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Outline for 1/28/09 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Take home messages last week:  Tx. Planning with implants ,[object Object],[object Object]
Take home messages last week:  Tx. Planning with implants ,[object Object],[object Object],[object Object]
Take home messages last week:  Tx. Planning with implants ,[object Object],[object Object],[object Object]
Take home messages last week:  treatment planning with implants ,[object Object]
Questions this week ,[object Object],[object Object],[object Object],[object Object]
Questions this week ,[object Object],[object Object]
Questions this week ,[object Object],[object Object]
Questions this week ,[object Object],[object Object]
Questions this week ,[object Object],[object Object]
Titanium Implants – Current Surfaces ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Titanium Implants - Surface Modification 2 nd  Generation   ,[object Object],Initial studies  indicated that the bone appositional index achieved is  50% greater with rough surfaces as compared to machined surfaces (Buser et al, 1991; Weinlander, 1993; Hamada, 1995; Nishimura and Ogawa, 2000, 2003) Dual Acid etched Electrolytically enhanceed Sandblast Acid-ethched
50 µm Near zone Far zone Histomorphometry Acid etched vs Machine surface More recent studies (Ogawa and Nishimura, 2000, 2003), reconfirm these findings * * Bone-implant contact ratio 0 20 W2 W4 40 60 80 (%) Machined Acid etched
Summary of Ogawa’s and Nishimura’s work re: gene expression ,[object Object],[object Object]
Questions this week ,[object Object],[object Object]
Micromotion ,[object Object],[object Object],[object Object],[object Object],[object Object],150µm 500µm 50µm Tolerated Deleterious
Ten cases ,[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object]
[object Object],[object Object],[object Object]
[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment planning decisions for single tooth implants ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Evaluate how much crown lengthening would be necessary if you were to save the tooth. Determine from the patient history and clinical examination how many implants make sense. If the patient has high biting forces you would need two splinted implants. If the patient is older and has sufficient tooth-to-tooth stops you might consider a SDA. If the patient has low levels of implant loading and a wide arch, you might consider a single wide diameter implant.
[object Object],[object Object],[object Object]
[object Object],[object Object]
[object Object]
[object Object]
[object Object]
Treatment planning decisions for single tooth implants ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
FDP, RDP or implant?? ,[object Object]
FPD Success Rates ,[object Object],[object Object],[object Object]
Implant success rates ,[object Object],[object Object],[object Object]
Treatment planning decisions for single tooth implants ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Determine what the patient’s expectations from treatment are Determine where bone might be grafted from. Then move foreword knowing that   much more force will be on the implants because of the lower natural dentition.
1)Complete diagnostic set-up 2)Index teeth 3)Place pins where you want implants 4) Complete 0.060 suck-down
 
[object Object],[object Object]
Site preparation for implants Orthodontics Ridge splitting Onlay grafting Membranes
Be sure to get the height of the implants correct; images of CT, pano
[object Object]
 
A connective tissue graft was added to hide the margin of the angulated implant.
Treatment planning decisions for single tooth implants ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Dental Implants
 
 
 
Nevin, M JPerio, 2005 Use open tray, have pre-selected denture tooth, use screw retained, out of occlusion, don’t touch for several months, altering proximal contacts to work papilla .
 
 
 
 
Immediate or Early Loading Was it feasible with the original machined surface?   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Biologic processes to complete  osseointegration* * In humans these events take about 4-5 months with machined surfaces  In most cases no!!!  WHY?
Initial Primary Stability ( 1 st   few days) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Courtesy Dr. C. Stanford
Treatment planning decisions for single tooth implants ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Surface Area of Implants ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What diameter do I use? ,[object Object],[object Object],[object Object],5.0 3.5
Treatment planning decisions for single tooth implants ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Internal vs. External connection ,[object Object],[object Object],[object Object]
Treatment planning decisions for single tooth implants ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
To splint or not to splint?
 
Splinting of implants ,[object Object],[object Object],[object Object],[object Object]
Splinting of implants ,[object Object],[object Object],[object Object]
Splint if bone is grafted, or low density
Internal vs. External connection ,[object Object]
Platform switching 4.8 mm 4.1 mm
Platform switching ,[object Object],[object Object],[object Object],4.8 mm 4.1 mm
Platform switching ,[object Object],[object Object],[object Object]
Treatment planning decisions for single tooth implants ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cement or screw retained ,[object Object],[object Object]
Cement or screw retained ,[object Object],[object Object],[object Object]
Cement or screw retained ,[object Object],[object Object]
Cement or screw retained ,[object Object],[object Object]
[object Object],[object Object]
[object Object],[object Object],Tooth ,[object Object],Implant ,[object Object]
Cement or screw retained ,[object Object]
Cement or screw retained ,[object Object],[object Object]
Other considerations for single tooth implants ,[object Object],[object Object]
Other considerations for single tooth implants ,[object Object]
Other considerations for single tooth implants ,[object Object],[object Object]
Other considerations for single tooth implants ,[object Object]
Other considerations for single tooth implants ,[object Object]
Other considerations for single tooth implants ,[object Object]
Other considerations for single tooth implants ,[object Object],[object Object],[object Object]
Please list the mistakes you can see with this implant placement
Patient worries about esthetics; you need to also worry about function
Steps for a single tooth implant
Tell me the steps
 
What is wrong?
Site preparation may not be necessary if the patient’s smile line is not very high. My preference is screw retained, using a metal lingual for less bulk and improved contours.

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Treatment planning review and implant questions

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  • 13. 50 µm Near zone Far zone Histomorphometry Acid etched vs Machine surface More recent studies (Ogawa and Nishimura, 2000, 2003), reconfirm these findings * * Bone-implant contact ratio 0 20 W2 W4 40 60 80 (%) Machined Acid etched
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  • 28. Evaluate how much crown lengthening would be necessary if you were to save the tooth. Determine from the patient history and clinical examination how many implants make sense. If the patient has high biting forces you would need two splinted implants. If the patient is older and has sufficient tooth-to-tooth stops you might consider a SDA. If the patient has low levels of implant loading and a wide arch, you might consider a single wide diameter implant.
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  • 39. Determine what the patient’s expectations from treatment are Determine where bone might be grafted from. Then move foreword knowing that much more force will be on the implants because of the lower natural dentition.
  • 40. 1)Complete diagnostic set-up 2)Index teeth 3)Place pins where you want implants 4) Complete 0.060 suck-down
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  • 43. Site preparation for implants Orthodontics Ridge splitting Onlay grafting Membranes
  • 44. Be sure to get the height of the implants correct; images of CT, pano
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  • 47. A connective tissue graft was added to hide the margin of the angulated implant.
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  • 53. Nevin, M JPerio, 2005 Use open tray, have pre-selected denture tooth, use screw retained, out of occlusion, don’t touch for several months, altering proximal contacts to work papilla .
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  • 66. To splint or not to splint?
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  • 70. Splint if bone is grafted, or low density
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  • 91. Please list the mistakes you can see with this implant placement
  • 92. Patient worries about esthetics; you need to also worry about function
  • 93. Steps for a single tooth implant
  • 94. Tell me the steps
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  • 97. Site preparation may not be necessary if the patient’s smile line is not very high. My preference is screw retained, using a metal lingual for less bulk and improved contours.