The surgical aspects of implant treatment Flashcards
What preoperative preparations do we need to make before implant surgery
- Proper diagnostics
- Treatment plan
3Pt explanation, warnings and informed consent
How do we carry out asepsis of the implant site
- Chlorohexidine mouth rinse pre op
- Skin preperation
- Isolation of surgical field with barrier draping
- Protection of patient and staff from cross infection
What are the stages of traditional implant surgery 1st stage
- Asepsis
- LA
- Incision
- Flap reflection
- Bone preparation
- Positional guide
- Enlarging osteotomy site
- Placement, torque and primary stability
- Cover screw placement, wound closure and temporisation
What do we mean by bone preparation
Getting through the soft tissue remnants to the bone
Cresting a flatten or scallop ridge crest
Talk through atraumatic implant site preparation
- Low speeds/ high torque
- Sharp graduated drills
- Efficient cooling/ evacuation of debris
What can happen if don’t have adequate cooling during bone preparation
If temperature reaches above 47 degrees fro 1 min bone necrosis will occur
What are the 4 different bone types called
I
II
III
IV
Describe bone quality I
Homogenous cortical bone
Describe bone quality II
Thick cortical bone with marrow centre
Describe bone quality III
Thin cortical bone with dense trabecular bone of good strength
Describe bone quality IV
Very thin cortical bone with low density trabecular bone of poor strength
Name the 3 positions we need to consider when placing our implant
- Mesio distal
- bucco palatally
- Apico coronally
What post operative considerations need to be made after implant surgery
- Avoid disturbing the surgical site
- Avoid alcohol, smoking and vigorous exercise
- Antibiotics
- Analgesics
- Cholorhexidine mouth rinse
- Ice pack
- Keep wel hydrated
- Balanced soft diet
After the first stage of implanted surgery is completed what do we wait for
For the bone and implant to integrate
Talk through the steps of the 2nd stage of implant surgery
- Simple crest incisor
- Reflection of soft tissues
- Removal of cover screw
- Check bone
- Placement of healing abutment
- Soft tissue sculpting
- Placement of sutures
- Allow soft toss healing for 4 weeks
If we find soft tissue is lacking interdentally between multiple implants what can we do
Implant exposure using rotation finger flaps
what are rotational finger flaps called
Palacci flaps
How do we create palace flaps
- Create a crystal incision
- Reflect flap to buccal
- Connect healing abutments
- Semi lunar incisors from distal of implant
- Rotate mini finger flaps medial into internal space and suture
What do we space on the implant after the second stage
A provisional crown fro 3 months to allow soft tissue remodelling
What do we mean by immediate placement of implants
Implants placed in to extraction sockets
What do we mean by delayed/ early placement of implants
Implants placed in to extraction sockets 6-8 weeks post extraction
What do we mean by delayed/ late placement of implants
Implant placed more than 3 months post extraction
What considerations do we need to make before immediate placement of implants
- Bone quality and quantity
- Integrity of buccal plate
- Implant to bone gap
- Primary stability
- Infection
- Soft tissue biotype
- Temporisation
How do we carry out immediate implant placement
- Careful removal of tooth
- Assess bone
- Use pilot drill to establish orientation of implant
- Protection of buccal plate of bone
- Prepare site Using direction indicator and surgical guide
- Implant placement
- Graft material between implant and socket wall
- Placement of healing abutment
How do we carry out delayed immediate implant placement
- Extract teeth
- Soft tissue healing over 6 weeks
- Flap reflection
- Contour down bone
- Implant placement with surgical guide
6.
List the different techniques we can use to augment deficient ridges
- Ridge expansion
- Guided bone regeneration
- Block only grafts
- Maxillary sinus grafts
- Combination procedures
What is ridge expansion
mechanically pushing out the buccal plate of bone to create space for an implant rather than drilling a hole for the implant
How do we carry out guided bone regeneration
- use a choral to remove bone chips from surrounding bone
- Decorticate the bone a chisel or bur
- Place bone chips over the implant site and adjacent area to augment deficient site
- Biomaterials can be used further augment the site and protect autogenous bone chips for resorption
- Collagen membrane is placed over the area
Why is a collagen membrane placed over there area following guided bone regernation
To protect the soft tissues in growth
Where can ewe harvest block bone cells fro a block only graft
The mental region
Name a technique we can use to carry out maxillary sinus graft
Lateral windows technique
Talk though the lateral window technique
- Use large particles of bovine bone granules mixed with bone chips and blood to graft the sinus floor
- Porcine collagen membrane is placed over the lateral window and stabilised with titanium tacks prior to closure
- 6 months needed for healing before implant placed
