Archive for the ‘ Two Stage ’ Category

Dental Implant Surgery Indications

Indications for Dental Implant Treatment

1. Edentulous patient.
2. Partially edentulous patient with history of difficulty in wearing removable partial dentures.
3. Patient with missing dentition requiring long span fixed partial denture (bridge) treatment.
4. Patient who refuses using removable type dental prosthesis.

Hobo S, Ichida E, Garcia L T: Osseointegration and Occlusal Rehabilitation, Quintessence Publishing Co., Ltd. 1989

Divisions of Available Bone for Dental Implants

There are four divisions of available bone based on width, height, length, angulation and crown height in the edentulous site.

1. Division A edentulous ridge offer abundant bone in all dimensions.
2. Division B bone may provide adequate width for narrower, small diameter root form endosteal implants.
3. Division C edentulous ridge exhibits moderate resorption and presents more limiting factors for predictable endosteal implants.
4. Division D edentulous ridge basal bone loss and severe atrophy, resulting in dehiscent mandibular canals or a completely flat maxilla.

Misch CE: Dental Implant Prosthetics, Mosby Inc 2005

Dental Implant Angulated Abutments

Angulated Abutment is an innovative component designed to adjust access hole position, prosthetic screw angulation and improve cosmetics. Before the development of Angled Abutments, if screws and access holes were positioned jutting through the labial aspect of an anterior tooth, there were basically three options:
1. The double casting technique.
2. Unsightly patch marks which closed the access holes after final insertion.
3. The combination of implant supported posts securing a crown and bridge type prosthesis.

Implant Angulated Abutments

Factors in Implant Retained Prosthesis

Factors to Consider in Dental Implant Treatment

1. How does the patient feel about surgery?
2. Is the patient prepared to pay the costs involved in implant theraphy?
3. Does the patient have sufficient bone to place dental implants? Bone grafting may be required and this could be a barrier to treatment.
4. If bone grafting is required, is the patient prepared to accept this?
5. Is the patient prepared to accept the burden of maintenance associated with implant retained prosthesis?

Implant Analog for Impression

Implant Abutment

Tools for titanium machining are used for drilling of titanium abutment. The fixture must be well fixed and correct RPM must also be checked before drilling. There must be adequate cooling so that overheating of abutments is prevented.

Titanium Implant Abutment Component

Bone Graft

The success rate of bone grafts in the jaw for dental implants is high. But, there is always a chance that the bone graft will fail. They are not rejected like organ transplants. Failure of bone graft is usually because of infection. There’s also higher risk of bone graft failure in patients who smoke and those with certain medical conditions.

Implant Bone Contact

Torque wrench was used to to achieve the desired dental implant bone contact and avoid too much compression on the bone that may lead to necrosis of the implant bed.

Implant was placed mesial to tooth number 22 (FDI Two-Digit Notation).

Implant was placed mesial to tooth number 22 (FDI Two-Digit Notation).

Drilling Procedure

Following dental implant surgical sequences and protocols, drilling should follow the desired RPM with copious irrigation preferably with an NSS refrigerated the night before surgery.

Drilling Procedure

Drilling Procedure

Prosthesis in Dental Implants

A cement type prosthesis is recommended in most dental implant cases. The said type of prosthesis has a simple procedure with lesser number of components and most prosthetic complications which could develop later can be resolved by recementation. Impression taking and correct passive fit can be obtained much easier. There is also a study that cement buffer biting force.

Dental Implant Insertion

Dental Implant body is installed with the recommended insertion torque. Appropriate insertion torque is needed to avoid too much compression of the bone. Excessive compression on the bone blocks blood supply and may lead to necrosis of the implant bed.

Dental Implant is being inserted mesial to 14 - FDI Two-Digit Notation, upper right first premolar.

Dental Implant is being inserted mesial to 14 - FDI Two-Digit Notation, upper right first premolar.

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