4 Didactics and Two Hands-on 1st Module : Let’s get started with Dental ImplantsDidactics 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 ?IOPAOPGMedical grade C.T. scanC.B.C.T . ScanDentascan ?Dicom – dire format ?Interactive CT scanBisphosphonatesAnticoagulant medicationHerbal supplements
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 .... ASEPSISCleaning , 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 bodyImplant design of endosseous root form ImplantImplant lengthImplant diameterImplant shape / MacrogeomatrySurface characteristicsCrest module consideration & design of apexCrest moduleBodyApexExternal hexInternal hexThread pitchThread shapeThread 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 AbutmentTransfer copingPick-up copingAbutment for screw retentionAbutment for cement retentionAbutment for attachmentStraight abutmentAngled abutment
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 copingPick-up type of impression copingImplant level impressionAbutment level impression
17 Didactics and Hands-on 2nd Module : Implant ProsthodonticsDidactics and Hands-on
18 Prosthetic Options in Implant Dentistry PROSTHETIC CLASSIFICATION ( Carl E Misch – 1989 )FP-1FP-2FP-3RP-4RP-5Kennedy'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 ?D1D2D3D4D5
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 ?MagnitudeDurationDirectionTypeMagnification
21 Preimplant Prosthodontics 5 initial elements that should be assessed in sequence and treated when indicated ...Maxillary anterior tooth positionExisting occlusal vertical dimensionsMandibular incisal edge positionMaxillary occlusal plateauMandibular occlusal plateau
22 Specific criterion .... Lip line Maxillo-mandibular relationship Existing occlusionCHSTMJ statusExtraction of hopeless teethExisting prosthesisArch form : Ovoid , Tapering , SquareNatural tooth adjacent to implant siteSoft 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 .
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 SurgeryUncovery 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 situationsPartially edentulousComplete edentulousMandible / MaxillaImplant supported over dentureorImplant & soft tissue supported over dentureImplant 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 StageDidactics 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 deficiencyArthritis
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 holderHand suturing
41 5th Hands-on ..Live Surgery of Implant placement .... One by mentor , one by participantCase 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 ?