IMPLANTOLOGY QUESTIONS & ANSWERS
•DR.MOUSTAFA MOAMEN •MDs. ORAL & DENTAL MEDICINE CAIRO UNIVERSITY•Assistant lecturer IN PROSTHESIS DEPARTMENT CAIRO UNIVERSITY•FELLOW TO THE INTERNATIONAAL CONGRESS OF ORAL IMPLANTOLOGISTS (ICOI)•PRESIDENT OF THE CLINICAL IMPLANT SOCIETY OF EGYPT (CISE)
COURSE OBJECTIVESTHEORATICAL PART:To be able to identify the advantages of implant
dentistryTo be able to identify cases capable for implant
placement
Practical part:To be able to diagnose, place & successfully
restore a single tooth replacement implant case
Implant Course map
System components & step by step procedures
Diagnosis & treatment planning
Basic knowledge
Then exam
What is a dental implant?A device of biocompatible material placed within the mandibular or maxillary bone
Why do we need implants?P,O.C. Removable Fixed ImplantMain prob Removable Tooth reduction surgery
Survival rate after 10 years
35% 50 %With precious alloys
85% -97%
Abutments 80% need repair within 10 years& 44% will be lost
15% will need endo. Abutment Screw loosening may occur easily retightened
Increased mobility, plaque, bleeding upon probing, and caries of abutment teeth
Bone Accelerated bone resorption especially from tissue supported restorations
Bone resorption from disuse atrophy under the pontics
Minimal to no resorption
What are the types of dental implant?I. Endosteal implantsRoot form implantsEndodontic stabilizersPlate or blade form
implantII. Subperiosteal implant
flap margins→ heal by primary intention soft tissues → around implants simulates that
around tooth structure i.e (attachment & junctional epithelia & free & attached gingivae all are present)
bone healing→granulation tissues (within 1 week after
implantation) → woven bone formation(within 2 weeks) → bone growth &mineralization(within 4 weeks) →bone maturation &organization(6-8weeks)
How does healing take place around dental implants?
What is osseointegration?It is the direct structural & functional
connection between living bone & the surface of a load bearing artificial implant without any intervening tissues
What are the criteria of a successfully osseointgrated dental implant?
Clinically immobileNo radiolucency around the implant< 0.2 mm bone loss / year after the 1st year Absence of signs &/or persistent symptoms as
(pain, pus, paresthesia or infection)
What is meant by the available bone?Available bone describes
the amount of bone in the edentulous area considered for implantation.
It is measured in: 1. Width (buccolingual) 2. Height (from bone crest to
landmark)3. Length (mesiodistal)4. angulation5. crown height space
1. The available bone height The height of available bone is measured from the crest
of the edentulous ridge to the opposing landmark.
1. The available bone height
Minimum bone height needed:
Implant length (at least 10mm)+ 2mm
This additional 2-mm to permit for:
1. surgical error
2. osteoplasty
1. The available bone height
Importance Selection of the proper implant length
which:affects implant/crown ratioaffects primary stability immediate
loading↑↑ surface area(SA) (every 1mm
contributes for 10-14% SA ↑↑) → better stress distribution
2. Available Bone Width B-L dimension
The minimum needed bone width is: 2mm > implant diameter for predictable survival These dimensions provide ≥ 1 mm of bone on
each side of the implant at the crest. Importance: Determination of implant diameter which
affects; ↑↑ SA (every 1mm →↑↑ SA by 30-40%) →
Better Stress distribution especially around the implant crest which is the most vulnerable area for future bone resorption
Can we increase the bone width?
3. Available Bone Length The mesiodistal length of available bone in an edentulous area is
often limited by adjacent teeth or implants. As a general rule, the implant should be at least>1.5 mm
from an adjacent tooth and 3 mm from an adjacent implant.
3. Available Bone LengthThis dimension allows for Crown contouring (emergence profile)compensation for the width of an implant
crestal defect, which is usually < 1.4 mm.
4. Available Bone AngulationDefinition: It is the angle between the long
axis of the remaining alveolar ridge with the long axis of the abutment in the planned restoration
The initial alveolar bone
angulation represents the natural tooth root trajectory in relation to the occlusal plane
the bone angulation changes after the loss of teeth, especially in the anterior edentulous arch
30˚
. Available Bone AngulationImportance:Bone angulation →
placement of the implant with angled abutment → angled load to an implant body ↑↑ the crestal stresses, so the less the bone angulation the better the stress distribution
4. Available Bone Angulation
Relation to ridge width
5. Crown Height Space The crown height space (CHS) is defined as the vertical distance
from the crest of the ridge to the occlusal plane. Importance: It affects the: Esthetics & appearance of the final prosthesis and the amount of moment force on the implant and surrounding
crestal bone during occlusal loading. Maximum acceptable CHS For an ideal treatment plan, the CHS should be ≤ 15 mm for ideal
conditions
Implant patient should have
Abundant available bone
Money $$
Misch classfication
8. criteria of division A (abundant) available bone ( Carl Misch classification)Width > 6 mmHeight > 12 mmMesiodistal length > 7 mmAngulation of occlusal load
(between occlusal plane and◦implant body) < 25 degrees
Crown height space ≤ 15 m
What is meant by bone density?
It refers to the internal structure of bone regarding its compact & cancellous components & reflects a number of biomechanical properties, such as strength and modulus of elasticity
As well as a determining factor in treatment planning, implant design, surgical approach, healing time, and initial progressive bone loading during prosthetic reconstruction
9 . Classify bone according to quality?
Is bone density related to specific jaw locations?
3% D1
50% D2
46% D3
1% D4
0% D1
10% D2
50% D3
40% D4
0% D1
10% D2
50% D3
40% D4
6% D1
66% D2
25% D3
3% D4
3% D1
50% D2
46% D3
1% D4
3% D1
50% D2
46% D3
1% D4
Does bone density affect implant dentistry?
Difference between implant E & bone E will lead to implant micromobility inside the bone creating microstrain on the implant bone interface
Does bone density affect implant dentistry?Implant to bone contact in D1 > D2 > D3
> D4 D1 D4
To summarize…..
Bone density affects
implant micromovemen
t during function
Bone to implant contact
So unfavorable bone density stress concentration
Does bone density affect treatment plan?
... unfavorable bone density stress concentration
... Stress = Force/Area... to ↓ stress we have to ↑ surface area• Implant number• Implant width• Implant length• Implant design• Implant surface condition
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