The document discusses implant failure, its classification, diagnosis, and treatment. It defines the different types of failure as ailing, failing, and failed implants based on clinical and radiographic signs. Risk factors for failure include host factors like smoking, parafunctional habits, and bone quality. Diagnosis involves assessing mobility, peri-implant bone loss, inflammation, and pain. Treatment depends on the type of failure but may include replacing abutments, bone grafting, modifying the prosthesis, or removing the implant. Proper implant placement and occlusal scheme are important to prevent mechanical failures.
The document discusses various impression techniques used for dental implants. It describes the key components used, such as implant analogues and impression copings. The most common impression materials are vinyl polysiloxanes and polyether rubbers due to their dimensional stability and detail reproduction. Direct open tray techniques involve exposing the impression coping screws and incorporating the copings into the impression tray. Indirect closed tray techniques retain the copings in the mouth and reattach them to analogues in the lab. Factors like implant angulation, number of implants, and interarch space determine whether open or closed tray methods are preferred. Accurate transfer of the implant positions is crucial for passive fitting of the final prosthesis.
This document discusses immediate loading of dental implants. It defines various types of implant loading protocols, including immediate occlusal loading (within 48 hours), early loading (2 days to 3 months), conventional loading (3-6 months), and delayed loading (longer than conventional). Immediate loading provides advantages like improved aesthetics and function, but risks include failure if primary stability is inadequate. Factors that influence success include adequate bone quality and quantity, implant design/surface, number of implants used, and controlled occlusal forces. Careful patient selection and following guidelines for factors like implant spacing can allow for successful immediate loading.
This document discusses soft tissue grafting procedures around dental implants. It begins by explaining the importance of soft tissue integration for implant success. It then describes the anatomy of periodontal and peri-implant soft tissues. Various grafting techniques are discussed including modified palatal roll, epithelialized palatal graft, alloderm grafting, and subepithelial connective tissue grafting. Indications and surgical principles/techniques for each method are provided. The goal of these grafts is to establish an adequate zone of keratinized attached tissue around implants for long term health of the peri-implant tissues.
This document discusses terminology and techniques for dental implant impressions. It defines terms like cover screws, healing caps, transfer copings, and implant analogues. It explains that impressions are needed to capture the implant position, depth, axis, and soft tissue contour. The document outlines two main impression techniques - open tray (using pick-up copings) and closed tray (using transfer copings). It notes the advantages and disadvantages of each technique. Abutment level impressions are also discussed for customization and laboratory abutment selection. Gingival simulation is described as a technique to simulate the soft tissue around implants.
This document discusses recent advances in implantology. It summarizes improvements in diagnostic imaging technologies like CBCT that provide high-resolution 3D imaging of implant sites. It also discusses advances in implant design, including mini implants less than 3mm in diameter, narrow diameter implants, transitional implants, and one-piece implants that integrate the implant body and abutment. Studies show high survival rates of over 90% for these newer implant designs.
loading protocols in dental implants about indications and contraindications of conventional , immediate,progressive and delayed loading of dental implants
Implant abutment and implant abutment connectionsDR.BHAVESH JHA
this ppt enlightened with different types of implant abutment connection. Detailed classification of abutments. Different types of abutments. Latest trends of abutments. Smart abutments. Platform switching, rationale of platform switching and related articles.
The document discusses various implant components and prosthodontic procedures. It describes the history and evolution of implant fixtures from the original Brånemark design to newer internal connection and tapered implants. It also covers abutment types including standard, esthetic, angled, UCLA and custom abutments. Impression techniques and the use of healing caps and gold cylinders are discussed for different clinical scenarios.
The document discusses various impression techniques used for dental implants. It describes the key components used, such as implant analogues and impression copings. The most common impression materials are vinyl polysiloxanes and polyether rubbers due to their dimensional stability and detail reproduction. Direct open tray techniques involve exposing the impression coping screws and incorporating the copings into the impression tray. Indirect closed tray techniques retain the copings in the mouth and reattach them to analogues in the lab. Factors like implant angulation, number of implants, and interarch space determine whether open or closed tray methods are preferred. Accurate transfer of the implant positions is crucial for passive fitting of the final prosthesis.
This document discusses immediate loading of dental implants. It defines various types of implant loading protocols, including immediate occlusal loading (within 48 hours), early loading (2 days to 3 months), conventional loading (3-6 months), and delayed loading (longer than conventional). Immediate loading provides advantages like improved aesthetics and function, but risks include failure if primary stability is inadequate. Factors that influence success include adequate bone quality and quantity, implant design/surface, number of implants used, and controlled occlusal forces. Careful patient selection and following guidelines for factors like implant spacing can allow for successful immediate loading.
This document discusses soft tissue grafting procedures around dental implants. It begins by explaining the importance of soft tissue integration for implant success. It then describes the anatomy of periodontal and peri-implant soft tissues. Various grafting techniques are discussed including modified palatal roll, epithelialized palatal graft, alloderm grafting, and subepithelial connective tissue grafting. Indications and surgical principles/techniques for each method are provided. The goal of these grafts is to establish an adequate zone of keratinized attached tissue around implants for long term health of the peri-implant tissues.
This document discusses terminology and techniques for dental implant impressions. It defines terms like cover screws, healing caps, transfer copings, and implant analogues. It explains that impressions are needed to capture the implant position, depth, axis, and soft tissue contour. The document outlines two main impression techniques - open tray (using pick-up copings) and closed tray (using transfer copings). It notes the advantages and disadvantages of each technique. Abutment level impressions are also discussed for customization and laboratory abutment selection. Gingival simulation is described as a technique to simulate the soft tissue around implants.
This document discusses recent advances in implantology. It summarizes improvements in diagnostic imaging technologies like CBCT that provide high-resolution 3D imaging of implant sites. It also discusses advances in implant design, including mini implants less than 3mm in diameter, narrow diameter implants, transitional implants, and one-piece implants that integrate the implant body and abutment. Studies show high survival rates of over 90% for these newer implant designs.
loading protocols in dental implants about indications and contraindications of conventional , immediate,progressive and delayed loading of dental implants
Implant abutment and implant abutment connectionsDR.BHAVESH JHA
this ppt enlightened with different types of implant abutment connection. Detailed classification of abutments. Different types of abutments. Latest trends of abutments. Smart abutments. Platform switching, rationale of platform switching and related articles.
The document discusses various implant components and prosthodontic procedures. It describes the history and evolution of implant fixtures from the original Brånemark design to newer internal connection and tapered implants. It also covers abutment types including standard, esthetic, angled, UCLA and custom abutments. Impression techniques and the use of healing caps and gold cylinders are discussed for different clinical scenarios.
This document discusses dental implant failures. It begins by defining key terms like implant failure, biological failure, and failed implants. It then lists probable factors that can affect implant failures like smoking, diabetes, and oral cancer. It discusses warning signs of implant failure like pain, bone loss, and infection. It presents criteria for determining if an implant has failed, like mobility, bone loss, and pain. It provides statistics on success and failure rates from various studies. It also discusses revised criteria for determining implant success, like bone loss less than 0.2mm per year. Finally, it lists parameters used to evaluate failing implants, such as clinical signs of infection, pain, mobility, and bone loss seen on radiographs.
Platform switching involves using a smaller diameter abutment on a larger diameter implant. This shifts the implant-abutment junction inward and away from the crestal bone. According to the document, platform switching reduces crestal bone loss in the following ways: 1) It shifts the inflammatory cell infiltrate inward, decreasing its effect on the crestal bone. 2) It maintains the biological width between the implant and bone. 3) It decreases stress levels in the peri-implant bone by shifting the stress concentration area away from the bone-implant interface. The document discusses the concept, history, advantages, and limitations of platform switching.
This document discusses periodontal regeneration and the various factors involved. It begins by defining key terminology related to grafting and regeneration. It then discusses the biology and objectives of periodontal regeneration, including the ideal outcome of new attachment formation and factors that can influence outcomes. The document outlines various techniques for periodontal regeneration including non-graft associated approaches involving removal of epithelium and surgical techniques, as well as graft-associated approaches using various graft materials. Requirements for predictable regeneration and assessment methods are also summarized.
Socket preservation or alveolar ridge preservation (ARP) is a procedure to reduce bone loss after tooth extraction to preserve the dental alveolus (tooth socket) in the alveolar bone
For more information, you can book an appointment at
Dr Sachdeva's Dental Aesthetic And Implant Institute,
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
• Phone : +919818894041,01142464041
• Our Websites:
• www.sachdevadentalcare.com
• www.dentalclinicindelhi.com
• www.dentalimplantindia.co.in
• www.dentalcoursesdelhi.com
• www.facialaestheticsdelhi.com
• Google+ link: https://goo.gl/vqAmvr
• Facebook link: https://goo.gl/tui98A
• Youtube link: https://goo.gl/mk7jfm
• Linkedin link: https://goo.gl/PrPgpB
• Slideshare link : http://goo.gl/0HY6ep
• Twitter Page : https://goo.gl/tohkcI
• Instagram page : https://goo.gl/OOGVig
This document discusses occlusal schemes for implants, known as implant protective occlusion (IPO). IPO aims to reduce stress at the implant-bone interface through 14 considerations including eliminating premature contacts, positioning occlusal contacts over implant bodies, reducing cantilever lengths, and decreasing crown heights. The goals of IPO are to reduce force magnification, improve force direction, and increase the implant support area to promote implant longevity and success.
The content covers majority of the aspect of immediate implant placement - why immediate implants?, case selection, decision making, classifications, surgical technique, healing following immediate implant placement, immediate implants in infected sockets/periapical infections, literature reviews and recommendations for clinical practice.
This document provides an overview of the history and evolution of dental implants from ancient times to the modern era. It discusses early attempts at implant dentistry dating back thousands of years, including the use of animal teeth, carved ivory, and other materials as implants. The document then outlines several key periods in the more recent history and development of dental implants, including pioneers who advanced implant techniques and materials in the 18th century through the early 20th century. It focuses on the foundational work done in the late 1930s and 1940s that marked the beginning of modern implant dentistry.
This document discusses considerations for implant placement and restoration in the esthetic zone. It covers:
1. Factors to consider pre-surgery like bone quality and site evaluation using the Garber classification system.
2. Implant positioning factors such as buccolingual and mesiodistal position, angulation, depth, and their influence on esthetics and function.
3. Techniques to develop the emergence profile like using healing abutments, provisional restorations, and custom abutments.
4. The multidisciplinary approach involving prosthodontists and consideration of soft tissues, abutment materials, and impression techniques.
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
There are several protocols for loading dental implants after surgery based on bone density and healing time requirements. Protocols include Brånemark's loading protocol, progressive loading, and immediate/early loading. The density of the bone where the implant is placed determines the appropriate loading protocol, as less dense bone requires more healing time before loading to allow for sufficient bone mineralization and strength. Progressive loading gradually increases stress on the implant over time to allow the bone to adapt, reducing risks of failure. It is particularly important for lower density bone which is weaker.
The document discusses the clinical evaluation of implant patients, including case types and indications, risk factors and contraindications, and the pre-treatment evaluation process. A comprehensive evaluation is needed to determine if implant therapy is possible, practical, and indicated for the patient. The evaluation should assess the patient's medical history, medications, habits, motivations, and oral examination to analyze the dentoalveolar condition and feasibility of implant placement. The patient's goals and expectations must also be evaluated to ensure realistic outcomes.
This document discusses the history of dental implants from ancient Egyptians using gold wires to stabilize teeth to modern developments like osseointegration and new implant materials and designs. It covers early uses of materials like gold, porcelain, and alloys as well as pioneers in the field like Branemark. The key development was Branemark's discovery of osseointegration in the 1960s which led to greater success and acceptance of dental implants. Modern implants are classified by material and design features to optimize stability and integration with bone. Patient evaluation and risk factors are also important considerations for dental implant treatment planning.
This document discusses immediate implant placement after tooth extraction. It begins with an introduction that outlines the healing process after extraction and bone resorption over time with traditional protocols. It then covers the advantages and indications of immediate placement, including reducing treatment time and better positioning. Contraindications and classification of extraction sites are presented. The treatment sequence of clinical examination, radiographs, surgical guide fabrication is outlined. Surgical procedures, soft tissue management, post-op care and different treatment protocols like immediate loading are summarized. Clinical trials are briefly discussed showing outcomes of immediate placement. Factors like primary stability, splinting and provisional restoration are highlighted to consider. The conclusion restates the key points about immediate implant placement.
This document discusses osseointegration, which refers to the direct structural and functional connection between bone and the surface of a load-bearing dental implant without intervening soft tissue. It traces the history and development of osseointegration from early experiments in the 1950s to its current understanding. The key aspects covered include definitions of osseointegration, the biological process of bone formation around implants over time, factors that influence osseointegration success, and future directions for improving integration.
This document discusses dental implants and the components and procedures involved in dental implant surgery. It begins by defining what a dental implant is and its uses. It then classifies implants based on placement location and material. The document discusses the different types of endosteal implants and their components like the implant body, crest module, and apex. It also covers the surgical setup, including draping, trays, instruments, handpieces, drills, guides. Impression techniques involving closed and open tray methods are briefly explained. In summary, the document provides an overview of dental implants, their classification, associated surgical components and procedures.
This seminar deals with implant-related complications that lead to implant failure.this also discus diagnostic criteria and preventive methods for an implant failure.
Dental implants can be modified at the macro, micro, and nano levels to improve osseointegration and healing times. At the macro level, implant thread design is modified. Micro level modifications alter the surface topography through processes like sandblasting and acid etching. Nano level modifications increase the surface area through additions like titanium nanotubes. Coatings of hydroxyapatite and other calcium phosphates are also used at the micro and nano scales to promote bioactivity. Surface modifications generally increase roughness and research shows rougher surfaces correlate with higher success rates.
The document discusses dental implants, including their classification, geometry, surfaces, and interfaces with bone and soft tissue. It covers implant design categories like endosseous, subperiosteal, and transmandibular implants. The stages of bone healing and osseointegration are described, from initial woven bone formation to remodeling of bone structure and quality over time to adapt to loads. A healthy peri-implant soft tissue interface features firm, keratinized mucosa and microscopic junctional epithelium similar to that around natural teeth.
This document discusses immediate loading of dental implants. It defines immediate loading as loading an implant with a restoration within 2 weeks of placement. Immediate loading has benefits like eliminating a second surgery and allowing immediate function. However, it risks overloading the implant interface during bone healing. Factors that reduce this risk include increasing the implant surface area, decreasing occlusal forces, and using bone-friendly surfaces like hydroxyapatite. The document describes procedures for immediate loading in fully and partially edentulous patients, including using a provisional restoration made on the day of surgery or at a follow-up appointment. A soft diet is recommended during initial healing from immediate loading.
Implant failures can occur for various reasons and can be classified in different ways. Implant failures are generally defined as the inability of an implant to fulfill its intended purpose of providing functional, aesthetic, and phonetic support. Failures may occur due to biological or mechanical factors related to the patient, surgical technique, implant selection, or prosthetic elements. Peri-implantitis is a common cause of late implant failure resulting from bacterial infection and/or biomechanical overload. Treatment depends on the severity and timing of the failure.
This document discusses dental implant failures. It begins by defining key terms like implant failure, biological failure, and failed implants. It then lists probable factors that can affect implant failures like smoking, diabetes, and oral cancer. It discusses warning signs of implant failure like pain, bone loss, and infection. It presents criteria for determining if an implant has failed, like mobility, bone loss, and pain. It provides statistics on success and failure rates from various studies. It also discusses revised criteria for determining implant success, like bone loss less than 0.2mm per year. Finally, it lists parameters used to evaluate failing implants, such as clinical signs of infection, pain, mobility, and bone loss seen on radiographs.
Platform switching involves using a smaller diameter abutment on a larger diameter implant. This shifts the implant-abutment junction inward and away from the crestal bone. According to the document, platform switching reduces crestal bone loss in the following ways: 1) It shifts the inflammatory cell infiltrate inward, decreasing its effect on the crestal bone. 2) It maintains the biological width between the implant and bone. 3) It decreases stress levels in the peri-implant bone by shifting the stress concentration area away from the bone-implant interface. The document discusses the concept, history, advantages, and limitations of platform switching.
This document discusses periodontal regeneration and the various factors involved. It begins by defining key terminology related to grafting and regeneration. It then discusses the biology and objectives of periodontal regeneration, including the ideal outcome of new attachment formation and factors that can influence outcomes. The document outlines various techniques for periodontal regeneration including non-graft associated approaches involving removal of epithelium and surgical techniques, as well as graft-associated approaches using various graft materials. Requirements for predictable regeneration and assessment methods are also summarized.
Socket preservation or alveolar ridge preservation (ARP) is a procedure to reduce bone loss after tooth extraction to preserve the dental alveolus (tooth socket) in the alveolar bone
For more information, you can book an appointment at
Dr Sachdeva's Dental Aesthetic And Implant Institute,
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
• Phone : +919818894041,01142464041
• Our Websites:
• www.sachdevadentalcare.com
• www.dentalclinicindelhi.com
• www.dentalimplantindia.co.in
• www.dentalcoursesdelhi.com
• www.facialaestheticsdelhi.com
• Google+ link: https://goo.gl/vqAmvr
• Facebook link: https://goo.gl/tui98A
• Youtube link: https://goo.gl/mk7jfm
• Linkedin link: https://goo.gl/PrPgpB
• Slideshare link : http://goo.gl/0HY6ep
• Twitter Page : https://goo.gl/tohkcI
• Instagram page : https://goo.gl/OOGVig
This document discusses occlusal schemes for implants, known as implant protective occlusion (IPO). IPO aims to reduce stress at the implant-bone interface through 14 considerations including eliminating premature contacts, positioning occlusal contacts over implant bodies, reducing cantilever lengths, and decreasing crown heights. The goals of IPO are to reduce force magnification, improve force direction, and increase the implant support area to promote implant longevity and success.
The content covers majority of the aspect of immediate implant placement - why immediate implants?, case selection, decision making, classifications, surgical technique, healing following immediate implant placement, immediate implants in infected sockets/periapical infections, literature reviews and recommendations for clinical practice.
This document provides an overview of the history and evolution of dental implants from ancient times to the modern era. It discusses early attempts at implant dentistry dating back thousands of years, including the use of animal teeth, carved ivory, and other materials as implants. The document then outlines several key periods in the more recent history and development of dental implants, including pioneers who advanced implant techniques and materials in the 18th century through the early 20th century. It focuses on the foundational work done in the late 1930s and 1940s that marked the beginning of modern implant dentistry.
This document discusses considerations for implant placement and restoration in the esthetic zone. It covers:
1. Factors to consider pre-surgery like bone quality and site evaluation using the Garber classification system.
2. Implant positioning factors such as buccolingual and mesiodistal position, angulation, depth, and their influence on esthetics and function.
3. Techniques to develop the emergence profile like using healing abutments, provisional restorations, and custom abutments.
4. The multidisciplinary approach involving prosthodontists and consideration of soft tissues, abutment materials, and impression techniques.
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
There are several protocols for loading dental implants after surgery based on bone density and healing time requirements. Protocols include Brånemark's loading protocol, progressive loading, and immediate/early loading. The density of the bone where the implant is placed determines the appropriate loading protocol, as less dense bone requires more healing time before loading to allow for sufficient bone mineralization and strength. Progressive loading gradually increases stress on the implant over time to allow the bone to adapt, reducing risks of failure. It is particularly important for lower density bone which is weaker.
The document discusses the clinical evaluation of implant patients, including case types and indications, risk factors and contraindications, and the pre-treatment evaluation process. A comprehensive evaluation is needed to determine if implant therapy is possible, practical, and indicated for the patient. The evaluation should assess the patient's medical history, medications, habits, motivations, and oral examination to analyze the dentoalveolar condition and feasibility of implant placement. The patient's goals and expectations must also be evaluated to ensure realistic outcomes.
This document discusses the history of dental implants from ancient Egyptians using gold wires to stabilize teeth to modern developments like osseointegration and new implant materials and designs. It covers early uses of materials like gold, porcelain, and alloys as well as pioneers in the field like Branemark. The key development was Branemark's discovery of osseointegration in the 1960s which led to greater success and acceptance of dental implants. Modern implants are classified by material and design features to optimize stability and integration with bone. Patient evaluation and risk factors are also important considerations for dental implant treatment planning.
This document discusses immediate implant placement after tooth extraction. It begins with an introduction that outlines the healing process after extraction and bone resorption over time with traditional protocols. It then covers the advantages and indications of immediate placement, including reducing treatment time and better positioning. Contraindications and classification of extraction sites are presented. The treatment sequence of clinical examination, radiographs, surgical guide fabrication is outlined. Surgical procedures, soft tissue management, post-op care and different treatment protocols like immediate loading are summarized. Clinical trials are briefly discussed showing outcomes of immediate placement. Factors like primary stability, splinting and provisional restoration are highlighted to consider. The conclusion restates the key points about immediate implant placement.
This document discusses osseointegration, which refers to the direct structural and functional connection between bone and the surface of a load-bearing dental implant without intervening soft tissue. It traces the history and development of osseointegration from early experiments in the 1950s to its current understanding. The key aspects covered include definitions of osseointegration, the biological process of bone formation around implants over time, factors that influence osseointegration success, and future directions for improving integration.
This document discusses dental implants and the components and procedures involved in dental implant surgery. It begins by defining what a dental implant is and its uses. It then classifies implants based on placement location and material. The document discusses the different types of endosteal implants and their components like the implant body, crest module, and apex. It also covers the surgical setup, including draping, trays, instruments, handpieces, drills, guides. Impression techniques involving closed and open tray methods are briefly explained. In summary, the document provides an overview of dental implants, their classification, associated surgical components and procedures.
This seminar deals with implant-related complications that lead to implant failure.this also discus diagnostic criteria and preventive methods for an implant failure.
Dental implants can be modified at the macro, micro, and nano levels to improve osseointegration and healing times. At the macro level, implant thread design is modified. Micro level modifications alter the surface topography through processes like sandblasting and acid etching. Nano level modifications increase the surface area through additions like titanium nanotubes. Coatings of hydroxyapatite and other calcium phosphates are also used at the micro and nano scales to promote bioactivity. Surface modifications generally increase roughness and research shows rougher surfaces correlate with higher success rates.
The document discusses dental implants, including their classification, geometry, surfaces, and interfaces with bone and soft tissue. It covers implant design categories like endosseous, subperiosteal, and transmandibular implants. The stages of bone healing and osseointegration are described, from initial woven bone formation to remodeling of bone structure and quality over time to adapt to loads. A healthy peri-implant soft tissue interface features firm, keratinized mucosa and microscopic junctional epithelium similar to that around natural teeth.
This document discusses immediate loading of dental implants. It defines immediate loading as loading an implant with a restoration within 2 weeks of placement. Immediate loading has benefits like eliminating a second surgery and allowing immediate function. However, it risks overloading the implant interface during bone healing. Factors that reduce this risk include increasing the implant surface area, decreasing occlusal forces, and using bone-friendly surfaces like hydroxyapatite. The document describes procedures for immediate loading in fully and partially edentulous patients, including using a provisional restoration made on the day of surgery or at a follow-up appointment. A soft diet is recommended during initial healing from immediate loading.
Implant failures can occur for various reasons and can be classified in different ways. Implant failures are generally defined as the inability of an implant to fulfill its intended purpose of providing functional, aesthetic, and phonetic support. Failures may occur due to biological or mechanical factors related to the patient, surgical technique, implant selection, or prosthetic elements. Peri-implantitis is a common cause of late implant failure resulting from bacterial infection and/or biomechanical overload. Treatment depends on the severity and timing of the failure.
This document discusses oral implantology and factors governing the success of dental implants. It begins by defining a dental implant and then discusses preoperative, intraoperative, and postoperative factors. Under preoperative factors, it emphasizes the importance of proper diagnosis, treatment planning, and patient evaluation. Intraoperatively, it notes the importance of maintaining sterility, proper surgical technique, and implant positioning. Postoperatively, it discusses the importance of follow-up, avoidance of premature loading, proper prosthetics, and maintenance of oral hygiene. It also outlines advantages and disadvantages of implants, as well as indications and contraindications. Finally, it discusses osseointegration and local factors that influence successful integration such as material, surface properties
The document discusses implant failure, its classification, diagnosis and management. It defines different types of implant failures such as ailing, failing and failed implants. The most common implant failures discussed are malpositioning, improper occlusal scheme, cantilevers that are too long, and implant abutment misfit. Management strategies focus on identifying the cause, nonsurgical debridement, and antiseptic treatment to resolve inflammation and prevent further bone loss.
This document discusses various types of dental implant complications, including surgical, biological, prosthetic, and esthetic complications. Surgical complications include hemorrhage, hematoma, neurosensory disturbances, and implant malposition. Biological complications involve inflammation, recession, peri-implantitis, and bone loss. Prosthetic complications consist of screw loosening, implant fracture, and fracture of restorative materials. The document provides details on the causes, presentations, and treatments of each complication.
A lecture for 5th stage dental students.
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This document discusses implant complications and failures. It begins with an introduction to dental implants and their success. It then defines key implant terms and outlines factors that can influence outcomes. The document details various types of implant complications including surgical, biological, augmentation-related, placement/loading protocol, and prosthetic/mechanical. It provides examples of specific complications within each category such as hemorrhaging, neurosensory disturbances, peri-implantitis, screw loosening, and esthetic problems. The document concludes with a section on implant removal.
This document provides an overview of dental implants. It discusses the history of implant dentistry from ancient civilizations to modern developments like osseointegration. It defines a dental implant and describes the phases of osseointegration. The document outlines different implant components, surfaces, and classifications. It notes the benefits of implants compared to other options as well as potential complications. Examples of implant cases from the Department of Periodontics are also mentioned.
This document discusses factors affecting the selection of patients for implant retained prostheses. It outlines that a thorough patient evaluation including medical history, dental evaluation through examination and imaging, and informed consent is required. The dental evaluation assesses bone quality and quantity, occlusion, and adjacent teeth. Indications for implants include missing teeth from congenital defects, trauma, or being edentulous. Contraindications include certain medical conditions, smoking, drugs/alcohol, or inadequate bone. Proper patient selection is key for implant success and satisfying treatment outcomes.
This document discusses factors to consider when selecting patients for implant retained prostheses. It outlines general patient factors like medical history and motivation that should be assessed. A thorough dental evaluation including extraoral and intraoral exams, various radiographs, and bone density assessment is important. Patients should provide informed consent and understand expectations, risks, and commitments. Clinical indications for implants include missing teeth due to congenital defects, trauma, or being edentulous. Contraindications include conditions that could compromise bone healing or the patient's ability to maintain implants. A multidisciplinary approach may be needed for complex cases.
The document discusses various factors that can contribute to dental implant failures, including host factors like poor medical health, smoking, bruxism, and poor oral hygiene; surgical factors like trauma during surgery; and implant selection factors like bone quality. It provides definitions for different types of implant failures and lists criteria for determining implant success. The classifications, predictors, warning signs, and ways to enhance outcomes with implants are also examined.
This document discusses different types of implants used in medicine. It begins by defining implants as artificial devices inserted into the body to replace or support damaged biological structures. Implants are categorized based on their application, with main groups being orthopaedic, dental, sensory/neurological, and cardiovascular implants. Orthopaedic implants discussed include screws, plates, and interlocking nails/rods used to treat bone fractures. Dental implants are also described as artificial tooth roots made of titanium that fuse with the jawbone. The document outlines reasons for using implants and concludes they provide long-term solutions when conditions allow for proper host tissue integration.
This document provides information on dental implants including:
1. It defines a dental implant as an artificial titanium fixture surgically placed into the jawbone to replace a missing tooth and root.
2. Implant dentistry/implantology is concerned with replacing missing teeth and supporting structures with prostheses anchored to the jawbone.
3. Common implant designs include parallel or tapered, threaded screw-shaped implants which are the most commonly used type today.
Implant related complications and failureJignesh Patel
This document discusses complications related to dental implants. It begins by discussing surgical complications such as hemorrhage, hematoma, neurosensory disturbances, and implant malposition. It then discusses biological complications affecting the peri-implant soft tissues, such as inflammation, recession, and progressive bone loss which can lead to peri-implantitis. Mechanical complications are also summarized, including screw loosening/fracture and implant fracture.
Prosthodontic rehabilitation of maxillary defect in a patientNishu Priya
Restoration of maxillectomy defects demand varied modifications in prosthesis fabrication, to make them lighter and well-tolerated by the patient.
Literature suggests the use of various retentive aids for the construction of conventional obturator to improve retention and oral function.
This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
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Hypertension and it's role of physiotherapy in it.Vishal kr Thakur
This particular slides consist of- what is hypertension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is summary of hypertension -
Hypertension, also known as high blood pressure, is a serious medical condition that occurs when blood pressure in the body's arteries is consistently too high. Blood pressure is the force of blood pushing against the walls of blood vessels as the heart pumps it. Hypertension can increase the risk of heart disease, brain disease, kidney disease, and premature death.
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2. • Introduction
• Success criteria for dental implants
• Implant failure classification
• Clinical & radiographic conditions.
• Diagnosis
• Risk factors
• Management of ailing and failing implants
• The treatment options for managing implant failure
• Conclusion
• References
Contents
3. • Implant dentistry has gained popularity because of very high success and survival
rates. However, implant failure and related complications also have been
reported.
• Dental implants demonstrated peri-implant inflammatory reactions which were
associated with crestal bone loss that may eventually lead to the loss of an
implant.
Introduction
4. • It has been shown that the inflammation is more pronounced and the
inflammatory process goes deeper and faster around the dental implant than
around the adjacent natural tooth.
• Not only inflammation various factors like faulty prosthesis, host factors are also
related to implant related complication.
5. (Koth DL, McKinney RV, Steflik DE, Davis QB. Clinical and statistical analyses of human clinical trials with the single crystal aluminum oxide
endosteal dental implant: Five-year results. Journal of Prosthetic Dentistry. 1988 Aug 1;60(2):226-34.)
Success criteria for dental implants
Mckinney, Koth, And Steflik
Subjective criteria
i. Adequate function.
ii. Absence of discomfort.
iii.Patient belief that esthetics, emotional, and psychological attitude are
improved.
6. Objective criteria
1. Good occlusal balance and vertical dimension.
2. Bone loss no greater than one third of the vertical height of the
implant.
3. No gingival inflammation.
4. Mobility of less than 1 mm buccolingually, mesiodistally, and vertically.
7. 5. Absence of symptoms and infection associated with the dental implant.
6. Absence of damage to adjacent tooth or teeth and their supporting
structures.
7. Absence of parasthesia or violation of mandibular canal, maxillary sinus, or
floor of nasal passage.
8. Healthy collagenous tissue without polymorphonuclear infiltration.
8. Revised Criteria For Implant Success Alberktson, Zarb, Washington,
And Erickson –
1. Individual unattached implant that is immobile when tested clinically.
2. Radiograph that does not demonstrate evidence of peri-implant
radiolucency.
3. Bone loss that is less than 0.2 mm annually after the implant's first year
of service.
4. Individual implant performance that is characterized by an absence
of persistent and/or irreversible signs and symptoms of pain,
infections, necropathies, paraesthesia, or violation of the mandibular
canal.
(Smith DE, Zarb GA. Criteria for success of osseointegrated endosseous implants. J Prosthet Dent 1998;62:567-72)
9. HEALTH SCALE FOR DENTAL IMPLANTS
International Congress of Oral Implantologists, Pisa, Italy, Consensus Conference, 2007.
Implant Quality Scale
Group
Clinical Conditions
1 Success (optimum
health)
a)No pain or tenderness upon function
b) No mobility
c)2 mm radiographic bone loss from initial surgery
d)No exudates history
2 Satisfactory survival a)No pain on function
b)No mobility
c)2–4 mm radiographic bone loss
d)No exudates history
(Misch CE, Perel ML, Wang HL, et al. Implant success, survival, and failure: the International Congress of Oral Implantologists (ICOI) Pisa Consensus Conference.
Implant Dent 2008;17(1):5-15.)
10. 3 Compromised survival a)May have sensitivity on function
b)No mobility
c)Radiographic bone loss 4 mm (less than1/2 of
implant body)
d)Probing depth 7 mm
e)May have exudates history
4 Failure (clinical or
absolute failure)
Any of following:
a)Pain on function
b)Mobility
c)Radiographic bone loss 1/2 length of implant
d)Uncontrolled exudate
e)No longer in mouth
11. Implant failure classification
Biological Failures
• Early or primary
(Before loading)
Late or
secondary (After
loading)
Mechanical
failures
• Fracture of
implants,
connecting
screws, bridge
framework,
coatings etc
3)Iatrogenic
Failures
• Improper
implant
angulation and
alignment, nerve
damage
Inadequate
Patient adaptation
• Phonetics,
esthetics,
psychological
problems.
• Marco Esposito, Jan Michael Hirsh, Ulf Lekholm et al have classified oral implant failures.
12. • According to Abdel Salam el Askary, Roland Meffert and terrence griffin
• 1) According to etiology :
A)Failures because of host factors :
o Medical status - Osteoporosis and other bone diseases; uncontrolled
diabetes.
o Habits - smoking, para-functional habits.
o Oral status - poor home care, juvenile, and rapidly progressive
periodontitis, irradiation therapy.
B) Restorative problems :
• Excessive cantilever, pier abutments, no passive fit, improper fit of the abutment, improper
prosthetic design, improper occlusal scheme, bending moments, connecting implants to natural
dentition, premature loading, excessivetorquing.
13. C) Surgical placement:
1. Off axis placement (severe angulation)
2. Lack of initial stabilization
3. Impaired healing and infection because of improper flap design or others.
4. Overheating the bone and exerting too much pressure.
5. Minimal space between implants
6. Placing the implant in immature bone grafted sites.
7. Placement of the implant in an infected socket or a pathologic lesion.
8. Contamination of the implant body before insertion
D) Implant selection :
• Improper implant type in improper bone type.
• Length of the implant (too short, crown-implant ratio unfavourable)
• Diameter of the implant.
14. 2) According to origin of infection :
• Peri-implantitis (infective process, bacterial origin)
• Retrograde peri-implantitis (traumatic occlusion origin, non-infective,
forces off the long axis, premature, or excessive loading).
3) According to timing of failure :
• Before stage II (after surgery)
• At stage II (With healing head and or abutment insertion)
• After restoration.
15. 4) According to condition of failure (clinical and radiographic status)
• Ailing implants
• Failing implants
• Failed implants
• Surviving implants
5) According to responsible personnel
• Dentist (oral surgeon, prosthodontist, periodontist)
• Dental hygienist
• Laboratory technician
• Patient.
16. 6) According to failure mode :
• Lack of osseointegration (usually mobility)
• Unacceptable esthetics
• Functional problems
• Psychological problems.
7) According to supporting tissue type :
• Soft tissue problems (lack of keratinized tissues,
inflammation, etc.)
• Bone loss (Radiographic changes, etc.)
• Both soft tissue and bone loss.
17. Clinical & radiographic conditions
Ailing Implant-
• The ailing implant expresses radiographic bone loss without inflammation.
A deep pocket around the implant is evident, with absence of bleeding.
Failing implants-
• The failing implant presents with constant deterioration at follow up and
maintenance appointments.
• Inflammation is present and is evident by signs of edema, redness,
bleeding, and suppuration. The implants are immobile, but radiographic
bone loss is obvious.
18. Failed implants-
• Failed implants are those with progressive bone loss with clinical mobility
and that are not functioning in the intended sense.
• Failed implants are encapsulated in fibrous capsule.
• A failed implant is one that is fractured, has been totally refractory to all
methods of treatment.
19. Surviving implants :
Surviving is a term described by Alberktson that applies to implants that are still
in function but have not been tested against success criteria.
Cluster failures of dental implants :
multiple implant failures occur in a patient; this is referred to as a “cluster
effect.
Cluster failures usually occur soon after implant placement.
Genetic or systemic factors ( Peget’s disease,Osteoporosis,Auto-immune
disorder) that influence the incidence of cluster failures.
Ekfeldt et al suggested that particular issues need to be considered to prevent
cluster implant losses (such as lack of bone support, heavy smoking habits and
bruxism)
(Ekfeldt A, Christiansson U, Eriksson T,et al. A retrospective analysis of factors associated with multiple implant failures in maxillae. Clin Oral Implants Res 2001;12(5):462-467.)
20. Bleeding on probing
Along with BOP modified gingival index can be used to assess marginal
mucosal conditions around oral implants
Apse P, Zarb GA, Schmitt A, Lewis DW. The longitudinal effectiveness of osseointegrated dental implants. The Toronto study: Periimplant mucosal
response. Int J Periodontics Restorative Dent 1991;11:95–111)
Diagnosis
21. Probing depth and loss of attachment
• Probing should be done in normal probing force .2N- .3N.Probing depth
penetration around teeth has been found to be < 3 mm as opposed to 2 mm
to 4 mm around implants.
Pus formation
• Pus formation is always a sign of infection with active tissue destructive
processes taking place.
22. Radiographic features of failed implants-
o There can be two well-distinct radiographic pictures: a thin peri-fixtural radiolucency
surrounding the entire implant, suggesting the absence of a direct bone-implant contact
and possibly a loss of stability, and an increased marginal bone loss.(>7 mm).
o When an implant fails because of a reason other than infection (such as surgical or
prosthetic trauma), it usually has mobility and peri-implant radiolucency, and there may
be an absence of inflammation.
23. Pain or sensitivity
• Pain or discomfort is often associated with mobility and could be one of the first
signs which indicate an implant failure.
Dull sound at percussion
• It has been suggested that a subdued sound upon percussion against the implant
carrier is indicative of soft tissue encapsulation, whereas a clear crystallization
sound indicates successful osseointegration.
Mobility-
o Clinically discernible mobility can be present without distinct radiographic bone
changes. Therefore, mobility is the cardinal sign of implant failure.
• Several different types of mobility can be seen
• Rotation mobility, Lateral or horizontal mobility, Axial or vertical mobility.
24. Assessment of implant stability-
o Reverse torque test-
Implants that rotate under the applied torque are considered failures and
are then removed.
o Periotest-
It is a device which is an electrically driven and electronically monitored tapping
head that percusses the implant a total of 16 times. The entire measuring
procedure takes about 4 s.
25. Esthetic evaluation
Mesiodistal dimension
of the crown
5-point rating scale
Grossly undercontoured, slightly undercontoured, no
deviation, slightly overcontoured, grossly overcontoured
Position of the incisal edge
of the crown
5-point rating scale
Grossly undercontoured, slightly undercontoured, no
deviation, slightly overcontoured, grossly overcontoured
Implant crown esthetic index was developed by Henry JA et al as an objective
tool in rating esthetics of implant-supported single crowns and adjacent soft tissues.
26. Labial convexity of the
crown
5-point rating scale grossly undercontoured, slightly
undercontoured, no deviation, slightly
overcontoured, grossly overcontoured
Color and translucency of
the crown
3-point rating scale gross mismatch, slight mismatch,
no mismatch
Surface of the crown 3-point ratingscale deviation of 1.5 mm or more,
deviation less than 1.5 mm, no deviation
Position of mucosa in the
approximal embrasures
3-point rating scale deviation of 1.5 mm or
more, deviation less than 1.5 mm, no deviation)
Contour of the labial
surface of the mucosa
5-point rating scale grossly undercontoured, slightly
undercontoured, no deviation, slightly
overcontoured, grossly overcontoured)
27. Host factors
Systemic diseases-
• Osteoporosis, osteomalacia, fibrous dysplasia, diabetes mellitus, thyroid
disorders responsible for poor wound healing and poor osseintegration
which causes early failure of implants.
Risk factors
28. • HABITS
1. Smoking:
Significance
•Causes alveolar vasoconstriction and decreased blood flow
In case of poor oral hygiene, smokers have 3 times more marginal bone loss
Recommendations:
• 1.Obtain a smoking history
• 2.Advice on risks of periodontal breakdown
• 3.Advice on the prognosis
• 4.Smoking cessation
29. 2. Parafunctional habits-
• Most common cause of implant bone loss or lack of rigid fixation
During the first year after implant insertion. Commonly manifests as
connecting screw loosening because of overload.
• Fracture of porcelain , progressive bone lose can also be seen
• Failures are higher in maxilla because of decrease in bone density.
30. • Increased number of implants to be placed
• Avoid cantilevers and occlusal contacts in lateral excursions
• Use of wide diameter implant to provide greater surface area. Progressive bone
loading and prosthetic design that improves the distribution of stresses
throughout the implant system.
• The anterior teeth may be modified to recreate the proper incisal
guidance and posterior interference during excursion.
• For maxillary implant restoration hollow night guard is used and in case of
mandibular implant supported prosthesis the occluding surface of maxillary
night guard are relieved over the implant crown.
31. Quality & quantity of bone-
• Patients with low quantity and low density of bone were at highest risk for
implant loss.
• In type IV bone due to its thin cortex, poor medullary strength, and low
trabecular density implant failure is more.
• In division C & D bone chances of failure of implants is more due to less
bone support.
32. • Osteoplasty (C–w)
• Root form implants (C–h)
• Subperiosteal implant (C–h, C–a
partial, or completely edentulous
mandible).
• Disk design implants (posterior
mandible, anterior maxilla)
• Ramus frame implant (C–h
completely edentulous mandible)
• Autogenous iliac crest bone grafts to
improve the anterior division D are
strongly recommended.
• Endosteal implants of adequate height
can rarely be positioned in the
posterior maxilla with division D bone
without a sinus graft.
• After 6 months post sinus graft, the
division D posterior maxilla is restored
to division A or C–h, and root form
implants may be inserted for posterior
prosthodontic support.
33. Malpositioning of Implants
Classification
• Proximity of implants to each other
• Proximity of implants to adjacent
teeth
• Abnormal angulation of the implant
• Malposition of implant in relation to
position of the missing tooth it
replaces
C/F & Diagnosis-
• Fracture of prosthesis.
• Fracture of abutment &
abutment screw.
• Bone loss.
• Peri-implantatis.
• Implant mobility.
IOPA
CBCT
34. • Mechanical debridement of the affected implant should be done followed by
antiseptic treatment.
• Bone grafting is necessary to provide the added bone support.
• Implant abutment can be replaced by angled abutment and custom made
abutment.
• If it is determined that the implant cannot be functionally or esthetically
restored in its existing location, the implant can be left unexposed beneath
the soft tissue and not uncovered, or it can be uncovered but not placed into
function.
35. Improper occlusal scheme
Articulating paper is used (30 μm) for the initial implant occlusion adjustment in
centric occlusion under light tapping forces.
The implant prosthesis should barely make contact.
Any mobile teeth opposite to the implant prosthesis should be extracted.
Fixed arch Prosthesis-Group function occlusion or mutually protected occlusion with
shallow anterior guidance when opposing natural dentition & No working and
balancing contact on cantilever.
For the occlusion on overdentures, it has been suggested to use bilateral balanced
occlusion & monoplane occlusion in resorbed ridge can be used.
C/F & Diagnosis-
• Bone loss.
• Screw loosening, screw fracture.
• Fracture of the prosthesis.
36. • Reduction in cusp inclination can decrease the resultant bending moment with a
lever-arm reduction and improvement of the axial loading force. Reduced cusp
inclination, shallow occlusal anatomy, and wide grooves and fossae may be
beneficial when constructing implanted prostheses.
• Typically, a 30%-40% reduction in the occlusal table in a molar region has been
suggested because any dimension larger than the implant diameter can cause
cantilever effects.
• Cusp inclination has been found to produce a high level of For every 10° increase
in cusp inclination, there is an approximately 30% increase in torque.
37. Cantilevers are class-1 levers, which increase the amount of stress on
implants.
According to Glantz ; D = F x L / E x W x H , D is the amount of deformation, F is
the force of occlusion, L, W,and H are the length, width, and height of the
cantilever, respectively, and E is the modulus of elasticity of the material .
The length of the cantilever should be minimized while maximizing the
height and width of the cantilever.
Cantilever length is influenced by type of arch, no of implants , A-P spread,
type of prostheses to be used.
Improper cantilever
38. • At each increment of 5 mm in cantilever length, stress increased by
approximately 30% to 37% on the cortical bone around implant.
• According to McAlarney and Stavropoulos ratio of cantilever length and A- P
spread should be between 2-1.5.
• Recommended cantilever lengths to be 1.5 times the A/P spread, but
shorter in poor quality bone.
39. C/F & Diagnosis-
• Progressive bone lose.
• Fracture of the framework.
• Prosthesis Fracture.
• Screw loosening.
• Fracture of implant abutment
junction.
After regenerative treatment in ailing/ failing implants additional implants can be
placed to reduce to cantilever length.
40. • C/F-
• Torque loss.
• Progressive bone loss due to
inflammation.
• Peri-implantitis.
• Screw loosening.
• Regenerative treatment should be done to
reduce the inflammation & to increase to bone
level.
• Use proper abutment with platform-switching
concept.
• CAD/CAM abutment can be used .
Implant Abutment misfit
41. Surgical Error
Excessive Pressure Heat generation Oversized osteotomy
Bone cell damage
The critical
temperature above
which bone necrosis
occurs is 47°C for 1
minute.
Lack of initial stability.
Mobility of implant
No regeneration of the peri-implant bone.
Presence of an inflammatory infiltrate in the gap between bone and implant
No .organization of the peri-implant bone clot
42. • Speed must not be above 1200 RPM.
• Proper coolant should be used while perform osteotomy.
• In case of over sized osteotomy larger diameter implant can be used &
loading can be delayed
Injury to the vital structures
Injury of inferior
alveolar nerve
Maxillary sinus
perforation
soft tissue injury
Paresthesia of lip
Nasal bleeding
Maxillary sinusitis
Flap dehiscence.
Presence of large edema
or hematomas.
Exposure of implant site.
43. • Proper flap design to prevent soft tissue injury .
• Large dehiscence can be treated by removal of granulation tissue and
resuturing.
• if sinus perforation occurs loading should be delayed by 6 months.
• Transantral endoscopic surgery can be done in case of maxillary sinusitis
or losing implant in maxillary sinus.
• Detailed initial treatment planning and careful surgery to unroof the canal
and move the neurovascular bundle inferiorly prior to fixture installation
can be done to prevent inferior alveolar nerve injury.
44. Management of ailing and failing implants
• Identification of the cause.
Peri-implantitis
• Prophylactic procedures
• The patient should be motivated to perform an adequate level of
plaque control on a regular basis.
• Overcontoured and sub-gingivally placed prosthesis, particularly in the
proximal region, will prevent the patient from attaining optimal oral
hygiene, thereby jeopardizing the health of abutment teeth and their
surrounding tissues.
45. Therapeutic strategies
• Cumulative interceptive supportive therapy (CIST)
• This protocol is cumulative in nature and includes four steps which should
not be used as single procedures, but rather as a sequence of therapeutic
procedures with increasing antibacterial potential, depending on the
severity and extent of the lesion.
• In 2004 it was modified and called AKUT-concept by Lang et al.
(Smeets R, Henningsen A, Jung O, Heiland M, Hammächer C, Stein JM, et al. Definition, etiology, prevention and treatment of peri-
implantitis – A review. Head Face Med 2014;10:34)
46. (Lang NP, Lindhe J. Maintenance of the implant patient. In: Lang NP, Lindhe J, eds. Clinical periodontology and implant dentistry. Vol. 2: Clinical concepts,
5th edn. Oxford: WileyBlackwell, 2008: Chapter 60.)
48. A. Mechanical debridement (supportive therapy protocol A)
• Oral implants with evident plaque or calculus deposits adjacent to only
slightly inflamed peri-implant tissues), but lacking suppuration and having
a probing depth not exceeding 3 mm.
• While calculus may be chipped off using carbon-fiber curettes, plastic hand
instruments or ultrasonic instruments with a plastic tip.
• The use of a high pressure air powder abrasive (mixture of sodium
bicarbonate and sterile water), has been advocated, as this removes the
microbial deposits, does not alter the surface topography and has no
adverse effect on cell adhesion.
49. • CO2, Diode-, Er:YAG- and Er,Cr:YSGG- lasers are used in the treatment of
peri-implant diseases with increasing frequency
• Most of these lasers, function through vaporization mode. High temperatures
could alter or damage the implant surface making them inappropriate for use
in treating the implant defect. They could also result in charring or coagulation
of tissue, delaying the reparative cascade.
• The Er, Cr: YSGG laser, operating at 2780 nm, blates tissue by a hydrokinetic
process that prevents temperature rise.
(El-Askary AS, Meffert RM, Griffin T. Why do implants fail? Part II. Implant Dentistry. 1999; 8:265– 276.)
50. B. Antiseptic treatment (supportive therapy protocol B)
• The type of implant surface will determine the method of
decontamination.
1. Critic acid (40% concentration; pH 1)
2. Chlorhexidine gluconate (.1%)
3. Stannous fluoride
4. Tetracycline
• contact with a supersaturated solution of antimicrobials and/or antibiotics,
for 30-60 seconds have been used for the preparation of the implant
surfaces, as they have the highest potential for the removal of endotoxins
from both the hydroxyapatite and the titanium implant surfaces.
• In general, 3–4 weeks of regular administration are necessary to achieve
positive treatment results.
51. • Machined titanium surfaces are the easiest to decontaminate.
• Tetracycline stimulates fibroblast growth in the affected area.
• Prolonged application time of citric acid solution are not recommended for use on
HA surfaces, since this would alter the quality and impair its ability to bond to
the titanium body of the implant.
• If the HA is already damaged due to the virulence of the infection surrounding
the implant. It is eliminated completely by drilling and then proceed to apply
air abrasion or ultrasound and subsequently decontaminate the area with
anticeptics.
(Buser D, Merickske-Stern R, Dula K, et al. Clinical experience with one-stage, non-submerged dental implants. Advances Dental Res. 1999; 13:153–161.)
52. C.Antibiotic treatment (supportive therapy protocol C)
• Before starting the antibiotic treatment the mechanical (A) and the antiseptic
(B) treatment protocols have to be applied.
• During the last 10 days of of the antiseptic treatment antibiotic treatment
should be used.
(El-Askary AS, Meffert RM, Griffin T. Why do implants fail? Part I. Implant Dentistry. 1999; 8:173–183.)
(Mombelli A, Van Oosten MAC, Schürch E, Lang NP. The microbiota associated with successful or failing osseointegrated titanium implants. Oral Microbiol Immunol
1987; 2: 145–51.)
53. D.Regenerative and resective therapy (supportive therapy protocol D)
• Only if infection is controlled successfully, as evidenced by an absence of
suppuration and reduced edema, further treatment to restore the bony support
of the implant by means of regenerative techniques or to reshape the peri-
implant soft tissues and/or bony architecture should be done.
• It is recommended to remove the prosthesis 8 weeks prior to surgical
treatment in order to ensure optimal results of oral hygiene practices and
allow the soft tissue to heal and collapse around the implant sites.
• The first step in surgical therapy is to degranulate the defect. It is followed by
exposing and treating the bacterially contaminated implant surface.
54. • If the surface is clean and detoxified, with all exposed areas of the implant
visualized and instrumented, it is possible to graft with an allograft material such
as DFDBA to achieve biologic healing.
• If the implant surface cannot be cleaned and detoxified due to vents, holes in
the implant fixture, it is advisable to graft with an alloplast material such as
HA or Bioactive Glass.
• The resective osseous surgery is indicated to reduce pockets and bone
recontouring to correct negative architecture of bone . This include Resection
techniques including ostectomy, with the raising of an apical repositioning flap,
and implantoplasty.
55. A 44-year-old woman with failing endodontically
treated maxillary central incisors presented for
treatment and after extraction of two incisors two
implants were placed.
After 4 months of healing,
1 implant was placed in site #11. Site #21 had poor
bone quality for initial stabilization, therefore, the
osteotomy was compressed with an osteotome and a
larger implant was installed.
CALCIUM HYDROXIDE PASTE AS A SURFACE DETOXIFYING AGENT FOR INFECTED
DENTAL IMPLANTS: CASE REPORT
Dennis Flanagan.
Journal of Oral Implantology, 2009.
56. At the eighth postoperative week, the patient presented with a small facial
swelling at site #21.
The source of the infection was the mid body of implant 21. The area was
debrided with a periodontal curet, treated with calcium hydroxide paste (Pulpdent
Corp, Watertown, Mass) for less than 30 seconds, and rinsed with sterile saline
An allograft material was then placed in the defect , and a barrier membrane was
placed (Biomend) and was primarily closed.
The site healed uneventfully and 2 porcelain fused to metal crowns were
subsequently made to complete the treatment
57. Removal of failed implant:
The techniques of removal of failed implants include use of a counter- torque
ratchet, Piezo tips, high-speed burs, elevators, forceps, reverse screw and
trephine burs and combinations of these tools.
Use of the counter-torque ratchet is the least invasive technique for
removing an implant. It is screwed into a failed implant and reverse
torqued. It works well in the maxilla.
In the mandible, where the bone is denser, it is advisable to use a bur 360 degrees
around an implant to remove bone at least one-half its length before counter
torquing.
THE TREATMENT OPTIONS FOR MANAGING IMPLANT FAILURE
58. Hopeless implant
Fracture
Screw not
engageable
Screw
engageable
Bone
removal
techniques
Reverse
screw
technique
No fracture
With internal
connection
No internal
connection
Screw not
engageable
Screw
engageable
Bone
removal
techniques
Ratchet
engageable
Ratchet not
engageable
Counter torque
ratchet technique
Bone removal
techniques
METHODS OF IMPLANT REMOVAL
(Mantena SR, Gottumukkala SNVS, Sajjan S, Rama
Raju A, Rao B, Iyer M. Implant Failures—
Diagnosis and Management. Int J Clin Implant Dent
2015;
1(2):51-59.)
59. o DENTAL IMPLANT REIMPLANTATIONS
Delayed Reimplantation after loss of an implant.
• When an implant is lost, a flap should primarily cover the entrance to the site
and after 9-12 months, a new implant can be replaced at that site.
• New implants are larger in length and diameter than the implants placed first.
Immediate Reimplantation after loss of an implant
• Failure rates after implant removal were not significantly different between
delayed and immediate reimplantations.
• If there is adequate bone to achieve primary stability, delayed placement does
not appear to provide any advantages.
60. Removed failed dental implant
Re-evaluate original treatment plan
Implant not critical for
restoration
Proceed to final
restoration
Critical for
restoration
Consider redoing the implant
Place new implant in
an adjacent site
Perform new implant at
same site
Revise treatment
plan to hybrid
implant tooth
FPD/T
ooth supported
FPD/RPD
Unsuccessful successful
Consider second
re-do
or
61. Treatment of peri-implantitis using an Er:YAG laser or an
air-abrasive device: a randomized clinical trial.
Renvert S, Lindahl C, Roos Jansa˚ker A-M, Persson GR J Clin Periodontol 2011; 38: 65–73.
The aim of the present study was to assess the clinical outcomes following
treatment with either a non-surgical debridement using an air- abrasive
device or an Er:YAG laser in subjects with implants and a diagnosis of
periimplantitis.
Results-
• No baseline subject characteristic differences were found. Bleeding on
probing and suppuration decreased in both the groups.
• The average change in the bone level was a loss of 0.3 mm for the laser
group and a loss of 0.1 mm bone height for the air-abrasive group.
Conclusion- Air- abrasive group shows better clinical out come than laser
group.
62. Prognosis of the implants replaced after removal of failed dental
implants.
Young-Kyun Kim, Jin-Young Park, Su-Gwan Kim Int J Oral Maxillofac Implants ;2016
This study was carried out to evaluate the survival rate and condition of tissue
surrounding the replaced implants after removal of failed implants.
• The most frequent site of implant failure was the maxillary first molar area.
• The average healing time for patients undergoing delayed replacement was
2-3months.
• No significant difference in the failure rate of the second implant was
observed between the immediate and delayed replacement groups.
63. Background: The aim of this study was to assess the clinical effectiveness of single
dental implants placed in sites of previously failed implants.
Methods: The study consisted of a consecutive cohort of 1,215 patients who
received 1,387 single implants for single-tooth replacement during a 6-year period
(1999 to 2005). Inclusion criteria were a single implant replacing a previously failed
implant and follow-up data ≥6 months.
64. Results: A total of 75 patients experienced the failure of 96 implants. Of those, 31
implants in 28 patients were replaced by a similar implant placed in the same location.
Nine of the replacement implants failed, resulting in an overall survival rate of 71%.
Follow-up ranged from 6 to 46 months.
Replacement of maxillary and mandibular failed implants was similar.
All failures occurred during the first year after implant replacement. On average,
implant replacement occurred 5.8 ± 5.2 months after original implant removal; three
implants were placed immediately after implant removal.
A third attempt for single implant replacement was made in two patients. However,
one failed.
65. Conclusions:
Replacement of a failed implant presents a challenge to achieve
osseointegration in a healed bone site and may result in a decline in the
survival rates.
Patients and clinicians should be aware of these results before a
replacement attempt is considered. The success of replacement may be
increased by the use of wider implants or with improved surfaces.
66. Conclusion
• Failure of implant can be multi-factorial.
• Often many factors come together to cause the ultimate failure of the
implant.
• One needs to identify the cause not just to treat the present condition
but also as a learning experience for future treatments.
• Proper data collection, patient feedback, and accurate diagnostic tool will
help point out the reason for failure.
• An early intervention is always possible if regular check-up are
undertaken.
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