1. Basic Dental Implantology
Present: Dr Emmanuel Motega,
Resident OMFS
Chairman: Dr Zacharia Shukuru
Date: 20th Desember, 2017

2. Outline Introduction Classification of dental implants
Case selection and treatment planning
Dental implant surgery
Prosthetic option on implants
Surgical challenges and complications
References

3. Introduction Definition
Dental implantology is the field of dentistry that is concerned with the replacement of missing teeth and their supporting structures with artificial prostheses anchored to the jawbone.

4. Introduction cont…
Dental implant is an alloplasstic/synthetic biocompatible material placed in the jaw bone to substitute for a missing tooth and its root(s)

5. Introduction cont… History
Successfully replacement of missing teeth and their supporting structures with artificial teeth has been an aspiration of humankind for centuries.
Archaeologists found a fragment of a mandible of Mayan origin, dating from about 600 AD which had three tooth-shaped pieces of shell placed into the sockets of three missing lower incisor teeth.

6. Introduction cont…
In 1952 the a Swedish orthopaedic surgeon, P I Brånemark, discovered the phenomenon of osseointegration of titanium implants
Defined it as “a direct structural and functional connection between ordered living bone and the surface of a load- carrying implant”.

7. Introduction cont…. Function of teeth Couses of loss of teeth Chewing
Aesthetic
Phonation
Couses of loss of teeth
Dental caries
Periodantal problems
Trauma

8. Introduction cont… Effects of unreplaced missed teeth.
Difficult in chewing hence poor general health.
Poor aesthetic- facial disfigurement
Difficult phonation.
Over eruption of opposing teeth.
Tilting of adjacent teeth.
Drifting of adjacent teeth.
Alveolar bone resorption
TMJ problems ( pain, clicking, hearing problem)

9. Introduction cont…
Besides functional problems, tooth loss can lead to psychological problems due to low self-esteem and social impairment thus considerably affecting the quality of one's life.

10. Introduction cont… Different ways of missing teeth replacement
Denture ( partial or complete).
Bridges/ crowns.
Implants
Advancement of dental sciences and public awareness of dental treatment options, a Dental Implant have been always considered as an option.

11. Introduction cont..
Advantages of dental implants over the conventional tooth replacement.
Prevents bone loss ( osseointergration).
Strongest and long lasting treatment for replacing a missing tooth.
Discomforts from Flanges and palatal extension can be avoided once the denture is retained by implants
Option for fixed prosthesis where the conventional bridge is not possible.

12. Dental implant Indications for implant treatment:
Restore dental aesthetics
Restore lost dental function:
Chewing
Speech
Space maintenance and occlusal stability
Orthodontic anchorage
Convenience and comfort
Bone preservation and prevention of disuse atrophy after tooth loss

13. Implants consist of; Parts of implant
Osseous part that interacts with the bone
Transmucosal component that interacts with the mucosa
Restoration (crown or bridge abutment, or anchors for dentures)

15. The materials used commonly for implants include commercially pure titanium, titanium alloys or occasionally ceramic materials (e.g. zirconium dioxide or aluminium oxide).

16. Dental Implant And Natural Tooth.

17. Classification of dental implant
Great majority of modern implants today are endosteal in design.
Endosteal implants are subdivided into several different types characterized by their
Geometry
Shape
surfaces and function
materials:

18. Endosteal implants Cylindrical or root form implants
Blade implants and the ramus frame
Pin implants
Disc implants
Pterygoid or zygomatic implants
Trans-osteal implants

19. Trans-osteal implants
Blade implants
Trans-osteal implants

20. Cylindrical or Root Form Implants
Root form implants can show variations with respect to:
Thread Design
Thread
Non thread
Geometry
Tapered
Parallel sided

21. One-piece or Two-piece Implants
Diameter
Implants are classified according to their general diameter in cross section.
One-piece or Two-piece Implants
Implants are manufactured either as one piece or two-piece fixtures

22. Case Selection Treatment and Planning
Adequate case assessment and treatment planning is a prerequisite for satisfactory implant.
During the planning stages, many factors are considered for dental implants including patient’s expectations and financial and time constraints.

23. Diagnosis and treatment planning
Patients presenting complaint and wishes and desires
Dental and social history
Medical history
Extra-oral examination including lip and smile lines
Intra-oral examination including full periodontal
charting
Diagnostic imaging

24. Additional investigations
Photography
Diagnosis and treatment plan presentation
Written treatment plan and cost estimate
Patient education and informed consent
Communication with other members of the team and the referring practitioners

25. Contraindications for implant treatment:
History of Periodontal Disease
Radiotherapy to the jaw bone
Untreated intraoral pathology or malignancy
Untreated periodontal disease
Uncontrolled drug or alcohol use (abuse)
Uncontrolled psychiatric disorders

26. Recent myocardial infarction (MI) or cerebrovascular accident (CVA) or valvular prosthesis surgery
Intravenous bisphosphonate therapy
Immunosuppression - for example following organ transplant or treatment of systemic disease
Inability to maintain high levels of plaque control

27. Dental Implant Surgery
Surgical planning
Prior to surgery, careful and detailed planning to identify vital structures such as the inferior alveolar nerve or the sinus, as well as the available bone quality, density and volume is mandatory to ensure predictable long-term results.
Bone density and volume can be determined clinically and radiologically.
The only validated method of doing so, however, is the CT or CBCT scanning

29. A stent may sometimes be required to facilitate the placement of implants.

30. Surgical timing Immediate post-extraction implant placement.
There are different approaches to place dental implants after tooth extraction.
Immediate post-extraction implant placement.
Delayed immediate post-extraction implant placement (2 weeks to 3 months after extraction).
Late implantation (3 months or more after tooth extraction)

31. Basic procedure
The placement of a dental implant requires a preparation into the bone using precision drills with highly regulated speed and torque to prevent overheating or putting too much pressure on the bone.

32. Healing time
In general implants are allowed to heal for 2–6 months before they are used to support crowns, bridges, or dentures.
Some studies have shown that early loading of implant may not increase early or long term complications.

33. A surgical procedure Surgical approach Implant Placement
Two stage technique
One stage technique
Surgical approach
Raising a mucoperiasteal flap
Flapless technique

34. One Stage Surgery

35. Advantages of one stage surgery
Easier mucogingival management around the implant
Simplified patient management since no 2nd surgery.

36. Two Stage Surgery

37. Advantages of two stage surgery
Simultaneuos procedures ( bone graft + implant)
Prevents movement of implants by patient
Augumentation of mucogingival tissues in 2nd surgery if required.

38. Rising Mucoperiosteal Flap

39. Simple Creastal Incisions

40. Flapless Technique

41. Flap Incision Vs Flapless

42. Advantages of flapless
Shorter and fast surgical treatment- less time needed for complete implant- prosthetic restoration
Minimal bleeding and post operative discomfort
Possibility for immediate loading of the inserted implant

43. SURGICAL SITE PREPARATION
Patient drape
Chlorhexidine gluconate 0.12% for 4-5 mins
Atraumatic implant site preparation
Avoid damage to bone or vital structures
Copious irrigation to avoid heating and debris removal
Implant must be place in health bone
Implant site should be kept aseptic

44. BONE DRILLING Atraumatic Drill speed 1200 rpm Torque 50 N
Intermitent drilling up and down
Low pressure drilling
Well sharpened drills
Drill reusage
Profuse irrigation during drilling
Gradual enlargement of the bur hole

45. Bone Drilling Atraumatic Drill speed 1200 rpm Torque 50 N
Intermitent drilling up and down
Low pressure drilling
Well sharpened drills
Drill reusage
Profuse irrigation during drilling
Gradual enlargement of the bur hole

46. Drilling video
..\Desktop\Dental Implant Procedure SICmax implant iertion.mp4

47. Post Surgery Care Antibiotic Pain killer
Chiorhexidine mouth wash 0.12%
Soft Diet
Refrain from tobaccio, cigarate and alcohol one wk before surgery and several wks after surgery
Provisional restoration ( fixed or removable)
Ice pack application several times each after min to minimize swelling.

48. Implant stability
Implant stability is measured at two different stages:
Primary and secondary, which comes from mechanical engagement with cortical bone.
Secondary stability, which develop from regeneration and remodeling of the bone and tissue around the implant.

50. Prosthetic Options On Implants

51. Prosthetic Options On Implants
2. Multiple teeh replacement.

52. Prosthetic Options On Implants
3. Implant supported removable prosthesis ( implant over denture)

53. Prosthetic Options On Implants

54. Prosthetic Options On Implants
Implant supported fixed prosthesis

55. Prosthetic Options On Implants
Implant supported fixed prosthesis

56. Implant Supported Bridge

57. Surgical Challenges Inadequate alveolar bone height.
Inadequate alveolar bone width.
Anatomical structures –
Inferior alveolar nerve, mental foramen Incisive nerve
maxillary sinus,
floor of the nose,
Bone pathology- eg cysts, cementomas etc

58. Complications of Dental Implant
Nerve injury
Maxillary sinus perforation
Perforation of the buccal/lingual cortical plate
Drilling adjacent root of tooth
Off axis implant
Infection
Implant failure
Connection screw loosening or fracture
Implant body fracture
Prosthesis fracture.
Peri-implantitis

59. IMPLANTS KEEPS THE WORLD SMILLING

60. References
 Newman, Takei, Klokkevold, Carranza. Carranza’s Clinical Periodontology, 10th Edition and 11th Edition.
Lindhe, Lang, Karring. Clinical Periodontology & Implant Dentistry, 5th Edition.
Carle E. Misch. Contemporary Implant Dentistry. 3rd edition.