CHAP 4-IMPLANTS BASIC CONCEPTS Flashcards
It’s made of biocompatible material
TITANIUM
Its DESIGN can be:
- Macro design: threaded, microspires, cylindrical-conical-pseudoconical
- Micro design : engraved surface, sandblasted..
No aggressive surgery procedures to bone
no bone suffering, Drilling technique, preparation
refrigeration during prep
Loading time?
- Immediate
- Early
- Conventional /Delayed
Loading Period: bone remodeling
- 1,1-1,2 mm first year
- 0,1-0,2 mm/year
M a c r o d e s i g n :
—cylindrical or conical designs —
internal or external connection to the prosthesis , polished or textured necks,more or less aggressive coil
MICRODESIGN
—more bioactive—
surfaces have been achieved with influence on tissue responses and greater adhesion: there is
—coating on the titanium surface by addition—-
or by subtraction of the titanium surface
HISTORY
1965 Branemark type threaded implants made of grade 1 Titanium
S I N G L E - S T A G E S U R G E R Y
One single surgurgical procedure for the patient
with or without prosthetic loading at the moment
increased risk :
-implant is exposed to oral cavity
-Microtrauma and masticatory loads can affect the osseointegration
T W O - S T A G E I M P L A N T S U R G E R Y
==>Implant is embedded/covered by soft tissue.
==>It requires a second surgical intervention to place the healing abutments.
==>Chosen method when:
-Advanced/difficult surgeries
-Patients with bad hygiene/oral habits
-When soft tissues around the implants need to be modified in a second intervention.
Immediate Implant
1)Its performed at the same time as the exodontia
2)only one surgery for the patient
3)Greater preservation of the osseogingival architecture
4) More difficulty for primary stability
5)Increased probability of infection due to alveolitis :caution in smokers and poor hygiene
Conventional implant
1) In mature bone
2) Increase the total time for definitive prosthetic restoration
3) Easier (except in bone atrophy)
4)Greater stability ( also easier immediate loading/aesthetics)
5)Loss of gingival architecture
Immediate load
The prosthesis is placed and fitted at the same time (right after) as the implants are placed or up to 7 days after surgery
Early load
New loading protocols in reduced bone healing time (one week to twelve weeks)
-Maxillae: loading after 8-12 weeks of implant placement
-Mandible : loading after 6-8 weeks
Delayed/conventional loading
The prosthesis is designed once the conventional healing
period of the bone has elapsed.
4 to 6 months in maxilla
2 to 4 months in the mandibula
INDICATIONS I
It makes possible to place fixed prostheses when there is no posterior prosthetic pillars.
==>Kennedy Class I and II.
In those edentulous posterior areas to the remaining natural teeth
where we only can place removable Prosthesis.
To avoid preparation of adjacent teeth
To improve retention, stability and support of complete dentures
(full-mouth prostheses)
INDICATION II
Enables fixed prostheses in completely edentulous patients in one or both arches.
Avoids overloading of the prosthetic pillars both by fixed prostheses on teeth and by the retainers of skeletal prostheses.
Reduce the resorption of the alveolar edges, mucosa and gingiva caused by the trauma of the removable prosthesis.
ABSOLUTE CONTRAINDICATIONS
- Systemic pathologies that
negatively influence the bone
healing: Intravenous
bisphosphonates, head and neck
radiotherapy… - Chronic pathologies or neoplastic
diseases of bone or mucous
membranes. - Non-regenerable bone atrophies.
Width
Mandible
height
maxilla
Density
Mandible
Milling
Maxilla
Irrigation
Maxilla
Primary stability
Max: Less Mand : more
Aesthetics
Max : less Mand :More
Blood Analysis
Complementary test INR
Up to 3 : surgery can be performed
Better if below 2.5
Do not treat w/o interconsultation
Bone drilling =>CONVENTIONAL
high revolution (900-1.200 rpm)
Always with irrigation
Always in the first drills at least
in very hard bone
Bone drilling => BIOLOGIC
Low revolution (50-450 rpm)
With or W/o irrigation
last drill
Always soft bone
Implant placement
Controlled torque: between 20 and 50 N/cm2
Low speed : 15-30 rpm
W/o irrigation
In contact with blood if possible
Last coils with ratchet in some cases
Intraoperative complication
1) Intraoperative bleeding
2) Swallowing aspiration and instrument fracture
3) Cavity penetration
4) Cortical Fracture: mandibular fracture
5) Injury to adjacent teeth
6) Incorrect technique resulting in surgical trauma
7) Fenestration or bone dehiscence
Delayed complications
1) Implant failure: periimplantitis, Mobility
2) Infection : Osteitis
3) Mucosal : gingivitis , gingival hyperplasia
4) Nerves : dysesthesia or aneshesia
5) Cavity penetration : sinus and nostrils
6) Fracture of the fixation : loads , design , prosthesis
