2.Dental Implant 2012
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Transcript of 2.Dental Implant 2012
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DENTAL IMPLANT
- Pengertian- Indikasi
- Klasifikasi- Material- Evaluasi
dental
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• Implantasi: proses grafting atau insersi material benda asing inert/alloplast atau jaringan kedalam tubuh
• Dental implant material atau device yang ditempatkan didalam atau pada jaringan mulut yang mendukung protesa dalam mulut
• Merupakan bagian restorasi gigi modern• Untuk tujuan: - terapetika - diagnostika, - prostetik
- penelitian/percobaan
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BIOCOMPATIBILITY OF IMPLANT
• ADA acceptance provions : (1) Evaluation of physical properties (strength) (2) Ease of fabrication & sterilization (3) Biocompatibility evaluation (cytotoxicity test) (4) Freedom from defect (5) Minimal of two clinical trials (min. 50 human) - 3 years to earn provisional acceptance or - 5 years to earn acceptance
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Indikasi dental implant:
• Seseorang yang: Kehilangan satu gigi/lebih Mengganti prostetik yang longgar• Faktor dominasi: Tingkat kesehatan Ketelitian evaluasi (gigi & medikal)
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Keuntungan Implan
• Peningkatan penampilan (appearance)• Peningkatan self esteem (percaya diri)• Peningkatan kenyamanan (comfort)• Bicara• Makan lebih baik• Konfeniensi• Proteksi gigi asli
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Klasifikasi
• Desain implan - Endosteal implan - Subperiosteal implan - Transostreal implan - Epitelial implan• Sifat implan - komposisi dan sifat fisis, mekanik, kimiawi, biologikal• Mekanisme perlekatan - osseointregrasi & fibrousintegrasi
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Subperosteal implantOsseous implant- Blade- Cylinder (hole ,
cutout)- Screw
Mandible
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Implant properties
Mechanical strength• Elastic modulus• Strength• DuctilityBiocompatibility evaluation• - non irritating - non allergy - non toxic• Non tarnish & corrosion• Freedom from defect
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Mechanical properties (Density metallic & Ceramic implant)
Material Yield strength Elongation Modulus elasticity
Tensile strength
Cp Titanium 170-483 24-15 102-104 240-550
Ti-6Al-4V 860 10 113 930
Ti-6Al-4V ELI 795 10 113 860
Co-Cr-Mo 450 8 240 700
Stainless steel 190-690 40-12 200 490-860
Aluminum oxide 400 0.1 380 220
Zirconium oxide 1200 0.1 200 350
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MATERIALS IMPLANT• 1. Metallic implant a. Titanium (CP Ti) & Titanium alloy (Ti-6Al-4V) b. Stainless Steel (SS) c. Co-Cr-Mo (Vitalium) d. Ni-Cr-Mo-Be (Ticonium)
• 2. Ceramics and Ceramic-Coated Implant a. Aluminum oxide b. Zirconia c. Hydroxyapatite d. Tricalcium phosphate (TCP) e. Bioglasses (SiO2-CaO-Na2O-P2O5)
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• implan metal perlu dimodifikasi permukaannya:• pasivasi (rendaman dlm 40% asam nitrat): - peningkatan lapisan oksida utk mencegah lepasnya ion logam (surface breakdown) dan - biokompatibilitas bahan• Anodisasi : dgn pengaliran listrik melalui metal - membtk lapisan oksida lebih tebal - meningkatkan biokompatibilitas• Ion implantasi: dgn membombarding permukaan
logam dgn ion energi tinggi (tebal sampai 0,1 m)• Teksturing permukaan dgn: plasma spraying (Ti), acid etching, blasting (Al2O3)
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• CP Ti mampu membtk : TiO, TiO2, Ti2O3• Cobalt-chromium Tambahan unsur dlm Co-Cr-Mo : - Mo (stabilizer), Cr (pasivasi), C (harderner) - bila terjadi agglomerisasi : low ductility
• 3. Bioglass : - terjadi migrasi ion Ca, Na, Si dan PO4 ke jaringan - stimulasi pembtk tulang - utk grafting: augmentasi & bony defect
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TISSUE GLASS
Kation & silika Dissolution network
Na – O - Si
Si – O – Si
H
OH
H – O – Si - Silanol formation
Si – O – Si O Si – O – Si O
Silica gel forms bycondensation of silanols
Ca & PO4Ca & PO4
CO3
OH-
F-
Calcium-phosphate-rich mineral forms
Ca-P mineral crystal-lizes into a hydroxy, carbonate, Fluorapatite layer
Ca10(PO4)6(OH) F
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• 4. Polimer: - Polimetil metakrilat - Politetrafluoroetilen - Polioksimetilen + sprayed Ti / HA intramobile elemen (internal shock breaker)
• 5. Karbon dan seny karbon (SiC) - vitreous carbon - SiC
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PORCELAIN FUSED to METAL (PFM)
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Pengertian
• Logam paduan untuk bangunan prostetik /implan yang mampu mengikat keramik dengan ikatan kimiawi dari hasil difusi -jerapan lapisan tipis oksida antara logam paduan dengan keramik dengan
tujuan utama biokompatibilitas material
Dalam PFM terdiri 3 substansi yang saling berikatan secara kimiawi yaitu logam, lapisan tipis oksida dan keramik
CerM MO
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Kegunaan alloi dengan porselin difusi dalam logam (PFM)
• Bangunan restorasi dengan veneer-porcelain• Restorast all-metal
• Implant device• Orthopaedic device
EstetikaNon corrosive
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Jenis material
• High Noble Alloy (contoh: Gold alloy) - Gold-palladium-platinum alloy - Gold-palladium-silver alloy - Gold-palladium alloy• Noble Alloy (contoh: Palladium alloy) - Palladium-silver alloy - Palladium-gallium-silver alloy - Palladium-gold alloy - Palladium-gold-silver alloy - Palladium-copper alloy - Palladium-cobalt alloy
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• Base Metal Alloy (contoh ) - Nickel – chromium alloy - Nickel – chromium- berrylium alloy - Cobalt – chromium alloy - Cp Titanium - Titanium-aluminum-vanadium
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Persyaratan khusus PFM
• Temp. melting alloi hrs lbh tinggi dp firing tempe-rature keramik
• Mampu menahan creep atau sag pada suhu melting alloi / firing temperatur keramik
• Koef. ekspansi termal (CTE) compatibel thd porselin• Mampu mengikat porselin• Memp. stiffness tinggi (adanya flexing dari alloi
menyebabkan porselin fraktur• Tidak boleh ter stain atau discoloration
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Sifat khusus High Noble Alloys PFM
• Melting range: 1149 – 1304 C• Density : 13.5 – 18.3 gr/cm3• Castability : easy to cast• Hardness & workability : 182 – 220 VHN, extremely
easy to work• Percent elongation : 5 – 20%• Porcelain bonding :oxide layer assists in chemical
bonding• Sag resistance : to withstand temp. of as high as
950 C
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Sifat khusus Noble Alloys PFM
• Melting range : 1155 – 1304 C• Density : 10,5 – 11,5 gr/cm3• Castability :do not cast as well than high noble• Hardness & workable : 189 - 270 VHN, extremely
easy to work• Percent elongation : 10 – 34% • Porcelain bonding : with base metal (Sn, In, etc)
are added to assists porcelain bonding• Sag resistance : similar with high noble
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Sifat khusus Base Metal Alloys
• Melting range : 1155 – 1304 C• Density : 7.8 – 8,4 gr/cm3• Castability : extremely technique sensitive• Hardness & workable : 175 – 360 VHN, extremely
difficult to work with• Percent elongation :10 – 28%, but not easily burnishable• Porcelain bonding : an adequate oxide layer is essential
for successful porcelain bonding• Sag resistance : far more stable at porcelain firing
temperature
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Perlekatan logam pada porselin pada PFM
• 2 jenis ikatan utama: - chemical bonding
across the porcelain – metal interface - pada Base metal melalui chromic oxide - pada Noble metal melalui tin oksida and iridium oksida dll - Mechanical interlocking between porcelain and metal (nodules)
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Pd-Ag alloy Porcelain
Hybrid layer PFM
4 µm 1 µm
nodules
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Mechanism Bonding of PFM
• 1. Chemical bonding (oxides)• 2. Mechanism entrapment (nodules)
• 3. van der Walls force• 4. Compressive force (physical)
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Discolorations• Greenish-yellow discoloration …….. high Ag - galium, geranium (2-9%)• Greenish ……………………………….. Cr• Dark brown – black ………………….. Cu• Dark ……………………………………. Co - galium, boron• Dark- grey …………………………….. Ni
• Opaque materials
Discolorasi ditutup dengan
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Kriteria seleksi pasien
- Memahami proses lama dan mengakibatkan rasa sakit, motivasi tinggi - Kesehatan psikologis terakses dgn baik - Sehat, bebas peny sistemik, luka mudah sembuh - Terjamin oral hygiene - Dapat mendukung protesis gigi yg di implan
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• Evaluasi keberhasilan implan - Implan Endoseosa (10 tahun): a. Maksilla : 81 – 85% b. Mandibula anterior : 98 – 99%• Karakteristik: - Immobile : - directly, - tapping, - listening for solid ring - Periodontal probing of sulcus depth• X-ray: - tanpa radiolusensi, - marginal bone loss (< 0,2
mm/thn)
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• Tanpa sakit persisten & dirasakan nyaman
• Penyebab kegagalan: - tak mampu mendukung beban - sudut penempatan/insersi sukar - oral hygiene tak terjamin - infeksi pada pasien
• Kontra indikasi: - osteoporosis, - bone disease & low bone density - smoking & poor home care - parafungsional habit, - periodontitis progresif
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• Anusavice KJ, 2003 Phillips’ Science Dental Materials, Saunders, USA
• Manappallil JJ, 2003 Basic Dental Materials, Jaypee Brother Pub, New Delhi