Advanced Concepts with Dental Implantsc1-preview.prosites.com/30459/wy/docs/s/2012/Copeland...

Advanced Concepts with

Dental Implants

Lisa Copeland RDH

Lcopelandrdhgmailcom

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Resources

Rismanchian M Effect of implants on

maximum bite force in edentulous pa-

tients J Oral Implantology

Types of Dental Implants

Subperiostealmdashplaced onto the bone

TransostealmdashExternal surgical procedure

Endostealmdashplaced into the bone

Immediate Transitional (ITI)

Mini amp Small Implants

Temporary Anchor Device (TADS)

Consequences of Missing Teeth

Psychological

Anatomical

Esthetic

2

2 Candidate Criteria

Appointment Flow

Consult Radiographs Study Models

Surgical Healing Prosthetic

Additional Surgical Procedures

Sinus Lift Bone Graft Membrane

Osteotomy Tissue Graft

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Resources

Teal Mercer Linda RDH MPH Implica-

tions for the Dental Hygienist When Dealing With Dental Implants Journal

of Practical Hygiene MarchApril 2008

pp14-16

Weinbergm Mea A Comprehensive Pe-

riodontics for the Dental Hygienist Up-

per saddle River NJ Pearson Education

Inc 2006

Misch CE Contemporary Implant Den-

tistry 3rd Edition St Lois Mosby 2008

Bone Types

3

3

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Resources

Interactive Videos wwwcaesycom

Single Stage Surgery

Transmucosal healing abutment placed

Two Stage Surgery

Standard Tx

Second surgery abutment placed

In-Office Education

Models Photos Literature

Flip Chart Pt Referrals Interactive

Video

Dental Professional Education

Webinars CE Certification

Publications Digital

Journals

4

4

Radiographic Guidelines

Vertical BW or PAX

Monitor MD bone

Baseline at prosthetic insert

6-8 monthsmdashcompare to baseline

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Resources

wwwwhatimplantisthatcom

Dental Professional Assessment

Tissue Consistency color form

Inflammation bleeding

Exudate

Radiographic bone level

Occlusion

Mobility

Selfcare

5

5

Mobility

Percussion

Tissue Assessment

ldquoThere are conflicting reports concerning the need

for keratinized tissue around implantsrdquo

~World Workshop Periodontics

Initial Crestal Bone Loss

Abutment connection

Implant surface alteration

Prosthetic table

Excessive stress

Frequent component change

Secondary Crestal Bone Loss

Biofilm

Stress

ProbingmdashIs It Safe

Gentle Pressure

Fixed reference point

1st yearmdash eval color form consistency BOP

depth

After 1st yearmdashof stable probing x-ray to moni-

tor MD bone

Correlate probing depth to bone loss

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Resources

Probes

PerioWisereg (Premier)

wwwpremiercom

Colorvuetrade (Hu-Friedy)

wwwhu-friedycom

Click-Probetrade (Kerr)

wwwkerrhawecom



6

6

Peri-implant Mucositis

Inflammatory change

Involves soft tissue only

Similar to gingivitis

Primary cause = plaque

Peri-implantitis

Involves hard and soft tissues

Similar to adult periodontitis

Includes Peri-implant Mucositis

Bone loss

PPD PPD lele 3 mm3 mm

-- plaque plaque

-- BOPBOP

+ plaque + plaque

+ BOP+ BOP

No No txtx

Mechanical Mechanical

debridementdebridement

+ polishing+ polishing

Regenerative or Regenerative or

resectiveresective therapytherapy

+ Radiographic + Radiographic

Evidence Evidence

PPD PPD gege5mm5mm

+ BOP + BOP

bone loss bone loss 2mm2mm

++

PPD PPD 44--5 mm5 mm

+ BOP + BOP

bone loss bone loss lele2mm2mm

Antiseptic Antiseptic

cleansing (CHX) cleansing (CHX)

Systemiclocal Systemiclocal

antibiotic therapyantibiotic therapy

+ BOP + BOP

no bone lossno bone loss

++

++

CIST Cumulative Interceptive Supportive Therapy

Adapted from consensus workshop group

ITI conference Dec 2003

Implant

Failure

and

Diseases

7

7 Supportive Therapies

Contraindicated

Traditional ultrasonic scalers

Traditional metal scalers

Abrasives

Accepted

Implant scalers

Air polishers

No abrasives

Non-metal OH aids

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Resources

Barnes CM Toothaker RW Ross JA

ldquoPolishing Dental Implants and Implant

Restorationsrdquo Journal of Practical Hy-

giene JanuaryFebruary 2006 Volume

15 No 1 p2829

Instrument Selection Guidelines

Light-weight

ldquoImplant friendlyrdquo

Disposable Rigid

Autoclavable

Cost efficient Sharpenable

Non-Surgical Peri-Mucositis Treatment

8mm pocket

8

8

Peri-implantitis Treatment

Other Complications

Tobacco and Dental Implants

AAP Position Paper

Increases risk of implant failure

Fibrotic tissue deceptive color

Decreased Healing response

Healing capacity only 28

80-90 chronic perio ptrsquos are smokers

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Resources

wwwsmokefreegov

wwwperioorg

wwwadhaorg

9

9

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Resources

Boere G Influence of fluoride on ti-

tanium in an acidic environment measured by polarization resis-

tance technique J Appl Biomater

1995 Winter6(4)283-8

Nakagawa M Matsuya S Shiraishi T

Ohta M Effect of fluoride concentra-

tion and pH on corrosion behavior

of titanium for dental use J Dent

Res 1999 Sep78(9)1568-72

Toumelin-Chemla F Rouelle F Burdai-

ron G Corrosive properties of fluo-

ride-containing odontologic gels

against titanium J Dent 1996 Jan-

Mar24(1-2)109-15

Bisphosphonates and Osteonecrosis (ONJ)

Determining Re-Care Intervals

Protecting the Investment Natural Teeth

Biofilm Management

Fluoride

NO ACP

Interproximal Device

Whitening

Self-Care Product Selection

( see back pages in handout)

Alternative Implant Treatments

Conclusion

Action Plan

What

Who

When

10

10 WHERE CAN I FIND WHAT I NEED TO SUCCEED

PROFESSIONAL ORGANIZATIONS

Academy of Osseointegration wwwosseoorg

Association of Dental Implant Auxillaries

And Practice Management wwwadiaonlineorg

International Congress of Oral

Implantologists (ICOI) wwwicoiorg

American Academy Implant Dentistry wwwaaid-implantorg

PRODUCTS

Hu-Friedy wwwhu-friedycom

Advanced Implant Technologies (AIT) wwwaitdentalcom

Premier wwwpremiercom

Hartzell Titanium Coated wwwghartzellandsoncom

Hartzell Suvan-OrsquoHehir wwwghartzellandsoncom

A-Titan Implant Scaler Kit wwwatitancom

Hartzell Ultrasonic Insert wwwghartzellandsoncom

Midwest Quixonic wwwdentsplycom

Cavitron Softiptrade wwwdentsplycom

Salvin Sonic Scaler attachments and tips wwwsalvincom

Titanium Implant Scaler (TIS) wwwtonyrisocom

ImplaKleantrade wwwpac-dentcom

Titanium Implant kits wwwcitagenixcom

ImplantProtrade wwwbrasselerusacom

EMS Piezo Tip wwwems-companycom

Satelec Piezoelectric Implant Insert wwwacteongroupcom

11

11

Lisa Copeland RDH


WHERE CAN I FIND WHAT I NEED TO SUCCEED

Probes

PerioWisereg (Premier) wwwpremiercom

Colorvuetrade (Hu-Friedy) wwwhu-friedycom

Click-Probetrade (Kerr) wwwkerrhawecom

Plaque Removal Products

Proxi-Flosstrade wwwaitdentalcom

Bridge and Implant Floss wwwthortonflosscom

Sturdyflosstrade wwwsturdyflosscom

Peri-O-Flossreg wwwphbinccom

Nylon coated proxybrushes wwwgumbrandcom

Proxy-tiptrade wwwaitdentalcom

Sulcabrushreg wwwsulcabrushcom

GUMreg Soft picksreg wwwgumbrandcom

GUMreg Go-Betweensreg wwwgumbrandcom

Perio aidreg wwwperio-aidnet

Philips AirFloss wwwsonicarecomdp

Philips Sonicarereg wwwsonicarecomdp

Denture Care Products

Smile Again ProTech Denture Cleaner wwwdentallabproductscom

2

2 Candidate Criteria

Appointment Flow

Consult Radiographs Study Models

Surgical Healing Prosthetic

Additional Surgical Procedures

Sinus Lift Bone Graft Membrane

Osteotomy Tissue Graft

Notes____________________________

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_________________________________

_________________________________

_________________________________

Resources

Teal Mercer Linda RDH MPH Implica-

tions for the Dental Hygienist When Dealing With Dental Implants Journal

of Practical Hygiene MarchApril 2008

pp14-16

Weinbergm Mea A Comprehensive Pe-

riodontics for the Dental Hygienist Up-

per saddle River NJ Pearson Education

Inc 2006



Bone Types

3

3

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Resources




Two Stage Surgery

Standard Tx


In-Office Education



Video




Journals

4

4


Vertical BW or PAX

Monitor MD bone



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Resources





Exudate


Occlusion

Mobility

Selfcare

5

5

Mobility

Percussion

Tissue Assessment





Abutment connection


Prosthetic table

Excessive stress



Biofilm

Stress


Gentle Pressure



depth


tor MD bone


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Resources

Probes


wwwpremiercom


wwwhu-friedycom


wwwkerrhawecom



6

6


Inflammatory change




Peri-implantitis




Bone loss


-- plaque plaque

-- BOPBOP

+ plaque + plaque

+ BOP+ BOP

No No txtx







Evidence Evidence

PPD PPD gege5mm5mm

+ BOP + BOP


++


+ BOP + BOP






+ BOP + BOP


++

++




Implant

Failure

and

Diseases

7


Contraindicated



Abrasives

Accepted

Implant scalers

Air polishers

No abrasives

Non-metal OH aids

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Resources





15 No 1 p2829


Light-weight


Disposable Rigid

Autoclavable



8mm pocket

8

8


Other Complications


AAP Position Paper






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Resources

wwwsmokefreegov

wwwperioorg

wwwadhaorg

9

9

Notes____________________________

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Resources




1995 Winter6(4)283-8





Res 1999 Sep78(9)1568-72





Mar24(1-2)109-15




Biofilm Management

Fluoride

NO ACP


Whitening




Conclusion

Action Plan

What

Who

When

10









PRODUCTS

















11

11

Lisa Copeland RDH



Probes



















3

3

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Resources




Two Stage Surgery

Standard Tx


In-Office Education



Video




Journals

4

4


Vertical BW or PAX

Monitor MD bone



Notes____________________________

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Resources





Exudate


Occlusion

Mobility

Selfcare

5

5

Mobility

Percussion

Tissue Assessment





Abutment connection


Prosthetic table

Excessive stress



Biofilm

Stress


Gentle Pressure



depth


tor MD bone


Notes____________________________

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Resources

Probes


wwwpremiercom


wwwhu-friedycom


wwwkerrhawecom



6

6


Inflammatory change




Peri-implantitis




Bone loss


-- plaque plaque

-- BOPBOP

+ plaque + plaque

+ BOP+ BOP

No No txtx







Evidence Evidence

PPD PPD gege5mm5mm

+ BOP + BOP


++


+ BOP + BOP






+ BOP + BOP


++

++




Implant

Failure

and

Diseases

7


Contraindicated



Abrasives

Accepted

Implant scalers

Air polishers

No abrasives

Non-metal OH aids

Notes____________________________

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_________________________________

_________________________________

_________________________________

_________________________________

Resources





15 No 1 p2829


Light-weight


Disposable Rigid

Autoclavable



8mm pocket

8

8


Other Complications


AAP Position Paper






Notes____________________________

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Resources

wwwsmokefreegov

wwwperioorg

wwwadhaorg

9

9

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_________________________________

_________________________________

_________________________________

Resources




1995 Winter6(4)283-8





Res 1999 Sep78(9)1568-72





Mar24(1-2)109-15




Biofilm Management

Fluoride

NO ACP


Whitening




Conclusion

Action Plan

What

Who

When

10









PRODUCTS

















11

11

Lisa Copeland RDH



Probes



















4

4


Vertical BW or PAX

Monitor MD bone



Notes____________________________

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_________________________________

_________________________________

Resources





Exudate


Occlusion

Mobility

Selfcare

5

5

Mobility

Percussion

Tissue Assessment





Abutment connection


Prosthetic table

Excessive stress



Biofilm

Stress


Gentle Pressure



depth


tor MD bone


Notes____________________________

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_________________________________

_________________________________

Resources

Probes


wwwpremiercom


wwwhu-friedycom


wwwkerrhawecom



6

6


Inflammatory change




Peri-implantitis




Bone loss


-- plaque plaque

-- BOPBOP

+ plaque + plaque

+ BOP+ BOP

No No txtx







Evidence Evidence

PPD PPD gege5mm5mm

+ BOP + BOP


++


+ BOP + BOP






+ BOP + BOP


++

++




Implant

Failure

and

Diseases

7


Contraindicated



Abrasives

Accepted

Implant scalers

Air polishers

No abrasives

Non-metal OH aids

Notes____________________________

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_________________________________

_________________________________

_________________________________

_________________________________

Resources





15 No 1 p2829


Light-weight


Disposable Rigid

Autoclavable



8mm pocket

8

8


Other Complications


AAP Position Paper






Notes____________________________

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Resources

wwwsmokefreegov

wwwperioorg

wwwadhaorg

9

9

Notes____________________________

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_________________________________

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_________________________________

Resources




1995 Winter6(4)283-8





Res 1999 Sep78(9)1568-72





Mar24(1-2)109-15




Biofilm Management

Fluoride

NO ACP


Whitening




Conclusion

Action Plan

What

Who

When

10









PRODUCTS

















11

11

Lisa Copeland RDH



Probes



















5

5

Mobility

Percussion

Tissue Assessment





Abutment connection


Prosthetic table

Excessive stress



Biofilm

Stress


Gentle Pressure



depth


tor MD bone


Notes____________________________

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_________________________________

_________________________________

Resources

Probes


wwwpremiercom


wwwhu-friedycom


wwwkerrhawecom



6

6


Inflammatory change




Peri-implantitis




Bone loss


-- plaque plaque

-- BOPBOP

+ plaque + plaque

+ BOP+ BOP

No No txtx







Evidence Evidence

PPD PPD gege5mm5mm

+ BOP + BOP


++


+ BOP + BOP






+ BOP + BOP


++

++




Implant

Failure

and

Diseases

7


Contraindicated



Abrasives

Accepted

Implant scalers

Air polishers

No abrasives

Non-metal OH aids

Notes____________________________

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_________________________________

_________________________________

_________________________________

_________________________________

Resources





15 No 1 p2829


Light-weight


Disposable Rigid

Autoclavable



8mm pocket

8

8


Other Complications


AAP Position Paper






Notes____________________________

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Resources

wwwsmokefreegov

wwwperioorg

wwwadhaorg

9

9

Notes____________________________

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_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

Resources




1995 Winter6(4)283-8





Res 1999 Sep78(9)1568-72





Mar24(1-2)109-15




Biofilm Management

Fluoride

NO ACP


Whitening




Conclusion

Action Plan

What

Who

When

10









PRODUCTS

















11

11

Lisa Copeland RDH



Probes



















6

6


Inflammatory change




Peri-implantitis




Bone loss


-- plaque plaque

-- BOPBOP

+ plaque + plaque

+ BOP+ BOP

No No txtx







Evidence Evidence

PPD PPD gege5mm5mm

+ BOP + BOP


++


+ BOP + BOP






+ BOP + BOP


++

++




Implant

Failure

and

Diseases

7


Contraindicated



Abrasives

Accepted

Implant scalers

Air polishers

No abrasives

Non-metal OH aids

Notes____________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

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_________________________________

_________________________________

_________________________________

_________________________________

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_________________________________

_________________________________

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_________________________________

_________________________________

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_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

Resources





15 No 1 p2829


Light-weight


Disposable Rigid

Autoclavable



8mm pocket

8

8


Other Complications


AAP Position Paper






Notes____________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

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_________________________________

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_________________________________

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Resources

wwwsmokefreegov

wwwperioorg

wwwadhaorg

9

9

Notes____________________________

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_________________________________

_________________________________

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_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

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_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

Resources




1995 Winter6(4)283-8





Res 1999 Sep78(9)1568-72





Mar24(1-2)109-15




Biofilm Management

Fluoride

NO ACP


Whitening




Conclusion

Action Plan

What

Who

When

10









PRODUCTS

















11

11

Lisa Copeland RDH



Probes



















7


Contraindicated



Abrasives

Accepted

Implant scalers

Air polishers

No abrasives

Non-metal OH aids

Notes____________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

Resources





15 No 1 p2829


Light-weight


Disposable Rigid

Autoclavable



8mm pocket

8

8


Other Complications


AAP Position Paper






Notes____________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

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_________________________________

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_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

Resources

wwwsmokefreegov

wwwperioorg

wwwadhaorg

9

9

Notes____________________________

_________________________________

_________________________________

_________________________________

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_________________________________

_________________________________

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_________________________________

_________________________________

_________________________________

_________________________________

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_________________________________

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_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

Resources




1995 Winter6(4)283-8





Res 1999 Sep78(9)1568-72





Mar24(1-2)109-15




Biofilm Management

Fluoride

NO ACP


Whitening




Conclusion

Action Plan

What

Who

When

10









PRODUCTS

















11

11

Lisa Copeland RDH



Probes



















8

8


Other Complications


AAP Position Paper






Notes____________________________

_________________________________

_________________________________

_________________________________

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_________________________________

_________________________________

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_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

Resources

wwwsmokefreegov

wwwperioorg

wwwadhaorg

9

9

Notes____________________________

_________________________________

_________________________________

_________________________________

_________________________________

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_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

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_________________________________

_________________________________

_________________________________

_________________________________

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_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

Resources




1995 Winter6(4)283-8





Res 1999 Sep78(9)1568-72





Mar24(1-2)109-15




Biofilm Management

Fluoride

NO ACP


Whitening




Conclusion

Action Plan

What

Who

When

10









PRODUCTS

















11

11

Lisa Copeland RDH



Probes



















9

9

Notes____________________________

_________________________________

_________________________________

_________________________________

_________________________________

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_________________________________

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_________________________________

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_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

_________________________________

Resources




1995 Winter6(4)283-8





Res 1999 Sep78(9)1568-72





Mar24(1-2)109-15




Biofilm Management

Fluoride

NO ACP


Whitening




Conclusion

Action Plan

What

Who

When

10









PRODUCTS

















11

11

Lisa Copeland RDH



Probes



















10









PRODUCTS

















11

11

Lisa Copeland RDH



Probes



















11

11

Lisa Copeland RDH



Probes



















Advanced Concepts with Dental Implantsc1-preview.prosites.com/30459/wy/docs/s/2012/Copeland...

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Transcript of Advanced Concepts with Dental Implantsc1-preview.prosites.com/30459/wy/docs/s/2012/Copeland...