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Basic Surgical Techniques for Endosseous Implant Placement

Basic Surgical Techniques for Endosseous Implant Placement. Division of Oral and Maxillofacial Surgery University of Minnesota. WHAT IS A DENTAL IMPLANT?. Dental implant is an artificial titanium fixture which is placed surgically into the jaw bone to

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Basic Surgical Techniques for Endosseous Implant Placement

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  1. Basic Surgical Techniques for Endosseous Implant Placement Division of Oral and Maxillofacial Surgery University of Minnesota

  2. WHAT IS ADENTAL IMPLANT? • Dental implant is an artificial titanium fixture which is placed surgically into the jaw bone to substitute for a missing tooth and its root(s).

  3. History of Dental Implants In 1952, Professor Per-Ingvar Branemark, a Swedish surgeon, while conducting research into the healing patterns of bone tissue, accidentally discovered that when pure titanium comes into direct contact with the living bone tissue, the two literally grow together to form a permanent biological adhesion. He named this phenomenon "osseointegration".

  4. First Implant Design by Branemark All current implant designs are modifications of this initial design

  5. Surgical Procedure STEP 1: INITIAL SURGERY STEP 2: OSSEOINTEGRATION PERIOD STEP 3: ABUTMENT CONNECTION STEP 4: FINAL PROSTHETIC RESTORATION

  6. Fibro-osseous integration • Fibroosseous integration – “tissue to implant contact with dense collagenous tissue between the implant and bone” • Seen in earlier implant systems. • Initially good success rates but extremely poor long term success. • Considered a “failure” by todays standards

  7. Osseointegration • Success Rates >90% • Histologic definition • “direct connection between living bone and load-bearing endosseous implants at the light microscopic level.” • 4 factors that influence: Biocompatible material Implant adapted to prepared site Atraumatic surgery Undisturbed healing phase

  8. Soft-tissue to implant interface • Successful implants have an • Unbroken, perimucosal seal between the soft tissue and the implant abutment surface. • Connect similarly to natural teeth-some differences. • Epithelium attaches to surface of titanium much like a natural tooth through a basal lamina and the formation of hemidesmosomes.

  9. Soft-tissue to implant interface • Connection differs at the connective tissue level. • Natural tooth Sharpies fibers extent from the bundle bone of the lamina dura and insert into the cementum of the tooth root surface • Implant: No Cementum or Fiber insertion. Hence the Epithelial surface attachment is IMPORTANT

  10. Subperiosteal

  11. Transmandibular Implant

  12. Blade Implant

  13. Endosteal Implants

  14. The “Parts” • Implant body-fixture • Abutment (gingival/temporary healing vs. final) • Prosthetics

  15. Clinical Components

  16. abutment

  17. Team Approach • A surgical – prosthodontic consultation is done prior to implant placement to address: • soft-tissue management • surgical sequence • healing time • need for ridge and soft-tissue augmentation

  18. Clinical Assessment • Assess the CC and Expectations • Review all restorative options: • Risks and Benefits • Select option that meets functional and esthetic requirements

  19. Patient Evaluation • Medical history • vascular disease • immunodeficiency • diabetes mellitus • tobacco use • bisphosphonate use

  20. History of Implant Site • Factors regarding loss of tooth being replaced • When? • How? • Why? • Factors that may affect hard and soft tissues: • Traumatic injuries • Failed endodontic procedures • Periodontal disease • Clinical exam may identify ridge deficiencies

  21. Surgical Phase- Treatment Planning • Evaluation of Implant Site • Radiographic Evaluation • Bone Height, Bone Width and Anatomic considerations

  22. Basic Principles • Soft/ hard tissue graft bed • Existing occlusion/ dentition • Simultaneous vs. delayed reconstruction

  23. Smile Line • One of the most influencing factors of any prosthodontic restoration • If no gingival shows then the soft tissue quality, quantity and contours are less important • Patient counseling on treatment expectations is critical

  24. Anatomic Considerations • Ridge relationship • Attached tissue • Interarch clearance • Inferior alveolar nerve • Maxillary sinus • Floor of nose

  25. Radiological/Imaging Studies • Periapical radiographs • Panoramic radiograph • Site specific tomograms • CAT scan (Denta-scan, cone beam CT)

  26. Width of Space and Diameter of Implant Attention must be paid to both the coronal and interradicular spaces

  27. A case against routine CT • Expense • Time consuming process • Use of radiographic template/proper fit requires DDS present • Contemporary panoramic units have tomographic capabilities • Usually adds no additional data over standard database

  28. Image Distortion

  29. Anatomic Limitations

  30. Dental Implant Surgery Phase I • Aseptic technique • Minimal heat generation • slow sharp drills • internal irrigation? • external cooling

  31. Dental Implant Surgery Phase I • Adequate time for integration • Adequate recipient site • soft tissue • bone • Kind & Gentle technique

  32. Disposition 1. Chlorhexidine 2. Analgesics +/- antibiotics

  33. Implant placement 3 months after menton bone grafting

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