Dr. Angelo C. Trödhan Center for Facial Esthetics Clinic OA Dr. Angelo C. Trödhan Dr. Izabela...
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Transcript of Dr. Angelo C. Trödhan Center for Facial Esthetics Clinic OA Dr. Angelo C. Trödhan Dr. Izabela...
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Dr. Angelo C. Trödhan
Center for Facial EstheticsCenter for Facial EstheticsClinic OA Dr. Angelo C. TrödhanClinic OA Dr. Angelo C. Trödhan
Dr. Izabela SchlichtingDr. Izabela Schlichting
www.perfectsmileandface.com www.kieferchirurgie.at www.parodontose.at
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Dr. Angelo C. Trödhan
Center for Facial EstheticsCenter for Facial EstheticsClinic OA Dr. Angelo C. TrödhanClinic OA Dr. Angelo C. Trödhan
Dr. Izabela SchlichtingDr. Izabela Schlichting
WorkShopImplantology
How to manage soft tissues and
immediate loading
Non invasive methods
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Dr. Angelo C. Trödhan
PART IPART IBasic PrinciplesBasic Principles
ofofAnatomyAnatomy
PhysiologyPhysiologyAtraumaticyAtraumaticy
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Dr. Angelo C. Trödhan
Basic PrinciplesBasic Principles
Soft Tissue is the Issue
But the Bone makes the tone
Use autraumatic surgical Procedures whenever Possible
Use the Tissues Regenerative Capacities whenever Possible
COPY NATURE
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Dr. Angelo C. Trödhan
Physiology of Regular Alveola Vs. Implant Physiology of Regular Alveola Vs. Implant Site („Bony Aspects“)Site („Bony Aspects“)
Alveolar BoneRoot
Periodontal Ligament
Crown Length
Root Lenght
NO Periodontal Ligament
Dental Implant:
Bone RESORBSon Pressure
Bone GROWS on Pullof the Perio-Ligament OVERLOAD of Implant
is ALWAYS RESORPTION !
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Dr. Angelo C. Trödhan
CONCLUSIONCONCLUSIONSimple cylindrical Implants ALWAYS have to be:LONGER than the natural toothWIDER than the natural toothto achieve the same SURFACE like the replaced tooth
OR
You have a screw designthat gives MORE surface to the Implant than thereplaced tooth and DISTRIBUTES FORCESbetter. Then the ImplantIs primarily stable and can be loadedIMMEDIATELY
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Dr. Angelo C. Trödhan
BONE PhysiologyBONE PhysiologyBone heals/regenerates/is prevented from resorption by:
The Periosteum(basal cells ofSinus membraneare periost-like)
Stabilized Blood CoagulumCALLUS (Haver´s/Volkmannvessels)
Microfractures in the Spongiosa Bone speed up Bone Healing TWO TIMES !
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Dr. Angelo C. Trödhan
CONCLUSIONCONCLUSION
WHENEVER POSSIBLE:
Keep the Periosteum in place and intact !(don´t denude the bone)
Set microfractures in the spongiosaBy Bone Condensing and Bone Spreading !
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Dr. Angelo C. Trödhan
BONE QualityBONE Quality
Is hard to determine Can be measured by
Bone-Densiometry (expensive !)
Can be approximately determined by CT
Most reliably felt by the hand of the Implantologist !
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Dr. Angelo C. Trödhan
BONE AtrophyBONE Atrophy
Reduces Implant Length and width
Forces us to put Implants in non-anatomical Positions and angles
Makes Bone augmentation necessary
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Dr. Angelo C. Trödhan
BONE AugmentationBONE Augmentation The Less The more
Success Primarily Bone
Spreading and Condensing / Sinuslift
If necessary Bone Distraction
Free Grafts as little as possible
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Dr. Angelo C. Trödhan
Soft Tissue/GingivaSoft Tissue/Gingiva
Is supported by the Bone and Periosteum
Free Gingiva is supported by the natural crown / Implant Neck / Prosthetic Crown
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Dr. Angelo C. Trödhan
Keep Biological WidthKeep Biological Width1,5 – 2,3 mm1,5 – 2,3 mm
If You reducethe gingivaYou reduceBone
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Dr. Angelo C. Trödhan
Keep Biological WidthKeep Biological Width1,5 – 2,3 mm1,5 – 2,3 mm
If You reducethe gingivaYou reduceBone:
„Brushing“-Recessions atNatural Teeth
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Dr. Angelo C. Trödhan
PART IIPART IIBasic PrinciplesBasic Principles
ofofPre-Surgical DiagnosisPre-Surgical Diagnosis
in everyday praxisin everyday praxis
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Dr. Angelo C. Trödhan
See Me, Feel Me,See Me, Feel Me,Touch Me, Heal me !Touch Me, Heal me !
From The WHO –From The WHO –Musical „Tommy“Musical „Tommy“
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Dr. Angelo C. Trödhan
SEE, TOUCH,SEE, TOUCH,FEEL !FEEL !
You have to TOUCHYou have to TOUCHbefore You understandbefore You understand
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Dr. Angelo C. Trödhan
Inspection of the Future Inspection of the Future Implant-SiteImplant-Site
LOOK ! Configuration of Gingiva and Alveolar Crest, Angulation of adjacent teeth, Oral Hygiene
TOUCH and FEEL ! Configuration of Alveolar Crest (Indentions, Height) onbuccal/palate/lingual sites
IMAGINE ! How You will proceed Surgically
PLAN ! What other investigations do Youneed for atraumatic surgery and immediateloading ?
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Dr. Angelo C. Trödhan
RadiographyRadiography
Panoramic X-Ray with 5mm metal balls for measurement(it also tells You the thickness of the mucosa especially inthe maxilla)
Intraoral X-Ray
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Dr. Angelo C. Trödhan
Maximum Security:Maximum Security:intra-OP digital Radiographyintra-OP digital Radiography
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Dr. Angelo C. Trödhan
Maximum Security:Maximum Security:intra-OP digital Radiographyintra-OP digital Radiography
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Dr. Angelo C. Trödhan
Sometimes a Dental CTSometimes a Dental CTis helpfulis helpful
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Dr. Angelo C. Trödhan
On a Cast-Model You can On a Cast-Model You can simulate the Operationsimulate the Operation
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Dr. Angelo C. Trödhan
Cardinal Principle of WHERE to place Implants for Cardinal Principle of WHERE to place Implants for good cosmetic resultsgood cosmetic results
Midline of Alveolar Crest
Palate connection line
Future cosmetic line
Implant Position
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Dr. Angelo C. Trödhan
How Much Bone will I have ?How Much Bone will I have ?The „Golden Rule“The „Golden Rule“
Mandible: Measure the Alveolar Crest and Mandible: Measure the Alveolar Crest and subtract 2mmsubtract 2mm
Maxilla: Measure the alveolar Crest and Maxilla: Measure the alveolar Crest and divide it by two and subtract another divide it by two and subtract another
2mm2mm(You will wonder how thick the mucosa is (You will wonder how thick the mucosa is in the upper jaw and how little bone You in the upper jaw and how little bone You
have !)have !)
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Dr. Angelo C. Trödhan
PART IIIPART IIIDecision makingDecision making
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Dr. Angelo C. Trödhan
After clinic Investigation, radiography and After clinic Investigation, radiography and Cast-model Planning You Know:Cast-model Planning You Know:
The bone height and width All esthetic necessities Which size of Implant You
will insert Where You will insert the
Implant
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Dr. Angelo C. Trödhan
Q1-IMPLANTQ1-IMPLANT
2 4
Q-IMPLANT ® standard
Neck = 4mm
Q-IMPLANT ® short
Neck = 2mm
Variable Insertion Depth
Length 8 mm 10 mm 12 mm 14 mm
Diameter 3.5 mm 4.5 mm
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Dr. Angelo C. Trödhan
SurfOss IISurfOss IISurfaceSurface
...... Not only Titanium !!!...... Not only Titanium !!!
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Dr. Angelo C. Trödhan
Single Part Implant SystemSingle Part Implant System
Copys the natural shape of the root
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Dr. Angelo C. Trödhan
Single Part Implant SystemSingle Part Implant System
Copys the natural shape of the root
Selfcutting screw-design
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Dr. Angelo C. Trödhan
Single Part Implant SystemSingle Part Implant System
Copys the natural shape of the root
Selfcutting screw-design Bone Trap
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Dr. Angelo C. Trödhan
Single Part Implant SystemSingle Part Implant System
Copys the natural shape of the root
Selfcutting screw-design Bone Trap Variable Insertion
Depths for better prosthetic and esthetic handling
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Dr. Angelo C. Trödhan
Single Part Implant SystemSingle Part Implant System
Copys the natural shape of the root
Selfcutting screw-design Bone Trap Variable Insertion
Depths for better prosthetic and esthetic handling
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Dr. Angelo C. Trödhan
NO AbuttmentsNO Abuttments
Q-MultiCap for:Provisional CrownImpressionCrown-Base
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Dr. Angelo C. Trödhan
Simple InstrumentsSimple Instruments
Pilot-Drill 1,5 Form-Drill 3,5/4,5 Insertion Wheel
Insertion-Handle
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Dr. Angelo C. Trödhan
Q-Implant-BoxQ-Implant-Box
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Dr. Angelo C. Trödhan
Impression & Preparation like Impression & Preparation like on a natural toothon a natural tooth
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Dr. Angelo C. Trödhan
MultiCapMultiCap
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Dr. Angelo C. Trödhan
OP - SCHEMEOP - SCHEME
Punch or Cut Pilot-Drill Form-Drill3,5mm
Form-Drill4,5mm(if Q1/4,5 isChosen)
Insertion Suture (if necessary) Provisional
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Dr. Angelo C. Trödhan
Single ToothSingle ToothTraumatic loss of front teeth WITHOUT fracture of the alveolar ridge (11/21: luxated, 22: crown fractured)
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Dr. Angelo C. Trödhan
Immediate Implant-Insertion after Immediate Implant-Insertion after extraction – Single toothextraction – Single tooth
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Dr. Angelo C. Trödhan
Immediate Implant-Insertion Immediate Implant-Insertion after extraction - Bridgeafter extraction - Bridge
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Dr. Angelo C. Trödhan
Immediate Implant-Insertion after Immediate Implant-Insertion after extraction – Single Toothextraction – Single Tooth
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Dr. Angelo C. Trödhan
Immediate Implant-Insertion after extraction – Immediate Implant-Insertion after extraction – Single ToothSingle Tooth
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Dr. Angelo C. Trödhan
One Week Later …One Week Later …
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Dr. Angelo C. Trödhan
Radiographic follow up …Radiographic follow up …
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Dr. Angelo C. Trödhan
Gingiva after 2 YearsGingiva after 2 Years
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Dr. Angelo C. Trödhan
Single ToothSingle Tooth
Immediate Implant-Insertion after extraction
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Dr. Angelo C. Trödhan
Edentulous MaxillaEdentulous Maxilla
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Dr. Angelo C. Trödhan
Q2-ImplantQ2-Implant… … when angulation does not fitwhen angulation does not fit
… … or two stage implantation or two stage implantation is mandatoryis mandatory
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Dr. Angelo C. Trödhan
Q2-AbuttmentsQ2-Abuttments
platescrew, platescrew, GinigvaformerGinigvaformer
Straight crown-basesStraight crown-bases
Angle-Angle-Abuttments 15 Abuttments 15 degreesdegrees
Q1-HeadQ1-Head
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Dr. Angelo C. Trödhan
Q2 – Single Stage ImplantationQ2 – Single Stage Implantation
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Dr. Angelo C. Trödhan
Q2: 2-stage ImplantationQ2: 2-stage Implantation
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Dr. Angelo C. Trödhan
Q3-Implant: Q3-Implant: affordable rigid affordable rigid Fixation of total prosthesisFixation of total prosthesis
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Dr. Angelo C. Trödhan
Prosthesis without gum baseProsthesis without gum base
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Dr. Angelo C. Trödhan
Anchors can be inserted in the old Anchors can be inserted in the old prosthesis !prosthesis !
Gaumenfrei
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Dr. Angelo C. Trödhan
Solution for complicated Cases Solution for complicated Cases (Marcoumar-Patients)(Marcoumar-Patients)
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Dr. Angelo C. Trödhan
Rigid fixation of lower Prosthesis at Rigid fixation of lower Prosthesis at uncompetable Prizeuncompetable Prize
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Dr. Angelo C. Trödhan
I thank You For Your I thank You For Your AttentionAttention
Dr. Angelo Trödhan
www.perfectsmileandface.com