AS08951.ppt

BASIC PRINCIPLESBASIC PRINCIPLES

AND PRACTICE OFAND PRACTICE OF

ORAL IMPLANTOLOGY AND ORAL IMPLANTOLOGY AND

OSSEOINTEGRATIONOSSEOINTEGRATION

AS08952.ppt

OSSEOINTEGRATIONOSSEOINTEGRATION

DefinitionDefinition

AS08953.ppt

OSSEOINTEGRATIONOSSEOINTEGRATION

A direct structural and functional connection A direct structural and functional connection between ordered living bone and the surface between ordered living bone and the surface of a load carrying implantof a load carrying implant

P-I BranemarkP-I Branemark

AS08954.ppt

OSSEOINTEGRATIONOSSEOINTEGRATION

Relies on an understanding of:-Relies on an understanding of:- Tissue healing and repairTissue healing and repair Tissue remodellingTissue remodelling Soft tissuesSoft tissues Hard tissuesHard tissues Effects of forces in all vectorsEffects of forces in all vectors Immune response to the insertion of Immune response to the insertion of

foreign bodiesforeign bodies

AS08955.ppt

HISTORYHISTORY

CenturyCentury

17 17 Dental transplantationDental transplantation

2020 SubperiostealSubperiosteal

TransostealTransosteal

Vitreous carbonVitreous carbon

BladeBlade

OsseointegratedOsseointegrated

AS08956.ppt

RESEARCH BASERESEARCH BASE

1952-19601952-1960 Vital microscopyVital microscopy

1960-19681960-1968 Repair and regeneration of Repair and regeneration of bone and marrowbone and marrow

1965 1965 First jaw implantFirst jaw implant

1965-1965- Clinical researchClinical research

AS08957.ppt

SUCCESSSUCCESS

RatesRates CriteriaCriteria Research reportsResearch reports

AS08958.ppt

HARVARD SUCCESS HARVARD SUCCESS

CRITERIACRITERIA

The dental implant must provide functional The dental implant must provide functional

service for 5 years in 75% of casesservice for 5 years in 75% of cases

AS08959.ppt

SUBJECTIVE CRITERIASUBJECTIVE CRITERIA

Adequate functionAdequate function

Absence of discomfortAbsence of discomfort

Improved aestheticsImproved aesthetics

Improved emotional and psychological Improved emotional and psychological wellbeingwellbeing

AS089510.ppt

OBJECTIVE CRITERIAOBJECTIVE CRITERIA

Bone loss no greater than 33% of vertical length of Bone loss no greater than 33% of vertical length of implantimplant

Good occlusal balance and vertical dimensionGood occlusal balance and vertical dimension Gingival inflammation amenable to treatmentGingival inflammation amenable to treatment Mobility of less than 1mm. in any directionMobility of less than 1mm. in any direction Absence of symptoms of infectionAbsence of symptoms of infection Absence of damage to surrounding structureAbsence of damage to surrounding structure Healthy connective tissuesHealthy connective tissues

AS089511.ppt

SUCCESS RATESSUCCESS RATES

%%

Subperiosteal Subperiosteal 39 - 9039 - 90

StapleStaple 9595

Vitreous carbonVitreous carbon 5050

BladeBlade 65 - 9065 - 90

OsseointegratedOsseointegrated 80 - 10080 - 100

AS089512.ppt

BRANEMARK SYSTEMBRANEMARK SYSTEM

DevelopmentDevelopment Integrated DesignIntegrated Design Quality ControlQuality Control PrecisionPrecision ReliabilityReliability

AS089513.ppt

ALTERNATIVE ALTERNATIVE TECHNOLOGYTECHNOLOGY

IMZIMZ ITIITI 3M3M CoreventCorevent Apatite coatedApatite coated

AS089514.ppt

INDICATIONS FOR TREATMENTINDICATIONS FOR TREATMENTFactors precluding wear of a removable prosthesisFactors precluding wear of a removable prosthesis Poor anatomy for denture supportPoor anatomy for denture support Poor oral muscular coordinationPoor oral muscular coordination Poor mucosal tissue tolerancePoor mucosal tissue tolerance Parafunctional habitsParafunctional habits Unrealistic expectationsUnrealistic expectations Hyperactive gag reflexHyperactive gag reflex Psychological inability to wearPsychological inability to wear Unfavourable number and location of abutmentsUnfavourable number and location of abutments Single tooth lossSingle tooth loss

AS089515.ppt

INDICATIONSINDICATIONS

Fully edentulousFully edentulous

Partially edentulousPartially edentulous

Single toothSingle tooth

AS089516.ppt

INDICATIONS - INDICATIONS -

FULLY EDENTULOUSFULLY EDENTULOUS Poor retentionPoor retention

Functional disturbancesFunctional disturbances

Psychological disturbancesPsychological disturbances

AS089517.ppt

MEDICAL EVALUATIONMEDICAL EVALUATION

CardiovascularCardiovascular

RespiratoryRespiratory

RenalRenal

MusculoskeletalMusculoskeletal

NeurologicalNeurological

EndocrineEndocrine

AS089518.ppt

SPECIFIC MEDICAL CONDITIONSSPECIFIC MEDICAL CONDITIONS

DiabetesDiabetes Coronary artery diseaseCoronary artery disease AlcoholismAlcoholism Drug therapyDrug therapy - anticoagulants- anticoagulants

- anti epileptics- anti epileptics- antidepressants- antidepressants- others- others

OsteoporosisOsteoporosis SmokingSmoking

AS089519.ppt

PSYCHEPSYCHE

Perception of outcomePerception of outcome hypercriticalhypercritical demandingdemanding unrealistic expectationunrealistic expectation

Time and expenseTime and expense AestheticsAesthetics MaintenanceMaintenance

AS089520.ppt

DENTAL EVALUATIONDENTAL EVALUATION

Assessment of overall oral healthAssessment of overall oral health

Prior to implant therapy, completion of:-Prior to implant therapy, completion of:- Oral SurgeryOral Surgery Periodontal therapyPeriodontal therapy EndodonticsEndodontics

Temporisation of restorative dentistryTemporisation of restorative dentistry

Oral hygiene controlled and maintainedOral hygiene controlled and maintained

AS089521.ppt

RADIOLOGYRADIOLOGY

OPGOPG Lateral CephalogramLateral Cephalogram PeriapicalsPeriapicals CT ScanCT Scan - axial- axial

- coronal- coronal

- 3D reconstruction- 3D reconstruction

- Dentascan- Dentascan MRMR

AS089522.ppt

DIAGNOSISDIAGNOSIS Bone QuantityBone Quantity Bone QualityBone Quality Associated structuresAssociated structures - inferior alveolar nerve- inferior alveolar nerve

- mental nerve- mental nerve- maxillary antrum- maxillary antrum- nasal floor- nasal floor- incisive canal- incisive canal

PathologyPathology - retained dental remnants- retained dental remnants- periapical pathology- periapical pathology- cysts- cysts- other pathology- other pathology

AS089523.ppt

ALVEOLAR FORMALVEOLAR FORM

AA Good alveolar ridge formGood alveolar ridge form

BB Moderate residual ridge formModerate residual ridge form

CC Advanced resorbtion / Basal bone onlyAdvanced resorbtion / Basal bone only

DD Basal bone resorbtionBasal bone resorbtion

EE Extreme resorbtionExtreme resorbtion

AS089524.ppt

BONE QUALITYBONE QUALITY

11 Mainly cortical plate compact boneMainly cortical plate compact bone

22 Thick compact bone with a dense Thick compact bone with a dense trabecular coretrabecular core

33 Thin cortical plate with dense trabecular Thin cortical plate with dense trabecular corecore

44 Thin cortical plate with low density Thin cortical plate with low density trabecular coretrabecular core

AS089525.ppt

BONE QUALITYBONE QUALITY

AS089526.ppt

ANATOMYANATOMY

Mental nerveMental nerve Inferior alveolar nerveInferior alveolar nerve Nasal cavityNasal cavity Maxillary antrumMaxillary antrum Incisive canalIncisive canal Soft tissuesSoft tissues

AS089527.ppt

SURGICAL REQUIREMENTSSURGICAL REQUIREMENTS

Standardised surgical protocolStandardised surgical protocol

Surgical environmentSurgical environment

Implant equipmentImplant equipment - reusable- reusable

- disposable/single use- disposable/single use

Fully evaluated and prepared patientFully evaluated and prepared patient

Trained staffTrained staff

AS089528.ppt

EQUIPMENTEQUIPMENT

FIRST STAGEFIRST STAGE

AS089529.ppt

STAINLESS STEELSTAINLESS STEEL

Guide drillGuide drill 2mm twist drill2mm twist drill Pilot drillPilot drill 3mm twist drill3mm twist drill CountersinkCountersink

AS089530.ppt

TITANIUMTITANIUM

TapTap ImplantImplant CoverscrewCoverscrew

AS089531.ppt

ANAESTHESIAANAESTHESIA

GeneralGeneral

LocalLocal

SedationSedation

AS089532.ppt

SURGICALSURGICAL

Aseptic techniqueAseptic technique GentlenessGentleness PrecisionPrecision

AS089533.ppt

SURGICAL PRELIMINARIESSURGICAL PRELIMINARIES

Induction of anaesthesiaInduction of anaesthesia

Endotracheal intubationEndotracheal intubation

Throat packThroat pack

Scrub and gownScrub and gown

Surgical preparationSurgical preparation

DrapingDraping

AS089534.ppt

AS089535.ppt

SURGICAL PROCEDURESURGICAL PROCEDURE

Local AnaestheticLocal Anaesthetic

Try in stentTry in stent

TattooTattoo

Surgical incisionSurgical incision

Flap reflectionFlap reflection

Flap retractionFlap retraction

Try in stentTry in stent

AS089536.ppt

AS089537.ppt

AS089538.ppt

Smooth ridgeSmooth ridge

Use stentUse stent

Guide drillGuide drill

Small twist drillSmall twist drill

Pilot drillPilot drill

Large twist drillLarge twist drill

Depth guideDepth guide

SURGICAL PROCEDURESURGICAL PROCEDURE

AS089539.ppt

AS089540.ppt

AS089541.ppt

AS089542.ppt

AS089543.ppt

AS089544.ppt

CountersinkCountersink

Fixture insertionFixture insertion

Cover screwCover screw

DebridementDebridement

ClosureClosure

SURGICAL PROCEDURESURGICAL PROCEDURE

AS089545.ppt

AS089546.ppt

AS089547.ppt

AS089548.ppt

AS089549.ppt

AS089550.ppt

AS089551.ppt

POSTOPERATIVE CAREPOSTOPERATIVE CARE

HaemostasisHaemostasis

AnalgesiaAnalgesia

Antibiotic regimeAntibiotic regime

Chlorhexidine mouthwashChlorhexidine mouthwash

Suture removalSuture removal

Temporary prosthesisTemporary prosthesis

AS089552.ppt

SECOND STAGESECOND STAGE

Soft tissueSoft tissue Bone removal Bone removal Cover screw removalCover screw removal Healing abutmentHealing abutment ReplacementReplacement DressingsDressings

AS089553.ppt

AS089554.ppt

AS089555.ppt

KEY POINTSKEY POINTS

Implant positioningImplant positioning - bucco/lingual- bucco/lingual

- axial- axial

- separation- separation Drill speedsDrill speeds - 2000rpm- 2000rpm

- 20rpm- 20rpm TorqueTorque IrrigationIrrigation

AS089556.ppt

MAXILLARY IMPLANTSMAXILLARY IMPLANTS

Lack of well defined cortexLack of well defined cortex

Poorer quality cancellous bonePoorer quality cancellous bone

Lack of bucco/lingual widthLack of bucco/lingual width

Reduced height of available boneReduced height of available bone

Proximity of anatomical structuresProximity of anatomical structures - nose- nose

- antrum- antrum

- incisive canal- incisive canal

AS089557.ppt

TECHNIQUE MODIFICATIONSTECHNIQUE MODIFICATIONS

CountersinkingCountersinking

Self tapping implantsSelf tapping implants

Wide implantsWide implants

AS089558.ppt

COMPLICATIONS WITH COMPLICATIONS WITH OSSEOINTEGRATED OSSEOINTEGRATED

IMPLANTSIMPLANTS

AS089559.ppt

COMPLICATIONSCOMPLICATIONS PreoperativePreoperative PerioperativePerioperative PostoperativePostoperative TransientTransient PersistentPersistent PermanentPermanent Soft tissueSoft tissue Hard tissueHard tissue

AS089560.ppt

SERIOUS COMPLICATIONSSERIOUS COMPLICATIONS

Jaw fractureJaw fracture HaemorrhageHaemorrhage IngestionIngestion InhalationInhalation NeurologicalNeurological DeathDeath

AS089561.ppt

COMPLICATIONSCOMPLICATIONS Patient selection Patient selection

PsychePsyche AnatomyAnatomy Systemic diseaseSystemic disease

Implant factorsImplant factors SurgicalSurgical ProsthodonticProsthodontic Errors in judgementErrors in judgement Deviation from established protocolDeviation from established protocol

AS089562.ppt

ANATOMYANATOMY

Unsuitable morphologicallyUnsuitable morphologically Reduced bone densityReduced bone density Reduced bone volumeReduced bone volume Attached tissueAttached tissue Nerve positionNerve position

AS089563.ppt

PREVENTION OF NERVE PREVENTION OF NERVE DAMAGEDAMAGE

CTCT Bone density measurementBone density measurement Drill sleevesDrill sleeves Discretion is better part of valourDiscretion is better part of valour

AS089564.ppt

COMPLICATIONSCOMPLICATIONS

PeroperativePeroperative

Failure to obtain anaesthesiaFailure to obtain anaesthesia

HaemorrhageHaemorrhage

Stuck implantStuck implant

Loose implantLoose implant

Lost implantLost implant

AS089565.ppt

SURGICAL FAILURESURGICAL FAILURE

Poor planningPoor planning Poor surgical techniquePoor surgical technique Lack of precisionLack of precision Thermal injuryThermal injury Faulty placementFaulty placement Damage to adjacent structuresDamage to adjacent structures

AS089566.ppt

SURGICALSURGICAL

HaemorrhageHaemorrhage Stuck implantStuck implant Loose implantLoose implant Lost implantLost implant

AS089567.ppt

Wound dehiscenceWound dehiscence InfectionInfection Mucosal perforationMucosal perforation Fistula formationFistula formation AnatomicalAnatomical - antral- antral

- nasal- nasal

- neurological- neurological

COMPLICATIONSCOMPLICATIONS

AS089568.ppt

STAGE ONE SURGERYSTAGE ONE SURGERY

Failure to obtain anaesthesiaFailure to obtain anaesthesia Faulty placementFaulty placement AnatomicalAnatomical SurgicalSurgical

AS089569.ppt

SURGICALSURGICAL

Stripped bone threadsStripped bone threads Exposed implant threadsExposed implant threads Fractured drillFractured drill Sheared implant hexSheared implant hex Excessive countersinkExcessive countersink Eccentric drillEccentric drill

AS089570.ppt

Second stageSecond stage

Loose implantLoose implant

Excess bone coverageExcess bone coverage

Exposed threadsExposed threads

Coverscrew problemsCoverscrew problems

COMPLICATIONSCOMPLICATIONS

AS089571.ppt

STAGE TWO SURGERYSTAGE TWO SURGERY

Wrong abutment lengthWrong abutment length Faulty abutment seatingFaulty abutment seating Retained suturesRetained sutures Gingival hyperplasiaGingival hyperplasia Mobile tissueMobile tissue Destroyed cover screw hexDestroyed cover screw hex Failure of integrationFailure of integration

AS089572.ppt

FAULTY PLACEMENTFAULTY PLACEMENT

Labial / buccalLabial / buccal LingualLingual Too closeToo close Straight line in mandibular anteriorsStraight line in mandibular anteriors AngulationAngulation DivergenceDivergence Correct by use of a surgical templateCorrect by use of a surgical template

AS089573.ppt

POSTOPERATIVEPOSTOPERATIVE

Fascial space infectionsFascial space infections HaematomaHaematoma Jaw fractureJaw fracture SinusitisSinusitis Wound dehiscenceWound dehiscence

AS089574.ppt

WOUND DEHISCENCEWOUND DEHISCENCE

Poor flap designPoor flap design Poor surgical techniquePoor surgical technique Poor repairPoor repair Poor tissue qualityPoor tissue quality Previous surgeryPrevious surgery Underlying medical conditionUnderlying medical condition Superficial implant placementSuperficial implant placement

AS089575.ppt

PERSISTENTPERSISTENT

Neurological damageNeurological damage AestheticsAesthetics SpeechSpeech FunctionFunction PsychologicalPsychological

AS089576.ppt

Long term Long term

AnatomicalAnatomical NeurologicalNeurological DeintegrationDeintegration Progressive thread exposureProgressive thread exposure GingivitisGingivitis Hyperplastic tissueHyperplastic tissue Fractured ImplantFractured Implant

COMPLICATIONSCOMPLICATIONS

AS089577.ppt

PROSTHODONTICPROSTHODONTIC Avoid premature loadingAvoid premature loading Passive fitPassive fit Good designGood design Good oral hygieneGood oral hygiene Loss of integrationLoss of integration Soft tissue problemsSoft tissue problems Oral hygiene and maintenanceOral hygiene and maintenance Retrievable v cementedRetrievable v cemented

AS089578.ppt

COMPONENT FAILURECOMPONENT FAILURE

Fractured fixtureFractured fixture Fractured abutment screwFractured abutment screw Fractured punch bladeFractured punch blade Fractured screw driver tipFractured screw driver tip Fractured castingsFractured castings

AS089579.ppt

MANAGEMENT OF MANAGEMENT OF FAILUREFAILURE

Failing implants FAILFailing implants FAIL RemovalRemoval AbandonAbandon Alternative siteAlternative site Larger diameterLarger diameter Replacement after healingReplacement after healing

AS089580.ppt

GRAFTING TECHNIQUESGRAFTING TECHNIQUES

AS089581.ppt

GRAFTINGGRAFTING

AutogenousAutogenous - Local- Localsymphysissymphysisthird molarthird molarangleangletuberositytuberosity

- Distant- Distantribribiliac crestiliac cresttibiatibiacalvarialcalvarial

AllogenicAllogenic - frozen- frozen- freeze dried- freeze dried- demineralized- demineralized

AS089582.ppt

BIOMATERIALSBIOMATERIALS

- methyl methacrylate- methyl methacrylate- silicone- silicone- proplast- proplast- teflon- teflon- calcium phosphates- calcium phosphates

- plaster of paris- plaster of paris- tricalcium phosphate- tricalcium phosphate- hydroxyapatite- hydroxyapatite- goretex- goretex

AS089583.ppt

GRAFTSGRAFTS

Autogenous boneAutogenous bone Freeze dried boneFreeze dried bone Synthetic biomaterialsSynthetic biomaterials

AS089584.ppt

FREEZE DRIED BONEFREEZE DRIED BONE

Commercial preparationCommercial preparation Multiple donorsMultiple donors Screened for HIV, Hep B and CScreened for HIV, Hep B and C Sterilised by irradiationSterilised by irradiation Risk of prion borne diseaseRisk of prion borne disease Not licensed in AustraliaNot licensed in Australia

AS089585.ppt

CALCIUM PHOSPHATESCALCIUM PHOSPHATES

Plaster of parisPlaster of paris Tricalcium phosphateTricalcium phosphate HydroxyapatiteHydroxyapatite

AS089586.ppt

INDICATIONS FOR INDICATIONS FOR GRAFTINGGRAFTING

Anterior maxillaAnterior maxilla Posterior maxillaPosterior maxilla Anterior mandibleAnterior mandible Posterior mandiblePosterior mandible After resectionAfter resection Post traumaticPost traumatic

AS089587.ppt

TECHNIQUESTECHNIQUES

Cortico-cancellous blocksCortico-cancellous blocks Trephined coreTrephined core Sinus LiftSinus Lift Vascularised bone flapVascularised bone flap