IMPLANTOLOGY QUESTIONS & ANSWERS DR.MOUSTAFA MOAMEN MDs. ORAL & DENTAL MEDICINE CAIRO UNIVERSITY Assistant lecturer IN PROSTHESIS DEPARTMENT CAIRO UNIVERSITY FELLOW TO THE INTERNATIONAAL CONGRESS OF ORAL IMPLANTOLOGISTS (ICOI) PRESIDENT OF THE CLINICAL IMPLANT SOCIETY OF EGYPT (CISE)

COURSE OBJECTIVES THEORATICAL PART: To be able to identify the advantages of implant dentistry To be able to identify cases capable for implant placement Practical part: To be able to diagnose, place & successfully restore a single tooth replacement implant case

Then exam Implant Course map System components & step by step procedures Diagnosis & treatment planning Basic knowledge Then exam

What is a dental implant? A device of biocompatible material placed within the mandibular or maxillary bone

Why do we need implants? P,O.C. Removable Fixed Implant Main prob Tooth reduction surgery Survival rate after 10 years 35% 50 % With precious alloys 85% -97% Abutments 80% need repair within 10 years & 44% will be lost 15% will need endo. Abutment Screw loosening may occur  easily retightened Increased mobility, plaque, bleeding upon probing, and caries of abutment teeth Bone Accelerated bone resorption especially from tissue supported restorations Bone resorption from disuse atrophy under the pontics Minimal to no resorption

What are the types of dental implant? I. Endosteal implants Root form implants Endodontic stabilizers Plate or blade form implant II. Subperiosteal implant

How does healing take place around dental implants? flap margins→ heal by primary intention soft 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)

What is osseointegration? It is the direct structural & functional connection between living bone & the surface of a load bearing artificial implant without any intervening tissues

What are the criteria of a successfully osseointgrated dental implant? Clinically immobile No radiolucency around the implant < 0.2 mm bone loss / year after the 1st year Absence of signs &/or persistent symptoms as (pain, pus, paresthesia or infection)

What 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) angulation crown height space

1. The available bone height The height of available bone is measured from the crest of the edentulous ridge to the opposing landmark.

1. The available bone height Minimum bone height needed: Implant length (at least 10mm)+ 2mm This additional 2-mm to permit for: surgical error osteoplasty

1. The available bone height Importance Selection of the proper implant length which: affects implant/crown ratio affects primary stability immediate loading ↑↑ surface area(SA) (every 1mm contributes for 10-14% SA ↑↑) → better stress distribution

2. Available Bone Width B-L dimension The minimum needed bone width is: 2mm > implant diameter for predictable survival These 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 resorption Can we increase the bone width?

3. Available Bone Length The 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.

3. 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.

4. 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 restoration   The initial alveolar bone angulation represents the natural tooth root trajectory in relation to the occlusal plane the bone angulation changes after the loss of teeth, especially in the anterior edentulous arch 30˚

. 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

4. Available Bone Angulation Relation to ridge width

5. Crown Height Space The 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 prosthesis and the amount of moment force on the implant and surrounding crestal bone during occlusal loading. Maximum acceptable CHS For an ideal treatment plan, the CHS should be ≤ 15 mm for ideal conditions

Implant patient should have Abundant available bone Money $$

Misch classfication

8. criteria of division A (abundant) available bone ( Carl Misch classification) Width > 6 mm Height > 12 mm Mesiodistal length > 7 mm Angulation of occlusal load (between occlusal plane and implant body) < 25 degrees Crown height space ≤ 15 m

What 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 elasticity As well as a determining factor in treatment planning, implant design, surgical approach, healing time, and initial progressive bone loading during prosthetic reconstruction

9 . Classify bone according to quality?

Is bone density related to specific jaw locations? 0 % D1 10 % D2 50% D3 40 % D4 0 % D1 10 % D2 50% D3 40 % D4 3 % D1 50 % D2 46% D3 1 % D4 6% D1 66% D2 25% D3 3 % D4 3 % D1 50 % D2 46% D3 1 % D4 3 % D1 50 % D2 46% D3 1 % D4

Does 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

Does bone density affect implant dentistry? Implant to bone contact in D1 > D2 > D3 > D4 D1 D4

To summarize….. Bone density affects implant micromovement during function Bone to implant contact So unfavorable bone density stress concentration

Does 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

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