BASIC PRINCIPLES

AND PRACTICE OF ORAL IMPLANTOLOGY AND

OSSEOINTEGRATION
AS08951.ppt

OSSEOINTEGRATION
Definition

AS08952.ppt

OSSEOINTEGRATION
A direct structural and functional connection between ordered living bone and the surface of a load carrying implant P-I Branemark

AS08953.ppt

OSSEOINTEGRATION
Relies on an understanding of: Tissue healing and repair Tissue remodelling Soft tissues Hard tissues Effects of forces in all vectors Immune response to the insertion of foreign bodies

AS08954.ppt

HISTORY
Century 17 20
Dental transplantation Subperiosteal Transosteal Vitreous carbon Blade Osseointegrated
AS08955.ppt

RESEARCH BASE
1952-1960
1960-1968 1965 1965-

Vital microscopy
Repair and regeneration of bone and marrow First jaw implant Clinical research
AS08956.ppt

SUCCESS

Rates Criteria Research reports

AS08957.ppt

HARVARD SUCCESS CRITERIA

The dental implant must provide functional service for 5 years in 75% of cases

AS08958.ppt

SUBJECTIVE CRITERIA

Adequate function
Absence of discomfort Improved aesthetics Improved emotional and psychological wellbeing

AS08959.ppt

OBJECTIVE CRITERIA

Bone loss no greater than 33% of vertical length of implant Good occlusal balance and vertical dimension Gingival inflammation amenable to treatment Mobility of less than 1mm. in any direction Absence of symptoms of infection

Absence of damage to surrounding structure

Healthy connective tissues
AS089510.ppt

SUCCESS RATES
Subperiosteal Staple Vitreous carbon Blade Osseointegrated

% 39 - 90 95 50 65 - 90 80 - 100

AS089511.ppt

BRANEMARK SYSTEM

Development Integrated Design Quality Control Precision Reliability

AS089512.ppt

ALTERNATIVE TECHNOLOGY

IMZ ITI 3M Corevent Apatite coated

AS089513.ppt

INDICATIONS FOR TREATMENT

Factors precluding wear of a removable prosthesis Poor anatomy for denture support Poor oral muscular coordination Poor mucosal tissue tolerance Parafunctional habits Unrealistic expectations Hyperactive gag reflex Psychological inability to wear Unfavourable number and location of abutments Single tooth loss

AS089514.ppt

INDICATIONS

Fully edentulous
Partially edentulous

Single tooth

AS089515.ppt

INDICATIONS FULLY EDENTULOUS

Poor retention

Functional disturbances
Psychological disturbances

AS089516.ppt

MEDICAL EVALUATION

Cardiovascular
Respiratory Renal Musculoskeletal Neurological Endocrine
AS089517.ppt

SPECIFIC MEDICAL CONDITIONS

Diabetes Coronary artery disease Alcoholism Drug therapy - anticoagulants - anti epileptics - antidepressants - others Osteoporosis Smoking

AS089518.ppt

PSYCHE

Perception of outcome hypercritical demanding unrealistic expectation Time and expense Aesthetics Maintenance
AS089519.ppt

DENTAL EVALUATION
Assessment of overall oral health Prior to implant therapy, completion of: Oral Surgery Periodontal therapy Endodontics Temporisation of restorative dentistry Oral hygiene controlled and maintained
AS089520.ppt

RADIOLOGY

OPG Lateral Cephalogram Periapicals CT Scan - axial - coronal - 3D reconstruction - Dentascan MR

AS089521.ppt

DIAGNOSIS

Bone Quantity Bone Quality Associated structures - inferior alveolar nerve - mental nerve - maxillary antrum - nasal floor - incisive canal Pathology - retained dental remnants - periapical pathology - cysts - other pathology AS089522.ppt

ALVEOLAR FORM
A Good alveolar ridge form
B Moderate residual ridge form C Advanced resorbtion / Basal bone only D Basal bone resorbtion E Extreme resorbtion

AS089523.ppt

BONE QUALITY
1 2 Mainly cortical plate compact bone Thick compact bone with a dense trabecular core

3
4

Thin cortical plate with dense trabecular core

Thin cortical plate with low density trabecular core
AS089524.ppt

BONE QUALITY

AS089525.ppt

ANATOMY

Mental nerve Inferior alveolar nerve Nasal cavity Maxillary antrum Incisive canal Soft tissues

AS089526.ppt

SURGICAL REQUIREMENTS

Standardised surgical protocol

Surgical environment Implant equipment - reusable - disposable/single use

Fully evaluated and prepared patient

Trained staff
AS089527.ppt

EQUIPMENT
FIRST STAGE

AS089528.ppt

STAINLESS STEEL

Guide drill 2mm twist drill Pilot drill 3mm twist drill Countersink

AS089529.ppt

TITANIUM

Tap Implant Coverscrew

AS089530.ppt

ANAESTHESIA

General
Local Sedation

AS089531.ppt

SURGICAL

Aseptic technique Gentleness Precision

AS089532.ppt

SURGICAL PRELIMINARIES

Induction of anaesthesia
Endotracheal intubation Throat pack Scrub and gown Surgical preparation Draping
AS089533.ppt

AS089534.ppt

SURGICAL PROCEDURE

Local Anaesthetic Try in stent Tattoo

Surgical incision
Flap reflection

Flap retraction
Try in stent
AS089535.ppt

AS089536.ppt

AS089537.ppt

SURGICAL PROCEDURE

Smooth ridge Use stent Guide drill

Small twist drill

Pilot drill

Large twist drill

Depth guide
AS089538.ppt

AS089539.ppt

AS089540.ppt

AS089541.ppt

AS089542.ppt

AS089543.ppt

SURGICAL PROCEDURE

Countersink
Fixture insertion Cover screw Debridement Closure

AS089544.ppt

AS089545.ppt

AS089546.ppt

AS089547.ppt

AS089548.ppt

AS089549.ppt

AS089550.ppt

POSTOPERATIVE CARE

Haemostasis
Analgesia Antibiotic regime Chlorhexidine mouthwash Suture removal Temporary prosthesis
AS089551.ppt

SECOND STAGE

Soft tissue Bone removal Cover screw removal Healing abutment Replacement Dressings

AS089552.ppt

AS089553.ppt

AS089554.ppt

KEY POINTS

Implant positioning

Drill speeds
Torque Irrigation

- bucco/lingual - axial - separation - 2000rpm - 20rpm

AS089555.ppt

MAXILLARY IMPLANTS

Lack of well defined cortex Poorer quality cancellous bone Lack of bucco/lingual width

Reduced height of available bone

Proximity of anatomical structures - nose - antrum - incisive canal
AS089556.ppt

TECHNIQUE MODIFICATIONS

Countersinking
Self tapping implants Wide implants

AS089557.ppt

COMPLICATIONS WITH OSSEOINTEGRATED IMPLANTS

AS089558.ppt

COMPLICATIONS

Preoperative Perioperative Postoperative Transient Persistent Permanent Soft tissue Hard tissue
AS089559.ppt

SERIOUS COMPLICATIONS

Jaw fracture Haemorrhage Ingestion Inhalation Neurological Death

AS089560.ppt

COMPLICATIONS

Patient selection

Psyche Anatomy Systemic disease

Implant factors Surgical Prosthodontic Errors in judgement Deviation from established protocol
AS089561.ppt

ANATOMY

Unsuitable morphologically Reduced bone density Reduced bone volume Attached tissue Nerve position

AS089562.ppt

PREVENTION OF NERVE DAMAGE

CT Bone density measurement Drill sleeves Discretion is better part of valour

AS089563.ppt

COMPLICATIONS
Peroperative

Failure to obtain anaesthesia Haemorrhage Stuck implant Loose implant Lost implant
AS089564.ppt

SURGICAL FAILURE

Poor planning Poor surgical technique Lack of precision Thermal injury Faulty placement Damage to adjacent structures

AS089565.ppt

SURGICAL

Haemorrhage Stuck implant Loose implant Lost implant

AS089566.ppt

COMPLICATIONS

Wound dehiscence Infection Mucosal perforation

Fistula formation
Anatomical - antral

- nasal
- neurological
AS089567.ppt

STAGE ONE SURGERY

Failure to obtain anaesthesia Faulty placement Anatomical Surgical

AS089568.ppt

SURGICAL

Stripped bone threads Exposed implant threads Fractured drill Sheared implant hex Excessive countersink Eccentric drill

AS089569.ppt

COMPLICATIONS
Second stage

Loose implant

Excess bone coverage

Exposed threads

Coverscrew problems
AS089570.ppt

STAGE TWO SURGERY

Wrong abutment length Faulty abutment seating Retained sutures Gingival hyperplasia Mobile tissue Destroyed cover screw hex Failure of integration
AS089571.ppt

FAULTY PLACEMENT

Labial / buccal Lingual Too close Straight line in mandibular anteriors Angulation Divergence Correct by use of a surgical template
AS089572.ppt

POSTOPERATIVE

Fascial space infections Haematoma Jaw fracture Sinusitis Wound dehiscence

AS089573.ppt

WOUND DEHISCENCE

Poor flap design Poor surgical technique Poor repair Poor tissue quality Previous surgery Underlying medical condition Superficial implant placement
AS089574.ppt

PERSISTENT

Neurological damage Aesthetics Speech Function Psychological

AS089575.ppt

COMPLICATIONS
Long term

Anatomical
Neurological

Deintegration
Progressive thread exposure Gingivitis Hyperplastic tissue Fractured Implant
AS089576.ppt

PROSTHODONTIC

Avoid premature loading Passive fit Good design Good oral hygiene Loss of integration Soft tissue problems Oral hygiene and maintenance Retrievable v cemented
AS089577.ppt

COMPONENT FAILURE

Fractured fixture Fractured abutment screw Fractured punch blade Fractured screw driver tip Fractured castings

AS089578.ppt

MANAGEMENT OF FAILURE

Failing implants FAIL Removal Abandon Alternative site Larger diameter Replacement after healing

AS089579.ppt

GRAFTING TECHNIQUES

AS089580.ppt

GRAFTING
Autogenous - Local symphysis third molar angle tuberosity - Distant rib iliac crest tibia calvarial - frozen - freeze dried - demineralized

Allogenic

AS089581.ppt

BIOMATERIALS
- methyl methacrylate - silicone - proplast - teflon - calcium phosphates - plaster of paris - tricalcium phosphate - hydroxyapatite - goretex

AS089582.ppt

GRAFTS

Autogenous bone Freeze dried bone Synthetic biomaterials

AS089583.ppt

FREEZE DRIED BONE

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

AS089584.ppt

CALCIUM PHOSPHATES

Plaster of paris Tricalcium phosphate Hydroxyapatite

AS089585.ppt

INDICATIONS FOR GRAFTING

Anterior maxilla Posterior maxilla Anterior mandible Posterior mandible After resection Post traumatic

AS089586.ppt

TECHNIQUES

Cortico-cancellous blocks Trephined core Sinus Lift Vascularised bone flap

AS089587.ppt