The document discusses radiographic evaluation techniques in implant surgery, highlighting the differences between conventional X-rays and CBCT imaging for accurate diagnosis. It outlines various implant placement protocols, including one-stage and two-stage surgeries, as well as their advantages and disadvantages, particularly in relation to healing times and esthetic outcomes. Additionally, it compares immediate versus delayed loading and emphasizes the importance of primary and secondary stability in achieving successful implant integration.

1. Marwan m. el said
BDS. MSc

2. Radiographic evaluation

3. • Conventional x-rays are 2D image for 3D
image
• Conventional x-rays are subjected to distortion
and magnification
• Don’t use single image for diagnosis

33. CBCT

46. Implant placement and loading
protocol

47. 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

48. 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

49. 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

50. 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

79. Implant
placement
Delayed
Immediat
e
Early
Implant
loading
Delayed
Immediat
e
Early

80. 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

81. 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

82. 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

83. 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

84. Earlyimplantplacement
Allow for soft tissue
healing
Placing the implant during
the bone formation phase
More esthetic results

85. delayed Loading
Advantages
Predictable
Complete
osseointegrati
on
Reduce risk of
failure
Disadvantages
Time
consuming
Less patient
satisfaction
Reduced
function and
esthetics

86. Immediate loading
Advantages
Early
restoration of
esthetic and
funtction
Reduce
treatment
time
Disadvantages
Need patient
cooperation
Complicated
technique
High risk of
faliure

87. • 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.

88. 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

90. • 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