Edentulous Implant

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CNUH , OMFS Dept. of OMFS, School of Dentistry Dept. of OMFS, School of Dentistry Chonnam National University Chonnam National University 2007.4.7 2007.4.7 Surgical considerations in the Surgical considerations in the edentulous patients for implant edentulous patients for implant installation installation

Transcript of Edentulous Implant

Indication for extraction (NIH)Dept. of OMFS, School of Dentistry
Chonnam National University
Medical consultation
Treatment plan
Simpler operation
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Radiographic Examination
Pathology
Ridge shape or quality
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Diagnostic Cast
Jaw relation
Wax-up, surgical stent

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Jaw Relation
Cl I
Cl II
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Post-op 2 yrs
ball type & short head for overdenture
Temporary denture ( )
Temporary fixed bridge
Temporary implant
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Osteoporosis
Control 16 75.9 11.9 69.5 82.2
RBM 10 87.1* 5.3 83.3 91.0
HA 8 95.4** 2.9 93.0 97.8
SLA 6 86.0* 3.5 82.4 89.7
Table 1. Percentage of bone-implant contact ratio in cortical bone of tibia (%)
*; p<0.05, **; p<0.01, SD; standard deviation
Table 2. Percentage of bone-implant contact ratio in marrow space of tibia (%)
N Mean SD Minimum Maximum
Control 8 29.6 5.4 25.1 34.1
RBM 8 36.7 10.3 28.0 45.3
HA 6 76.1** 15.0 60.4 91.8
SLA 8 45.1 15.0 32.5 57.6
**; p<0.01, SD; standard deviation
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Minimal drilling
Nasal cavity
Maxillary sinus
Incisive foramen
Vertical alveolar bone height
: more than 10 mm
Small diameter fixture
Veneer (saddle) bone graft
Alveolar distraction
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(Ridge expansion effect : 1 ~ 2 mm)
Immediate implantation
Radiographs progression
(Ridge expansion effect : 3 ~ 5 mm)
Healing period : 4 ~ 5 months. 
Provisional occlusal loading : 3 ~ 5 months
Success rate : 85 ~ 98 %
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Split-Crest Technique
Intraoperative photographs
Radiographs progression
Peri-implant defects (fenestration, dehiscence)
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(Ridge augmentation effect : 3 ~ 10 mm)
Choice of graft material
: Significant less resorption
than particulate bone
Post-op 5mon
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Postoperative Radiographs
Implant installation (Iliac BG + 5 months)
Implant + 4 months (Iliac BG + 10 months)
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Zygomaticoalveolar implant
Vertical alveolar distraction (?)
Chonnam Univ. Hospital (Oh)
2nd step 3 - 4 mo later
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Indication
: Use particulated bone graft
: Use block bone graft
Stable initial implant fixation
No maxillary sinus infection
Implant installation on #12i-16i, 22i-26i
Temporary implant (4X) installation
Implant installation on the lower jaw & temporary implant
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Unstable initial implant fixation
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PMH: HTN & DM (Med. for 10 yrs)
Imp: Edentulous state on #14-17, #24-27, #37-47,
& chronic severe periodontitis
04. 2.23. Ext of #11-13, 21-23,
implant on #32i-36i, #42i-46i,
04. 8. 7. Implant on #12i-16i, #22i-26i
05. 1.20. 2nd Surg.
Onlay bone graft on Rt alveolous, Implant on #32i-36i, #42i-46i,
Post-op 5mo
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Mental nerve
Veneer (saddle) bone graft
Imp: Full edentulous state on both jaws
HxPi: 04. 6.17. Implant on #32i,33i,42i,43i
for bar-retained overdenture
Imp: Atrophic ridge on both side of lower posterior,
Edentulous state on # 34-37
05. 1.12. Rt IAN reposition,
implant on #44i, 45i, 46i,
& Lt alveolar DO device delivery
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Dental CT Findings : 2005. 1. 6. (pre-op)
: 4mm, 5mm
IAN Repositioning & DO
IAN Repositioning & DO
In the edentulous patients,
1. Many factors, such as jaw relation, inter-arch space, remaining bone,
anatomical structures, soft tissue and so on, should be considered.
2. In old patients, general condition is primarily considered.
The simple and safe implantation techniques are usually recommended.