RATIONALEFOR

DENTAL IMPLANTS

WHAT MAKES IMPLANT DENTISTRY UNIQUE:

It restores the patient to normal contour, function, comfort, esthetics, speech and health regardless of the atrophy, disease or injury of the stomatognathic system

It is the most natural method to replace a tooth rather than preparing adjacent teeth and joining them together with a prosthesis

SINGLE TOOTH REPLACEMENT-FPD

Estimated mean life span of FPD (50% survival) reported at 10 years.

Caries most common cause of FPD failure.

15% of FPD abutments require endodontics.

Failure of abutment teeth of FPD 12% at 10 years and 30% at 15 years.

80% of teeth adjacent to missing teeth have no or minimal reastoration.

SINGLE TOOTH IMPLANTS- ADVANTAGES

High success rate (above 97% for 10 years) Decreased risk of caries of adjacent teeth Improved ability to clean the proximal surfaces

of the adjacent teeth Decreased risk of endodontic problems on

adjacent teeth Improved esthetics of adjacent teeth Improved maintenance of bone in the

edentulous area Decreased cold or contact sensitivity of

adjacent teeth Psychological Advantages Decreased abutment tooth loss

CONSEQUENCES OF BONE LOSS IN FULLY EDENTULOUS PATIENTS

Decreased width of supporting bone Decreased height of supporting bone Prominent mylohyoid and internal oblique ridges

with increased sore spots Progressive decrease in keratinized mucosa surface Muscle attachment near crest of ridge Elevation of prosthesis with contraction of

mylohyoid and buccinator muscles Loss of basal bone More active role of tongue in mastication Loss of anterior ridge and nasal spine, causing

increased denture movement and sore spots during function

SOFT TISSUE CONSEQUENCES OF EDENTULISM

Attached, keratinized gingiva is lost as bone is lost

Unattached mucosa for denture support causes increased soft spots

Thickness of tissue decreases with age and systemic disease causes more sore spots for dentures

Tongue increase in size, which decreases denture stability

Tongue has more active role in mastication, which decreases denture stability

Decreased neuromuscular control of jaw in the elderly patients

ESTHETIC CONSEQUENCES OF BONE LOSS

Decreased facial height Deepening of vertical lines in lip and

face Chin rotates forward- gives a prognathic

look Loss of tone in muscles of facial

expression Deepening of nasolabial groove

NEGATIVE EFFECTS OF REMOVABLE PROSTHESIS Bite force is decreased from 200 psi to

50 psi 15 year denture wearers have reduced

bite force to 6 psi Masticatory efficiency is decreased Gastrointestinal disorders Food selection is limited Healthy food intake is dicreased

ADVANTAGES OF IMPLANT SUPPORTED PROSTHESES Maintain bone Restore and maintain occlusal vertical dimension Maintain facial esthetics (muscle tone) Improve esthetics, phonetics, occlusion and

masticatory performance Increase prostheses success Reduce size of prostheses Improved stability and retention of removable

prostheses Increase survival times of prostheses No need to alter adjacent teeth More permanent replacement Improve psychological health

GENERAL PRINCIPLES

The purpose of this phase is to reduce bone tissue by maximum possible way according to the implant surface, providing primary implant stability micro motion preventing and reducing the risk of integration failure. One should avoid overheat that cause the osteocytes death, using sharp tools, equipment intermittent preparation drills and abundant irrigation with saline. Drills application technique is extremely important, especially when working in very dense bone tissue, for example the seam area of the mandible.

Manufacturers produce a variety of drills systems with external or internal cooling supply (or two options at the same time). Both systems used properly provide good cooling of the surgical field. In most implant systems range includes drills that allow for a gradual increase in bone bed, ensuring correct orientation of the implant and prevent overheating as well as excessive preparation of the bone bed. Drills may vary in length, diameter according the implant size. As a rule a diameter of the last drill is slightly less than the implant diameter. This provides a good primary stability upon installation. In very dense bone can be pre- sliced for easy implant insertion. Accelerated introduction of the implant To the narrow bed can cause overheating, partial immersion of the implant and bone fracture. To improve primary stability if possible, the implant should be placed between the cortical bones. This is usually achieved in the apical and coronal areas, but you can use the buccal and lingual plates. In cases where the work is carried out over the lower alveolar first, the use of lower field mandible is highly risky. The upper jaw may be used bicortical principle of stability using the bottom of the sinuses and nasal cavity. Note that only the apical portion of the implant can be fixed to the cortical plate.

EQUIPMENT FOR IMPLANTATION PREPARATION

Most installation systems have a different speed and torque, but they do not have specific differences in the device. Osteotomy is usually carried out at 2000 rpm . /min to avoid overheating. Bed preparation and subsequent introduction of the implant osteotomy or cutting is performed at a speed of 25 vol./min with the restriction torque to 40 N/cm depending on the bone density.

BASIC TOOLS: surgical wipes, dental surgical hoses,

dental probe, dental mirror, scalpel, needle holders and suture, various retractors, gauze

The submission of physiological cooling can be implemented as by filing internal and external; both options together are also possible.

CONSISTENCY IN THE USE OF DRILLS

After tilting flap mounted surgical template. Sterile surgical pencil should note the location of the implant in the bone tissue is then formed primary bed using a small spherical boron

IRRIGATION: EXTERNAL AND INTERNAL. TARGETS OF IRRIGATION:

• Preventing working part of the tool overheating, and therefore, bone overheating;

• Constantly wash bone chips and clean the working part of drills.