1、Implant Guidelines for the Restorative Dentist,Prosthodotic Teaching and Researching Section Department of Stomatology Lanzhou Medical College,Implant Guidelines for the Restorative Dentist,Liu Bin Yu Zhanhai,Right now my life is just one learning experience after another By the end of the week I sh
2、ould be a genius! Jeanette Osias,Implant Guidelines,What is a dental implant? Definition an endosteal (within bone) alloplastic biologically compatible material surgically inserted into the edentulous bony ridge,Implant Guidelines,What is a dental implant? Use to serve as a foundation for prosthodon
3、tic restoration,Implant Guidelines,What is a dental implant? History (endosseous) dates to Egyptians Greenfield (1913) - patented two-stage system Formiggini (1947) - “father of modern implantology” helical wire spiral,Implant Guidelines,What is a dental implant? History (endosseous) single stage on
4、e-piece from bone through oral mucosa (crystal sapphire implants) two-stage bony implant separate from transmucosal portion variable design & materials,Implant Guidelines,What is a dental implant? Biomaterials most commonly used commercially pure (CP) titanium titanium-aluminum-vanadium alloy (Ti-6A
5、l-4V) - stronger & used w/ smaller diameter implants,Implant Guidelines,What is a dental implant? Titanium lightweight biocompatible corrosion resistant (dynamic inert oxide layer) strong & low-priced,Implant Guidelines,What is a dental implant? Fixture types HA coated Ti surface modified tap or sel
6、f-tapping screw or press fit,Implant Guidelines,What is a dental implant? “Osseointegration” Brnemark - late 1980s direct structural & functional connection between ordered, living bone & surface of a load-carrying implant,Implant Guidelines,What is a dental implant? “Osseointegration” similar soft-
7、tissue relationship to natural dentition (sulcular epithelium) hemi-desmosome like structures connect epithelium to titanium surface,Implant Guidelines,What is a dental implant? “Osseointegration” circumferential and perpendicular connective tissue no connective tissue insertion no intervening Sharp
8、eys fiber attachment,Implant Guidelines,What is a dental implant? “Osseointegration” bone-implant interface osteoblasts in close proximityto interface separated from implant by thin amorphous proteoglycan layer osseointegration - highly predictable,Implant Guidelines,What is a dental implant? “Osseo
9、integration” bone-implant interface osteoblasts in close proximityto interface separated from implant by thin amorphous proteoglycan layer osseointegration - highly predictable,Implant Guidelines,What is a dental implant? “Osseointegration” bone-implant interface oxide layer continues to grow-(2000
10、A at 6 yrs) - mineral ion interaction increase in trabecular pattern bone deposition & remodeling in response to stress,Implant Guidelines,What is a dental implant? “Osseointegration” bone-implant interface oxide layer continues to grow-(2000 A at 6 yrs) - mineral ion interaction increase in trabecu
11、lar pattern bone deposition & remodeling in response to stress,Implant Guidelines,What is a dental implant? Components & terminology coping or prosthesis screw (top) coping analog implant body abutment transfer coping (indirect or direct),Implant Guidelines,What is a dental implant? Components & ter
12、minology hygiene screw abutment for screw, cement or attachment second stage permucosal abutment first stage cover screw implant body or fixture (bottom),Implant Guidelines,Implant Guidelines,What is a dental implant? Modern types implants are small - standard abutment - usually 3.75mm or larger in
13、diameter wide-body or wide-platform - up to 6.0mm,Implant Guidelines,What is a dental implant? Modern types lengths - typically range from about 7 to 18mm Navy uses “external hex” good research literature able to be maintained (3i or Nobel Biocare systems),Implant Guidelines,What is a dental implant
14、? Modern types (Nobel Biocare) Fixtures Standard Mk II,Implant Guidelines,What is a dental implant? Modern types (Nobel Biocare) Abutments Standard CeraOne EsthetiCone MirusCone Angulated 17 (new) or 30,Implant Guidelines,What is a dental implant? Modern types (Nobel Biocare) Standard no anti-rotati
15、onal properties can use for multiple units can use for hybrid dentures,Implant Guidelines,What is a dental implant? Modern types (Nobel Biocare) CeraOne single tooth esthetic replacement abutment attached to fixture w/ restoration cemented to abutment accommodation for fixture misalignment can provi
16、sionalize,Implant Guidelines,What is a dental implant? Modern types (Nobel Biocare) EsthetiCone esthetic FPD restorations machined gold cylinder abutment allows crown margin to seat close to fixture (within 1mm),Implant Guidelines,What is a dental implant? Modern types (Nobel Biocare) MirusCone esth
17、etic FPD restorations use when decreased vertical height allows 4.5mm clearance,Implant Guidelines,What is a dental implant? Modern types (Nobel Biocare) Angulated abutment 17 or 30 use to achieve better esthetic result where complicated anatomy exists use if less than ideal fixture placement use wh
18、ere esthetic cervical margin required,Implant Guidelines,What is a dental implant? Modern types (Nobel Biocare) CeraOne EsthetiCone MirusCone Angulated abutments All come with narrow, regular or wide platforms (NP, RP, WP),Implant Guidelines,What is a dental implant? Modern types (3i) Fixtures Micro
19、Miniplant Miniplant Standard Wide Diameter ( surface area to use where vertical height),Implant Guidelines,What is a dental implant? Modern types (3i) Fixtures ICE (incremental cutting edge)super self-tapping implant uses tapered cutting flutes allows more placement control rapid bone engagement & i
20、mplant stabilization,Implant Guidelines,What is a dental implant? Modern types (3i) Abutments EP (conical) - (esthetic profile) Gold UCLA-type Two-piece abutment post STA (standard) Pre-Angled New Gold Standard ZR (zero rotation),Implant Guidelines,What is a dental implant? Modern types (3i) Gold UC
21、LA-type abutment screw-retained at fixture level non-segmented abutment screw-retained crown to implant uses larger screw because it runs all the way to the fixture,Implant Guidelines,What is a dental implant? Modern types (3i) Gold UCLA-type abutment thin buccal-lingual tissues limited inter-occlus
22、al distance (as little as 4.5mm) single or multiple units,Implant Guidelines,What is a dental implant? Modern types (3i) EP (conical) - (esthetic profile) screw-retained crown to the abutment gold cylinder non-parallel implant placement single or multiple units minimum 7mm inter-occlusal distance re
23、quired,Implant Guidelines,What is a dental implant? Modern types (3i) Two-piece abutment post non-rotational cement-retained crown to the abutment simplicity of treatment - chairside preparation use when access to posterior region w/ screw driver is limited,Implant Guidelines,What is a dental implan
24、t? Whats new? (3i) Prep-Tite Posts screw retained abutment standard impression procedure cemented restoration 6 taper with 3 vertical grooves multiple collar heights,Implant Guidelines,What is a dental implant? Whats new? (3i) Osseotite (“clot retentive surface”) specific micro-topographic acid-etch
25、ed implant surface design Vs. machined-surface implant single stage implant loaded after 2 months claim 98.5% success after 3 years,Implant Guidelines,What is a dental implant? Remember. For FPDs plan for screw-retained restorations no anti-rotational properties always use at least 2 fixtures when r
26、estoring posterior spaces not bound by natural teeth!,Implant Guidelines,What is a dental implant? Advantages no preparation of tooth/adjacent teeth bone stabilization & maintenance retrievability improvement of function psychological improvement,Implant Guidelines,What is a dental implant? Disadvan
27、tages risk of screw loosening risk of fixture failure length of treatment time need for multiple surgeries challenging esthetics,Implant Guidelines,Consultation Appointment Treatment planning phase “Diagnosis begins with a complete patient evaluation” guidelines for “decision-making” process treat t
28、he “entire” patient restore form, function & esthetics,Implant Guidelines,Consultation Appointment Treatment planning phase problem list & patient desires initial evaluation chief complaint medical/dental history review intra/extraoral exam evaluation of existing prosthesis,Implant Guidelines,Consul
29、tation Appointment Treatment planning phase initial evaluation diagnostic impressions/articulated casts radiographs - panoramic and periapical (CT scan or tomography - as indicated) photographs,Implant Guidelines,Consultation Appointment Treatment planning phase treatment options/informed consent ex
30、planation of long-term commitment restorative - surgical joint consult two-stage surgery stage I stage II,Implant Guidelines,Consultation Appointment Treatment planning phase two-stage surgery (use of clear acrylic surgical stent is mandatory!) stage I - implant fixture placement w/ cover screw (lef
31、t submerged),Implant Guidelines,Consultation Appointment Treatment planning phase stage I - healing phase 3 month minimum (mandible ) - usually 6 months for posterior regions 6 month minimum (maxilla) - usually 6-9 months for all regions,Implant Guidelines,Consultation Appointment Treatment planning
32、 phase stage II - uncovering & placement of transmucosal healing abutment healing phase 4-6 weeks for soft tissue healing,Implant Guidelines,Consultation Appointment Treatment planning phase restorative phase maintenance and regular recall fee & payment policy goal to restore form, function & esthet
33、ics,Implant Guidelines,Treatment planning phase Problem list & treatment considerations teeth periodontium radiographic analysis surgical analysis esthetic analysis,Implant Guidelines,Treatment planning phase Problem list & treatment considerations occlusal analysis advs/disadvs of proposed treatmen
34、t referrals/specialty consults appointment sequencing treatment alternatives,Implant Guidelines,Treatment planning phase Problem list & treatment considerations teeth periodontium radiographic analysis surgical analysis esthetic analysis,Implant Guidelines,Treatment planning phase Problem list & tre
35、atment considerations teeth - number & existing condition prognosis of remaining teeth size, shape & diameter of existing dentition tooth & root angulations & proximity mesiodistal width of edentulous space,Implant Guidelines,Treatment planning phase Problem list & treatment considerations teeth - n
36、umber & existing condition minimum 6-7mm between teeth to facilitate implant placement (based on 3mm fixture) 1.5mm between implant & natural teeth 7mm from center of implant - to center of implant for edentulous area,Implant Guidelines,Treatment planning phase Problem list & treatment consideration
37、s teeth - number & existing condition more than 10mm mesiodistal space - single tooth implant not recommended (multiple abutments should be splinted),Implant Guidelines,Treatment planning phase Problem list & treatment considerations teeth periodontium radiographic analysis surgical analysis estheti
38、c analysis,Implant Guidelines,Treatment planning phase Problem list poorest in posterior regions,Implant Guidelines,Treatment planning phase Problem list & treatment considerations periodontium - bone support quantity - required for implant - 6mm buccal-lingual width w/sufficient tissue volume 8mm i
39、nterradicular bone width 10mm alveolar bone above IAN canal or below maxillary sinus,Implant Guidelines,Treatment planning phase Problem list & treatment considerations periodontium - bone support quantity - required for implant - if inadequate bone support may need ridge or site augmentation ramus
40、or chin graft (autograft) DFDBA (allograft) Bio-Oss(xenograft),Implant Guidelines,Treatment planning phase Problem list & treatment considerations periodontium - bone support place implants minimum of 2mm from IAN canal or below maxillary sinus crown/root ratio mobility furcations probing depths,Imp
41、lant Guidelines,Treatment planning phase Problem list & treatment considerations periodontium mucogingival problems need sufficient tissue volume to recreate gingival papilla need some attached gingiva to maintain peri-implant sulcus 1st year post-op bone resorption 1mm*crest of bone optimal 2- 3mm
42、below CEJ,Implant Guidelines,Treatment planning phase Problem list & treatment considerations periodontium mucogingival problems place implant 2-3mm apical to free gingival margin of adjacent tooth recreates biologic width of peri-implant sulcus *soft tissue height 4mm may create challenge!,Implant
43、Guidelines,Treatment planning phase Problem list & treatment considerations periodontium oral hygiene - important pre & post systemic manifestations - ie. diabetics are predisposed to delayed healing destructive habits - smoking is contraindicated - delayed or inadequate tissue healing & osseointegr
44、ation noted,Implant Guidelines,Treatment planning phase Problem list & treatment considerations teeth periodontium radiographic analysis surgical analysis esthetic analysis,Implant Guidelines,Treatment planning phase Problem list & treatment considerations radiographic analysis periapical pathology
45、radiopaque/radiolucent regions adequate vertical bone height adequate space above IAN or below maxillary sinus,Implant Guidelines,Treatment planning phase Problem list & treatment considerations radiographic analysis adequate interradicular area bone quality & quantity radiographs - panoramic and pe
46、riapical (CT scan or tomography - as indicated),Implant Guidelines,Treatment planning phase Problem list & treatment considerations radiographic analysis radiographs - aid to determine amount of “space”& bone available CT (computed tomography) scan - gives more accurate & reliable assessment of bone
47、 (quality, quantity & width) & locale of anatomic structures,Implant Guidelines,Treatment planning phase Problem list & treatment considerations radiographic analysis - radiographic stent - (can double as surgical stent) acrylic stent with lead beads or ball -bearings (5mm) placed in proposed fixtur
48、e locationsallows more accurate radiographic interpretation,Implant Guidelines,Treatment planning phase Problem list *most accurate (1.0-1.1x) Lateral Ceph 8% Periapical 2.5-5%,Implant Guidelines,Treatment planning phase Problem list & treatment considerations teeth periodontium radiographic analysi
49、s surgical analysis esthetic analysis,Implant Guidelines,Treatment planning phase Problem list & treatment considerations surgical analysis - surgical guide stent - *one of the most critical factors for obtaining an ideal surgical & esthetic result used during fixture installation as guide for optim
50、al B/L and M/D position use of buccal channel drill guide allows improved access & visibility,Implant Guidelines,Treatment planning phase Problem list & treatment considerations surgical analysis - implant length/diameter determined by quantity of bone apical to extraction site use longest implant safely possible diameter dictated by corresponding root anatomy at crest of bone,
