1. Dental Implants Not just Implantology but the Science behind it .
Sanjay CHAUHAN
PG Diploma in Implant Dentistry ( France )
PG Certificate in Endodontics ( IGNOU )
B.D.S. ( Govt Dental College – Goa )

2. Dedicated to my Mentor Professor Dr. Manuel Chanavaz

3. I N S P R A T O

4. Didactics and Two Hands-on
1st Module : Let’s get started with Dental Implants
Didactics and Two Hands-on

5. Rationale , Evolution & Scope of Oral Implantology
What are the aims & objectives of oral rehabilitation by means of dental implants and bone reconstructive surgeries ?
What is Wolff’s law ? What are its clinical implications in Implantology ?
Anatomical consequences of edentulism in mandible and maxilla .
Historical review and evolution of dental implants from blade form to contemporary endosseous root form implants .

6. Philosophy of contemporary Implant Surgery
Definition of Oral Implantology ?
ASA Classification ? Its significance in Implantology ?
What is alveolar bone ?
What is occlusal plateau ?
What are Preprosthetic Surgeries ?
What are absolute contraindications for implants ?
What are relative contraindications for implants ?
French volumetric classification of available bone by Professor Manuel Chanavaz ( Quantitative ) .
Classification of bone based on density by Carl E Misch ( Qualitative )
What is osteointegeration ?
What are primary & secondary interferences ?

7. What do you mean by confidential medical questionnaire ?
What are tests of primary intention ?
What are tests of secondary intention ?
CLINICAL EXAMINATION ????
Medical imaging ?
Medications of special interest to implant dentistry ?
IOPA
OPG
Medical grade C.T. scan
C.B.C.T . Scan
Dentascan ?
Dicom – dire format ?
Interactive CT scan
Bisphosphonates
Anticoagulant medication
Herbal supplements

8. Lifestyle related factors . . .
Calcium metabolism ?
Osteoporosis ? Primary & Secondary osteoporosis ?
GTR ?
PRF ?
Tobacco
Alcohol
Obesity
Sports
Drug addiction
Psychological diseases

9. Definition of treatment planning ?
What are the objectives of treatment planning ?
Oral rehabilitation using endosseous implants in general practise ???
Oral rehabilitation using endosseous implants in general practise with bone grafts ???
Oral rehabilitation using endosseous implants in general practise with bone grafts in hospital ???
Oral rehabilitation using endosseous implants and extensive bone grafts & orthognathic procedures in hospital ???
Oral rehabilitation using endosseous implants and extensive bone grafts & orthognathic procedures and tissue graft in hospital ???

10. What are the ideal goals of modern dentistry ?
What are the advantages of a single tooth implant ?
What are the disadvantages of a single tooth implant ?
What are the factors that influence treatment planning ?
What is the minimum age at which implant can be inserted in males and females and why ?
Which are the conditions that must be ideal to get desirable aesthetics of implants ?
How far an implant should be from adjacent tooth and why ?
What should be the minimum gap between the two implants and why ?
How far an implant should be from a neurovascular bundle ?
How far an implant should be from maxillary sinus ?
How far an implant should be from floor of the nose ?
Two stage implant ? One stage implant ? Immediate loading implants ?

11. Asepsis , Sterilization & Disinfection
Define asepsis ?
What is the difference between asepsis & sterilization ?
What is cross contamination ?
What are nosocomial infections ?
What is the difference between the bacteriostatic & bactericidal ?
Modalities of sterilization ?
Autoclaving ?
Standard international protocol of sterilization ?
Standard international operation theatre protocol ?

12. Cleaning , packing & sterilization of instruments .
1st Hands-on .... ASEPSIS
Cleaning , packing & sterilization of instruments .
Arrangement & management of surgical disposables .
Scrub suit for doctor & patient .
International protocol for scrubbing .
How to wear surgical gloves ?
How to drape the patient ?
Management of trolleys ?
How to connect suction and handpiece for implant motor ?
How to administer LA without hampering the asepsis ?
Role of operating surgeon , assistant , mentor & circulating nurse ?
Brief idea about implant placement under conscious sedation and under GA ?

13. Types of dental implants ? ( Endosseous & Subperiosteal )
Implant body & prosthetic abutment ?
Implant body
Implant design of endosseous root form Implant
Implant length
Implant diameter
Implant shape / Macrogeomatry
Surface characteristics
Crest module consideration & design of apex
Crest module
Body
Apex
External hex
Internal hex
Thread pitch
Thread shape
Thread depth

14. Surgical placement of implant ?
Sub-gingival healing & trans-gingival healing ?
2nd stage surgery ?
Healing abutment / healing screw / gingival former ?
Impression coping / impression post ?
Permanent Abutment
Transfer coping
Pick-up coping
Abutment for screw retention
Abutment for cement retention
Abutment for attachment
Straight abutment
Angled abutment

15. Diagnostic Casts & Surgical Template
Surgical stent / Surgical guide ?
Radiographic stent ?
Computer guided implant placement ?
Computer assisted design & manufacturing of surgical guides ?
Surgical navigation / Electronic surgery ?

16. 2nd Hand-on ....Implant Placement in dummy mandible
Introduction to armamentarium of surgical & prosthetic kit .
Introduction to implant motor / Physiodispenser .
Introduction to surgical guide .
Osteotomy on dummy mandible with sequential drilling .
Introduction to external & internal irrigation .
Implant placement on dummy mandible .
Placement of cover screw .
Introduction to prosthetic components .
Basic idea of impression procedure in Implant dentistry ?
Transfer type of impression coping
Pick-up type of impression coping
Implant level impression
Abutment level impression

17. Didactics and Hands-on
2nd Module : Implant Prosthodontics
Didactics and Hands-on

18. Prosthetic Options in Implant Dentistry
PROSTHETIC CLASSIFICATION ( Carl E Misch – 1989 )
FP-1
FP-2
FP-3
RP-4
RP-5
Kennedy's Classification ?
Applegate’s Modifications ?
What is crown height space ?
What are the measures that are to be done when CHS increases ?

19. Bone Density : A key determinant for treatment planning
Misch Bone density classification scheme ...
CT determination of bone density . ‘ Tomodensitometry ’
What is the effect of bon density on treatment plan ?
Key implant position & number ? D1 D2 D3 D4 D5

20. Implant Body Size : A biomechanical & Aesthetic Rationale
Forces applied to the dental implants may be characterised in terms of 5 distinct factors ..
Short v/s long implants ?
Narrow v/s wide implants ?
Implant diameter criterion ?
Implant length criterion ?
Magnitude
Duration
Direction
Type
Magnification

21. Preimplant Prosthodontics
5 initial elements that should be assessed in sequence and treated when indicated ...
Maxillary anterior tooth position
Existing occlusal vertical dimensions
Mandibular incisal edge position
Maxillary occlusal plateau
Mandibular occlusal plateau

22. Specific criterion .... Lip line Maxillo-mandibular relationship
Existing occlusion
CHS
TMJ status
Extraction of hopeless teeth
Existing prosthesis
Arch form : Ovoid , Tapering , Square
Natural tooth adjacent to implant site
Soft tissue evaluation of implant site

23. Implant Prosthodontics
PROSTHODONTIC REVIEW of the patient .
FPD impression V/S Implant impression .
Wolff’s Law...Clinical Implications .
Hex design of Implant ..External hex & Internal hex .
Cement retained restorations & screw retained restorations .
Implant level screw retained & abutment level screw retained restorations .
An introduction to all the prosthetic components .
Transgingival & Subgingival healing .
When to do 2nd stage surgery .
Healing abutment / healing screw / gingival former .
Abutment diameter selection .
Impression procedure & Interocclual record registration .
Implant level impression & Abutment level impression .
Closed tray impression & Open tray impression .

24. Transfer coping / Impression coping .
When to use transfer impression coping ?
When to use pick up impression coping ?
Impression technique overview .
Impression materials for implant dentistry .
Impression trays .
Tray adhesives .
Manipulation of elastomeric impression materials .
Protect cap .
Incorporation of soft tissue contours around implants .
Screw retained implant supported prosthesis .
Cement retained implant supported prosthesis .
Convertible abutments .
ABUTMENT : Height & Angulation selection .
Single piece & two piece abutment .
CAD – CAM prosthesis .
Precision attachment in Implants .

25. O – ring / Ball attachment . Locator attachment .
Hadder bar & Dolder bar .
Single tooth replacement & multiple teeth replacement .
Complete implant supported prosthesis .
Implant supported overdentures ..Mandible & Maxilla .
Implant supported fixed prosthesis .. Mandible & Maxilla .

26. Partial edentulous condition
Single tooth / Multiple teeth
Maxillary / Mandibular
Anterior / Posterior
Implants are parallel / non parallel
Connection : External hex / internal hex
Screw retained / Cement retained prosthesis

27. Mandibular implant supported overdentures
Agony of mandibular denture .... ?
Mandibular implant supported overdentures .. Advantages ?
Implant supported overdentures v/s fixed prosthesis ?
Mandibular Overdentures ...Treatment options
Overdenture -1.
Overdenture -2.
Overdenture -3 A.
Overdenture -3 B
Overdenture - 4.
Overdenture - 5 .

28. Edentulous Mandible : Treatment plan for fixed restoration
Advantages of fixed prosthesis in Mandible .
Disadvantages of fixed prosthesis in Mandible .
Mandibular Dynamics ???????
Treatment options for fixed prosthesis ?
Treatment Option - 1.
Treatment Option - 2.
Treatment Option -3.
Treatment Option - 4.
Treatment Option - 5.

29. Maxillary arch implant considerations : Fixed & IODs
Premaxilla compromised anatomical conditions .
Premaxillary arch form .. Square , Ovoid , Tapering .
Premaxilla partial edentulous ... Treatment plan ?
Premaxilla complete edentulous ...Treatment plan ?
Posterior maxilla partial edentulous ...Treatment plan ?
Posterior maxilla complete edentulous ...Treatment plan ?
Completely edentulous maxilla ...Treatment plan ?
Key implant positions ?
Implant dimensions ...Length & Diameter ?
Maxillary Implant supported over dentures ...Treatment options .... RP -5 , RP - 4 .
Maxillary Implant supported fixed prosthesis ?
Special considerations for edentulous posterior maxilla ?

30. Single Tooth Replacement
Disadvantages of replacing 2nd Mandibular molar ?
Local contraindications for a single tooth implant ?
Implant placement in mandibular molar region ?
Implant placement in mandibular premolar region ?
Implant placement in mandibular canine region ?
Implant placement in mandibular incisor region ?
Implant placement in maxillary molar region ?
Implant placement in maxillary premolar region ?
Implant placement in maxillary canine region ?
Implant placement in maxillary incisor region ?

31. Uncovery and management of complications ? Surgical failure ?
Second Stage Surgery
Uncovery and management of complications ?
Surgical failure ?
Osseous healing failure ?
Early loading failure ?
Intermediate loading failure ?
Late failure ?
Criterion for evaluation of successful implant at 2nd stage Uncovery ?
Reasons for greater Crestal bone loss around a prematurely exposed implant ?
Causes of bone loss at 2nd stage surgery ?
Resolution of bone loss at Uncovery ?
Rigid fixation determination ?

32. 3rd Hands-on ...Implant Prosthodontics
Prosthetic review of the case ?
Mounted articulated study casts ?
Two situations
Partially edentulous
Complete edentulous
Mandible / Maxilla
Implant supported over denture or
Implant & soft tissue supported over denture
Implant supported fixed prosthesis

33. Prosthodontically driven case selection?
Live demonstration of stage Two surgery .
Management of complication at stage Two surgery .
Temporisation .
Abutment selection ?
Platform switching ?
Loading protocol ?
Impression techniques ?
Implant occlusion ?
Lab communication ?
Prosthesis insertion ?
Establishing occlusion ?
Instructions to the patient for maintenance ?
Follow up schedule ?

34. Didactics and Two Hands-on
3rd Module : Surgical Stage
Didactics and Two Hands-on

35. Bone Physiology , Metabolism & Biomechanics
What are functions of bone ?
What is modelling ?
What is remodelling ??? A.-R.-Q.-F.-M.
Remodelling cycle ?
B.M.U. / Cutting filling cones ?
Osteoblasts & Osteoclasts ?
Activation ? Activators ?
What is one ‘ Sigma ’ ? Explain it ...
Composition of bone ?
Osteoinduction ?
Osteoconduction ?
Density of bone : Effect on surgical approach & healing ?

36. How periosteum is connected to cortical & medullary bone ?
What is Periosteum ?
How periosteum is connected to cortical & medullary bone ?
Histology of periosteum ?
Functions of periosteum ?
Which main function of periosteum is of prime importance to an Implantologist ?
Blood supply to the bone cortex ?
Blood supply of bone as a whole ?
From where the periosteum gets blood supply ?
What are the protective mechanism of periosteum if its damaged ?
What are the causes of periosteal destruction ?
What are the consequences of damage of periosteal blood supply ?

37. What are the factors that effect healing ? Define healing .
What is healing ?
What are the factors that effect healing ?
Define healing .
What is the purpose of healing ?
Effect of osseous healing on the behaviour of soft tissue ?
What are different phases of healing ?
What is primary healing ?
What is definitive healing ?
What is reactive healing ?
What is one ‘ SIGMA ’ ?
How many days it takes to form a woven bone ?
How many days does it take to form a lamellar bone ?
When a bone can bear a load ?
What are the ideal conditions for healing ?

38. What are the principal phases of surgical healing ? Healing in ...
How to successfully manage post extraction socket ?
What is the standardized protocol of healing after curettage ?
What is the standard protocol of healing after fracture ?
Conditions required for success of implant surgery ?
Conditions required for the success of graft ?
Endocrine deficiency
Arthritis

39. Bone Expansion & Compaction
Define compaction & expansion of bone .
What is the ultimate aim of bone expansion ?
What is the effect of bone expansion on density of bone ?
What is the meaning of word ‘ Compaction Expansion ’ ?
What is the scientific basis of compaction expansion ?

40. 4th Hands-on ...Soft tissue management & suturing
( Animal Cadaver )
Review of asepsis & gowning .
Analysis & interpretation of radiographic & CT scans including measurement techniques of bone volumes .
Basic surgical techniques ..( on animal cadavers )
Flap design .
Incision pattern .
Meticulous handling of periosteum .
Flap retraction .
Suturing .
Suturing with needle holder
Hand suturing

41. 5th Hands-on ..Live Surgery of Implant placement
.... One by mentor , one by participant
Case Presentation & Treatment planning by participant ?
Briefing of surgery by the participant ?
Review & live demonstration of international OT protocol ?
Preparation & arrangement of armamentarium ?
Patient’s preparations ?
Administration of L.A. without hampering asepsis ?
Flap design ?
Incision ?
Flap retraction ?
Sequential osteotomy ?
Implant placement ?
Placement of cover screw & suturing ?
Post – operative instructions ?
Debriefing of surgery ?
Healing without antibiotics ?