Practical Procedures in Implant Dentistry
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Группа авторов. Practical Procedures in Implant Dentistry
Table of Contents
List of Tables
List of Illustrations
Guide
Pages
Practical Procedures in Implant Dentistry
Foreword
List of Contributors
About the Companion Website
1 Introduction
References
2 Patient Assessment and History Taking
2.1 Principles
2.1.1 Medical History
2.1.2 Medications and Allergies
2.1.3 Past Medical History
2.1.3.1 Cardiovascular Disorders
2.1.3.2 Diabetes Mellitus
2.1.4 Age
2.1.5 Smoking
2.1.6 Osteoporosis and Bisphosphonate Therapy
2.1.7 Radiotherapy
2.1.8 Dental History
2.1.9 Social History
2.2 Tips
References
3 Diagnostic Records
3.1 Principles. 3.1.1 Diagnostic Imaging and Templates
3.1.1.1 Three‐Dimensional Imaging
3.1.1.2 Templates
3.1.2 Guided Surgery
3.1.3 Diagnostic Records. 3.1.3.1 Articulated Study Models
3.1.3.2 Photographic Records
3.2 Procedures. 3.2.1 Template Design. 3.2.1.1 Traditional Templates
3.2.1.2 Digital Templates
3.2.2 Photography
3.3 Tips
References
4 Medico‐Legal Considerations and Risk Management
4.1 Principles
4.1.1 Informed Consent
4.2 Procedures. 4.2.1 Dental Records
4.3 Tips
Reference
5 Considerations for Implant Placement: Effects of Tooth Loss
5.1 Principles
5.1.1 Local Site Effects of Tooth Loss
5.1.2 Effects of Tooth Loss on the Individual Level
5.1.3 Effects of Tooth Loss on the Population Level
5.2 Procedures
5.3 Tips
References
6 Anatomic and Biological Principles for Implant Placement
6.1 Principles
6.1.1 Osteology
6.1.2 Innervation and Vascular Supply
6.1.3 Musculature
6.2 Procedures
6.3 Tips
References
7 Maxillary Anatomical Structures
7.1 Principles
7.2 Maxillary Incisive Foramen and Canal
7.2.1 Importance in Oral Implantology
7.3 Nasal Cavity
7.3.1 Importance in Oral Implantology
7.4 Infraorbital Foramen
7.4.1 Importance in Oral Implantology
7.5 Maxillary Sinus
7.5.1 Importance in Oral Implantology
7.6 Greater Palatine Artery and Nerve
7.6.1 Importance in Oral Implantology
References
8 Mandibular Anatomical Structures
8.1 Principles
8.2 Mental Foramen and Nerve
8.2.1 Importance in Oral Implantology
8.3 Mandibular Incisive Canal and Nerve
8.3.1 Importance in Oral Implantology
8.4 Genial Tubercles
8.4.1 Importance in Oral Implantology
8.5 Lingual Foramen and Accessory Lingual Foramina
8.5.1 Importance in Oral Implantology
8.6 Sublingual Fossa
8.6.1 Importance in Oral Implantology
8.7 Submental and Sublingual Arteries
8.7.1 Importance in Oral Implantology
8.8 Inferior Alveolar Canal and Nerve
8.8.1 Importance in Oral Implantology
8.9 Lingual and Mylohyoid Nerves
8.9.1 Importance in Oral Implantology
8.10 Submandibular Fossa
8.10.1 Importance in Oral Implantology
8.11 Mandibular Ramus
8.11.1 Importance in Oral Implantology
References
9 Extraction Ridge Management
9.1 Principles
9.2 Osteoconductive Materials for Ridge Management
9.3 Biologically Active Materials for Ridge Management
9.4 Influence of Buccal Wall Thickness on Ridge Management
References
10 Implant Materials, Designs, and Surfaces
10.1 Principles
10.2 Implant Bulk Materials
10.2.1 Pure Titanium Used for Implant Bulk Material
10.2.2 Titanium Alloys Used for Implant Bulk Material
10.2.3 Zirconia Used for Implant Bulk Material
10.2.4 Other Materials as Bulk Implant Material
10.3 Implant Surface Treatments
10.4 Implant Design
10.4.1 Implant Body Shape Design
10.4.2 Implant Thread Design
10.4.3 Implant Connection Designs
10.4.4 Which Implant Connections Are Better and Why?
10.5 Summary
References
11 Timing of Implant Placement
11.1 Principles
11.1.1 Classification for Timing of Implant Placement
11.1.2 Immediate Placement
11.1.3 Delayed Implant Placement. 11.1.3.1 Resolution of Local Infection
11.1.3.2 Dimensional Changes of the Alveolar Ridge
11.2 Procedures
11.2.1 Systemic Risk Factors
11.2.2 Local Risk Factors
11.2.3 Biomaterials
11.2.4 Socket Morphology
11.2.5 Flapless Protocol
11.2.6 Clinician Experience
11.2.7 Adjunctive Procedures with Implant Placement. 11.2.7.1 Simultaneous Bone Augmentation with Implant Placement
11.2.7.2 Adjunctive Soft Tissue Grafting
11.2.8 Selecting the Appropriate Treatment Protocol
11.3 Tips
References
12 Implant Site Preparation
12.1 Principles
12.2 Assessing Implant Sites and Adjacent Teeth
12.2.1 Periodontal Charting
12.2.2 Assessment of Gingival Biotype and Attached Mucosa
12.2.3 Photography
12.2.4 Aesthetic Assessment
12.2.5 Radiography
12.2.6 Occlusal Analysis
12.2.7 Endodontic Status of Adjacent Teeth
12.3 Site Preparation
12.3.1 Grafting – Sinus, Buccal, Soft Tissue
12.3.2 Occlusion
12.3.3 Adjacent and Opposing Teeth
12.3.4 Crown Lengthening and Gingivectomy
12.3.5 Orthodontics and Site Preparation
12.3.6 Provisional Phase
References
Further Reading
13 Loading Protocols in Implantology
13.1 Principles
13.1.1 Definitions
13.1.2 Conventional Loading
13.1.3 Early Loading
13.1.4 Progressive Loading
13.1.5 Immediate Loading
13.2 Procedures. 13.2.1 Selecting a Loading Protocol
13.2.2 Methods of Evaluation of the Primary Stability for Immediate Loading
13.3 Tips
References
14 Surgical Instrumentation
14.1 Principles
14.1.1 Mirror, Probe, and Tweezers
14.1.2 Scalpel Handles
14.1.3 Scalpel Blades
14.1.4 Curettes
14.1.5 Needle Holders
14.1.6 Periosteal Elevators
14.1.7 Retractors
14.1.8 Depth Probe
14.1.9 Tissue Forceps/Pliers
14.1.10 Mouth Props/Bite Blocks
14.1.11 Scissors
14.1.12 Extraction Forceps, Periotomes and Elevators
14.1.13 Kidney Dish
14.1.14 Surgical Kit, Electric Motor, 20:1 Handpiece, and Consumables
14.1.15 Grafting Well
14.2 Optional Instrumentation. 14.2.1 Rongeurs
14.2.2 Benex
14.2.3 Bone Harvesters
14.2.4 Anthogyr Torq Control
14.2.5 Piezosurgery
14.3 Tips
15 Flap Design and Management for Implant Placement
15.1 Principles. 15.1.1 Neurovascular Supply to Implant Site
15.1.2 Flap Design and Management
15.1.3 Types of Flap Reflection
15.2 Procedures. 15.2.1 Tissue Punch
15.2.2 Envelope Flap
15.2.3 Triangular (Two‐Sided) and Trapezoidal (Three‐Sided) Flap
15.2.4 Papilla‐Sparing Flap
15.2.5 Buccal Roll
15.2.6 Palacci Flap
15.3 Tips
References
16 Suturing Techniques
16.1 Principles
16.1.1 Types of Sutures
16.1.1.1 Absorbable Sutures
16.1.1.2 Non‐absorbable Sutures
16.1.2 Suture Adjuncts
16.1.3 Suture Size
16.1.4 Needle
16.2 Procedures. 16.2.1 Simple/Interrupted Sutures
16.2.2 Continuous/Uninterrupted Suture
16.2.3 Mattress Sutures
16.2.3.1 Horizontal Mattress
16.2.3.2 Vertical Mattress
16.2.4 Suture Removal
16.3 Tips
17 Pre‐surgical Tissue Evaluation and Considerations in Aesthetic Implant Dentistry
17.1 Principles
17.2 The Influence of Tissue Volume on Peri‐implant ‘Pink’ Aesthetics
17.3 Tissue Volume Availability and Requirements
17.3.1 Hard Tissue Requirements (Figure 17.3 and 17.4)
17.3.2 Soft Tissue Requirements (Figure 17.5)
17.4 Pre‐operative Implant Site Assessment (Figures 17.6 and 17.7)
17.5 Key Factors in Diagnosis of the Surrounding Tooth Support Prior to Extraction
17.5.1 Integrity of the Interproximal Height of Bone
17.5.2 Essential Criteria Evaluation Prior to Extraction
17.5.3 Integrity of the Buccal Plate of Bone
17.6 Tips
17.7 Conclusion
References
18 Surgical Protocols for Implant Placement
18.1 Principles
18.1.1 Implant Positioning
18.2 Procedures
18.2.1 One‐Stage versus Two‐Stage Protocols
18.2.2 Post‐operative Management Protocols
18.3 Tips
References
19 Optimising the Peri‐implant Emergence Profile
19.1 Principles
19.1.1 The Peri‐implant Emergence Profile
19.2 Procedures. 19.2.1 Single‐Stage versus Two‐Stage Implant Surgery
19.2.2 Buccal Roll Flap
Steps
19.2.3 Pouch Roll Technique [4]
Steps
19.2.4 Apically Repositioned Flap
Steps
19.2.5 Buccally Repositioned Flap
Steps
19.2.6 Free Gingival Graft
Steps – Recipient Site Preparation
Steps – Harvesting of the Free Gingival Graft
Steps – Preparation and Stabilisation of the Free Gingival Graft
19.3 Tips
References
20 Soft Tissue Augmentation
20.1 Principles
20.1.1 Types of Oral Soft Tissue
20.1.2 Anatomical Considerations for Harvesting Autogenous Soft Tissue Grafts. 20.1.2.1 Hard Palate
20.1.2.2 Tuberosity
20.1.2.3 Buccal Attached Gingiva of Maxillary Molars
20.1.3 Soft Tissue Substitutes. 20.1.3.1 Allogenic Origin
20.1.3.2 Xenograft Origin
20.1.4 Purpose of Soft Tissue Graft (Periodontal Plastic Surgery) 20.1.4.1 Aesthetic Purpose
20.1.4.2 Functional Purpose
20.2 Procedures. 20.2.1 Techniques. 20.2.1.1 Harvesting the Palatal Tissue Graft as a Free Gingival Graft and Connective Tissue Graft
20.2.1.2 Root Coverage
20.2.1.3 Soft Tissue Augmentation Prior to Bone Grafting
20.2.1.4 Soft Tissue Graft to Gain Keratinised Tissue
20.3 Tips
References
Further Reading
21 Bone Augmentation Procedures
21.1 Principles
21.1.1 Why is Bone Grafting Necessary?
21.1.2 Defect Topography Classification
21.1.3 Requirements for Successful Tissue Grafting
21.1.4 Materials Used for Augmentation. 21.1.4.1 Autogenous Bone
21.1.4.2 Membranes
21.1.4.3 Membrane Fixation Systems
21.2 Procedures. 21.2.1 Bone Graft with Non‐resorbable Membrane (Figures 21.2 and 21.3)
21.2.2 Autogenous Bone Graft (Figures 21.4–21.10)
21.3 Tips
References
22 Impression Taking in Implant Dentistry
22.1 Principles
22.1.1 Impression Techniques Used in Implant Dentistry
22.1.1.1 Abutment Level Impressions
22.1.1.2 Implant Level Impressions
22.1.2 Customised Impression Copings
22.1.3 Multiple Unit Impressions
22.2 Procedures
22.2.1 Implant Level Impression
22.2.2 Digital Impressions
22.3 Tips
References
23 Implant Treatment in the Aesthetic Zone
23.1 Principles
23.1.1 General Considerations
23.1.1.1 Lip Contour and Length
23.1.1.2 Tooth Display at Repose and in Broad Smile
23.1.1.3 Smile Line
23.1.1.4 Teeth Length, Shape, Alignment, Contour, and Colour
23.1.1.5 Gingival Display, Gingival Zeniths, and Papillae of Maxillary Anterior Teeth
23.1.1.6 Width of Edentulous Space
23.1.1.7 Gingival Biotype
23.1.2 Major Deficiencies in Hard and Soft Tissues
23.2 Procedures
23.2.1 Assessment of Gingival Biotype
23.2.2 Clinical Management
23.2.3 Timing of Implant Placement
23.2.4 Thickness of Soft Tissues
23.3 Tips
References
24 The Use of Provisionalisation in Implantology
24.1 Principles
24.1.1 Prosthetically Guided Tissue Healing
24.2 Procedures
24.2.1 Direct Techniques
24.2.2 Indirect Techniques
24.3 Tips
Reference
25 Abutment Selection
25.1 Principles
25.1.1 Custom Abutments
25.1.2 Prefabricated (Stock) Abutments
25.1.3 Material Selection
25.1.4 Abutment Design
25.2 Procedures
25.3 Tips
References
26 Screw versus Cemented Implant‐Supported Restorations
26.1 Principles
26.1.1 Retrievability
26.1.2 Aesthetics
26.1.3 Passivity
26.1.4 Hygiene (Emergence Profile)
26.1.5 Reduced Occlusal Material Fracture
26.1.6 Inter‐arch Space
26.1.7 Occlusion
26.1.8 Health of Peri‐Implant Tissue
26.1.9 Provisionalisation
26.1.10 Clinical Performance
26.2 Procedures
26.2.1 Screw‐Retained Restoration
26.2.2 Cement‐Retained Restoration
26.2.3 Lateral Set‐Screw (Cross‐Pinning)
26.2.4 Angle Screw Correction/Bi‐axial Screws
26.3 Tips
References
27 A Laboratory Perspective on Implant Dentistry
27.1 The Shift from Analogue to Digital
27.2 Standards in Manufacturing Today
27.3 The Importance of Implant Planning for the Laboratory
27.4 Digital Planning to Manage Aesthetic Cases
27.5 Scanning for Implant Restorations
27.6 Digital Data Acquisition for Full Arch Cases
27.7 Inserting Full Arch Cases at Surgery
27.8 Tips
28 Implant Biomechanics
28.1 Principles
28.1.1 Forces and their Nature
28.1.1.1 Pressure = Force/Area
28.1.1.2 Impulse = Force/Time
28.1.1.3 Compressive, Tensile, and Shear Forces
28.1.1.4 Application to Materials and Occlusion
28.1.1.5 Incline Plane Mechanics (Normal Force)
28.1.2 Beams
28.1.3 Levers
28.1.4 Cantilevers
28.1.5 Bone
Reference
Further Reading
29 Delivering the Definitive Prosthesis
29.1 Principles
29.1.1 Soft Tissue Support
29.1.2 Occlusal Verification
29.1.3 Aesthetic Evaluation
29.1.4 Torque Requirement for Delivery
29.1.5 Cementation Technique and Material Selection – Cemented Crowns
29.1.6 Screw Access Channel Management – Screw‐Retained Crowns
29.1.7 Pink Porcelain
29.2 Procedures
29.2.1 Delivering a Cement‐Retained Crown – Chairside Copy Abutment Technique
29.2.1.1 Creating a Polyvinyl Siloxane Copy Abutment
29.2.1.2 Delivering a Cement‐Retained Crown Using a Copy Abutment Technique
29.3 Tips
References
30 Occlusion and Implants
30.1 Principles
30.1.1 Excessive Forces on Dental Implants
30.1.2 Bruxism and Implants
30.2 Procedures
30.2.1 Clinical Occlusal Applications
30.3 Tips
References
31 Dental Implant Screw Mechanics
31.1 Principles
31.1.1 Factors Affecting Implant Screw Joint Stability. 31.1.1.1 Preload
31.1.1.2 Embedment Relaxation (Settling Effect)
31.1.1.3 Screw Material and Coating
31.1.1.4 Screw Design
31.1.1.5 Abutment/Implant Interface Misfit
31.1.1.6 Abutment/Implant Interface Design
31.1.1.7 Functional Forces
31.1.1.8 Number of Implants
31.1.1.9 Torque Wrench
31.2 Procedures
31.2.1 Techniques for Retrieving a Fractured Screw. 31.2.1.1 The Ultrasonic Scaler Technique [11]
31.2.1.2 Screwdriver Technique
31.2.1.3 Manufacturer Rescue Kits
31.3 Tips
References
32 Prosthodontic Rehabilitation for the Fully Edentulous Patient
32.1 Principles
32.1.1 Number of Implants for Full Arch Implant Rehabilitation. 32.1.1.1 Removable Overdenture
32.1.2 Fixed Implant‐Supported Bridgework
32.2 Procedures. 32.2.1 Occlusal Vertical Dimension
32.2.2 Phonetics
32.2.3 Swallowing
32.2.4 Facial Appearance
32.2.5 Impression Taking
32.2.6 Abutment Selection
32.2.7 Prosthodontic Options for Fixed Bridgework
32.2.8 Occlusion
32.3 Tips
References
33 Implant Maintenance
33.1 Principles
33.1.1 Radiographic Analysis
33.2 Procedures
33.3 Tips
References
34 The Digital Workflow in Implant Dentistry
34.1 Components and Steps of the Digital Implant Workflow. 34.1.1 Digital Diagnostic Impression
34.1.2 Cone Beam Computed Tomography
34.1.3 Digital Implant Treatment Planning
34.1.4 The Digital Surgical Guide
34.1.5 Pre‐surgical Fabricated Temporary Prosthesis
34.1.6 Guided Implant Surgery
34.1.7 Implant Digital Impressions
34.1.8 Manufacturing of the Customised Prosthesis
References
35 Biological Complications
35.1 Principles
35.1.1 Attachment Differences
35.1.2 Crestal Bone Loss
35.1.3 Peri‐implant Disease
35.1.3.1 Prevalence of Peri‐implant Diseases
35.1.3.2 Risk Factors in Peri‐implant Disease
35.1.3.2.1 Cement versus Screw Retention
35.1.3.2.2 Prosthodontic Contour
35.1.3.2.3 Prosthodontic Design (Accessibility for Hygiene)
35.1.3.2.4 Implant Surface
35.2 Procedures. 35.2.1 Treatment of Peri‐implant Disease
35.2.1.1 Methods of Decontamination
35.2.1.1.1 Mechanical Decontamination
35.2.1.1.2 Chemical Decontamination
35.2.1.1.3 Lasers and Photodynamic Therapy
35.2.2 Treatment of Peri‐implant Mucositis
35.2.3 Treatment of Peri‐implantitis
35.2.3.1 Non‐surgical Therapy for Peri‐implantitis
35.2.3.2 Surgical Therapy for Peri‐implantitis
35.2.4 Recommendations
35.2.5 Supportive Care
35.3 Tips
References
36 Implant Prosthetic Complications
36.1 Principles
36.1.1 Incidence of Prosthetic Complications. 36.1.1.1 Implant‐Supported Single Tooth Crowns and Implant‐Fixed Dental Prostheses
36.1.1.2 Full Arch Implant‐Fixed Dental Prostheses
36.1.2 Aetiology of Prosthetic Complications
36.1.2.1 Mechanical Overloading
36.1.2.2 Cement Excess
36.1.2.3 Proximal Contact Loss
36.2 Procedures. 36.2.1 Occlusion
36.2.2 Unfavourable Implant Position
36.2.3 Anterior Implants
36.2.4 Implant Fracture
36.2.5 Screw Loosening
36.2.6 Abutment Screw Fracture
36.2.7 Stripped Screw Head
36.2.8 Passive Fit
36.2.9 Mechanical and Biological Complications of Framework Misfit
36.2.10 Impression Technique
36.2.11 Gingival Fistula
36.2.12 Prevention of Prosthetic Complications
36.3 Tips
References
Index
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Further technological advances have led to the launch of dynamic surgical navigation (e.g. X‐Guide™; X‐Nav Technologies) in which real‐time surgery is guided using computer software and delivers interactive information to improve the precision and accuracy of implant positioning.
Study models that have been articulated with a facebow transfer record and a maxillo‐mandibular relationship (MMR) record allow the clinician to measure and analyse occlusal relationships and spatial considerations, and to manufacture templates. The casts can be used to create a diagnostic set‐up of the proposed prosthesis using wax and/or denture teeth. This set‐up may then be transferred to the mouth to be evaluated, used as a radiographic guide or a surgical guide, and potentially transformed into a provisional restoration. More recently, the use of chairside intra‐oral scanning, DICOM data files from CBCT, and STL files from 3D optical scanning are merged to allow planning with interactive 3D software. The proposed virtual set‐up of teeth allows visualisation of the planned restoration in relation to the bone and soft tissue architecture. This allows analysis of the bony ridge in relation to the planned tooth position, so that the length, diameter, position, and alignment of implants can be determined accurately.
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