L14- Digital Dentistry Flashcards
why CBCT?
evaluates the bone profile, volume and architecture
identifies important structures
avoid snafus?
implant placement methods without CBCT?
freehand
acrylic guide
implant guiding system
thermoplastic template
use of pilot drills?
adhere to hard and soft tissue criteria
HARD TISSUE – 2 MM OF L ABIAL OR BUCCAL BONE
SOFT TISSUE 2MM OF KERATINIZED TISSUE
HAVE TO KNOW THIS
___ mm of labial r buccal bone
2mm hard tissue !!!
___ mm of ____ tissue needed
2 mm of KERATINIZED tissue
soft tissue !!!
bio basis for the soft and hard tissue criteria?
bio width?
requires a minimum of 2.04 mm of sound tooth structure ABOVE the osseous crest
sulcular - .69
junctional epi attachment -.97
CAT - connective tissue attahment = 1.07
approx. 3 mm of soft tissue in the apico-coronal dimension
connective tissue provides? junctional?
mechanical protection
mechanial barrier
and the junctional is the biological barrier
make up the biological width
compare the periodontal and perimplant soft tissue
what do they both have?
what lacks in the implant side?
both have
- oral epithelium
- sulcular epithelium
- junctional epithelium
IMPLANT
- NO CONNECTIVE TISSUE ATTACHMENT
- HAS CONNECTIVE TISSUE ZONE
- hypovascular / hypocellular CT zone
- NO CONNECTIVE TISSUE ATTACHMENT
- hypovascular
- less blood supply because no supply from pdl
key difference in implant and not
blood supply
natural
- many sources of blood supply
1. soft tissue
2. bone
3. from PDL
implant
1. no PDL blood supply ***
connective ___ in implant
connective tissue ZONE but NO CT attachment
connective tissue attachemnt in implants
NO
but there is junctional epithelium
cellular zone adjacent to the implant
hypovascular - hypocellular CT zone adjacent to implant
what is 3D guided implant surgery ***
does not matter method but start CROWN DOWN APPROACH
placing implant where bone is?
not necessarily we practiec prosthetically driven implant placement
so if graft you do it
epithlium with implant
still have oral epithelium and sulcular epithelium with junctional epithelium
no connective tissue attachment and no PDL
guided surgery work up
- 3D scan and digital impression
- crown down virtually
- integrate and plan the case
- fabricate the stent of your choice
implant placement method we use with CBCT
cerec guide 2
classic guide?
completely guided
when place pilot – everything goes through this key whole
method to use for first time
classic guide
optiguide radiogrpah?
no radiogrpahic guide
uses the cerec galileos integration with CBCT
fully guided systems
- classic method
2. optiguide
no radiographic guide with
optiguide with CGI and cerec guide 2
more details on cerec guide 2
+ additional requirement
requirement is the milling unit
no models necessary - so no alginate impressions
no radiographic guide required
cerec guide 2 fully guided?
NO
optical scan becomes the surgical guide
hard and soft tissue defect
how do we treat?
especially if patient on bisphosphonates?
avoid ridge augmentation
serum CTX
free gingival graft - 3 months
then placement
MRONJ
medically related osteo necrosis of the jaw
serum CTX test
higher number you get – represents osteoclastic activity
HIGHER NUMBER IS BETTER
high risk CTX levels
moderate
low
high risk is CTX lower than 100 pg/ml
moderate risk is CTX from 100-150 pg/ml
minimal risk is CTX over 150 pg/ml
his opinion on hard and soft tissue grafting
he likes soft tissue first
YOMI
robotic assisted surgery
mechanical barrier is
why important?
the connective tissue
- acts to protect against bacteria - infectoins, etc
junctional epithelium is bio barrier
guided surgery work up
basic 4 steps
- 3D scan and digital impression
- crown design virtually
- integrate and plan the case
- fabricate the stent of your choice
classic guide uses
radiographic guide
T/F optiguide uses a radiographic guide
false – it does not
2 requirements for guided surgery
need cbct scanner and cerec acquisition
additional requirement for cerec guide 2
milling unit
so need the CBCT
cerec aquisition and a milling unit
- no rx guide
impressions for cerec guide 2
no models necessary
so no alginate impressions
no radiographic guide required
if no radiographic guide ?
the optical scan you take becomes the surgical guide
how long he waits after soft tissue graft
3 months
platalet rich fibrin
next generation of platalet concentration
so we can get good clot
