Myanmar Society of Oral Implantology collaborates with Dental Implant system using in Myanmar and celebrates Two days seminar. At this event, as the President of MSOI, I present this topic on preparation for dental implant treatment. It was sponsored by MDA (Naypyidaw).

1. What are you preparing for
dental implant treatments?
Dr. Kyaw Tint
Professor/ Head
Department of Prosthodontics
UDMM

2. You have to prepare
• Knowledge about dental implantology
• Skill for implantation
• Attitude for yourself, patients

3. Knowledge
• History
• Pretreatment preparation
• Types of bone and bone density
• Implant design and surface modification
• Surgical procedure for dental implant
• Bone augmentation & Sinus floor elevation

4. Knowledge
• Drilling protocol
• Prosthodontics treatment- principle
• Prost Tr- Impression taking and framework
• Implant maintenance and peri-implantitis
• Immediate loading
• Full arch restorations

5. History
• More than 60 yrs

6. Component parts of Dental Implant

7. Pretreatment Preparation
• Interview- Disease, Drug, Habit
• Inspection and palpation- Local
structures
• Study model- superstructures
• Panoramic X-ray- length
• CB/CT- dia, bone quality
• Blood test- BP, Sugar, BT, CT

8. 2 major process: Surgery & Prosthesis

9. • Anatomical landmarks
Check in X-ray

10. Lingual fenestration

11. Numbness

12. Bone Shape and Bone Density
• Initial Stability – at least 4 mm
• Safety zone- 2mm
• Implant Bed & Bone density & Implant Dia
• Augmentation- graft, substitute,
• Osteointegration
• Loading Protocol
• Complication

26. Implant Body

27. Threaded
Screw-Shaped
Parallel-Sided TaperedTransitional
Self-Tapping
( + )
( - )

28. Thread Design

29. Three types of loads are generated at the interface;
compressive, tensile and shear forces.
Good Bad
Compression ShearTension

30. Macro design
Microthread

31. Microthread
• “Microthread” decreases the stress to the
bone maintaining the marginal bone.
• Microthread might be also be effective to
stabilize the implant in thin residual bone of
posterior maxilla.

32. Factors affecting primary stability
• Increase
Good bone quality
Long implant
Wide diameter
More threads
Small pitch
Deep thread
Decreased thread helix
angle
• Decrease
Low bone quality
Short implant
Narrow diameter
Fewer threads
Longer pitch
Shallow thread
Increased thread helix
angle

33. Connecting structure
between implant body and
abutment
External connection (Butt connection)
Internal connection

34. A B C

35. Ankylos
Tight sealing
Less micro-gap
Good connection
Conical Connection
(Conical Sealing)

36. Connecting structure
between implant body and abutment
Platform switching

37. Platform switching
Lazzara RJ, Porter SS. Platform switching: a new concept in
implant dentistry for controlling postrestorative crestal bone
levels. nt J Periodontics Restorative Dent. 2006 Feb;26(1):9-17.

38. Platform Switching
• “Platform switching” provides more soft tissue
including blood supply
• It has been reported that “platform switching”
decreases the stress to the bone.
• As a result, “platform switching” is beneficial
for maintaining the marginal bone.

39. Implant Implant
Abutment Abutment

40. Implant Surface Modification
Machined
Textured
Subtracted
Coated
Oxidized Hydroxyapatite (HA)
Etched
Acid
Laser
Blasted
Sintered
Titanium Plasma Sprayed
(TPS)

41. Implant Surgery
• Incision
• Blade
• flap
• Needle
• Suture
• Scissors

42. Basic design of incision for implant surgery

43. blades
Full thickness incision
Relaxing incision
Incision on soft tissue

44. Full thickness
Partial
thickness
Full & partial
thickness
periosteum

45. Needle for suture

46. Cutting needle Cutting needle
Taper point
needle
Thin mucosa
Ex: Lower jaw
Thick mucosa
Ex: Upper jaw
Proper use for needles

47. Suture

48. suture
Synthetic
polymer
Animal-
derived
Non absorbable
ePTFE
Nylon
polypropylene
absorbable
polyglactin
Non absorbable
silk
absorbable
Gut (not available in Japan)

49. structure
Monofilament;
structured by single filament
Ex: Nylon, PTFE
Multifilament;
Consist of multiple filaments
Ex: silk, nylon

50. Simple suture

51. Mattress suture (horizontal)

52. Mattress suture (vertical)

53. Mattress suture

54. Cross suture

55. ❁Suture must be done
through the periosteum
periosteum

56. Surgical knot
1.Double knot
2.opposite

57. Square knot
1.single knot
2.opposite

58. Remove suture
Cut the suture
scissors
ForcepsForceps
Cotton pellet
suture

59. scissors
straight curve

60. Implant Placement

61. over1.5mm Over 3mm
Keep away from inferior alveolar canal
Over 3mm

62. 3mm
1mm 1mm
Position of installing implants
1.5~2mm 1.5~2mm
Nobel biocare

63. Bone Grafting and Biomaterial

66. Bone particle Bone substitutes

67. Bone grafting

73. Cover by collagen membrane

75. Augmentation

77. Summers Technique

79. Crestal Approach

80. Lateral Approach

81. Drilling Protocol
• Please check in Demo:

82. Ⓒ2017 KYOCERA Medical Corporation
82
Marking Bur
DRILL EXTENDER
A component for
extending drill length in
case of difficulty such as
intereference by adjacent
teeth.
Drilling protocol (Preparation of fiimplantation)
Marking Bur （ trade name ：
MARKINGBUR)is used to mark
insertion site
On the bone surface.
(Drilling at rotation speed 800-1,200rpm)

83. Ⓒ2017 KYOCERA Medical Corporation
83
Place the implant using Driver CH (trade name: FBL-I DRIVER CH)or
Driver WH(FBL-I DRIVER WH). The insertion torque should not
exceed 50N ・ cm.
Placement (Preparation of implantation)

84. Ⓒ2017 KYOCERA Medical Corporation
11/06/18 84
Torque Wrench
trade name:(TORQUEWRENCH)
CH Adapter
(trade name: CH ADAPTER)
Upper limit of insertion torque value:
50N ・ cm
Placement (Preparation of implantation)
Check grasping function of a Driver CH and Driver WH by
trying onto an Analog before clinical use.
(The part may not function as designed if it is not
properly maintained.)
Caution

88. Implant maintenance and peri-
implant disease
• Complication
• Prevalence of Peri-implantitis
• Risk factors
• Treatment protocol of peri-implantitis

89. Complication
• Biological- peri-implant mucosa/bone
• Hardware complications- Material/Technical
component #, loosening
veneer fracture
loss of retention
metal framework fracture
loss of access restoration

90. Prevalence of peri-implantitis
• Peri-implant mucositis –
soft tissue inflammation
• Peri-implantitis
soft tissue + crestal bone loss

91. Risk factors
• Systemic risk factors-
smoking,radiation,diabetes
• Local risk factors-
abutment surface/design, keratinized tissue,
residual cement, periodontal health,
volume of jaw bone, overload
• Patient related risk factors-
lack of supported peri-implant therapy,
genetics

92. Treatment of per-implantitis
a. Pretreatment phase-
untreated periodontistis
systemic disease,
reduction of risk factors
(poor oral hygiene, tobacco use)
Prosthesis adjustment
a. Nonsurgical debridement- removal of biofilm

93. Treatment of peri-implantitis
b. Nonsurgical debridement
Mechanical debridement, Air-powder
abrasive, Photodynamic th/ Laser therapy,
c. Reassessment- within 1 to 2 months
d. Surgical access-
removal of granulation tissue,
implant surface decontamination,
regenerative or resective approach
a. Maintenance care- supportive therapy

94. Skill

95. Preparation
• Sterilization- autoclave

96. Hand washing(Rubbing method)
Well up hand lotion HP

97. operator assistant
Sterile drape
Sterile gown
Sterile gown
Sterile glove
Disposable suction
tube and tip
Sterile instruments
Clean field

98. Operation style
(2nd
operation)
Sterile glove
Sterile operation kit
(prepared for next surgery)
Isolation gown
Head cap
mask
Prof Shohei KASUGAI

159. Post Op
• Instructions
• Check up
• 2nd
Surgery after 3/6 months
• Healing abutment
• Real Abutment

161. • Two types of traditional impression
• techniques can be used according to the
treatment necessities and objectives, Open
Tray (Direct) and Closed Tray (Indirect)

162. Open Tray Technique
1. The transfer was brought to the impression
2. A custom tray with screw access holes is
required
3. After the impression material sets, the screw
of transfer is removed through the hole
4. The impression is removed from the patients’
mouth with the transfer
5. Then the analog is connected to the transfer

163. • Advantages: more precise, allow splinting
effect
• Disadvantage: Not suitable for posterior areas
with a limited intermaxillary space
Fixture level

164. Step 1. Exposure

165. Placing the Transfer

166. Step 02 Adjust tray and Check Fit

167. Step 03: Cover transfer with
impression material

168. Step 04: Take impression

170. Step 05: Impression Accuracy

172. Closed Tray Impression Technique
1. The transfer is screwed into the implant
2. Impression taking with heavy body
3. The transfer is removed from the mouth and
connected with appropriate analog
4. The transfer+ analog re-inserted into the
impression
Abutment level

173. CLOSED TRAY
Impression
Technique

175. Useful Tip
1. Remove healing abutment and replace
immediately with impression coping
2. Work from the posterior to anterior

176. Step 02: Placing the transfer

177. Step 03: Placing the transfer

178. Step 04: The X-ray

179. Step 05: Filling out the hole

180. Step 06: Cover transfer with
impression material

181. Step 07: Impression taking
Using custom tray
for accuracy and
passive casting

182. Step 08: Impression accuracy

183. Step 09: Removing the transfer

184. Step 10 & 11: Replacing
the healing cap

185. Step 12:Connecting Implant Analog and transfer

186. Step 13: Simulation of Gingiva
1. Insert transfer-analog unit back into
the impression
2. The flat side of the transfer matches
the flat side in the impression

187. Step 14: DONE

188. Attitude

189. • 25 dental implantation last 4 months ago
• Patient seek dental treatment to another
doctor
• He made 23.24.25 and 25 is cantilever
• System…
present one implant
rent the old surgical kit,
Comp boss said it is new one…

190. Attitude
• Yourself!… MSOI..free to all…both academic
and authority..no limitation..
• Objectives: More speakers and practitioners
• Welcome to all systems
• Mutual benefits to both system and society
• Advice-
be competent, complete discussion and
getting total agreement with your patients,
Pl do not hesitate to contact MSOI if you have some weakness

191. Thanks to
• MDA (Naypyidaw) and MDA ( Central)
• All participants
• MSOI instructors and Ecs..
• Zizawa company (Dentium)

192. Reference
• TMDU Training Course
• Osstem Surgical Cases
• BenQ instructional books
• Personal experiences