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implant placement protocol where and when
- 2. Bone density
- 3. Bone density • Directly related to implant successes • Four types of bone were identified • Progressive loading change the amount of bone density around the dental implants
- 4. Etiology of variable bone density • Do you remember Wolff ? • The mandible Vs. maxilla • Bone density location
- 8. Misch bone density classification
- 19. Key implant positions and number
- 20. Key implant positions and number • Some implant positions are more important than others • The most important abutment is the terminal abutment • Cantilevers are force magnifiers
- 28. 4 golden laws of multiple implant placement 1 •No cantilever 2 •No three adjacent pontics 3 •Canine molar rule 4 •Arch dynamics
- 29. No cantilever
- 34. No three adjacent pontics
- 45. Implant size
- 46. Forces applied to dental implant shear tension compression
- 50. • Advantages of shorter implants Less bone grafting in hieght – Less time for treatment – Less cost – Less discomfert Less surgical risk of – Sinus perforation – Paresthia – Osteotomy truma – Tooth damage Surgical ease – Decreased inter arch space – Less inventory / less cost
- 51. • Implant size manipulation Increase the diameter Splint together Decrease crown height Increase implant surface area OD VS FPD Minimize lateral forces Improve bone density
- 53. • Surgical advantages of wide implants – Surgical rescue implant – Failed implant/immediate – Tooth extraction /immediate • Loading advantages – Increase surface area – Compensate for unfavorable forces – Compensate for poor bone density – Increase surface area for short implants
- 54. • Disadvantages of wide implants Bone trauma Decreased facial bone thickness Stress shielding Increased surgical failure Damage to the adjacent tooth
- 55. • Implant diameter criteria Esthetics • Size of the tooth (minimum implant size) • Adjacent tooth- inter proximal bone (maximum implant size) • Faciopalatal bone (maximum implant size) Function • Functional surface area • Fatigue strength
- 56. Implant placement and loading protocol
- 57. Implant surgery Two stage surgery First stage implant placement Second stage placement of healing abutment One stage surgery The implant is exposed from day one
- 58. First stage surgery • Flap or flapless Implant placement • Immediate or delayed 3 to 6 months healing Second stage surgery • Flap or flapless Healing abutment 2 weeks Final restoration
- 59. One stage surgery • Flap or flapless Implant placement • Immediate or delayed placement • Immediate or delayed loading Healing for 3 to 6 months • With or without loading Final restoration
- 63. Implant surgery Flapless More conservative Better soft tissue healing Less bone loss More esthetic outcome Less visibility Risk of bone dehiscence or fenestration More sensitive technique Flap elevation More visibility Better irrigation Bone augmentation Complete wound closer Bone resorption More healing time Risk of flap dehiscence
- 93. Implant placement delayed 3 to 6 months after tooth extraction Early 1 week to 2 months after extraction Immediate At the same time of tooth extraction
- 94. Implant loading delayed 3 to 6 months after implant placement Early from 2 weeks to 2 months of implant placement Immediate within 1 week of implant placement
- 95. • primary stability achieved by direct contact between implant body and threads with bone during implant placement. • Secondary stability As healing progresses, the original bone around the implant surface remodels and areas of new bone emerge at the implant surface. The remodeled bone contact and new bone contact result in secondary or biologic stability.
- 102. Delayed placement Advantages Improved bone structure improved Primary stability Uninterrupted implant healing Soft tissue healing More predictable prosthetic results Disadvantages Time consuming Bone loss at the extraction site More trauma to the bone during preparation
- 103. Immediate placement Advantages reduce the treatment time reducing the number of surgical procedures Bone preservation at the extraction site Disadvantages risk of infection from residual bacterial poor esthetic outcomes unpredictable amount of alveolar wall resorption
- 104. Earlyimplantplacement Allow for soft tissue healing Placing the implant during the bone formation phase More esthetic results
- 105. delayed Loading Advantages Predictable Complete osseointegrati on Reduce risk of failure Disadvantages Time consuming Less patient satisfaction Reduced function and esthetics
- 106. Immediate loading Advantages Early restoration of esthetic and funtction Reduce treatment time Disadvantages Need patient cooperation Complicated technique High risk of faliure
- 107. • primary stability achieved by direct contact between implant body and threads with bone during implant placement. • Secondary stability As healing progresses, the original bone around the implant surface remodels and areas of new bone emerge at the implant surface. The remodeled bone contact and new bone contact result in secondary or biologic stability.
- 108. Immediate VS. delayed • Esthetics: esthetic recovery is more difficult in implant site • Function: Anterior vs posterior • Structure: Soft tissue surrounding teeth teeth • Biology: primary stability Quantity and quality of bone Pace of bone formation around the implant
- 110. • Esthetics: The implant site is in the esthetic zone • Function: The patient lacks posterior support, deep vertical overlap (overbite) present • Structure: Additional teeth require restoration due to dental caries • Biology: Thin biotype