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Dental Implants Sanjay CHAUHAN PG Diploma in Implant Dentistry ( France ) PG Certificate in Endodontics ( IGNOU ) B.D.S. ( Govt Dental College – Goa )

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Presentation on theme: "Dental Implants Sanjay CHAUHAN PG Diploma in Implant Dentistry ( France ) PG Certificate in Endodontics ( IGNOU ) B.D.S. ( Govt Dental College – Goa )"— Presentation transcript:

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

2 Dedicated to my Mentor Professor Dr. Manuel Chanavaz

3 I N S P I R A T I O N

4 1 st Module : Lets 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 Wolffs 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 Treatment Planning 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 1 st 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 Dental Implants Types of dental implants ? ( Endosseous & Subperiosteal ) Implant body & prosthetic abutment ? Implant body Implant design of endosseous root form Implant 1.Implant length 2.Implant diameter 3.Implant shape / Macrogeomatry 4.Surface characteristics 5.Crest module consideration & design of apex Crest module Body Apex 1.External hex 2.Internal hex 1.Thread pitch 2.Thread shape 3.Thread depth

14 Surgical placement of implant ? Sub-gingival healing & trans-gingival healing ? 2 nd stage surgery ? Healing abutment / healing screw / gingival former ? Impression coping / impression post ? Permanent Abutment 1.Transfer coping 2.Pick-up coping 1.Abutment for screw retention 2.Abutment for cement retention 3.Abutment for attachment 1.Straight abutment 2.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 2 nd 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 ? 1.Transfer type of impression coping 2.Pick-up type of impression coping 1.Implant level impression 2.Abutment level impression

17 2 nd 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 ? Applegates 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 ? 1.Magnitude 2.Duration 3.Direction 4.Type 5.Magnification

21 Preimplant Prosthodontics 5 initial elements that should be assessed in sequence and treated when indicated... 1.Maxillary anterior tooth position 2.Existing occlusal vertical dimensions 3.Mandibular incisal edge position 4.Maxillary occlusal plateau 5.Mandibular occlusal plateau

22 Specific criterion Lip line 2.Maxillo-mandibular relationship 3.Existing occlusion 4.CHS 5.TMJ status 6.Extraction of hopeless teeth 7.Existing prosthesis 8.Arch form : Ovoid, Tapering, Square 9.Natural tooth adjacent to implant site 10.Soft tissue evaluation of implant site

23 Implant Prosthodontics PROSTHODONTIC REVIEW of the patient. FPD impression V/S Implant impression. Wolffs 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 2 nd 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 1. Single tooth / Multiple teeth 2. Maxillary / Mandibular 3. Anterior / Posterior 4. Implants are parallel / non parallel 5. Connection : External hex / internal hex 6. 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 2 nd 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 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 2 nd stage Uncovery ? Reasons for greater Crestal bone loss around a prematurely exposed implant ? Causes of bone loss at 2 nd stage surgery ? Resolution of bone loss at Uncovery ? Rigid fixation determination ?

32 Prosthetic review of the case ? Mounted articulated study casts ? Two situations 1.Partially edentulous 2.Complete edentulous 1.Mandible / Maxilla 2.Implant supported over denture or Implant & soft tissue supported over denture or Implant supported fixed prosthesis 3 rd Hands-on...Implant Prosthodontics

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 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 Periosteum 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 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 4 th 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 5 th Hands-on..Live Surgery of Implant placement.... One by mentor, one by participant C ase Presentation & Treatment planning by participant ? B riefing of surgery by the participant ? R eview & live demonstration of international OT protocol ? P reparation & arrangement of armamentarium ? P atients preparations ? A dministration of L.A. without hampering asepsis ? F lap design ? I ncision ? F lap retraction ? S equential osteotomy ? I mplant placement ? P lacement of cover screw & suturing ? P ost – operative instructions ? D ebriefing of surgery ? H ealing without antibiotics ?


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