D2 Introduction to Dental Implantsjvc

8/9/2019 D2 Introduction to Dental Implantsjvc

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Introduction to Dental

Implants

Joseph V. Califano D.D.S., Ph.D.


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Implants: The Numbers>400,000 implants placed annually.

>90% success rate.

Mandible > maxilla.

$500-3500 per fixture.

$200-400 cost of fixture and drills.

6 months-? Amount of time from day ofplacement to finished restoration.


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Implants: Patient Selection

Relative contraindications:

Uncontrolled diabetes

Alcoholism

Heavy smoking

Post-irradiated jaws

Poor oral hygiene General surgical contraindications


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Implants: Presurgical EvaluationRestorative requirements

Interarch space

Location of edentulous areaBone quality and quantity

Radiographs

Panoramic

Periapical Lateral cephs

Computerized tomograms


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Implants: Treatment Planning

Single most important aspect of dental

implantology.

High success rates are almost always

accompanied by careful case selection.

The increased predictability of grafting

procedures allows for optimal estheticplacement.


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SimPlant


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Implants: Treatment PlanningBone Quality

1. Type I (most dense) to Type IV

(least dense).

2. Impacts stability of fixture.

3. Determines length of healing

period.

4. Influences osteotomy

preparation.

5. Established at time of surgery.


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Implants: Treatment PlanningSurgical Template

1. Provides a visual

communication between the

restorative dentist and implantsurgeon.

2. Indicates optimal site for

placement of fixtures.

3. Conveys critical esthetic

information.

4. May be used to fix index

copings at the time of fixture

placement.


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Implants: Stage I - Placement


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Implant Placement Step 1Round bur


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Implant Placement Step 22 mm twist

1. Apical portion of twist drillsare conical, which means that

this portion of the drill isdeeper than the actual implantlength.

2. The graduations on the twistdrills represent the height ofthe fixture together with aslotted cover screw.

3. Direction and parallelismshould be checked frequentlyand by more than one person ifpossible.

4. Use direction indicators.


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Implant Placement Step 3Pilot drill

1. Expands the entrance of the

osteotomy to 3 mm in

preparation for the 3 mm twist.

2. Limited reorientation may be

accomplished at this step.

3. The cutting portion of this drill

are the sides.


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Implant Placement Step 43 mm twist drill

1. This is the terminal twist drill

for the standard platform

fixtures.

2. In very dense bone, a 3.15 mm

twist drill is recommended.

3. Reorientation may be

performed at this stage.


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Implant Placement Step 5Countersink

1. Used to widen osteotomy at

coronal position so that cover

screw may be placed at orbelow the level of the bone.

2. Counersinking is NOT

typically performed.


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Fixture1. Come in a variety of lengths

and widths.

2. Typically, wider is better.

3. A variety of surfaces and

thread configurations are

available.

4. One- and two-stage fixtures.

5. Type of fixture to be used is

often dictated by restorative

dentists preference.

Implant Placement Step 6


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Implant Placement Step 7Cover screw


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Implants: Stage II - Uncovering


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Implants: Restored


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Implants: Complications

Early failure: lack of integration

Late failure: rarely occurs after first year

after restoration, can due to occlusal

considerations (heavy forces out of the

long axis), one loose screw in a multiunit

prosthesis, etc.Periimplantitis


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Implants: Maintenance

Regular recall schedule that is patient

specific

Titanium vs. steel vs. resin curettes

Implants are subject to the same

problems that the natural dentition is

with respect to periodontal status.


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