kuliah fkg unissula

7/26/2019 KULIAH FKG UNISSULA

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AUTO BIOGRAPI

RUSDIMA UDI

CIREBONJ 17 MEI 1943

FKG UGM 1972

PPDGS I B.H. UGM 1993

FK UNISSULA


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GAWAT DARURAT PHLEGMOON MANDIBULA

GAWAT DARURAT PENYAKIT SYSTEMIS

INFEKSI ODONTOGEN

TERLOKALISIR PADA APEX GIGI

MENYEBAR KE JARINGAN SEKITAR

PENYEBARAN SYSTEMIS

HEMATOGEN LYMFOGEN


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PERTAHANAN TUBUH

HUMORAL

IMMUNOGLOBULIN

KOMPLEMEN SELLULER

LEUKOSIT MONOSIT LIMFOSIT

MAKROFAG ! PMN


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BARTER PERTAHANAN

TULANG AL"EOLAR

PERIOSTEUM

MUSKULUS

FASIA


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PERKEMBANGAN INFEKSI

JARINGAN KERAS PULPITIS

GANGRENE PERIODONTITIS

OSTEITIS

OSTEOMYELITIS


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JARINGAN LUNAK

PERIKORONITS

ABSCES SUB MUKUS

ABSCES SUBCUTAN

CELLULITIS$PHLEGMOON MANDIBULA

LUDWIG ANGINAMEDIASTINITIS


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PHLEGMOON MANDIBULA $ CELLULITIS

RADANG JARINGAN SELLULLAR

DIFFUS ! BERKEMBANG CEPAT TANPA BATAS KAUSA HYALURONIDASE

PALPASI KERAS TIDAK ADA FLUKTUASI

MEN JADI ABSCES ! LUDWIG ANGINA

MEDIASTINITIS ! CA"ERNOUS SINUS THROMBOSIS


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LUDWIG ANGIMA

INFEKSI BILATERAL

SUBMENTUM SUBMANDIBULAR SUBLINGUAL

TIDAK ADA FLUKTUASI LIDAH TERDORONG KEATAS DAN BELAKANG

EDEMA GLOTIS

DEHYDRASI SEPTIKEMI ! MEDIASTINITIS


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A%&'()* +&% J&,*%-&% P%+/0/%- G*-*


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P,&&%&% D%'& C&,*


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P%5&,&% *%60* -*-*


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PENATA LAKSANAAN

TERAPI MEDIKAMENTOSA TERAPI KAUSA ANTI MIKROBA

TERAPI SYMPTOMATIK ANALGETIKA ANTI INFLMASI

ANTI PYRETIKA


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TERAPI SUPPORTIF

TERAPI NUTRISI

KARBOHYDRAT

PROTEIN LEMAK

ROBORANSIA

ELECTROLIT


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TERAPI BEDAH

INSISI

PENGAMBILAN GIGI KAUSA

TERAPI REHABILITASI

FUNGSI MASTIKASI ESTETIS

FONETIK TERAPI PSIKIS


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CA"UM ORIS

FOKAL INFEKSI MENYEBAR HEMATOGEN

LIMFOGEN


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BAROMETER

DIABET

ODOR ACETON

HYPERTROPY GINGI"ALEUKEMIA$HEMOFILIA

PENDARAHAN SPONTAN HYPERTHROFI GINGI"A


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HEMOFILIA

KELAI AN PEMBEKUAN DARAH

DEFISIENSI P ROTEIN PROSES PEMBEKUAN

DITURUNKAN MELALUI KROMOSOM X

S3CARA RESECIF

LEBIH BANYAK PADA ANAK LAKI2

NYERI PADA PERSENDIAN

MUDAH PERDARAHAN PD TRAUMA RINGAN


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LEUKEMIA

KANKER DARAH SUMSUM TULANG BELAKANG

PENDARAHAN GUSI SPONTAN

MUDAH TERINFEKSI

PEMBENGKAKAN KELENJAR GETAH BENING

LEHER AXILLA FEMUR

SESAK NAFAS

KU MENURUN


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DIABETES


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HEMOFILIA


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PHLEGMOON MANDIBULA


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P%5&,&% *%60* -*-*


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P,&&%&% D%'& C&,


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GIGI IMPL N


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Implant GuidelinesWhat is a dental implant?

Biomaterialsmost commonly used

commercially pure (CP) titanium


282/439

titanium-aluminum-vanadium alloy(Ti-6Al-!) - stron"er # used $% smallediameter implants


Titaniumli"ht$ei"ht&iocompati&le


283/439

corrosion resistant(dynamic inert o'ide layer)stron" # lo$-priced


i'ture typesA coatedTi sur*ace modi*ied


284/439

tap or sel*-tappin"scre$ or press *it


+,sseointe"rationBr.nemar/ - late 01234s

direct structural # *unctional

i & d d li i


285/439

connection &et$een ordered5 livin"&one # sur*ace o* a load-carryin"implant


+,sseointe"rationsimilar so*t-tissue relationship to

natural dentition (sulcular epithelium)

h i d li/ t t


286/439

hemi-desmosome li/e structuresconnect epithelium to titaniumsur*ace


+,sseointe"rationcircum*erential and perpendicular

connective tissue

ti ti i ti


287/439

no connective tissue insertionno intervenin" harpey4s *i&er

attachment


+,sseointe"ration&one-implant inter*ace

osteo&lasts in close pro'imity

to inter*acet d * i l t & thi


288/439

separated *rom implant &y thinamorphous proteo"lycan layer

osseointe"ration - hi"hly predicta&le



osteo&lasts in close pro'imity

to inter*acet d * i l t & thi


289/439

separated *rom implant &y thinamorphous proteo"lycan layer

osseointe"ration - hi"hly predicta&le



o'ide layer continues to "ro$-

(7333 A at 6 yrs) - mineral ion interaction


290/439

increase in tra&ecular pattern&one deposition # remodelin" in

response to stress



o'ide layer continues to "ro$-

(7333 A at 6 yrs) - mineral ion interaction

i i t & l tt


291/439

increase in tra&ecular pattern&one deposition # remodelin" in

response to stress


Components # terminolo"ycopin" or prosthesis scre$ (top)copin"analo"

i l t & d


292/439

implant &odya&utment

trans*er copin" (indirect or direct)


Components # terminolo"yhy"iene scre$a&utment

*or scre$5 cement or attachment

second sta"e permucosal a&utmen


293/439

second sta"e permucosal a&utmen*irst sta"e cover scre$implant &ody or *i'ture (&ottom)

Implant Guidelines


294/439


8odern typesimplants are small-

standard a&utment- usually 9:;


295/439

$ide-&ody or $ide-plat*orm- up to6:3mm


8odern typeslen"ths- typically ran"e *rom a&out

; to 02mm

=avy uses +e'ternal he'


296/439

=avy uses e'ternal he' "ood research literature a&le to &e maintained

(9i or =o&el Biocare systems)


8odern types (=o&el Biocare)i'tures

tandard

8/ II


297/439

8/ II


8odern types (=o&el Biocare)A&utments

tandardCera,ne>sthetiCone


298/439

>sthetiCone8irusConeAn"ulated 0; (ne$) or 93


8odern types (=o&el Biocare)tandard

no anti-rotational propertiescan use *or multiple units

can use *or hy&rid dentures


299/439

can use *or hy&rid dentures


8odern types (=o&el Biocare)Cera,ne

sin"le tooth esthetic replacementa&utment attached to *i'ture $%

restoration cemented to a&utment


300/439

restoration cemented to a&utmentaccommodation *or *i'ture misali"nmen

can provisionali@e


8odern types (=o&el Biocare)>sthetiCone

esthetic P restorationsmachined "old cylinder a&utment allo$

cro$n mar"in to seat close to *i'ture


301/439

cro$n mar"in to seat close to *i'ture($ithin 0mm)


8odern types (=o&el Biocare)8irusCone

esthetic P restorationsuse $hen decreased vertical hei"htallo$s :


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allo$s :


303/439

use i* less than ideal *i'ture placementuse $here esthetic cervical mar"in

reuired


8odern types (=o&el Biocare)Cera,ne>sthetiCone8irusConeAn"ulated a&utments


304/439

An"ulated a&utments All come $ith narro$5 re"ular or $ide

plat*orms (=P5 P5 WP)


8odern types (9i)i'tures8icro8iniplant8iniplant

tandardWid i t


305/439

ta da dWide iameter

( sur*ace area to use $here vertical hei"ht)


8odern types (9i)i'turesIC> (incremental cuttin" ed"e)

super sel*-tappin" implant

uses tapered cuttin" *lutesallo s more placement control


306/439

p "allo$s more placement controlrapid &one en"a"ement # implant

sta&ili@ation


8odern types (9i)A&utments>P (conical) - (esthetic pro*ile)Gold DCEA-typeT$o-piece a&utment postTA (standard)


307/439

( )Pre-An"led=e$ Gold tandard F (@ero rotation)


8odern types (9i)Gold DCEA-type a&utment

scre$-retained at *i'ture levelnon-se"mented a&utment

scre$-retained cro$n to implantuses lar"er scre$ &ecause it runs all th


308/439

puses lar"er scre$ &ecause it runs all th

$ay to the *i'ture


8odern types (9i)Gold DCEA-type a&utment

thin &uccal-lin"ual tissues

limited inter-occlusal distance

(as little as :


309/439

( )sin"le or multiple units


8odern types (9i)>P (conical) - (esthetic pro*ile)scre$-retained cro$n to the a&utment"old cylindernon-parallel implant placementsin"le or multiple units


310/439

" pminimum ;mm inter-occlusal distance

reuired


8odern types (9i)T$o-piece a&utment postnon-rotationalcement-retained cro$n to the a&utmentsimplicity o* treatment - chairside

preparation


311/439

use $hen access to posterior re"ion $%scre$ driver is limited


What4s ne$?(9i)Prep-Tite Posts

scre$ retained a&utmentstandard impression procedure

cemented restoration6 taper $ith 9 vertical "rooves


312/439

6 taper $ith 9 vertical "roovesmultiple collar hei"hts


What4s ne$?(9i),sseotite (+clot retentive sur*ace)

speci*ic micro-topo"raphic acid-etched implant sur*ace desi"n !s:machined-sur*ace implant

sin"le sta"e implant


313/439

" " p loaded a*ter 7 monthsclaim 12:


314/439

restorin" posterior spaces not &ound &ynatural teeth


Advanta"esno preparation o* tooth%adJacent teeth&one sta&ili@ation # maintenanceretrieva&ility improvement o* *unction


315/439

psycholo"ical improvement


isadvanta"esris/ o* scre$ loosenin"ris/ o* *i'ture *ailure len"th o* treatment timeneed *or multiple sur"eries


316/439

challen"in" esthetics

Implant GuidelinesConsultation Appointment

Treatment plannin" phaseDiagnosis begins with a complete

patient evaluation

"uidelines *or +decision-ma/in"process


317/439

ptreat the +entire patientrestore *orm5 *unction # esthetics


Treatment plannin" phasepro&lem list # patient desires

initial evaluationchie* complaint

medical%dental history revie$i t % t l


318/439

intra%e'traoral e'amevaluation o* e'istin" prosthesis


Treatment plannin" phaseinitial evaluation

dia"nostic impressions%articulated castradio"raphs - panoramic and periapical

(CT scan or tomo"raphy - as indicated)photo"raphs


319/439

photo"raphs


Treatment plannin" phasetreatment options%in*ormed consent

e'planation o* lon"-term commitmen

restorative - sur"ical Joint consultt$o-sta"e sur"ery


320/439

stage Istage II


Treatment plannin" phaset$o-sta"e sur"ery

(use o* clear acrylic sur"ical stent ismandatory)

stage I -implant *i'ture placement $%cover scre$ (le*t su&mer"ed)


321/439

cover scre$ (le*t su&mer"ed)


Treatment plannin" phasestage I - healin" phase

9 month minimum (mandi&le ) - usually months *or posterior re"ions

6 month minimum (ma'illa) - usually 6-1months *or all re"ions


322/439

"


Treatment plannin" phasestage II - uncoverin" # placement o*

transmucosal healin" a&utment

healin" phase


323/439

-6 $ee/s *or so*t tissue healin"


Treatment plannin" phaserestorative phase

maintenance and re"ular recall

*ee # payment policy

"oal to restore *orm5 *unction #th ti


324/439

esthetics


325/439

Implant GuidelinesTreatment plannin" phase

Pro&lem list # treatment considerationsocclusal analysis

advs%disadvs o* proposed treatment

re*errals%specialty consults

appointment seuencin"treatment alternatives


326/439

treatment alternatives


Pro&lem list # treatment considerationsteeth

periodontium

radio"raphic analysis

sur"ical analysisesthetic analysis


327/439

esthetic analysis


Pro&lem list # treatment considerationsteeth - num&er # e'istin" condition

pro"nosis o* remainin" teethsi@e5 shape # diameter o* e'istin"

dentitiontooth # root an"ulations # pro'imity


328/439

" ymesiodistal $idth o* edentulous space


Pro&lem list # treatment considerations

teeth - num&er # e'istin" conditionminimum 6-;mm &et$een teeth to

*acilitate implant placement

(&ased on 9mm *i'ture)K 0:


329/439

;mm *rom center o* implant - to centero* implant *or edentulous area



teeth - num&er # e'istin" conditionmore than 03mm mesiodistal space -

sin"le tooth implant notrecommended

(multiple a&utments should &e splinted)


330/439



teeth

periodontium




331/439

esthetic analysis


Pro&lem list # treatment considerationsperiodontium- &one supportEe/holm # Far& classi*ication

quality- &est - thic/ compact cortical&one $%core o* dense tra&ecularcancellous &one

&est re"ion - mandi&ular symphysisL


332/439

&est re"ion mandi&ular symphysisLpoorest in posterior re"ions


Pro&lem list # treatment considerationsperiodontium- &one support

quantity- reuired *or implant -6mm &uccal-lin"ual $idth $%su**icient

tissue volume2mm interradicular &one $idth03mm alveolar &one a&ove IA= canal or


333/439

03mm alveolar &one a&ove IA= canal or&elo$ ma'illary sinus



quantity- reuired *or implant - i* inadeuate &one support may need

rid"e or site au"mentationramus or chin "ra*t (auto"ra*t)BA (allo"ra*t)


334/439

BA (allo"ra*t)Bio-,ss('eno"ra*t)



place implants minimum o* 7mm *romIA= canal or &elo$ ma'illary sinus

cro$n%root ratio

mo&ility*urcations


335/439

pro&in" depths

Implant Guidelines

Treatment plannin" phase Pro&lem list # treatment considerations

periodontiummuco"in"ival pro&lems

need su**icient tissue volume to recreat"in"ival papilla

need some attached "in"iva to maintainperi-implant sulcus0st year post-op &one resorption M 0mm


336/439

0st year post op &one resorption 0mm

Ncrest o* &one optimal 7- 9mm &elo$ C>

Implant Guidelines


periodontiummuco"in"ival pro&lems

place implant 7-9mm apical to *ree"in"ival mar"in o* adJacent tooth

recreates &iolo"ic $idth o* peri-implantsulcusNso*t tissue hei"ht 7mm or K mm may


337/439

so*t tissue hei"ht 7mm or K mm maycreate challen"e

Implant Guidelines


periodontiumoral hy"iene - important pre # post

systemic mani*estations - ie: dia&eticsare predisposed to delayed healin"

destructive ha&its - smokingiscontraindicated - delayed or inadeuate


338/439

contraindicated delayed or inadeuatetissue healin" # osseointe"ration noted

Implant Guidelines


teeth

periodontium




339/439

y

Implant Guidelines


radio"raphic analysisperiapical patholo"y

radiopaue%radiolucent re"ions

adeuate vertical &one hei"htadeuate space a&ove IA= or &elo$


340/439

ma'illary sinus

Implant Guidelines


radio"raphic analysisadeuate interradicular area

&one uality # uantity

radio"raphs - panoramic and periapical(CT scan or tomo"raphy - as indicated)


341/439

Implant Guidelines


radio"raphic analysisradio"raphs- aid to determine amount

o* +space# &one availa&le

CT (computed tomo"raphy) scan - "ives

more accurate # relia&le assessment o*

&one (uality5 uantity # $idth) # locale


342/439

( y5 y )

o* anatomic structures

Implant Guidelines


radio"raphic analysis-radio"raphic stent- (can dou&le as

sur"ical stent)acrylic stent $ith lead &eads or &all

-&earin"s (


343/439

allo$s more accurate radio"raphicinterpretation

Implant Guidelines


radio"raphic analysis-distortion (common to all Q-rays)

Panore' M 7


344/439

Eateral Ceph M 2Periapical M 7:


345/439

Implant Guidelines


sur"ical analysis-sur"ical "uide stent- None o* the

most critical *actors *or o&tainin" an idealsur"ical # esthetic result

used durin" *i'ture installation as "uide*or optimal B%E and 8% position

use o* &uccal channel drill "uide allo$s


346/439

use o* &uccal channel drill "uide allo$simproved access # visi&ility

Implant Guidelines


sur"ical analysis-implant len"th%diameter

determined &y uantity o* &one apical toe'traction site

use lon"est implant sa*ely possi&lediameter dictated &y correspondin" roo

anatomy at crest o* &one


347/439

anatomy at crest o* &one

Implant Guidelines


sur"ical analysistreatment options

immediate- place implant at time o*tooth e'traction

delayed immediate- 2-03 $ee/ delaydelayed- 1-03 months or lon"er

immediate $ill not allo$ &one resorption5 &ud l d ll & *ill * t &ili ti


348/439

delayed allo$s &one *ill *or sta&ili@ation

Implant Guidelines


sur"ical analysisproper sur"ical techniue durin"

implant placement is critical

minimal heat "eneration important ; Celsius *or one minute or less

provides most predicta&le healin"response


349/439

response

Implant Guidelines


teeth

periodontium




350/439

Implant Guidelines


esthetic analysissmile line - hi"h in ma'illaL lo$ in

mandi&le

lip shape - *ull !s: thine'istin" rid"e de*ect - i* visi&le $%

hi"h smile line $ill need au"mentation


351/439

hi"h smile line $ill need au"mentation

Implant Guidelines


esthetic analysisimplant emer"ence pro*ile (963)

restored implant should appear to+"ro$ or emer"e *rom the "in"iva

very natural # desira&le in appearanceavoid +tomato on a stic/ cro$ns or

periodontal pro&lems may develop


352/439

periodontal pro&lems may develop

Implant Guidelines


occlusal analysisadvs%disadvs o* proposed treatment




353/439

Implant Guidelines


occlusal analysisimprovement o* *unction and%or

esthetics (?)para*unctional ha&its

can &e destructiveteeth lost to occlusal trauma or

para*unction less success $% implants


354/439

para*unction - less success $% implants

Implant Guidelines


occlusal analysisdia"nostic casts

(mounted to determine opposin" occlusion

rid"e $idthe'istin" inter-arch vertical space

0-0


355/439

0-0


356/439

Implant Guidelines






357/439

Implant Guidelines


advs%disadvs o* proposed treatmentare as individual as the case &ein"

treatment plannedcostpatient desiresclinician a&ilitiesetc


358/439

etc:

Implant Guidelines






359/439

Implant Guidelines


re*errals%specialty consultscan pro"nosis &e improved $ith (?)R

orthodontics

periodontal therapyendodontic therapy


360/439

Implant Guidelines


re*errals%specialty consultspre-prosthetic sur"ery

e'tractions

rid"e contourin" or e'ostosis remova osteotomy

&one or so*t tissue au"mentation


361/439

"

Implant Guidelines






362/439

Implant Guidelines


appointment seuencin"len"th o* treatment time

need *or multiple sur"eries


363/439

Implant Guidelines






364/439

Implant Guidelines


treatment alternatives*i'ed partial denturesremova&le partial denturesresin-&onded *i'ed partial denturesorthodonticsdo nothin"


365/439

Implant Guidelines

Treatment plannin" phase Indications

"ood "eneral healthadeuate &one uality # volumeappropriate occlusion # Ja$ relations ina&ility to $ear conventional prosthesis

un*avora&le num&er%location o* a&utmentsin"le tooth loss


366/439

Implant Guidelines

Treatment plannin" phaseContraindications

unrealistic patient e'pectationsalcohol%dru" dependence (smo/in")para*unctional ha&itspsycholo"ical *actors

anatomical *actors inadeuate rid"e%interarch dimensions immunosuppression


367/439

Implant Guidelines

Treatment plannin" phaseContraindications (relative)

(need sur"ical intervention)ramus "ra*t

inadeuate &one at implant sitee'cessive &ony concavities

sinus li*t or IA= transposition inadeuate vertical space *or implant


368/439

Implant Guidelines

Treatment plannin" phase +,sseointe"rated implants can &e

placed in the irradiated mandi&les o*

selected patients $ithout hyper&aric

o'y"en treatment =iini5 Deda5 Seller5 Worthin"tonL Experience with

Osseointegrated Implants laced in Irradiated !issues in "apan

and the #nited $tates5 Intl O ,ral 8a'illo*ac Implants 0112L

09R3;-00


369/439

Implant Guidelines

8aintenance

Criteria *or success 8aintenance and ecall

y"iene Aids

Pro&lems


370/439

Implant Guidelines

8aintenance

Primary "oal is to protectandmaintain +tissue-inte"rationL

good oral hygieneis a /ey

element


371/439

Implant Guidelines

8aintenance +Implant patients should &e

thorou"hly instructed inmaintenance therapy $ith theunderstandin" that the patientserves as co-therapist

Grant et al5 eriodontics% in the !radition o&

'ottlieb and Orban5 ed 6: t: Eouis5 C! 8os&y Co5

01225 pp03;


372/439

1225 pp 3 < 31

Implant Guidelines

8aintenance +Any practitioner $ishin" to

practice dental implantolo"y must&e /no$led"ea&le concernin"postinsertion maintenance o* theimplant

0122 =ational Institutes o* ealth Consensus

evelopment Con*erence


373/439

Implant Guidelines

8aintenance


y"iene Aids

Pro&lems


374/439

Implant Guidelines

8aintenance Criteria *or successR(most important is "ood dia"nosis)

no peri-implantitisno associated radio"raphic

radiolucencymar"inal &one loss 0:3-0:


375/439

Implant Guidelines

8aintenance Criteria *or successR

tissue inte"rationR &one%so*t tissue+osseointe"ration

a&sence o* mo&ilityno pro"ressive so*t tissue chan"es o

&one losssta&le clinical attachment level


376/439

Implant Guidelines


a&sence o* &leedin" uponpro&in"%e'cessive pro&in" depths

a&sence o* discom*ort

success rate varies $ith &one ualityloadin" dynamics5 etc:


377/439

Implant Guidelines


anticipated success rate o*

1; anterior mandi&leL 13 ma'illaL

decreases in posterior uadrants

due to poorer &one uality (03 yrs)&est &oneR "ood cortical $ith some

cancellous *or vascular supply


378/439

Implant Guidelines

8aintenance


y"iene Aids

Pro&lems


379/439

Implant Guidelines

8aintenance 8aintenance # ecallR

(our elementshome-care re"imenperiodic recalls rein*orcin" re"imenstrict adherence to recall schedule #

veri*ication o* *unction5 com*ort5 andesthetics li*etime maintenance commitment


380/439

Implant Guidelines


(requency o& recall immediate post-delivery7 hoursone $ee/

t$o $ee/s (re-torue i* needed)6 months&i-annual or annual evaluation


381/439

Implant Guidelines


)linical arameters o& Evaluationoral hy"iene includin" plaue inde' implant sta&ility (evaluate mo&ility)retrieva&ilityperi-implant tissue healthcrevicular pro&in" depths


382/439

Implant Guidelines


)linical arameters o& Evaluation&leedin"radio"raphic assessment (serial)

crestal &one level # inte"rity o*

attachment systemsproper torue on scre$ Jointsocclusion


383/439

Implant Guidelines

)linical arameters o& Evaluation oral hy"iene (plaue inde')

plaue is 0 etiolo"ic *actor in tissuedestruction (peri-implant and natural toothrevie$ oral hy"iene instructionmonitor throu"h plaue indices

same reuirements as *or natural teethuse neutral sodium *luorides


384/439

Implant Guidelines

)linical arameters o& Evaluation implant sta&ility (evaluate mo&ility)

may &e the key indicatoro* *i'ture healthminimal mo&ility $% osseointe"rated

*i'turesR 0;-


385/439

Implant Guidelines

)linical arameters o& Evaluation retrieva&ility

*ailin" implant may &e mas/ed i* connecteto same prosthesis

important to remove P to evaluateannual removal recommended *or multiple

unit prosthesis

early *ailure detection $ill minimi@e *i&routissue @one si@e # may allo$ placement o*$ider diameter *i'ture


386/439

Implant Guidelines

)linical arameters o& Evaluation peri-implant tissue health

visual inspectionR si"ns o* pathoses? Alterations in color5 contour # consistencyalveolar mucosa may surround implant #

appear more erythematous than "in"ivatissue movement $hen adJacent tissues

retracted may a**ect so*t-tissue-implantattachment M (detrimental)perimucosal /eratini@ed tissue is &est


387/439

Implant Guidelines

)linical arameters o& Evaluation crevicular pro&in" depths

most accurate means o& detecting perimplant destruction *use plastic pro&es)pro&in" measurements closely

appro'imate actual &one levelsavoid durin" *irst 9 months a*ter a&utment

connection to avoid dama"in" $ea/epithelial attachmentmay &e di**icult i* threads supra-osseous


388/439

Implant Guidelines

)linical arameters o& Evaluation &leedin"

controversy as to si"ni*icance o* B,P atperi-implant inter*aceB,P may precede clinical si"ns o*

in*lammationB,P # radio"raphic chan"es are most val

indicators o* peri-implant &rea/do$nrecommend continued use o* peri-implant

sulcus pro&in" to monitor implant success


389/439

Implant Guidelines

)linical arameters o& Evaluation radio"raphic assessment

one o* most valua&le measures o* implantsuccesso* value $hen

cannot pro&e area due to constricted implantnec/5 and

to assess *uture mo&ility $ithout P removal to accurately determine amount o* &one loss ia&sence o* increased crevicular depth


390/439

Implant Guidelines


compare &ony chan"es $ith sta&lelandmar/s - implant threads - (one-hal* thread U 3:9mm)

compare hori@ontal%vertical implantdimensions &et$een serial radio"raphs

periapical radio"raphs U 7:< -


391/439

Implant Guidelines


bone level determination should be basedonly upon standardi+ed periapicalradiographs

threads o* implant must appear sharp #$ell-delineated on Q-ray to &e accurate

Q-ray &eamR direct V1 *rom lineperpendicular to lon" a'is o* implant/eep *ilm parallel # close to implant


392/439

Implant Guidelines


recommend /!p o* not 63 (&est 6


393/439

Implant Guidelines


uality in *ilm development is paramountpost-op radio"raphic intervalsR

not &et$een *i'ture placement to a&utmentconnection

one $ee/ a*ter a&utment insertion

immediately *ollo$in" *i'ed prosthesisinsertion5 then 6 months later annually *or *irst 9 years5 then every 7 years


394/439

Implant Guidelines


e'pect 0:3mm mar"inal &one loss durin"*irst year postinsertionL V3:0mm per yearanticipated therea*ter

"reater &one loss o&served in ma'illa


395/439

Implant Guidelines


rapid &one loss seen i*R *ractured *i'ture initial osseous trauma at insertion *i'ture over-ti"htenin" occlusal trauma poor adaptation o* prosthesis to a&utment

+normal physiolo"ic response plaue-associated in*ection (peri-implantitis)


396/439

Implant Guidelines


>8>8B> HHH

>ndosseous implants may lose

e'tensive amounts o* &one support

$ithout sho$in" rather o&vious

radio"raphic chan"es or increase inmo&ility detecta&le in periodontally

involved teeth


397/439

Implant Guidelines

)linical arameters o& Evaluation proper torue on scre$ Joints

loosened scre$s are the most commonpro&lem

can result in locali@ed in*lammation5 looserestorations5 and discom*ort

i* re-toruin" a loose a&utment - care not tstrip or +round-o** the he'

e'cessive *orce can *racture scre$%implanor create increased stresses in the &one


398/439

Implant Guidelines

)linical arameters o& Evaluation occlusion

e'cessive *orce concentrations - result ine'tensive &one loss and implant *racture 8AO, CAD>R poor a&utment prosthesis

adaptation poor *orce distri&ution # improperly planned

occlusal schemes also *actors

recommend anterior "uidance NN B>T"roup *unction%&alanced occlusion also


399/439

Implant Guidelines

)linical arameters o& Evaluation occlusion

"oal to prevent lateral *orces on posteriorimplants concentrated in cervical area

relationship &et$een para*unctional activit# increased mar"inal &one loss

ideal is +li"ht centric occlusion onlyL

no contact in lateral e'cursionsno contact in 8I5 &ut $ith hard clench $illhold shim stoc/ (:3330)


400/439

Implant Guidelines

8aintenance


y"iene Aids

Pro&lems


401/439

Implant Guidelines

8aintenance y"iene AidsR

plastic scalers- ,=E - *ora&utmentscalin" to prevent easy a&rasion o* so*ttitaniumL use in only one direction startin"at the "in"iva (&est are *rom 9i)

ultrasonic scalers- =, - do not useTitan- or ultrasonic scalers unless specianon-metal tips used


402/439

Implant Guidelines


prophy Jets- use $ith caution

*ine prophy pasteor *lour o* pumice-,S -use $ith &lue ru&&er tips or ru&&erprophy cups

uper-loss or Post-care- nylon *i&ersthread *or interpro'imal use &et$eena&utments and under e'tensions


403/439

Implant Guidelines


end-tu*ted # small interdental&rushes(Pro'i&rushes) -*or cleanin"&uccal # lin"ual a&utment sur*acesL allmetal sur*aces must &e nylon coated

electric tooth&rushes -use at discretioo* dentistL may &e use*ul i* limited manualde'terity


404/439

Implant Guidelines


chlorhe'idine - use durin" peri-sur"icalperiods or as needed i* episodes o* acuteso*t tissue in*lammation occur

*luoride rinses or "els -use neutral

sodium *luoride to avoid dama"e totitanium *i'tures that may occur $ithacidulated types


405/439

Implant Guidelines

8aintenance


y"iene Aids

Pro&lems


406/439

Implant Guidelines

8aintenance Pro&lemsR

so*t tissue reactions*ractured or loosened scre$s*ailin" or *ailed *i'ture

&ro/en attachments% components


407/439

Implant Guidelines

Pro&lemsRso*t tissue reactions

most common due to loose scre$spoor oral hy"iene can lead to

+peri-implantitis - may result in

pro"ressive &one loss

lac/ o* attached peria&utment so*t tissu*ailed or *ailin" implants


408/439

Implant Guidelines

Pro&lemsRso*t tissue reactions

treatmentRremove o**endin" scre$5 ti"htena&utment # reinsert prosthesis

rein*orce oral hy"ieneso*t-tissue auto"ra*t

replacement o* *ailed implant


409/439

Implant Guidelines

Pro&lemsR*ractured or loosened scre$s

0st suspicion $hen complaint o* +looseimplant or discom*ortuse correct scre$driver *or scre$ head

$ithout e'cess *orce or can +round o**he'

i* retrievin" (+teasin" out) *racturedscre$ caution not to dama"e he'


410/439

Implant Guidelines

Pro&lemsR*ailin" or *ailed *i'ture

*ailin" implant !s *ailedimplant

+implantitis !s

periodontal disease


411/439

Implant Guidelines

Pro&lemsR*ailin" or *ailed *i'ture

*ailin" implantclinical si"nsR pro"ressive crestal

&one lossL so*t tissue poc/etin"L B,

$% possi&le purulenceL tenderness to

percussion or torue


412/439

Implant Guidelines

Pro&lemsR*ailin" or *ailed *i'ture *i'ture loss

*ailin" implantcausesR sur"ical compromises (&on

overheatin"5 lac/ o* initial sta&ility)Lnonpassive superstructuresL too rapinitial loadin"L *unctional overloadLinadeuate scre$ Joint closureLin*ection


413/439

Implant Guidelines


*ailin" implanttreatmentRremove and replace $ith lar"er

diameter *i'tureL or treat in*ection

# re- evaluate

interim - remove prosthesis #a&utments # irri"ate area $% CQLdisin*ect components # reinsert


414/439

Implant Guidelines


*ailedimplantclinical si"nsR mo&ilityL +dull

percussion soundL peri-implantradiolucency

(connective tissue implantencapsulation may not &e visi&le onradio"raph)


415/439

Implant Guidelines


*ailed implant (most noted at ta"e II)causesR sur"ical compromises (&on

overheatin"5 lac/ o* initial sta&ility)Lnonpassive superstructuresL too rapinitial loadin"L *unctional overloadLinadeuate scre$ Joint closureLin*ection


416/439

Implant Guidelines


*ailed implant (most noted at ta"e II)treatmentR

removal o* implant


417/439

Implant Guidelines


+implantitis !s periodontitisclinical si"nsRsimilar clinical

presentation $% same patho"enic

microor"anisms

causesRpoor oral hy"ieneL &acteriaLcause may &e un/no$n (?)


418/439

Implant Guidelines


+implantitis !s periodontitistreatmentRconsults to provider - consider

rema/e or "uided tissue re"enerationetc:

interim - remove prosthesis #a&utments # irri"ate area $% CQLdisin*ect components # reinsert


419/439

Implant Guidelines

Pro&lemsR&ro/en attachments% components

remove o**endin" attachment(i* possi&le) and replace or

provisionali@e

&e care*ul not to dama"e e'ternal he' oscratch titanium *i'ture or a&utment


420/439

Implant Guidelines

Case election Implant recommended

replacement o* teeth X7;501 # 93

Implant not recommended

replacement o* tooth X72s


421/439

Case X0


422/439

Implant Guidelines

Implant recommended 6 y%o male presented $ith *ailin"

=CT X7; and severe locali@edperiodontitis

tooth deemed hopeless ande'tracted


423/439

Implant Guidelines

Implant recommended :3 ' 02mm =o&elpharma *i'ture

placed


424/439

Implant Guidelines

Implant recommended Cera-,ne a&utment restored $ith

cemented (Setac Cem) P8 cro$n


425/439

Case X 7


426/439

Implant Guidelines

Implant recommended 90 y%o *emale presented $ith

missin" X01 # 935 and retainedX0; # 97 (third molars)


427/439

Implant Guidelines

Implant recommended mesial-an"ulated X02 # 90 $ith

inadeuate mesial-distal andinterarch spacin" due to super-erupted opposin" X 9 # 0


428/439

Implant Guidelines

Implant recommended &uccal-lin"ual rid"e $idths in areas

o* missin" X01 and X93 alsode*icient


429/439

Implant Guidelines

Implant recommended teeth X 0; # 97 e'tracted and

&ilateral ramus "ra*ts placed atedentulous sites (X01 # 93)


430/439

Implant Guidelines

Implant recommended molar upri"htin" o* teeth X02 # 90

completed to create adeuatespace *or implants


431/439

Implant Guidelines

Implant recommended


432/439

Implant Guidelines

Implant recommended restoration o* *i'tures $ith scre$-

retained non-se"mented DCEAa&utments $% P8 cro$ns


433/439

Implant Guidelines

Implant recommended restoration o* teeth X 9 # 0 $ith

P8 cro$ns to re-esta&lish properocclusal plane


434/439

Case X 9


435/439

Implant Guidelines

Implant not recommended 9 y%o male presented $ith past

history o* supernumerary X72 =oteR dilacerated root to mesial on

X72


436/439

Implant Guidelines

Implant not recommended edentulous site presented $ith

inadeuate *acial &one5 andinadeuate spacin" e'isted&et$een X7; # 72 root apices toallo$ implant placement


437/439

Implant Guidelines

Implant not recommended a*ter t$o years o* orthodontic

therapy5 X72 *ailed to move to*acilitate implant placement


438/439

Implant Guidelines

Implant not recommended edentulous area restored $ith a

resin-&onded *i'ed partial denture(BP X7;-72)


439/439

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