Ch.27 Implantology Sandy Rosales Ms. Mchuen (Dental implant site…
Ch.27 Implantology Sandy Rosales Ms. Mchuen
Age, systemic and social factors
age does not affect the success or failure of implants.
implant therapy may not be an option for patients suffering from systemic disease or adverse risk factors.
it is important to consult with a physician if pt is suspected to have issues with blood coagulation, long time steroids, or chemotherapy needs.
alternate ways of replacing missing teeth:
fixed partial dentures, complete dentures , or removable partial dentures.
:star: I brought this to my family member because they never floss and they suffer from diabetes.
Components of dental implants
Super Structure is the prosthetic replacement that is screwed or cemented into the the abutment
abutment is the part that that is attached to the implant body and will be fitted for a restoration to be placed over it
implant body is the part that is surgically placed in the bone
Types of dental implants
" through the bone" The mandibular anchors are placed all the way through the mandible from under the chin to the mouth
they have a good success record but there is greater risk for tissue damage and infection
less than 3 mm in diameter
they are called mini implants
diameter is between 1.8 and 2.9
they have machine or treated surfaces.
Best used for alternative to provisional restorations, success rate is 90%
easy surgical procedure, cost is less than a traditional dental implant
Main Advantages: retention, stability, support of prosthesis, better chewing , protect of an augmentation site and vertical stop.
\fits closely above the bone but under the periosteum and gingiva
Posts protrude through the gingiva and serve as anchors for the replacement teeth.
They are not frequently used. Used only when there is not enough bone for an implant
in and through the tooth
it is a long wide post inserted into the prepared root canal space that extends at least a centimeter beyond the apex
the point was to help stabalize the tooth and improve its function. It is not commonly used due to possible root fracture, mechanical retention problems and root resorption.
within the bone
most commonly used
they are placed in edentoulous areas of the maxilla and mandible
come in different shapes, size, blade cylinder, and screw types.
success is at 90%
direct contact of a implant with bone without any intervening connective tissue.
bone height loss is 1-2 mm
:star: It would be nice to be more educated by the oral surgeons regarding what type of implant they will be using on you.
preoperative steps are necessary before actual surgical procedure
bone quality and quantity is important for success including width ( minimum of 5 mm ) , height, and length ( minimum of 3mm distance between two implants
surgical procedures are done in out patient procedure and few complications
determine bone quality by the density which reflects the strength of the bone
Type I, II, III bone are of good strength, type IV is poor
Two stage surgery
1. incision is made through the crest of the gingiva and flaps are reflected to expose the bone. 2. drilling is done at slow speed with irrigation to keep bone cool. 3. sutures are left in 7-14 days.4.
to expose the top of the implant to create a permanent opening and replace the cover screw with a temporary healing abutment. Procedure is done using local anesthesia. The area is left to heal for 2-3 weeks. Impressions are taken.
Single Stage surgical Procedure
3-6 months healing time
cover screws or healing abutment is removed and the final restoration is placed.
area is left exposed but not loaded at the time of surgery
Single tooth Replacement
generally caused by trauma/injury, congenitally missing teeth, extensive caries, or failed endodontic procedures. Aesthetics used to be an issue on anterior teeth
Immediate implant placement in extraction sockets
Drawbacks: poor healing, excessive pain, swelling and large ridge defect if the implant fails has to be removed.
implant can be placed at the same time that a tooth is taken out .
:star: I think giving the body time to heal will be best. I think it is a little traumatizing to extract a tooth and then place another immediately.
Dental implant site preservation and development
guided bone regeneration is a surgical procedure performed to increase the amount of alveolar bone available for the proper placement of a dental implant
implant is usually placed about 6 months after socket bone grafting.
atraumatic extractions and socket preservation techniques have been introduced to minimize bone resorption after tooth extraction.
guided bone regeneration surgery is indicated when there is a volume, height, or width deficiency of the residual ridge that prohibits implantation
bone grafting and use of an absorbable or non absorbable membrane used to stimulate the patient's osteoblasts to develop additional alveolar bone mass done about 6 month prior to placement of implant.
sinus grafts are needed to increase the height of the posterior alveolus.
:star: Did not realize there were so many advances in the surgical portion of dentistry. With new technology also come the high cost I assume.
Completely edentulous mouths may be treated with fixed prostheses. Partially edentulous mouths may be treated with fixed partial prostheses and single- tooth replacement.
dental implants are surrounded by peri- implant tissue. The abutment is surrounded by gingiva which heals around the abutment
the junctional epithelium also adheres to the surface of the implant
Blood Supply :
implants have low supply of blood near the neck. It has a more scar tissue appearance.
:star: Thought it has equal amount of blood supply
dental plaque has been shown to grow faster on titanium than on enamel. This is due to a lack of limiting attachment connective tissue fibers. Infected implants loose bone faster.
:star: I never saw it this way, I guess I have to do a way better job at taking care of my implant
neither dental implants or natural teeth are immune to plaque accumulation.
Implant maintenance program:
goal is to continue to monitor the stable condition created by active treatment. Recalls should be every three months.
Implant bone levels are best determined by regular accurate radiographic evaluation. It is recommended to test the implant for mobility by removing the prosthesis.
It is important not to overload the implant. Occlusal surfaces placed on implants are transmitted directly to the alveolar bone instead of the periodontal ligament.
Pt care is extremely important for the implant to succeed.
Instruments for implants:
non metalic instruments should be used as not to scratch the prosthesis. Some examples are: plastic, graphite, Teflon, nylon are recommended