted in no direct bone to implant contact, indicating
the need for close approximation between bone and
implant for rigid fixation.
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CRITERIA FOR IMPLANT SUCCESS
(Smith & Zarb)
Individual unattached implant should be immobile
No evidence of peri-implant radiolucency
Mean vertical bone loss less than 0.2mm annually
after the first year of function or service.
No persistent pain, discomfort, or infection
attributable to the implant
There is an 85% success rate at the end of a 5
year postrestorative period, with an 80% success rate
at the end of 10 years postrestorative or function.
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SCREW LOOSENING AND FRACTURE
More common in maxilla 50% than mandible 20%
Causes
Inadequate torque application
Inaccurate framework abutment interface
Arch form
Cantilever extension
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INADEQUATE TORQUE APPLICATION
Recommended torque for prosthetic gold screws
is 10 Ncm and for abutment screw is 20 Ncm
A manual torque converter is available to adjust
torque between 10 Ncm and 20 Ncm.
It is recommended that all screws be tightened
with a torque driver.
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Patients are advised at the prosthetic delivery
appointment and during hygiene recall appointments to
monitor for prosthesis loosening.
If movement is present, saliva can be seen
percolating at the interface
The prosthesis is removed and all components
are examined.
If any of the screws are loose, they are
replaced.
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ARCH FORM
When an arch form is maintained a tripod effect
lessens bonding moments transmitted to the screw
joint.
The destructive forces cause loosening of
prosthetic and abutment screws as well as fracture of
the screws.
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CANTILEVER EXTENSION
The cantilevered distance beyond the distal
implant determines the lever arm length and the
amount of force that is transmitted to the implants,
framework and component.
For mandible 15mm or less
For maxilla 10mm or less
Factors - Arch form
- Bone quality
- Parafunctional habits
Over extension of the cantilever may lead to
Screw loosening Prosthesis Implant loss
or Fracture loosening
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INACCURATE FRAMEWORK ABUTMENT
INTERFACE
An ideal framework abutment connection is one
that has circumferential contact and is without an
opening at the interface.
A non passive fit will create stresses in the
screws and on the implant
Screw loosening and lack of osseointegration
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When evaluating the fit, screws should be
tightened one at a time while observing the lift of the
frame and the open interfaces.
Torquing all screw before evaluating the
interface may bend the framework giving the
appearance of accuracy.
If these frames are allowed to seat will cause
constant stress on the implant and the component.
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IMPLANT FRACTURE
Fractures occurs due to
Fatigue Trauma
The most frequent area of fracture is just
below the abutment level.
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Treatment includes removal of the fragments
Usually apical portion of the implants is
osseointegrated and should be left behind, if not to be
replaced, to prevent further osseous loss (Maeglin
1988)
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ESTHETIC COMPLICATION
It is a major problem in maxillary anteriors due
to
- Labial inclination of implants
- Gingival recession
Implant inclination can be corrected using angled
abutments upto 30°
Gingival recession requires mucogingival surgery
for correction.
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Gingival margin, normally follows crestal bony
margins.
Gingival recession often occurs if the facial
plates of the bone is lost or if it is extremely thin
following implant insertion.
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FRAMEWORK FRACTURE
A cross sectional dimension of at least
4mmx6mm is needed.
Common areas of framework fracture are :
- Solder joints
- Distal to the distal most implant
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Zarb et al 1990 – reported an increased
incidence of framework breakage if extensions in the
mandible exceed 20mm.
The fractured solder joint is reindexed
intraorally and then soldered.
The heat of soldering will destroy any acrylic
veneering material, which is replaced after the
framework fit has been verified after soldering.
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UNFAVOURABLE IMPLANT LOCATION AND AXIS
ORIENTATION
Esthetics, phonetics, hygiene and prosthetic
design may be compromised by poor implant position.
In extreme situations, implants may be so poorly
positioned that it is impossible to include them in the
treatment plan.
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Block et al 1990 – demonstrated that implants
with an axis orientation angle of greater than 30° were
more likely to be associated with peri-implant bony
defects.
17° or 30° of angulation can be corrected by
placing angulated abutments.
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AILING IMPLANTSAILING IMPLANTS
It is least seriously affected of the three
pathologic states.
Exhibits soft tissue problems (Peri-implant
mucositis.
Have a favourable prognosis.
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FAILING IMPLANTSFAILING IMPLANTS
Shows evidence of
- Pocketing
- Bleeding upon probing
- Purulence
- Progressive bone loss
Have a poorer prognosis when compared with
Ailing Implants
If properly treated, a failing implant may be
saved.
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FAILED IMPLANTSFAILED IMPLANTS
Horizontal mobility beyond 0.5mm
Rapid progressive bone loss
Pain during percussion or function
Continued uncontrolled exudate
Generalized radiolucency around an implant
More than one half of the surrounding bone lost
around an implant
Implant inserted in poor position making them
useless for prosthetic support. (Sleepers)
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MAINTENANCE GUIDELINES
The long term success of the dental implant lies
to a great extent, in the ability of the patient to
control daily plaque.
A twice daily for 30 sec. Chlorhexidine rinse is
recommended for at least 1 week after stage 2
surgery.
A soft tooth brush or
flat end-tuft brush is used in
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Plastic sealers are used to remove calculus
Metal instruments, including ultrasonic scalers,
are not recommended.
Rough surface
Plaque accumulation
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After removal of hard deposits the prosthesis
and abutments are selectively polished with a
Rubber cup Flossing cord
Aluminum oxide polishing paste is recommended
to avoid scratching of the titanium abutments and
prosthetic suprastructure.
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MAINTENANCE INTERVALS
Appropriate recall intervals are determined on
an individual basis, taking into consideration the
patient’s history and present evaluation.
At prosthesis delivery
- Oral hygiene instruction given
One month after prosthesis delivery
- Review of home care techniques
- Calculus removal and coronal polish
Three months later
- Examination of tissues
- Calculus removal and coronal polish
- Establishment of a recall interval between
3 & 6 months
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CONCLUSION
There are three most basic principles for
implant therapy.
Do not harm
Evaluate risks and benefits
Avoid over treatment
One should not have heroic effect
Implant therapy should only be provided when all
of the pre requisites for success are present and when
the patient can be better served by means of implant
prosthesis treatment than by conventional prosthetic
replacement.
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BIBLIOGRAPHY
The Branemark implant system – John Beumer
(III)
Implant prosthodontics - Stevens
Implant dentistry – Carl E.Misch
Atlas of oral implantology – A Norman Cranin
Implantology - Hubertus Spiekermann
Implants and restorative dentistry – Carl E.
Misch
Clinical Periodontology – Carranza
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