Archive for the ‘ Two Stage ’ Category

Aesthetic Dental Implants

These are the Guidelines in Treatment of Aesthetic Implant Cases, according to Dr. Sherwin Villareal, Resident Oral Implantology, Ashman Department of Periodontology and Implant Dentistry, New York University, College of Dentistry.

1. Pre-surgical planning
2. Site development
3. 3-D Implant positioning
4. Soft tissue management
5. Provisionalization
6. Prosthetic management

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

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

Implant Bed

Bone quality for the 3rd implant is assessed under the raised full thickness flap. Drilling should follow the same desired RPM ang copious irrigation preferably with an NSS refrigerated the night before the surgery.

Bony defect near the site for the middle implant body

Bony defect near the site for the middle implant body

Rehabilitation with Dental Implants

According to Dr. Sherwin Villareal – NYU, “The establishment of optimum and predictable esthetics is one of the most important and challenging aspects of rehabilitaion with dental implants.” Esthetic rehabilitation has to be predictable implying reproducibility and stability of the outcome in both short and long term. Achieving these characteristics depends on the interactions between multiple valuables namely biological, surgical, prosthetic and implant design.

Drilling procedure done on implant site.

Drilling procedure done on implant site.

Dental Implant Design for Immediate Placement

Dental Implants which are favorable to immediate placement after extraction are as follows:

Tapered Implant
For immediate replacement after extraction, initial fixation is very important because the contact area between fixture and bone is inevitably small. Therefore, a tapered implant with has excellent initial fixation is more favorable than the straight type.

Oneplant design is favorable to GBR, photo credit: Oneplant

Oneplant design is favorable to GBR, photo credit: Oneplant

Implant Favorable to Bone Grafts
In case of placement after extraction, Guided Tissue/Bone Regeneration or GBR is frequently performed because of the dehiscence or space between the fixture and alveolar bone. Therefore, an implant design with a proper surface treatment for its alveolar ridge should be selected.
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Dental Implants after RTR

Dental Implants after RTR placement and before suturing. Thorough understanding of the rationale of specific suturing techniques and materials used is important to get proper implant closure.

Dental Implants before Closure

Dental Implants before Closure

Guided Tissue Regeneration GTR

GTR or Guided Tissue Regeneration material is placed in bony defect area. It is used to to assist in regeneration of bone tissue to maximize the potential for success of dental implant procedure.

Resorbable Tissue Replacement (RTR) placed labial to Dental Implant

Resorbable Tissue Replacement (RTR) placed labial to Dental Implant


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Implant Soft Tissue Management

It important to attain a water tight suture especially over the area with GTR or Guided Tissue/Bone Regeneration material.

Suture Technique on Dental Implant and Bony Defect with GTR

Suture Technique on Dental Implant and Bony Defect with GTR

Dental Implant Closure

Implant closure – the mucosa was sutured in a water-tight manner.

Dental Implant Closure, third dental implant is still visible (mesial to 14, upper right first premolar)

Dental Implant Closure, third dental implant is still visible (mesial to 14)

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