2/13/2014

Dental Implants -Part - 1 by Dr. Shahid Ppt Presentation

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Dental Implants -part - 1 by Dr. Shahid

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Dental Implants -Part - 1 by Dr. Shahid Ppt Presentation

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Hassan Sadek Cairo, Egypt great informative and educational presentation, it would be very useful as a reference. please send me this presentation my e mail drhs28@hotmail.com Reply 2 Like December 30, 2013 at 8:47am

Santosh Nelogi SDM good one , can i have ur ppt .please send me on santrodent@rediffmail.com Reply 1 Like November 23, 2013 at 7:34pm

Manar Magdy Works at Sinai University-Faculty of Dentistry@ please send me this ppt to my e-mail ( mydreams_5050@yahoo.com) Reply Like December 27, 2013 at 4:45am Manar Magdy Works at Sinai University-Faculty of Dentistry@ very good Reply Like December 27, 2013 at 4:44am dr.hanan alasad (signed in using Hotmail) nice presentation please send me this ppt to my e-mail(alasad20092009@hotmail.com) Reply Like December 10, 2013 at 9:47am Moe Abaza Please send me this ppt abazadentalclinic@hotmail.com , Thanx Reply Like November 25, 2013 at 1:05pm Ankush Rajput Software Developer at Graebert India Please send me this ppt at ankush.raj18@gmail.com if possible....it can be more helpful for me ... Reply Like October 11, 2013 at 4:12am
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PowerPoint Presentation: IMPLANTS MODERATOR: Dr. Neelakamal Sir Presenter: Dr. Shahid PowerPoint Presentation: Introduction History And Evolution Of Implants Terminology & Definitions Classifications & Implant Systems Ideal Properties Of Implants Indications & Contraindications Advantages & Disadvantages Evaluation Of Bone- Divisions & Density Diagnosis & Pt. Selection -History -Examination -Radiographic Assesment Study Models Contents: PowerPoint Presentation: Part-2 Surgical placement Ossiointegration Healing Period Prosthetic phase Implant Maintainace Implant Complications & Management Special consideration- full Mouth implants supported, Zygoma Implants Conclusion Future References PowerPoint Presentation: Introduction: Dental implants are designed to provide a foundation for replacement of teeth that look, feel, and function like natural teeth. Reconstruction with dental implants has changed considerably. Rather than merely focusing on the tooth/teeth to be replaced, todays implant practitioners considers a broad and complex set of interwoven factors before formulating an implant treatment plan. PowerPoint Presentation: History Of Implants 1. Ancient Era - 1000 A.D 2. Medieval Period (1000-1799 A.D) 3. The Foundation Period (1800-1910) The Endosseous Oral Implantology Truly Began In The 19 th Century. 4. Premodern Era ( 1910-1930) 5.The Dawn Of The Modern Era (1935-1978) A.D History.: History. 2500 BC - Ancient Egyptians - gold ligature. 500 BC - Etruscan population - gold bands incorporating pontics. PowerPoint Presentation: 500 BC - Phoenician population gold wire. 300 AD - Phoenician population - Carved Ivory teeth. 600 AD - Mayan population - Implantation of pieces of shell. Albucasis de Condue ( 936- 1013 A.D) an Arab surgeon use ox bone to replace missing teeth described the transplantation procedures . . PowerPoint Presentation: 1700 - John Hunter - Transplanting the teeth. 1911 - Greenfield Irridoplatinum basket soldered with 24 carat gold. PowerPoint Presentation: THE DAWN OF THE MODERN ERA 1935-1978 A.D. The modern era of implant dentistry most definitely began in the late1930s with the work of Venable, Strock , Dahl , Gershkoff & Goldberg . Venable in 1937 developed the cast Co- Cr- Mo alloy known as Vitallium . 1937 Adams- Introduced submerged implants with ball head screws. In 1939 Alvin & Strock used the Venable screw type implant . PowerPoint Presentation: In 1938 Stock placed the threaded vitallium implant into the extraction socket, the first long term endosseous implant. It remained firm & asymptomatic for nearly 17 years . PowerPoint Presentation: 1943 Dahl -sub periosteal type of implant In 1947, Formiggini developed a single helix wire spiral implants made of stainless steel or tantalum. Two ends of the wire were soldered together to form a post or neck. PowerPoint Presentation: Chercheve Modified it by increasing the length of the neck & double helix out of vitallium . In 1950 Lees - design i.e central narrow post with extensions . PowerPoint Presentation: 1960 Linkow developed blade Implants Late 1970s and Early 1980s - Tatum - custom blade implants of Titanium alloy. Early 1980s -Tatum - Titanium root form implant

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1978 Bren mark in North America started 2 stage threaded implant placement. After PowerPoint Presentation: 1980s hollow basket Core vent implant - Screw vent implant - Screw vent implant with Hydroxyapatite -coating implant with titanium plasma spray PowerPoint Presentation: TERMINOLOGY: Implant (GPT 8 ) Any object or material such as an alloplastic substance or other tissue, which is partially or completely inserted or grafted into the body for therapeutic, diagnostic, prosthetic or experimental purposes. Dental Implant : A prosthetic device made of alloplastic material implanted into the oral tissues beneath the mucosal or/ & periosteal layer &/or within the bone to provide retention & support for a fixed or removable dental prosthesis. A substance that is placed into or / & upon the jaw bone to support a fixed or removable dental prosthesis. PowerPoint Presentation: Implantology: Term historically coined as the study or science of planning and restoring dental implants. Implant system (GPT, 1993): Dental implant components that are designed mate together and can represent a specific concept & inventor. It consists of the necessary parts and instruments to complete the implant body placement and abutment components. Osseointegration: The apparent direct attachment or connection of osseous tissue to an inert, alloplastic material without intervening connective tissue. Classifications & Implant Systems : Classifications & Implant Systems Based on Implant placement within the tissues Epiosteal exp- Subperiosteal Endosteal - Root form Implants - Bladevent/plate form Implant - Ramus frame Implant Transosteal / Transosseus /Transmandibular/Staple bone implant Mucosal Inserts Epiosteal Implant: Epiosteal Implant It is a dental implant structure that covers almost the entire crestal surface of the maxillary and mandibular residual alveolar bone under the soft tissue periosteum. It is a dental implant that receives its primary bone support by resting on the bone. So new bone will grow around the implant. Example- Subperiosteal Implant PowerPoint Presentation: SUBPERIOSTEAL IMPLANTS first placement Goldberg and Gershkoff (1949). covers the almost entire crestal surface of ridge, with the four to six posts protruding out through gingiva and on it the complete denture will be attached . for atrophic mandible. Maxillary subperiosteal implants have higher failure rate and was not done routinely. PowerPoint Presentation: Endosteal Implant: In 1930 Strock placed first. It is a dental implant that extends into the basal bone for support. Only 1 cortical plate is involve. Root form Plate form Used over a vertical column of bone. -used for horizontal column of bone which is flat and narrow facial lingual direction. PowerPoint Presentation: ROOT FORM IMPLANTS Advantages: Adaptability to multiple intra oral location. Uniform precise Implant site preparation. Types of root form implants- Based on surgical procedure Two staged Single staged Based on surface Press-fit/Non-threaded Screw type/Threaded Hollow basket implant PowerPoint Presentation: Blade vent / Plateform implants Introduced by Linkon in (1967). This form of implant uses a horizontal dimension of base and is flat and narrow in faciolingual dimension. These are one stage system. Indication: In distal extension cases that offer sufficient depth of bone to avoid damage to maxillary Sinus and the mandibular canal. In long inter tooth span, which are not restorable, by fixed prosthodontics. completely edentulous arches where four implants are used. PowerPoint Presentation: Contraindications: As abutments for a removable prosthesis, except in complete arch overdenture. As a single tooth replacement unless these implants are splinted to at least one and preferably two adjacent natural teeth. Disadvantages Bone necrosis due to large amount of bed preparation. Fibrous ankylosis of implant due to base necrosis from high temperature during implant bed preparation and immediate loading. Difficulty to prepare a precise slot for blade placement. Large areas of bone lost when these blades are to be removed. PowerPoint Presentation: Ramus frame implants Developed by HD Roberts and RA Roberts in 1965. Used to aid in retention and stability of mandibular full dentures. One piece endosseous implant that uses tripodal mechanical support in the mandible (the ramii and the bony symphysis ).. It can be bent and shaped without difficulty. Indications Patients with h/o mandibular bone resorption. Patients inability to wear dentures. Patients with knife edged ridges, high labial muscles, mucosal attachments and high convex to flat symphyseal areas with fibrous and flabby tissue. PowerPoint Presentation: Transosteal implants / Mandibular Staples/ Transcortical implants A dental implant that penetrates both cortical plates and passes through entire thickness of the alveolar bone. indicated in atropic anterior mandible, where root form implants further compromises the strength of the jaw. PowerPoint Presentation: Advantages: Stock implants usually fits all mandibles. No special preoperative surgical or preprosthetic preparation Short time required with minimal armamentarium Immediate wearing of denture with early to limited function and chewing Stability adequate Adequate high success rate. PowerPoint Presentation: Mucosal inserts These are attachments in dentures to provide added stability and retention . This technique was introduced by Dahl in 1943 ,modified by Lew 1957,Izikowitz 1961, Trainin 1962, Cronin 1970 . In 1973 Wein & Judy introduced a newly designed mucosal inserts that had more satisfactory design and health . PowerPoint Presentation: Advantagenous for providing retention Complete maxillary dentures . Distal extension partial dentures. Large bulb obturator. Usually 14 inserts are used for dentures. Disadvantages Retention is not adequate Soreness due to ridge resorption PowerPoint Presentation: Other Classifications Based on Surface characteristics: Titanium plasma- sprayed Coating Sand Blasting- Surface Etching Laser Induced surface roughening Hydroxyapatite coating Depending on function Cosmetic cannot withstand masticatory forces Semifunctional can withstand along with mucoperiosteal. Functional can withstand masticatory load and transfer to bone PowerPoint Presentation: Based on Faundation : Implant supported Implant assisted Based on Retention of prosthesis: Removable Fixed- screw retained, cement retained PowerPoint Presentation: PARTS: Various Implant Systems: Various Implant Systems Branemark system Developed from the pioneering work of Prof. Per-Ingvar Branemark who introduced the term osteointegration . ( 1960) Branemark USA, Inc: 33 Branemark USA , Inc Advantages ADA full acceptance (edentulous) and provisional acceptance for all other uses. Longest documented research. Relatively simple surgery. Excellent education availability. Disadvantages Some sponsors do not allow general practitioners to take surgery course . Most expensive system. Has only pure titanium implants. BRANEMARK SYSTEM COMPONENTS : BRANEMARK SYSTEM COMPONENTS FIXTURE pure titanium with machined threads . The top of the fixture has hexagonal design & threads .. The apical portion tapered with four vertical notches. COVER SCREW- seals the coronal potion of fixture during the interim period.

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PowerPoint Presentation: ABUTMENT - -made of titanium in a cylinder shape. the apical portion has hexagonal shape to fit the coronal portion of fixture. ABUTMENT SCREW insert through the abutment & threads into the fixture to connect the two components. GOLD CYLINDER- made of Au , Pl, Pd. It is machined to fit the coronal portion of the abutment. It becomes integral part of final prosthesis. GOLD SCREW inserted through the gold cylinder & threads into the abutment screw to connect the gold cylinder & abutment. FRIALIT Implant system: FRIALIT Implant system 1n 1974 Dr. Willi Schulte developed Frialit 1 also known as Tubingen Implants Worlds first root analog system. Advantages Optimum stabilization of the implant abutment interface. Anti-rotational connection between the abutment and the implant. Clear and secure positioning of the abutment on the implant. No possibility of screw breaking or loosening. Minimum risk of soft tissue perforation. ITI Implant System: ITI Implant System International team of implantology Types Hollow cylinder, Hollow screw Solid screw Single stage and 2 stage versions Advantages: The microgap between the primary and secondary components is supragingival good peri -implant hygiene. The construction of the implant body is such that no second stage surgery for uncovering it is required. Other popular cylindrical endosseous dental implant systems : 38 Other popular cylindrical endosseous dental implant systems Core-Vent (CORE-VENT Corp.): 39 Core -Vent (CORE-VENT Corp.) Advantages Extensive implant options Extensive Prosthodontics options Simple surgery Lower cost Good education High popularity Sells "Branemark" clone at lower cost Disadvantages Complexity of options (both surgical and prosthodontic) requires good organization Interpore IMZ: 40 Interpore IMZ Advantages ADA provisional acceptance for all uses. Relatively simple surgery Moderate cost Good education Provides simulated periodontal ligament intramobile eIement - IMZ) if desired Pioneer in research on hydroxylapatite coating for faster integration Tissue recession on HA coating leaves polished surface Disadvantages Intramobile element (IMZ) requires replacement on annual basis Steri OSS Denar Corp: 41 Steri OSS Denar Corp Advantages Prosthodontics acceptability good Company will replace implants that fail Simple surgery Good education Moderate cost Disadvantages Suggests very low hand piece rpm (300 rpm), can get higher rpm if desired Stryker Precision Stryker Inc: 42 Stryker Precision Stryker Inc Advantages Moderate cost Relatively simple surgery Hand auger ostectomy is kind biologically Mechanical retention good Disadvantages Fair prosthodontic acceptability Education availability fair Prosthodontic esthetics can be difficult because of some head designs Lacks ADA acceptance Ideal Properties of implants: Ideal Properties of implants According to Branemark, 1969 & Brunski, 1988 : It should be biocompatible (Not produce foreign body reaction / response). Non-allergenic. Non-carcinogenic. Should be sterilizable . Resistant to strain. It should be able to moulded to specifically required forms. It would be ideal for the implant to be integrated with surrounding bone and soft tissues. Inserted with atraumatic surgical technique. Placed with initial stability Not functionally loaded during the healing period of 4 to 6 months. Indications : Indications Patients who are unable to wear removable dentures and have adequate bone for replacement of dental implants. Complete or partial edentulism . Painful / loose dentures. Bone resorption leading to lack of stability of denture. Posterior edentulism where FPD is not possible. Orthodontic skeletal anchorage( micro /mini implants). Cranio and maxillofacial defects either- Congenital Acquired General Medical Contraindications : General Medical Contraindications Absolute Contraindications : Systemic diseases such as developing cancer and Aids. Even HIV positive patients should not to be considered. Cardiac diseases patients with heart valve replacements and recent infarcts. Deficient hemostasis and blood dyscrasias. Disorders involving erythrocytes Anemia. Anticoagulant medication or any medication leading to impaired hemostasis. Psychological diseases may carry potential risks. Uncontrolled infections. Relative Contraindications: Relative Contraindications Diabetes. Irradiation of the Jaws. - Specifically if the jaw has been exposed to irradiation over the level of 50 Gy . (Sennerby & Rasmusson 2001, Lekholm Periodontology 2000, Vol. 33, 2003) Hyperbaric oxygen treatment preceding implant therapy, the failure rate can be reduced from 60% to about 5% . ( Cochrane Library, Issue 1, 2006. Granstrom 1992) Reports have indicated a lower risk for failures if the preoperative irradiation has been less than 40 Gy and carried out two years or more prior to the implant placement. Chemotherapy. If the implants are placed during medication or if the chemotherapy is given in combination with irradiation higher failure rates have been indicated. (Wolfhardt et al 1996) PowerPoint Presentation: Smoking. If the patient stops smoking during the healing period, implants survival rate may improve. (Bain 1996) Misuse of alcohol and drugs patients suffering from severe osteoporosis have been treated with implants without developing any negative results in the long term. Robert A. Jaffin, INT J ORAL MAXILLOFAC IMPLANTS 2002;17:816819) Friberg et al Clinical Implant Dentistry and Related Research,January2001,Sennerby & Rasmusson 2001 Intraoral Contraindications: Intraoral Contraindications No Pathologic conditions should be present. All Oral lesions, including periodontal inflammation should be treated. Unfavorable intermaxillary relationships. Pathologic conditions in alveolar bone. Pathologic alterations of Oral mucosa. Xerostomia- reduced salivary flow rate is a relative contraindication for oral implantology. (Matukas 1998) Macroglossia. Unrestored teeth and poor oral hygiene. PowerPoint Presentation: Advantages Reduce the stress on the remaining teeth by offering independent support and retention. Preserve natural teeth by avoiding the need to cut down adjacent teeth for conventional bridgework. Preserve bone that results in loss of jaw height and the appearance of aging. Long-term data suggests that implants last longer than conventional bridgework. Implants will allow to chew better and speak more clearly. Implant restorations are very natural appearing and easy to clean and maintain. PowerPoint Presentation: Disadvantages A surgical procedure is necessary for implant placement. There may be insufficient bone for implant placement. This may necessitate bone grafting and additional expense. While implant fixtures (roots) have a 95% success rate, a porcelain crown placed on the implant may still fracture with time. Initial implant expense may be costly but in the longterm is actually more cost-effective PowerPoint Presentation: Evaluation of Bone Divisons & density BONE EVALUATION : BONE EVALUATION Available bone : is the amount of bone in the edentulous area considered for implantation. it is measured in : width height length angulation crown : implant PowerPoint Presentation: Available bone height : crest of edentulous ridge to opposing landmarks . Max- Maxillary canine Min.-Mandibular 1 st pre-molar Minimum bone height long term survival - 10 mm Height requirement depends on bone density . PowerPoint Presentation: Available bone width : once adequate height is available for implants width is the primary criteria width facial & lingual plates at the crest Can be measured directly using bone callipers. ridge mapping By

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subtracting the sum of facial and palatal mucosal thicknesses from the width of the entire alveolar ridge, effective bone width can be calculated ( Spiekermann 1987). PowerPoint Presentation: Available bone length : length mesio distal for bone > 5 mm wide : min m - d : 7 mm narrower ridge 2 / more implants of smaller diameter Available bone angulation : Ideally it is aligned with the forces of occlusion & is parallel to the long axis of prosthodontic restoration. Premolar region-10* 1 st Molar -15* 2 nd Molar20-25* For Wider ridge 30* is acceptable. PowerPoint Presentation: CROWN : IMPLANT : Affects appearance of the final prosthesis & the amount of moment force on the implant & surrounding bone during occlusal loading. as the C: I increases the number of implants & / or wider implants should be inserted to counteract the increase in stress. Most ideal 1 : 2 More common 1 : 1.5 Minimum requirement 1 : 1 PowerPoint Presentation: Divisions of available bone : By Mish & Judy ( 1990) Division A (Abundant bone) Dimension > 5mm width > 10-13 mm height > 7 mm length < 30 degree angulation Crown / implant ratio < 1 Treatment options: Division A root form implant PowerPoint Presentation: Division B (Barely sufficient bone) : Adequate bone height, but reduced bone width Dimensions 2.5 5 mm width > 10 13 mm height > 12mm length < 20 degree angulation Crown / implant ratio < 1 Treatment Options Osteoplasty , Division A root form Augumentation, Demanding aesthetics Great force factors Narrow Implant Division B root form, Plate form. PowerPoint Presentation: Division C (Compromised bone) Unfavourable in : Width , Height , Length Angulation > 30 o , Crown / implant ratio > 1 T/t options: Osteoplasty / Augumentation Fixed prosthesis endosteal or ramus frame or transosteal implants. PowerPoint Presentation: Division D (Deficient bone): severe atrophy Dimension: Severe atrophy Basal bone loss Flat maxilla Pencil thin mandible T/t options: Augumentation BONE QUALITY: Lekholm and Zarb (1985) classified the bone quality into four classes : BONE QUALITY: Lekholm and Zarb (1985) classified the bone quality into four classes Q1: Dense homogenous cortical bone with a small trabecular bone Q2: Large, dense layer of cortical bone surrounding dense trabecular core Q3: Thinner layer of cortical bone around dense trabecular core Q4: Thin cortical layer surrounding low-density trabecular bone. PowerPoint Presentation: Classification (Misch 1990) : D1 - Thick, dense compact bone Site : Anterior segment of the atrophic edentulous mandible Thick lateral aspects of anterior mandible Advantages : Provides good primary stability for the implants. More implant bone interface approximately 80%. Because of this use of shorter implants is possible. It is highly mineralized and able to withstand greater loads. PowerPoint Presentation: 5. Ensures excellent bone stability even after trauma. 6. Threaded Titanium implants when placed into D1 bone, proved to be very predictable over long term period with a success rate of above 94%. ( Adell 1981, Babbush 1986) Disadvantages: Low Vascular supply compared with other bone categories and healing phase is longer. Bone height is often short and so crown to implant ratio is increased . Difficult implant bed preparation and may require greater burr revolutions ( up to 2000 rpm). Healing time is 5 months and immediate loading can be done PowerPoint Presentation: D2 Bone : Thick porous compact bone with coarse trabecular core. Site: Anterior and posterior segment of the mandible. Anterior maxillary segment ( palatal aspect). Advantages: Provides immediate stability and long term survival. Osseointegration is very predictable. The intrabony bleeding helps control over heating during preparation. The percentage of contact at bone implant interface is 70%. The excellent blood supply and rigid initial fixation permit adequate bone healing within 4 months. Progressive loading is important. PowerPoint Presentation: D3 Bone: Thin porous compact bone with coarse trabecular core. Site: Anterior (Facial aspect) and posterior segments of the maxilla, posterior segments of the mandible, Condition following osteoplasty of D2 bone Advantages: Good blood supply. Disadvantages Difficult implant bed preparation (widening). careful to avoid lateral perforations of the cortical bone. PowerPoint Presentation: The rotations of the drill may have to be reduced to less than 1000 rpm to improve the tactile sense of the bone preparation. 3. Because of reduced implant bone interface, more number of implants may be necessary. Time period of healing - 6 months. Extended gradual loading should be done. PowerPoint Presentation: D4 Bone: Fine trabecular bone Site: Maxillary tuberosity, condition following osteoplasty of D3 Bone. Advantages: None. Disadvantages: Has very little bone density and little or no crestal cortical bone. Difficult implant bed preparation. The bone site is easily distorted resulting in reduced initial stability of the implant. PowerPoint Presentation: Reduced implant bone interface, so optimum usage of available bone is necessary. Number of implants to be placed is increased. Obtaining rigid fixation for the implant is very difficult. Up to 8 months of undisturbed healing is suggested. PowerPoint Presentation: Diagnosis & Patient Evaluation PowerPoint Presentation: Evaluation of the patient for implant therapy: -Includes medical, dental and diagnostic evaluation. Medical evaluation : The placement of an implant is basically a surgical procedure, the patients should be evaluated if she/ he is fit to undergo surgery. Medically compromised patients who are unfit for surgical therapy are contraindicated for implant therapy. Eg : endocrine disorder, cardiovascular disorder etc PowerPoint Presentation: Factors that affect the prognosis of implant prosthesis include-: Diabetes Arteriosclerosis Renal diseases Endocrine imbalances Malnutritional effects Diseases of the CNS Smoking Age Motivation Dental evaluation:: Dental evaluation: Dental history will involve an oral examination, a radiographic examination and a diagnostic evaluation. The oral examination should include routine assessment of hard & soft tissues. A dental & periodontal evaluation will elicit information on the presence of caries, periodontal diseases & oral hygiene status. PowerPoint Presentation: EXTRA ORAL EXAMINATION: - Smile line -Smile symmetry -Incisal edges in relation to Lower lip - Functional analyses - examination of the temporomandibular joints, muscles of mastication and occlusal relationships. If functional disturbances of the masticatory system are present, recreate functional harmony by selective grinding or fabrication of night guard. PowerPoint Presentation: INTRA ORAL EXAMINTION : Inspection of the oral cavity - Mucosal situation ( such as width of attached gingiva) -Possible existence of pathological changes -Extent of bone resorption -Presence of lesions / abscess : Inter arch space : Ideal inter arch space : 7 mm posterior 8 10 mm anterior Tooth Mobility oral hygiene habits & periodontal health PowerPoint Presentation: Intraoral bidigital palpation - available bone mass (width), contour of the alveolar process and thickness of mucosa. Measurement of Mucosal thickness: to evaluate the width of available bone. The needle is inserted through the mucosa to the bone surface and a rubber stop marks the position of the depth.

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Diagnostic methods: Diagnostic methods A primary determinant for the long term success of the endosteal implants is the best possible anchorage in the bone. Before attempting any implant treatment. Analysis of appropriate and adequate radiographs. Analysis of mounted study models. Timing of implant radiography: Timing of implant radiography Time in months Radiographic procedures Treatment planning -1 Periapical, panoramic, cross sectional tomography, CT, Cephalometry Surgery (fixture placement) 0 Films only for the correction of problems. Healing 0-3 Films only for the correction of problems Remodelling 4-12 Periapical, panoramic Maintenance (without problem) 13+ Periapical, panoramic (follow up every three years) Problem present (any time) Periapical, panoramic, cross sectional tomography Radiographic diagnosis: Radiographic diagnosis Peri apical radiographs: Intra oral radiographs provide valuable information concerning - The mesiodistal dimension, bone height . To determine whether implant treatment can be performed after bone augmentation, if available bone volume is less. Any residual pathology. PowerPoint Presentation: Disadvantages : It cannot provide information about the buccolingual dimension of the bone and whether implant treatment can be performed. 2. Limited value in determining bone density as a lateral cortical plates prevent accurate interpretation. 3. Little use in depicting the spatial relationship between the critical structures and the proposed implant site PowerPoint Presentation: Occlusal radiograph: Can provide information about the cortical and cancellous bone structure in edentulous jaw segments i.e., bone quality. It provides the 3 rd dimension in combination with other radiographs to clarify the existence and localization of root tips, cysts, tumors etc. The disadvantage is that it shows the widest width of the bone (at the base), rather than the width at the crest where diagnostic information is needed most. PowerPoint Presentation: Panoramic radiograph: General view of both jaw & bone condition Jaw relationship. Location of landmarksPowerPoint Presentation: Advantages : 1. The opposing landmarks are easily identified. 2. The vertical height of bone can be assessed. 3. Procedure is performed with convenience and speed. Gross anatomy of the jaws and any related pathologic findings can be evaluated. Disadvantages : Produces vertical magnification of up to 10 % and horizontal magnification of up to 20 %. 2. Does not demonstrate bone quality. 3. Does not provide spatial relationship between the critical structures and the implant site. PowerPoint Presentation: Overcoming the shortcomings Use of diagnostic templates that have 5mm ball bearings or wires incorporated around the curvature of the dental arch when the radiograph is taken can enable the clinician to determine the amounts of magnification in the radiograph. These metal spheres appear radio opaque in the film. Because their diameter is known, it is easy to calculate the true bone height. (Spiekermann 1987) PowerPoint Presentation: Lateral cephalometric radiograph : Demonstrates a cross sectional image of the alveolus of both the mandible and the maxilla in the midsagittal plane. Is more accurate for bone quantity determinations unlike panoramic or periapical images. Magnification ranges from 6% to 15%. Provides information on bone availability in the region of premaxilla and symphysis of the mandible. : Computed tomography : CT enables differentiation of both hard tissues and soft tissues. Tomographic sections produced are of best image quality due to less disturbing ghost shadows from adjacent structures. CT enables identification of disease, identification of critical structures at the proposed region determination of bone quantity, quality determination of the position and orientation of dental implants. PowerPoint Presentation: Evaluation of Mischs bone density using CT number or Hounsfield unit : Each CT image produced has 2,60,000 pixels and each pixel has a CT number or Hounsfield unit (HU) related to the density of the tissues within the pixel Higher the CT number, denser is the tissue. D1 : >1250 HU D2: 850 HU - 1250 HU D3: 350 HU 850 HU D4: <400 HU PowerPoint Presentation: 3-D reconstruction from CT data : 3-dimensional anatomical models of the jaws and skulls can be fabricated using CT data. Such models permit direct preoperative measurements as well as precise determinations of the spatial relationships between mandible and maxilla. COSMETIC, RESTORATIVE & IMPLANT DENTISTRY 2009 PowerPoint Presentation: Stereolithography: From the available CT data a model can be created from a solid block of material by means of a computer guided milling device or with two laser beams. In the future these type of 3-D reconstruction may become a mandatory aid for pre-operative planning in dental implant cases in situations where difficulties are anticipated. PowerPoint Presentation: Advantages: Precise evaluation of the actual osseous condition. Surgical therapy can be precisely planned preoperatively for determination of the most favorable implant axis orientation. Helpful for evaluating the relationship of mandible to maxilla. Diagnostic casts or study model analysis: Diagnostic casts or study model analysis For edentulous patients Study models of edentulous patients mounted in an adjustable articulator using bite registration enables to determine -inter maxillary relationship. Prognathism & Retrognathism after resorbtion. increase in inter alveolar distance. vertical relationships placement and orientation of implants Shape of the ridge & future corrections if required. PowerPoint Presentation: Study model analysis partially edentulous patients The goal is to analyze balance between applied force and the implant bone segment. clinical length of the prosthetic crown that will be supported by the implant. (Crown-implant ratio). Inter arch distance In the saggital plane, the implant axes should parallel the axes of adjacent natural teeth. Number of implants. PowerPoint Presentation: Surgical guides: Partially edentulous patients: Helps to position the implants appropriately from the prosthetic point of view. with some remaining teeth, these stents can be fabricated in the form of clasp retained partial dentures or modified bridge constructions. Holes are drilled into the acrylic at appropriate locations with proper axis orientation. holes in the acrylic that guide the pilot drills are ideally located in the center of the occlusal surface of the artificial teeth. PowerPoint Presentation: Edentulous patients Surgical guide is not necessary if the treatment plan involves a complete denture retained by 2-4 implants in the anterior segment of the edentulous maxilla or mandible. But if the therapy involves rigid screw fixation prosthesis then the use of a surgical guide is required to achieve the best possible treatment result. The guide is prepared from clear acrylic. It could even be the patients own complete denture. Bibliography: Bibliography Contemporary Implant Dentistry, Carl E. Misch; 2 nd edition. Implantology Hubertus Spiekermann Atlas of Oral Implantology, A. Norman Cranin ; 2 nd edition Clinical Periodontology and Implant Dentistry. Jan Lindhe ; 4 th edition . Carranzas Clinical Periodontology. Takei, Newman, Carranza; 9 th edition.

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