Advanced Concepts with. Dental Implants. Consequences of Missing Teeth. Psychological. Anatomical. Esthetic. Types of Dental Implants

Transcription

1 Advanced Concepts with Dental Implants Lisa Copeland, RDH _ Rismanchian M, Effect of implants on maximum bite force in edentulous patients. J Oral Implantology. Consequences of Missing Teeth Psychological Anatomical Esthetic Types of Dental Implants Subperiosteal placed onto the bone Transosteal External surgical procedure Endosteal placed into the bone Immediate Transitional (ITI) Mini & Small Implants Temporary Anchor Device (TADS)

2 2 Candidate Criteria Appointment Flow: Consult Radiographs Study Models Surgical Healing Prosthetic Bone Types Additional Surgical Procedures: Sinus Lift Bone Graft Membrane Teal Mercer, Linda, RDH, MPH, Implications for the Dental Hygienist When Dealing With Dental Implants, Journal of Practical Hygiene, March/April 2008, pp Osteotomy Tissue Graft Weinbergm Mea A. Comprehensive Periodontics for the Dental Hygienist. Upper saddle River, NJ Pearson Education Inc Misch CE. Contemporary Implant Dentistry. 3rd Edition. St Lois: Mosby;

3 3 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 Interactive Videos Publications Digital Journals 3

4 4 Dental Professional Assessment Tissue Consistency, color, form Inflammation / bleeding Exudate Radiographic bone level Occlusion Mobility Selfcare Radiographic Guidelines: Vertical BW or PAX Monitor M/D bone Baseline at prosthetic insert 6-8 months compare to baseline 4

5 5 Probes PerioWise (Premier): Colorvue (Hu-Friedy): Initial Crestal Bone Loss Abutment connection Implant surface alteration Prosthetic table Excessive stress Frequent component change Secondary Crestal Bone Loss Biofilm Stress Mobility Percussion Tissue Assessment There are conflicting reports concerning the need for keratinized tissue around implants ~World Workshop Periodontics Probing Is It Safe? Gentle Pressure Fixed reference point 1st year eval color, form, consistency, BOP, depth After 1st year of stable probing, x-ray to monitor M?D bone Correlate probing depth to bone loss Click-Probe (Kerr): Misch CE. Contemporary Implant Dentistry. 3rd Edition. St Lois: Mosby;

6 6 Implant Failure and Diseases 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 CIST Cumulative Interceptive Supportive Therapy PPD 3 mm PPD 4-55 mm + Radiographic Evidence PPD 5mm - plaque - BOP + plaque + BOP + BOP no bone loss + BOP bone loss 2mm + BOP bone loss 2mm No tx. Mechanical debridement + polishing + Antiseptic cleansing (CHX) + Systemic/local antibiotic therapy + Regenerative or resective therapy Adapted from consensus workshop group ITI conference, Dec

7 7 Supportive Therapies Accepted Implant scalers Air polishers No abrasives Non-metal OH aids Contraindicated Traditional ultrasonic scalers Traditional metal scalers Abrasives Instrument Selection Guidelines Light-weight Implant friendly Disposable Rigid Autoclavable Cost efficient Sharpenable Non-Surgical Peri-Mucositis Treatment Barnes CM, Toothaker RW, Ross JA. Polishing Dental Implants and Implant Restorations. Journal of Practical Hygiene January/February Volume 15 No 1: p28,29. 8mm pocket 7

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 pt s are smokers 8

9 9 Boere G. Influence of fluoride on titanium in an acidic environment measured by polarization resistance technique. J Appl Biomater Winter;6(4):283-8 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) Nakagawa M, Matsuya S, Shiraishi T, Ohta M. Effect of fluoride concentration and ph on corrosion behavior of titanium for dental use. J Dent Res Sep;78(9): Alternative Implant Treatments Conclusion: Action Plan Toumelin-Chemla F, Rouelle F, Burdairon G. Corrosive properties of fluoride-containing odontologic gels against titanium. J Dent Jan- Mar;24(1-2): What: Who: When: 9

10 10 WHERE CAN I FIND WHAT I NEED TO SUCCEED? PROFESSIONAL ORGANIZATIONS: Academy of Osseointegration Association of Dental Implant Auxillaries And Practice Management International Congress of Oral Implantologists (ICOI) American Academy Implant Dentistry PRODUCTS: Hu-Friedy Advanced Implant Technologies (AIT) Premier Hartzell Titanium Coated Hartzell Suvan-O Hehir A-Titan Implant Scaler Kit Hartzell Ultrasonic Insert Midwest Quixonic Cavitron Softip Salvin Sonic Scaler attachments and tips Titanium Implant Scaler (T.I.S.) ImplaKlean Titanium Implant kits ImplantPro EMS Piezo Tip Satelec Piezoelectric Implant Insert

11 11 WHERE CAN I FIND WHAT I NEED TO SUCCEED? Probes PerioWise (Premier): Colorvue (Hu-Friedy): Click-Probe (Kerr) Plaque Removal Products Proxi-Floss Bridge and Implant Floss Sturdyfloss Peri-O-Floss Nylon coated proxybrushes Proxy-tip Sulcabrush GUM Soft picks GUM Go-Betweens Perio aid Philips AirFloss Philips Sonicare Denture Care Products Smile Again / ProTech Denture Cleaner Lisa Copeland, RDH Lcopeland.rdh@gmail.com 11