Presentation on theme: "IMPLANTOLOGY QUESTIONS & ANSWERS"— Presentation transcript:
1IMPLANTOLOGY QUESTIONS & ANSWERS DR.MOUSTAFA MOAMENMDs. ORAL & DENTAL MEDICINE CAIRO UNIVERSITYAssistant lecturer IN PROSTHESIS DEPARTMENT CAIRO UNIVERSITYFELLOW TO THE INTERNATIONAAL CONGRESS OF ORAL IMPLANTOLOGISTS (ICOI)PRESIDENT OF THE CLINICAL IMPLANT SOCIETY OF EGYPT (CISE)
2COURSE OBJECTIVES THEORATICAL PART: To be able to identify the advantages of implant dentistryTo be able to identify cases capable for implant placementPractical part:To be able to diagnose, place & successfully restore a single tooth replacement implant case
3Then exam Implant Course map System components & step by step proceduresDiagnosis & treatment planningBasic knowledgeThen exam
4What is a dental implant? A device of biocompatible material placed within the mandibular or maxillary bone
5Why do we need implants? P,O.C. Removable Fixed Implant Main prob Tooth reductionsurgerySurvival rate after 10 years35%50 %With precious alloys85% -97%Abutments80% need repair within 10 years& 44% will be lost15% will need endo.Abutment Screw loosening may occur easily retightenedIncreased mobility, plaque, bleeding upon probing, and caries of abutment teethBoneAccelerated bone resorption especially from tissue supported restorationsBone resorption from disuse atrophy under the ponticsMinimal to no resorption
6What are the types of dental implant? I. Endosteal implantsRoot form implantsEndodontic stabilizersPlate or blade form implantII. Subperiosteal implant
7How does healing take place around dental implants? flap margins→ heal by primary intentionsoft tissues → around implants simulates that around tooth structure i.e (attachment & junctional epithelia & free & attached gingivae all are present)bone healing→granulation tissues (within 1 week after implantation) → woven bone formation(within 2 weeks) → bone growth &mineralization(within 4 weeks) →bone maturation &organization(6- 8weeks)
8What is osseointegration? It is the direct structural & functional connection between living bone & the surface of a load bearing artificial implant without any intervening tissues
9What are the criteria of a successfully osseointgrated dental implant? Clinically immobileNo radiolucency around the implant< 0.2 mm bone loss / year after the 1st yearAbsence of signs &/or persistent symptoms as (pain, pus, paresthesia or infection)
10What is meant by the available bone? Available bone describes the amount of bone in the edentulous area considered for implantation.It is measured in:Width (buccolingual)Height (from bone crest to landmark)Length (mesiodistal)angulationcrown height space
111. The available bone height The height of available bone is measured from the crest of the edentulous ridge to the opposing landmark.
121. The available bone height Minimum bone height needed:Implant length (at least 10mm)+ 2mmThis additional 2-mm to permit for:surgical errorosteoplasty
131. The available bone height ImportanceSelection of the proper implant length which:affects implant/crown ratioaffects primary stability immediate loading↑↑ surface area(SA) (every 1mm contributes for 10-14% SA ↑↑) → better stress distribution
142. Available Bone Width B-L dimension The minimum needed bone width is:2mm > implant diameter for predictable survivalThese dimensions provide ≥ 1 mm of bone on each side of the implant at the crest.Importance:Determination of implant diameter which affects;↑↑ SA (every 1mm →↑↑ SA by 30-40%) → Better Stress distribution especially around the implant crest which is the most vulnerable area for future bone resorptionCan we increase the bone width?
153. Available Bone LengthThe mesiodistal length of available bone in an edentulous area is often limited by adjacent teeth or implants.As a general rule, the implant should be at least>1.5 mm from an adjacent tooth and 3 mm from an adjacent implant.
163. Available Bone Length This dimension allows for Crown contouring (emergence profile)compensation for the width of an implant crestal defect, which is usually < 1.4 mm.
174. Available Bone Angulation Definition:It is the angle between the long axis of the remaining alveolar ridge with the long axis of the abutment in the planned restorationThe initial alveolar bone angulation represents the natural tooth root trajectory in relation to the occlusal planethe bone angulation changes after the loss of teeth, especially in the anterior edentulous arch30˚
18. Available Bone Angulation Importance:Bone angulation → placement of the implant with angled abutment → angled load to an implant body ↑↑ the crestal stresses, so the less the bone angulation the better the stress distribution
194. Available Bone Angulation Relation to ridge width
205. Crown Height SpaceThe crown height space (CHS) is defined as the vertical distance from the crest of the ridge to the occlusal plane.Importance:It affects the:Esthetics & appearance of the final prosthesisand the amount of moment force on the implant and surrounding crestal bone during occlusal loading.Maximum acceptable CHSFor an ideal treatment plan, the CHS should be ≤ 15 mm for ideal conditions
21Implant patient should have Abundant available bone Money $$
238. criteria of division A (abundant) available bone ( Carl Misch classification) Width > 6 mmHeight > 12 mmMesiodistal length > 7 mmAngulation of occlusal load (between occlusal plane andimplant body) < 25 degreesCrown height space ≤ 15 m
24What is meant by bone density? It refers to the internal structure of bone regarding its compact & cancellous components & reflects a number of biomechanical properties, such as strength and modulus of elasticityAs well as a determining factor in treatment planning, implant design, surgical approach, healing time, and initial progressive bone loading during prosthetic reconstruction
26Is bone density related to specific jaw locations? 0 %D110 %D250%D340 %D40 %D110 %D250%D340 %D43 %D150 %D246%D31 %D46%D166%D225%D33 %D43 %D150 %D246%D31 %D43 %D150 %D246%D31 %D4
27Does bone density affect implant dentistry? Difference between implant E & bone E will lead to implant micromobility inside the bone creating microstrain on the implant bone interface
28Does bone density affect implant dentistry? Implant to bone contact in D1 > D2 > D3 > D4D1D4
29To summarize….. Bone density affects implant micromovement during functionBone to implant contactSo unfavorable bone density stress concentration
30Does bone density affect treatment plan? ... unfavorable bone density stress concentration... Stress = Force/Area... to ↓ stress we have to ↑ surface area• Implant number• Implant width• Implant length• Implant design• Implant surface condition