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OSSEOINTEGRATION
AS08951.ppt
OSSEOINTEGRATION
Definition
AS08952.ppt
OSSEOINTEGRATION
A direct structural and functional connection between ordered living bone and the surface of a load carrying implant P-I Branemark
AS08953.ppt
OSSEOINTEGRATION
Relies on an understanding of: Tissue healing and repair Tissue remodelling Soft tissues Hard tissues Effects of forces in all vectors Immune response to the insertion of foreign bodies
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HISTORY
Century 17 20
Dental transplantation Subperiosteal Transosteal Vitreous carbon Blade Osseointegrated
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RESEARCH BASE
1952-1960
1960-1968 1965 1965-
Vital microscopy
Repair and regeneration of bone and marrow First jaw implant Clinical research
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SUCCESS
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SUBJECTIVE CRITERIA
Adequate function
Absence of discomfort Improved aesthetics Improved emotional and psychological wellbeing
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OBJECTIVE CRITERIA
Bone loss no greater than 33% of vertical length of implant Good occlusal balance and vertical dimension Gingival inflammation amenable to treatment Mobility of less than 1mm. in any direction Absence of symptoms of infection
SUCCESS RATES
Subperiosteal Staple Vitreous carbon Blade Osseointegrated
% 39 - 90 95 50 65 - 90 80 - 100
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BRANEMARK SYSTEM
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ALTERNATIVE TECHNOLOGY
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INDICATIONS
Fully edentulous
Partially edentulous
Single tooth
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Poor retention
Functional disturbances
Psychological disturbances
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MEDICAL EVALUATION
Cardiovascular
Respiratory Renal Musculoskeletal Neurological Endocrine
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Diabetes Coronary artery disease Alcoholism Drug therapy - anticoagulants - anti epileptics - antidepressants - others Osteoporosis Smoking
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PSYCHE
Perception of outcome hypercritical demanding unrealistic expectation Time and expense Aesthetics Maintenance
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DENTAL EVALUATION
Assessment of overall oral health Prior to implant therapy, completion of: Oral Surgery Periodontal therapy Endodontics Temporisation of restorative dentistry Oral hygiene controlled and maintained
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RADIOLOGY
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DIAGNOSIS
Bone Quantity Bone Quality Associated structures - inferior alveolar nerve - mental nerve - maxillary antrum - nasal floor - incisive canal Pathology - retained dental remnants - periapical pathology - cysts - other pathology AS089522.ppt
ALVEOLAR FORM
A Good alveolar ridge form
B Moderate residual ridge form C Advanced resorbtion / Basal bone only D Basal bone resorbtion E Extreme resorbtion
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BONE QUALITY
1 2 Mainly cortical plate compact bone Thick compact bone with a dense trabecular core
3
4
BONE QUALITY
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ANATOMY
Mental nerve Inferior alveolar nerve Nasal cavity Maxillary antrum Incisive canal Soft tissues
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SURGICAL REQUIREMENTS
Trained staff
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EQUIPMENT
FIRST STAGE
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STAINLESS STEEL
Guide drill 2mm twist drill Pilot drill 3mm twist drill Countersink
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TITANIUM
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ANAESTHESIA
General
Local Sedation
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SURGICAL
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SURGICAL PRELIMINARIES
Induction of anaesthesia
Endotracheal intubation Throat pack Scrub and gown Surgical preparation Draping
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SURGICAL PROCEDURE
Surgical incision
Flap reflection
Flap retraction
Try in stent
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SURGICAL PROCEDURE
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SURGICAL PROCEDURE
Countersink
Fixture insertion Cover screw Debridement Closure
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POSTOPERATIVE CARE
Haemostasis
Analgesia Antibiotic regime Chlorhexidine mouthwash Suture removal Temporary prosthesis
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SECOND STAGE
Soft tissue Bone removal Cover screw removal Healing abutment Replacement Dressings
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KEY POINTS
Implant positioning
Drill speeds
Torque Irrigation
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MAXILLARY IMPLANTS
Lack of well defined cortex Poorer quality cancellous bone Lack of bucco/lingual width
TECHNIQUE MODIFICATIONS
Countersinking
Self tapping implants Wide implants
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COMPLICATIONS
Preoperative Perioperative Postoperative Transient Persistent Permanent Soft tissue Hard tissue
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SERIOUS COMPLICATIONS
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COMPLICATIONS
Patient selection
Implant factors Surgical Prosthodontic Errors in judgement Deviation from established protocol
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ANATOMY
Unsuitable morphologically Reduced bone density Reduced bone volume Attached tissue Nerve position
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COMPLICATIONS
Peroperative
Failure to obtain anaesthesia Haemorrhage Stuck implant Loose implant Lost implant
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SURGICAL FAILURE
Poor planning Poor surgical technique Lack of precision Thermal injury Faulty placement Damage to adjacent structures
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SURGICAL
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COMPLICATIONS
Fistula formation
Anatomical - antral
- nasal
- neurological
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SURGICAL
Stripped bone threads Exposed implant threads Fractured drill Sheared implant hex Excessive countersink Eccentric drill
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COMPLICATIONS
Second stage
Loose implant
Coverscrew problems
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Wrong abutment length Faulty abutment seating Retained sutures Gingival hyperplasia Mobile tissue Destroyed cover screw hex Failure of integration
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FAULTY PLACEMENT
Labial / buccal Lingual Too close Straight line in mandibular anteriors Angulation Divergence Correct by use of a surgical template
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POSTOPERATIVE
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WOUND DEHISCENCE
Poor flap design Poor surgical technique Poor repair Poor tissue quality Previous surgery Underlying medical condition Superficial implant placement
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PERSISTENT
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COMPLICATIONS
Long term
Anatomical
Neurological
Deintegration
Progressive thread exposure Gingivitis Hyperplastic tissue Fractured Implant
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PROSTHODONTIC
Avoid premature loading Passive fit Good design Good oral hygiene Loss of integration Soft tissue problems Oral hygiene and maintenance Retrievable v cemented
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COMPONENT FAILURE
Fractured fixture Fractured abutment screw Fractured punch blade Fractured screw driver tip Fractured castings
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MANAGEMENT OF FAILURE
Failing implants FAIL Removal Abandon Alternative site Larger diameter Replacement after healing
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GRAFTING TECHNIQUES
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GRAFTING
Autogenous - Local symphysis third molar angle tuberosity - Distant rib iliac crest tibia calvarial - frozen - freeze dried - demineralized
Allogenic
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BIOMATERIALS
- methyl methacrylate - silicone - proplast - teflon - calcium phosphates - plaster of paris - tricalcium phosphate - hydroxyapatite - goretex
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GRAFTS
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Commercial preparation Multiple donors Screened for HIV, Hep B and C Sterilised by irradiation Risk of prion borne disease Not licensed in Australia
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CALCIUM PHOSPHATES
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Anterior maxilla Posterior maxilla Anterior mandible Posterior mandible After resection Post traumatic
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TECHNIQUES
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