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implant

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Rikko Hudyono

on 23 September 2016

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Transcript of implant

IMPLANT
Difficult
Expensive
Usually failed
Pharaoh's Implant 1000 BC
This piece which looks like a sort of a bridgework is from pure gold. Archaeologist think it was made at 1.000 BC for a king or a royalty
This bridge was discovered by a group of Italian researchers for unidentified Mayan woman, she was buried in a very elaborate tomb. This work estimated from 100-200 A.D
The ancient Romans use of iron implants and the remains of a female Mayan skull dating back to 600 AD indicated that seashell was the material of choice when it came to replacing missing teeth.
The ancient civilization has been shown to have used the earliest known examples of endosseous implants (implants embedded into bone), dating back over 1,350 years before Per-Ingvar Brånemark started working with titanium.
The ancient implants were found in Egypt, Roman and Mayan civilization
Native Americans to add bling to their teeth as far back as 2,500 years ago, a new study says.
In ancient Egypt, reconstructive work was rare—but when they did it, they really did it. This bridge was made by stringing wire through donor teeth, tied to surrounding teeth
Mucosal Inserts
Found by Dahl at 1940 in Germany

First made to stabilize the denture on the upper jaw

This design consist of intramucosal button which later inserted to to specially prepared palatal mucosa
The concept
Subperiosteal Implant
Goldberg and Gershkoff in 1948

Made from vitallium

In 1984, this kind of implant were
made with CT scan to eliminate the
need of bone impression
The concept
Due to the nature of bone resorption, the subperiosteal implant will later become exposed and infected
Transosteal Implant
TRANSOSSALES IMPLANTAT
THE CONCEPT
Sollier, Chercheve and Small in 1953

Mechanically screwed through bicortical layer of the mandibular bone

Provide fixation for denture on the lower jaw
Transosteal implant on the mandibula
Ramus Implant
An arch shaped implant that is placed through the residual bone.

It crosses the mandibular midline and is placed into osteotomy sites into the mandibular basal bone.

It penetrate through the occlusal of the residual alveolar ridge using an extraoral approach.
Ramus implant (Roberts & Roberts, 1970)
IMPLANT
Single crown replacement
Rikko Hudyono
The history of modern implantology
The history started from 3.000 B.C
Blade Implant
Linkow, 1967

was not longer used

demonstrated no osseointegration around it
Per Ingvar Branemark
Started his work in dental implant since 1952

Revolutionized the modern implant with screw-type implant.

Accidentally found the concept of osseointegration onto the titanium while he was working in his lab
Disc Implant
bioactive
TODAY
Branemark's first implant
Single tooth missing
what will we do?
CASE
bridge work
need grinding for abutment teeth
removable denture
is it comfortable doctor ?
Overall Medical
Record
- inquire physician for successful treatment
- sometimes sedative agent may help
- please do the most simple operation
procedure
- prepare nitroglycerin in your office
- limit the use of epinephrine
Stenocardia
Hypertension
Hypertension
- consult the physician
- usually suspend the dosage for 4 to 5 days
Anticoagulant
- amoxicillin 2 mg 1 hour prior to surgery
Sub-acute bacterial endocarditis
- may impair wound healing and affect the
microvascularisation
Diabetes
Diabetic patient has no increased risk of
implant failure and a similar number of
prosthodontic complications compared
to non-diabetic patient (Mambelli, 2006).
no association
between osteoporosis and
implant failure
Osteoporosis
!
be careful to the bisphoponalt
as it may cause osteoradionerosis
Dental
Evaluation
Radiographic
Evaluation
Clinical evaluation
Implant shoulder
Bone layer minimum 1 mm in thickness
Bone layer minimum 1 mm in thickness
2 mm
? mm
?
Periapical
any focus in the adjacent teeth
bony structure of the adjacent teeth
any strange object
paralellism
Panoramic
important anatomical structure
bone quantity and quality
CT Scan
minimum distance
implant - tooth = 1.5 - 2 mm
implant - implant = 3 mm
3 D imagination
Occlusal Radiography
D1 D2 D3 D4
1.5 - 2 mm
Biological width reason
Bone Mapping
Panoramic
Distortion may occur

Magnification of 1.25 - 1.3 times
4.8 x tinggi tulang x-ray
tinggi tulang =
diameter bola x-ray
Our problem
H
W
CONCEPT
Look back at the history
the first consultation
How to imagine the bone topography without CT?
shall we use ?
DENTAL IMPLANT
what kind of
vs
one piece
cheaper
easier to place
simple
don't need second stage surgery
small implant diameter is available
abutment choice limited
angulation can be a problem
more abutment choice
abutment change is possible in the future
abutment angle can be adjusted especiall in bridge
can be placed in minimum occlusal height
more complicated
more expensive
usually have bigger diameter
Two stage implantation
subgingival healing process
needs surgical uncovering to connect mesostructure
needs mesostructure
The angulation of the abutment is easily adjusted.
Mucogingival correction is possible to be performed.
Supra structure may easily designed
+
-
Needs surgical uncovering
More complicated
The presence of microcleft
One Stage Implantation
the healing process takes place transgingivally
This healing permits primary adaptation of the soft-tissue structures around the implant.

One-stage implants may be supplied with a prosthesis and loaded immediately after insertion, or they may heal unloaded.

In one-stage implant systems, part of the implant perforates the mucosa during the healing phase and thus protrudes into the oral cavity.

Do not need mesostructure
Surgical uncovering is therefore not required
two piece
tissue level
implant
bone level
implant
Biological Width
reasonb
IMPLANT
Difficult
Expensive
Usually failed
Pharaoh's Implant 1000 BC
This piece which looks like a sort of a bridgework is from pure gold. Archaeologist think it was made at 1.000 BC for a king or a royalty
This bridge was discovered by a group of Italian researchers for unidentified Mayan woman, she was buried in a very elaborate tomb. This work estimated from 100-200 A.D
The ancient Romans use of iron implants and the remains of a female Mayan skull dating back to 600 AD indicated that seashell was the material of choice when it came to replacing missing teeth.
The ancient civilization has been shown to have used the earliest known examples of endosseous implants (implants embedded into bone), dating back over 1,350 years before Per-Ingvar Brånemark started working with titanium.
The ancient implants were found in Egypt, Roman and Mayan civilization
Native Americans to add bling to their teeth as far back as 2,500 years ago, a new study says.
In ancient Egypt, reconstructive work was rare—but when they did it, they really did it. This bridge was made by stringing wire through donor teeth, tied to surrounding teeth
Mucosal Inserts
Found by Dahl at 1940 in Germany

First made to stabilize the denture on the upper jaw

This design consist of intramucosal button which later inserted to to specially prepared palatal mucosa
The concept
Subperiosteal Implant
Goldberg and Gershkoff in 1948

Made from vitallium

In 1984, this kind of implant were
made with CT scan to eliminate the
need of bone impression
The concept
Due to the nature of bone resorption, the subperiosteal implant will later become exposed and infected
Transosteal Implant
TRANSOSSALES IMPLANTAT
THE CONCEPT
Sollier, Chercheve and Small in 1953

Mechanically screwed through bicortical layer of the mandibular bone

Provide fixation for denture on the lower jaw
Transosteal implant on the mandibula
Ramus Implant
An arch shaped implant that is placed through the residual bone.

It crosses the mandibular midline and is placed into osteotomy sites into the mandibular basal bone.

It penetrate through the occlusal of the residual alveolar ridge using an extraoral approach.
Ramus implant (Roberts & Roberts, 1970)
IMPLANT
Single crown replacement
Rikko Hudyono
The history of modern implantology
The history started from 3.000 B.C
Blade Implant
Linkow, 1967

was not longer used

demonstrated no osseointegration around it
Per Ingvar Branemark
Started his work in dental implant since 1952

Revolutionized the modern implant with screw-type implant.

Accidentally found the concept of osseointegration onto the titanium while he was working in his lab
Disc Implant
bioactive
TODAY
Single tooth missing
what will we do?
CASE
bridge work
removable denture
need grinding for abutment teeth
is it comfortable doctor ?
implant
what i should do?
Relative
Risk
Factors
- inquire physician for successful treatment
- sometimes sedative agent may help
- please do the most simple operation
procedure
- prepare nitroglycerin in your office
- limit the use of epinephrine
Stenocardia
Hypertension
Hypertension
- consult the physician
- usually suspend the dosage for 4 to 5 days
Anticoagulant
- amoxicillin 2 mg 1 hour prior to surgery
Sub-acute bacterial endocarditis
- may impair wound healing and affect the
microvascularisation
Diabetes
Diabetic patient has no increased risk of
implant failure and a similar number of
prosthodontic complications compared
to non-diabetic patient (Mambelli, 2006).
no association
between osteoporosis and
implant failure
Osteoporosis
!
be careful to the bisphoponalt
as it may cause osteoradionerosis
Dental
Evaluation
Radiographic
Evaluation
Clinical evaluation
Implant shoulder
Bone layer minimum 1 mm in thickness
Bone layer minimum 1 mm in thickness
? mm
? mm
?
Periapical
any focus in the adjacent teeth
bony structure of the adjacent teeth
any strange object
paralellism
Panoramic
important anatomical structure
bone quantity and quality
CT Scan
minimum distance
implant - tooth = 1.5 - 2 mm
implant - implant = 3 mm
3 D imagination
Occlusal Radiography
D1 D2 D3 D4
1.5 - 2 mm
Biological width reason
Bone Mapping
Panoramic
Distortion may occur

Magnification of 1.25 - 1.3 times
4.8 x tinggi tulang x-ray
tinggi tulang =
diameter bola x-ray
Our problem
H
W
CONCEPT
Look back at the history
the first consultation: what should we know
How to imagine the bone topography without CT?
shall we use ?
DENTAL IMPLANT
what kind of
vs
one piece
cheaper
easier to place
simple
don't need second stage surgery
small implant diameter is available
abutment choice limited
angulation can be a problem
more abutment choice
abutment change is possible in the future
abutment angle can be adjusted especiall in bridge
can be placed in minimum occlusal height
more complicated
more expensive
usually have bigger diameter
Two stage implantation
subgingival healing process
needs surgical uncovering to connect mesostructure
needs mesostructure
The angulation of the abutment is easily adjusted.
Mucogingival correction is possible to be performed.
Supra structure may easily designed
+
-
Needs surgical uncovering
More complicated
The presence of microcleft
One Stage Implantation
the healing process takes place transgingivally
This healing permits primary adaptation of the soft-tissue structures around the implant.

One-stage implants may be supplied with a prosthesis and loaded immediately after insertion, or they may heal unloaded.

In one-stage implant systems, part of the implant perforates the mucosa during the healing phase and thus protrudes into the oral cavity.

Do not need mesostructure
Surgical uncovering is therefore not required
two piece
tissue level
implant
bone level
implant
The objectives of implant
Protection of remaining dental hard tissues
Fixed dentures that could not otherwise be implemented with conventional treatment
Stabilization of removable dentures
Preservation of bone bed (prevention of disuse atrophy)
Oral rehabilitation after trauma, tumor, etc.
History of tooth loss
Trauma
Periodontitis
Caries
Agenesis
In case of trauma the alveolar bone may be intact, partially loss or totally lost
Consider the bone grafting procedure prior to implant placement
Marginal bone loss particularly on the buccal aspects
check the periodontal active disease and maintenance the healthy state
prior to any regeneration procedure
Reason for
implant
psychogenic prosthesis
intolerance
patient's
cooperation
Preliminary Consultation
smoking
smoking reduces the implant
success rate
treatment time and procedure
costs
probability of success
increased necessity of check ups
•Anticoagulation
•Hemophilia
•Hepatic cirrhosis
•Unstable Type I diabetes mellitus
•Disorders of the hematogenic system (leucocytosis,...)
•Immunosuppressive therapy (cortisone, cytostatic agents,...)
•Kidney diseases, dialysis, treatment with diuretics (Ca++, P++ levels)
•Rheumatic diseases or collagenoses•
Bone system disorders
HIV
•Allergies
•Neuroses/psychoses
•Convulsive disorders
Contra Indication
Prosthodontic Criteria
Interarch relationship
Adjacent teeth evaluation
Parafunctional habit
Inspection of existing denture
Centric and dynamic occlusion
TMJ
Esthetic Evaluation
Smile line

Patient perception &
expectation
Periodontal Criteria
Oral Hygiene



Periodontal disease



Width of the keratinized mucosa
patient cooperation shall be sufficient



no active disease



minimum 3 mm of keratinized mucosa
Manufacturer
Product
price....
CASE
every case is unique
It's depend on our creativity and ability
implant product, diameter & length availability
abutment choices
implant kit and service
Thank you
for your attention
biological width
Full transcript