Basic Implant Lecture 2007

7/25/2019 Basic Implant Lecture 2007

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Basic Surgical Techniques for

Endosseous Implant PlacementDivision of Oral and Maxillofacial Surgery

University of Minnesota


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Dental implantisan artificial titanium

fixturewhich is placedsurgically into the

jaw bone tosubstitute for a missing

tooth and its root(s).

WHAT IS ADENTAL IMPLANT?


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In 1952 !rofessor !er"Ing#ar $ranemar%

a &wedish surgeon while conducting research

into the healing patterns of bone tissue accidentally

disco#ered that when pure titanium comes into

direct contact with the li#ing bone tissue the two

literally grow together to form a permanentbiological adhesion. 'e named this phenomenon

"osseointegration".

'istory of ental Implants


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ll current implant

designs are

modifications of thisinitial design

*irst Implant esign by $ranemar%


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&+,! 1- II+I/ &0,3

&+,! 2- 4&&,4I+,+I4 !,I4

&+,! - $0+6,+ 74,7+I4&+,! 8- *I/ !4&+',+I7

,&+4+I4

&urgical !rocedure


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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


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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


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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-somedifferences.

Epithelium attaches to surface of titanium much

like a natural tooth through a basal lamina and theformation of hemidesmosomes.


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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


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Subperiosteal


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TransmandibularImplant


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Blade Implant


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Endosteal Implants


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The Parts

Implant body-fixture

Abutment (gingival/temporary healing vs.

final)

Prosthetics


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Clinical Components


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abutment


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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


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Clinical Assessment

Assess the CC and Expectations

Review all restorative options:

Risks and Benefits

Select option that meets functional and

esthetic requirements


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Patient Evaluation

Medical history

vascular disease

immunodeficiency

diabetes mellitus

tobacco use

bisphosphonate use


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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


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Surgical Phase- Treatment Planning

Evaluation of Implant Site

Radiographic Evaluation

Bone Height, Bone Width and Anatomic

considerations


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Basic Principles

Soft/ hard tissue graft bed

Existing occlusion/ dentition

Simultaneous vs. delayed reconstruction


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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 treatmentexpectations is critical


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Anatomic Considerations

Ridge relationship

Attached tissue

Interarch clearance

Inferior alveolar nerve

Maxillary sinus

Floor of nose


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Radiological/Imaging Studies

Periapical radiographs

Panoramic radiograph

Site specific tomograms

CAT scan (Denta-scan, cone beam CT)


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Width of Space and Diameter of Implant

Attention must be paid to both the coronal andinterradicular spaces


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A case against routine CT

Expense

Time consuming process

Use of radiographic template/proper fitrequires DDS present

Contemporary panoramic units have

tomographic capabilities Usually adds no additional data over

standard database


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Image Distortion


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Anatomic Limitations

Buccal Plate 0.5mm

Lingual Plate 1.0 mmMaxillary Sinus 1.0 mm

Nasal Cavity 1.0mm

Incisive canal AvoidInterimplant distance 1-1.5mm

Inferior alveolar canal 2.0mm

Mental nerve 5mm from foramenInferior border 1 mm

Adjacent to natural

tooth

0.5mm


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Dental Implant Surgery Phase I

Aseptic technique

Minimal heat generation

slow sharp drills

internal irrigation?

external cooling


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Dental Implant Surgery Phase I

Adequate time for integration

Adequate recipient site

soft tissue

bone

Kind & Gentle technique


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Disposition


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1. Chlorhexidine

2. Analgesics

+/- antibiotics

Disposition


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Implant placement 3 months after menton bone

grafting


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Exposure of Implant during

Placement


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Summers Osteotomes


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Limitations to Implant placement in the

Maxilla

Ridge width Ridge height

Bone quality


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Surgical Solutions to Anatomical

Limitations

Onlay Bone Graft Sinus Lift


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Summers, RB. A New concept in Maxillary

Implant Surgery: The Osteotome technique.

Compendium. 15(2): 152, 154-6

Ridge expansion technique

3-4 mm of crestal alveolar widthrequired

Sinus floor elevation technique

8-9 mm of alveolar bone heightrequired in order to place a 13 mmimplant

(4-5 mm sinus floor elevation)


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Introduction

Ridge expansion technique 1.6 mm pilot hole

Summers osteotome # 1-4

sequenced tapered osteotomes.

ridge expansion (displacement) versus

bone removal. Final drill coincident with the final

implant size (sometimes not

necessary)


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Introduction

Sinus floor elevation technique 1.6 mm pilot hole

Summers osteotome # 1-4

Sinus floor microfractured superiorly

Sinus floor can be elevated 4-5 mm

May backfill with bone allograft/alloplast

Final drill coincident with final

implant size


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Surgical Technique


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k d k if i


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A. Rake, K. Andreasen, S. Rake, J. SwiftA Retrospective

Analysis of Osteointegration in the Maxilla Utilizing an

Osteotome Technique versus a Sequential Drilling

Technique, 1999 AAOMS Abstract

155 maxillary implants in 84 patients restored

for at least 6 months

57 were placed utilizing the osteotome technique

98 were placed utilizing the drilling technique

One implant failed of the 98 in the drill group

None of the implants had failed of the 57 in the

osteotome group


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Stage II Surgery Preoperative

Considerations 3-6 months after stage I


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Stage II Surgery Preoperative

Considerations Done under local anesthesia

Pre-op medications

Chlorhexidine rinse


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Placement ofhealing abutment


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The failing implant is very difficult to treat

Traumatic surgical manipulation with

initial instability of implant increases riskof failure

Implant success is only as good as the

prosthodontic reconstruction

conclusions

Basic Implant Lecture 2007

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