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DENTAL IMPLANT IN ESTHETIC ZONE
• INTRODUCTION:
NOWADAYS
osseointegrated implants are used, which have been proven to be totally biocompatible.
Dental implant: is a "root" device, usually made of titanium (or may use zirconium), used in dentistry to support restorations that resemble a tooth or group of teeth to replace missing teeth.
Osseointegration: is a process refers to the direct fusion between mental implant surface and the healthy surrounding bone.
• DEFINITIONS:
• PARTS OF IMPLANT
1. Implant body 2. Healing screw3. Healing caps4. Abutments5. Impression post
• CLASSIFICATION
A. Depending on placement within the tissue
subperiosteal implantEndosteal implant transosteal implant
B.Depending on materials used
Metallic ex: titanium
Non metallic ex: ceramic
C. Depending on design : screw shaped
Dental implants will fuse with bone; however they lack the periodontal ligament , so they will feel slightly different than natural teeth during chewing.
1. Uncontrolled diabetes2. Cardiovascular disorders3. Psychological disorders4. Systemic hematological disorders5. Smoking Drug and alcohol abuse6. Local pathology (root fragment, cyst, foreign
body, granuloma)7. Problematic occlusal and functional relationships8. Irradiation of jaws9. Osteoporosis/ low bone mineral content
• CONTRAINDICATION:
• ANTERIOR SPACES
midline
The influence of the lip position
position of the incisive canal
bone resorption in both a labial and vertical direction
Analysis of appropriate and adequate radiographs.
Analysis of mounted study models.
Measurement of bone and mucosal thickness.
• SPECIAL DIAGNOSTIC METHOD FOR IMPLANT PATIENT?
Analysis of appropriate and adequate radiographs.
Panoramic radiograph with templateLateral cephalometric radiograph
Computed tomography
• Analysis of mounted study models.
• Measurement of bone and mucosal thickness.
vernia
X-ray ruler
using sterile needle with rubber stop
• CRITICAL FACTOR FOR ESTHETIC ZONE IMPLANT RESTORATION
1. Width and height of available bone.
2. Soft tissue condition.3. Smile line.4. Color of teeth.5. Symmetry.6. Position of the implant.
• WHAT SPACE IS REQUIRED FOR PLACING IMPLANTS?
Preoperative measures
Flap less and Flap Designs
• THE SURGICAL PROCEDURE
Crestal flap
3 sided flap
3 sided flap
Crestal flap
For single tooth replacement, and If there is sufficient bone available also for esthetic reasons the mucoperiosteal flap should leave a 1mm margin of sound interdental papilla tissue to insure that it maintain fine . length of mucoperiosteal must not exceed two times its width in order not to compromise the blood supply.
Dr. PAUL A. FUGAZZOTTO (1998) noted the precise flap design should be governed according each individual situation, and not by an overall generic flap design. He categorized implant sites for single-tooth maxillary anterior placement as follows: Class I: Minimal or no ridge atrophy buccolingually or apicocoronally.
Class II: Minor buccolingual atrophy with no apicocoronally . Class IIA: Both minor buccolingual and apicocoronally atrophy.
Class III: Moderate buccolingual ridge atrophy with no apicocoronal deficiency dehiscence and/or fenestration.
Class IIIA: The same as Class III, accompanied by moderate apicocoronal ridge atrophy. Class IV: Moderate-to-severe buccolingual ridge atrophy with or without an apicocoronal component; as a result, the hard tissue atrophy precludes ideal implant positioning and necessitates hard tissue augmentation prior to implant placement.
• First using round as Pilot bur.• Twisted bur with triangular end to determine
the length.• Master bur which is round bur with blind end to
determine the width of the bone.
• During bone preparation, the temperature most not exceeds 43c because it causes osteocyte necrosis.
• Insertion of implant body and suture this will end the first stage fixture have to stay about 3 month in mandible and 5-6 month in maxilla.
• After that 2nd stage start which is exposed implant body again remove the cover screw and insert healing cap for up to 20 days after that the crown sealed and follow up vest start.