KULIAH FKG UNISSULA
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AUTO BIOGRAPI
RUSDIMA UDI
CIREBONJ 17 MEI 1943
FKG UGM 1972
PPDGS I B.H. UGM 1993
FK UNISSULA
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GAWAT DARURAT PHLEGMOON MANDIBULA
GAWAT DARURAT PENYAKIT SYSTEMIS
INFEKSI ODONTOGEN
TERLOKALISIR PADA APEX GIGI
MENYEBAR KE JARINGAN SEKITAR
PENYEBARAN SYSTEMIS
HEMATOGEN LYMFOGEN
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PERTAHANAN TUBUH
HUMORAL
IMMUNOGLOBULIN
KOMPLEMEN SELLULER
LEUKOSIT MONOSIT LIMFOSIT
MAKROFAG ! PMN
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BARTER PERTAHANAN
TULANG AL"EOLAR
PERIOSTEUM
MUSKULUS
FASIA
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PERKEMBANGAN INFEKSI
JARINGAN KERAS PULPITIS
GANGRENE PERIODONTITIS
OSTEITIS
OSTEOMYELITIS
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JARINGAN LUNAK
PERIKORONITS
ABSCES SUB MUKUS
ABSCES SUBCUTAN
CELLULITIS$PHLEGMOON MANDIBULA
LUDWIG ANGINAMEDIASTINITIS
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PHLEGMOON MANDIBULA $ CELLULITIS
RADANG JARINGAN SELLULLAR
DIFFUS ! BERKEMBANG CEPAT TANPA BATAS KAUSA HYALURONIDASE
PALPASI KERAS TIDAK ADA FLUKTUASI
MEN JADI ABSCES ! LUDWIG ANGINA
MEDIASTINITIS ! CA"ERNOUS SINUS THROMBOSIS
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LUDWIG ANGIMA
INFEKSI BILATERAL
SUBMENTUM SUBMANDIBULAR SUBLINGUAL
TIDAK ADA FLUKTUASI LIDAH TERDORONG KEATAS DAN BELAKANG
EDEMA GLOTIS
DEHYDRASI SEPTIKEMI ! MEDIASTINITIS
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A%&'()* +&% J&,*%-&% P%+/0/%- G*-*
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P,&&%&% D%'& C&,*
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PENATA LAKSANAAN
TERAPI MEDIKAMENTOSA TERAPI KAUSA ANTI MIKROBA
TERAPI SYMPTOMATIK ANALGETIKA ANTI INFLMASI
ANTI PYRETIKA
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TERAPI SUPPORTIF
TERAPI NUTRISI
KARBOHYDRAT
PROTEIN LEMAK
ROBORANSIA
ELECTROLIT
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TERAPI BEDAH
INSISI
PENGAMBILAN GIGI KAUSA
TERAPI REHABILITASI
FUNGSI MASTIKASI ESTETIS
FONETIK TERAPI PSIKIS
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CA"UM ORIS
FOKAL INFEKSI MENYEBAR HEMATOGEN
LIMFOGEN
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BAROMETER
DIABET
ODOR ACETON
HYPERTROPY GINGI"ALEUKEMIA$HEMOFILIA
PENDARAHAN SPONTAN HYPERTHROFI GINGI"A
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HEMOFILIA
KELAI AN PEMBEKUAN DARAH
DEFISIENSI P ROTEIN PROSES PEMBEKUAN
DITURUNKAN MELALUI KROMOSOM X
S3CARA RESECIF
LEBIH BANYAK PADA ANAK LAKI2
NYERI PADA PERSENDIAN
MUDAH PERDARAHAN PD TRAUMA RINGAN
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LEUKEMIA
KANKER DARAH SUMSUM TULANG BELAKANG
PENDARAHAN GUSI SPONTAN
MUDAH TERINFEKSI
PEMBENGKAKAN KELENJAR GETAH BENING
LEHER AXILLA FEMUR
SESAK NAFAS
KU MENURUN
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DIABETES
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HEMOFILIA
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PHLEGMOON MANDIBULA
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P%5&,&% *%60* -*-*
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P,&&%&% D%'& C&,
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GIGI IMPL N
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Implant GuidelinesWhat is a dental implant?
Biomaterialsmost commonly used
commercially pure (CP) titanium
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titanium-aluminum-vanadium alloy(Ti-6Al-!) - stron"er # used $% smallediameter implants
Implant GuidelinesWhat is a dental implant?
Titaniumli"ht$ei"ht&iocompati&le
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corrosion resistant(dynamic inert o'ide layer)stron" # lo$-priced
Implant GuidelinesWhat is a dental implant?
i'ture typesA coatedTi sur*ace modi*ied
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tap or sel*-tappin"scre$ or press *it
Implant GuidelinesWhat is a dental implant?
+,sseointe"rationBr.nemar/ - late 01234s
direct structural # *unctional
i & d d li i
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connection &et$een ordered5 livin"&one # sur*ace o* a load-carryin"implant
Implant GuidelinesWhat is a dental implant?
+,sseointe"rationsimilar so*t-tissue relationship to
natural dentition (sulcular epithelium)
h i d li/ t t
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hemi-desmosome li/e structuresconnect epithelium to titaniumsur*ace
Implant GuidelinesWhat is a dental implant?
+,sseointe"rationcircum*erential and perpendicular
connective tissue
ti ti i ti
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no connective tissue insertionno intervenin" harpey4s *i&er
attachment
Implant GuidelinesWhat is a dental implant?
+,sseointe"ration&one-implant inter*ace
osteo&lasts in close pro'imity
to inter*acet d * i l t & thi
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separated *rom implant &y thinamorphous proteo"lycan layer
osseointe"ration - hi"hly predicta&le
Implant GuidelinesWhat is a dental implant?
+,sseointe"ration&one-implant inter*ace
osteo&lasts in close pro'imity
to inter*acet d * i l t & thi
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separated *rom implant &y thinamorphous proteo"lycan layer
osseointe"ration - hi"hly predicta&le
Implant GuidelinesWhat is a dental implant?
+,sseointe"ration&one-implant inter*ace
o'ide layer continues to "ro$-
(7333 A at 6 yrs) - mineral ion interaction
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increase in tra&ecular pattern&one deposition # remodelin" in
response to stress
Implant GuidelinesWhat is a dental implant?
+,sseointe"ration&one-implant inter*ace
o'ide layer continues to "ro$-
(7333 A at 6 yrs) - mineral ion interaction
i i t & l tt
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increase in tra&ecular pattern&one deposition # remodelin" in
response to stress
Implant GuidelinesWhat is a dental implant?
Components # terminolo"ycopin" or prosthesis scre$ (top)copin"analo"
i l t & d
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implant &odya&utment
trans*er copin" (indirect or direct)
Implant GuidelinesWhat is a dental implant?
Components # terminolo"yhy"iene scre$a&utment
*or scre$5 cement or attachment
second sta"e permucosal a&utmen
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second sta"e permucosal a&utmen*irst sta"e cover scre$implant &ody or *i'ture (&ottom)
Implant Guidelines
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Implant GuidelinesWhat is a dental implant?
8odern typesimplants are small-
standard a&utment- usually 9:;
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$ide-&ody or $ide-plat*orm- up to6:3mm
Implant GuidelinesWhat is a dental implant?
8odern typeslen"ths- typically ran"e *rom a&out
; to 02mm
=avy uses +e'ternal he'
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=avy uses e'ternal he' "ood research literature a&le to &e maintained
(9i or =o&el Biocare systems)
Implant GuidelinesWhat is a dental implant?
8odern types (=o&el Biocare)i'tures
tandard
8/ II
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8/ II
Implant GuidelinesWhat is a dental implant?
8odern types (=o&el Biocare)A&utments
tandardCera,ne>sthetiCone
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>sthetiCone8irusConeAn"ulated 0; (ne$) or 93
Implant GuidelinesWhat is a dental implant?
8odern types (=o&el Biocare)tandard
no anti-rotational propertiescan use *or multiple units
can use *or hy&rid dentures
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can use *or hy&rid dentures
Implant GuidelinesWhat is a dental implant?
8odern types (=o&el Biocare)Cera,ne
sin"le tooth esthetic replacementa&utment attached to *i'ture $%
restoration cemented to a&utment
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restoration cemented to a&utmentaccommodation *or *i'ture misali"nmen
can provisionali@e
Implant GuidelinesWhat is a dental implant?
8odern types (=o&el Biocare)>sthetiCone
esthetic P restorationsmachined "old cylinder a&utment allo$
cro$n mar"in to seat close to *i'ture
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cro$n mar"in to seat close to *i'ture($ithin 0mm)
Implant GuidelinesWhat is a dental implant?
8odern types (=o&el Biocare)8irusCone
esthetic P restorationsuse $hen decreased vertical hei"htallo$s :
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allo$s :
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use i* less than ideal *i'ture placementuse $here esthetic cervical mar"in
reuired
Implant GuidelinesWhat is a dental implant?
8odern types (=o&el Biocare)Cera,ne>sthetiCone8irusConeAn"ulated a&utments
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An"ulated a&utments All come $ith narro$5 re"ular or $ide
plat*orms (=P5 P5 WP)
Implant GuidelinesWhat is a dental implant?
8odern types (9i)i'tures8icro8iniplant8iniplant
tandardWid i t
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ta da dWide iameter
( sur*ace area to use $here vertical hei"ht)
Implant GuidelinesWhat is a dental implant?
8odern types (9i)i'turesIC> (incremental cuttin" ed"e)
super sel*-tappin" implant
uses tapered cuttin" *lutesallo s more placement control
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p "allo$s more placement controlrapid &one en"a"ement # implant
sta&ili@ation
Implant GuidelinesWhat is a dental implant?
8odern types (9i)A&utments>P (conical) - (esthetic pro*ile)Gold DCEA-typeT$o-piece a&utment postTA (standard)
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( )Pre-An"led=e$ Gold tandard F (@ero rotation)
Implant GuidelinesWhat is a dental implant?
8odern types (9i)Gold DCEA-type a&utment
scre$-retained at *i'ture levelnon-se"mented a&utment
scre$-retained cro$n to implantuses lar"er scre$ &ecause it runs all th
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puses lar"er scre$ &ecause it runs all th
$ay to the *i'ture
Implant GuidelinesWhat is a dental implant?
8odern types (9i)Gold DCEA-type a&utment
thin &uccal-lin"ual tissues
limited inter-occlusal distance
(as little as :
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( )sin"le or multiple units
Implant GuidelinesWhat is a dental implant?
8odern types (9i)>P (conical) - (esthetic pro*ile)scre$-retained cro$n to the a&utment"old cylindernon-parallel implant placementsin"le or multiple units
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" pminimum ;mm inter-occlusal distance
reuired
Implant GuidelinesWhat is a dental implant?
8odern types (9i)T$o-piece a&utment postnon-rotationalcement-retained cro$n to the a&utmentsimplicity o* treatment - chairside
preparation
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use $hen access to posterior re"ion $%scre$ driver is limited
Implant GuidelinesWhat is a dental implant?
What4s ne$?(9i)Prep-Tite Posts
scre$ retained a&utmentstandard impression procedure
cemented restoration6 taper $ith 9 vertical "rooves
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6 taper $ith 9 vertical "roovesmultiple collar hei"hts
Implant GuidelinesWhat is a dental implant?
What4s ne$?(9i),sseotite (+clot retentive sur*ace)
speci*ic micro-topo"raphic acid-etched implant sur*ace desi"n !s:machined-sur*ace implant
sin"le sta"e implant
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" " p loaded a*ter 7 monthsclaim 12:
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restorin" posterior spaces not &ound &ynatural teeth
Implant GuidelinesWhat is a dental implant?
Advanta"esno preparation o* tooth%adJacent teeth&one sta&ili@ation # maintenanceretrieva&ility improvement o* *unction
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psycholo"ical improvement
Implant GuidelinesWhat is a dental implant?
isadvanta"esris/ o* scre$ loosenin"ris/ o* *i'ture *ailure len"th o* treatment timeneed *or multiple sur"eries
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challen"in" esthetics
Implant GuidelinesConsultation Appointment
Treatment plannin" phaseDiagnosis begins with a complete
patient evaluation
"uidelines *or +decision-ma/in"process
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ptreat the +entire patientrestore *orm5 *unction # esthetics
Implant GuidelinesConsultation Appointment
Treatment plannin" phasepro&lem list # patient desires
initial evaluationchie* complaint
medical%dental history revie$i t % t l
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intra%e'traoral e'amevaluation o* e'istin" prosthesis
Implant GuidelinesConsultation Appointment
Treatment plannin" phaseinitial evaluation
dia"nostic impressions%articulated castradio"raphs - panoramic and periapical
(CT scan or tomo"raphy - as indicated)photo"raphs
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photo"raphs
Implant GuidelinesConsultation Appointment
Treatment plannin" phasetreatment options%in*ormed consent
e'planation o* lon"-term commitmen
restorative - sur"ical Joint consultt$o-sta"e sur"ery
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stage Istage II
Implant GuidelinesConsultation Appointment
Treatment plannin" phaset$o-sta"e sur"ery
(use o* clear acrylic sur"ical stent ismandatory)
stage I -implant *i'ture placement $%cover scre$ (le*t su&mer"ed)
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cover scre$ (le*t su&mer"ed)
Implant GuidelinesConsultation Appointment
Treatment plannin" phasestage I - healin" phase
9 month minimum (mandi&le ) - usually months *or posterior re"ions
6 month minimum (ma'illa) - usually 6-1months *or all re"ions
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"
Implant GuidelinesConsultation Appointment
Treatment plannin" phasestage II - uncoverin" # placement o*
transmucosal healin" a&utment
healin" phase
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-6 $ee/s *or so*t tissue healin"
Implant GuidelinesConsultation Appointment
Treatment plannin" phaserestorative phase
maintenance and re"ular recall
*ee # payment policy
"oal to restore *orm5 *unction #th ti
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esthetics
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Implant GuidelinesTreatment plannin" phase
Pro&lem list # treatment considerationsocclusal analysis
advs%disadvs o* proposed treatment
re*errals%specialty consults
appointment seuencin"treatment alternatives
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treatment alternatives
Implant GuidelinesTreatment plannin" phase
Pro&lem list # treatment considerationsteeth
periodontium
radio"raphic analysis
sur"ical analysisesthetic analysis
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esthetic analysis
Implant GuidelinesTreatment plannin" phase
Pro&lem list # treatment considerationsteeth - num&er # e'istin" condition
pro"nosis o* remainin" teethsi@e5 shape # diameter o* e'istin"
dentitiontooth # root an"ulations # pro'imity
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" ymesiodistal $idth o* edentulous space
Implant GuidelinesTreatment plannin" phase
Pro&lem list # treatment considerations
teeth - num&er # e'istin" conditionminimum 6-;mm &et$een teeth to
*acilitate implant placement
(&ased on 9mm *i'ture)K 0:
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;mm *rom center o* implant - to centero* implant *or edentulous area
Implant GuidelinesTreatment plannin" phase
Pro&lem list # treatment considerations
teeth - num&er # e'istin" conditionmore than 03mm mesiodistal space -
sin"le tooth implant notrecommended
(multiple a&utments should &e splinted)
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Implant GuidelinesTreatment plannin" phase
Pro&lem list # treatment considerations
teeth
periodontium
radio"raphic analysis
sur"ical analysisesthetic analysis
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esthetic analysis
Implant GuidelinesTreatment plannin" phase
Pro&lem list # treatment considerationsperiodontium- &one supportEe/holm # Far& classi*ication
quality- &est - thic/ compact cortical&one $%core o* dense tra&ecularcancellous &one
&est re"ion - mandi&ular symphysisL
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&est re"ion mandi&ular symphysisLpoorest in posterior re"ions
Implant GuidelinesTreatment plannin" phase
Pro&lem list # treatment considerationsperiodontium- &one support
quantity- reuired *or implant -6mm &uccal-lin"ual $idth $%su**icient
tissue volume2mm interradicular &one $idth03mm alveolar &one a&ove IA= canal or
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03mm alveolar &one a&ove IA= canal or&elo$ ma'illary sinus
Implant GuidelinesTreatment plannin" phase
Pro&lem list # treatment considerationsperiodontium- &one support
quantity- reuired *or implant - i* inadeuate &one support may need
rid"e or site au"mentationramus or chin "ra*t (auto"ra*t)BA (allo"ra*t)
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BA (allo"ra*t)Bio-,ss('eno"ra*t)
Implant GuidelinesTreatment plannin" phase
Pro&lem list # treatment considerationsperiodontium- &one support
place implants minimum o* 7mm *romIA= canal or &elo$ ma'illary sinus
cro$n%root ratio
mo&ility*urcations
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pro&in" depths
Implant Guidelines
Treatment plannin" phase Pro&lem list # treatment considerations
periodontiummuco"in"ival pro&lems
need su**icient tissue volume to recreat"in"ival papilla
need some attached "in"iva to maintainperi-implant sulcus0st year post-op &one resorption M 0mm
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0st year post op &one resorption 0mm
Ncrest o* &one optimal 7- 9mm &elo$ C>
Implant Guidelines
Treatment plannin" phase Pro&lem list # treatment considerations
periodontiummuco"in"ival pro&lems
place implant 7-9mm apical to *ree"in"ival mar"in o* adJacent tooth
recreates &iolo"ic $idth o* peri-implantsulcusNso*t tissue hei"ht 7mm or K mm may
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so*t tissue hei"ht 7mm or K mm maycreate challen"e
Implant Guidelines
Treatment plannin" phase Pro&lem list # treatment considerations
periodontiumoral hy"iene - important pre # post
systemic mani*estations - ie: dia&eticsare predisposed to delayed healin"
destructive ha&its - smokingiscontraindicated - delayed or inadeuate
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contraindicated delayed or inadeuatetissue healin" # osseointe"ration noted
Implant Guidelines
Treatment plannin" phase Pro&lem list # treatment considerations
teeth
periodontium
radio"raphic analysis
sur"ical analysisesthetic analysis
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y
Implant Guidelines
Treatment plannin" phase Pro&lem list # treatment considerations
radio"raphic analysisperiapical patholo"y
radiopaue%radiolucent re"ions
adeuate vertical &one hei"htadeuate space a&ove IA= or &elo$
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ma'illary sinus
Implant Guidelines
Treatment plannin" phase Pro&lem list # treatment considerations
radio"raphic analysisadeuate interradicular area
&one uality # uantity
radio"raphs - panoramic and periapical(CT scan or tomo"raphy - as indicated)
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Implant Guidelines
Treatment plannin" phase Pro&lem list # treatment considerations
radio"raphic analysisradio"raphs- aid to determine amount
o* +space# &one availa&le
CT (computed tomo"raphy) scan - "ives
more accurate # relia&le assessment o*
&one (uality5 uantity # $idth) # locale
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( y5 y )
o* anatomic structures
Implant Guidelines
Treatment plannin" phase Pro&lem list # treatment considerations
radio"raphic analysis-radio"raphic stent- (can dou&le as
sur"ical stent)acrylic stent $ith lead &eads or &all
-&earin"s (
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allo$s more accurate radio"raphicinterpretation
Implant Guidelines
Treatment plannin" phase Pro&lem list # treatment considerations
radio"raphic analysis-distortion (common to all Q-rays)
Panore' M 7
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Eateral Ceph M 2Periapical M 7:
-
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Implant Guidelines
Treatment plannin" phase Pro&lem list # treatment considerations
sur"ical analysis-sur"ical "uide stent- None o* the
most critical *actors *or o&tainin" an idealsur"ical # esthetic result
used durin" *i'ture installation as "uide*or optimal B%E and 8% position
use o* &uccal channel drill "uide allo$s
-
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use o* &uccal channel drill "uide allo$simproved access # visi&ility
Implant Guidelines
Treatment plannin" phase Pro&lem list # treatment considerations
sur"ical analysis-implant len"th%diameter
determined &y uantity o* &one apical toe'traction site
use lon"est implant sa*ely possi&lediameter dictated &y correspondin" roo
anatomy at crest o* &one
-
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anatomy at crest o* &one
Implant Guidelines
Treatment plannin" phase Pro&lem list # treatment considerations
sur"ical analysistreatment options
immediate- place implant at time o*tooth e'traction
delayed immediate- 2-03 $ee/ delaydelayed- 1-03 months or lon"er
immediate $ill not allo$ &one resorption5 &ud l d ll & *ill * t &ili ti
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delayed allo$s &one *ill *or sta&ili@ation
Implant Guidelines
Treatment plannin" phase Pro&lem list # treatment considerations
sur"ical analysisproper sur"ical techniue durin"
implant placement is critical
minimal heat "eneration important ; Celsius *or one minute or less
provides most predicta&le healin"response
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response
Implant Guidelines
Treatment plannin" phase Pro&lem list # treatment considerations
teeth
periodontium
radio"raphic analysis
sur"ical analysisesthetic analysis
-
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Implant Guidelines
Treatment plannin" phase Pro&lem list # treatment considerations
esthetic analysissmile line - hi"h in ma'illaL lo$ in
mandi&le
lip shape - *ull !s: thine'istin" rid"e de*ect - i* visi&le $%
hi"h smile line $ill need au"mentation
-
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hi"h smile line $ill need au"mentation
Implant Guidelines
Treatment plannin" phase Pro&lem list # treatment considerations
esthetic analysisimplant emer"ence pro*ile (963)
restored implant should appear to+"ro$ or emer"e *rom the "in"iva
very natural # desira&le in appearanceavoid +tomato on a stic/ cro$ns or
periodontal pro&lems may develop
-
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periodontal pro&lems may develop
Implant Guidelines
Treatment plannin" phase Pro&lem list # treatment considerations
occlusal analysisadvs%disadvs o* proposed treatment
re*errals%specialty consults
appointment seuencin"treatment alternatives
-
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Implant Guidelines
Treatment plannin" phase Pro&lem list # treatment considerations
occlusal analysisimprovement o* *unction and%or
esthetics (?)para*unctional ha&its
can &e destructiveteeth lost to occlusal trauma or
para*unction less success $% implants
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para*unction - less success $% implants
Implant Guidelines
Treatment plannin" phase Pro&lem list # treatment considerations
occlusal analysisdia"nostic casts
(mounted to determine opposin" occlusion
rid"e $idthe'istin" inter-arch vertical space
0-0
-
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0-0
-
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Implant Guidelines
Treatment plannin" phase Pro&lem list # treatment considerations
occlusal analysisadvs%disadvs o* proposed treatment
re*errals%specialty consults
appointment seuencin"treatment alternatives
-
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Implant Guidelines
Treatment plannin" phase Pro&lem list # treatment considerations
advs%disadvs o* proposed treatmentare as individual as the case &ein"
treatment plannedcostpatient desiresclinician a&ilitiesetc
-
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etc:
Implant Guidelines
Treatment plannin" phase Pro&lem list # treatment considerations
occlusal analysisadvs%disadvs o* proposed treatment
re*errals%specialty consults
appointment seuencin"treatment alternatives
-
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Implant Guidelines
Treatment plannin" phase Pro&lem list # treatment considerations
re*errals%specialty consultscan pro"nosis &e improved $ith (?)R
orthodontics
periodontal therapyendodontic therapy
-
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360/439
Implant Guidelines
Treatment plannin" phase Pro&lem list # treatment considerations
re*errals%specialty consultspre-prosthetic sur"ery
e'tractions
rid"e contourin" or e'ostosis remova osteotomy
&one or so*t tissue au"mentation
-
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"
Implant Guidelines
Treatment plannin" phase Pro&lem list # treatment considerations
occlusal analysisadvs%disadvs o* proposed treatment
re*errals%specialty consults
appointment seuencin"treatment alternatives
-
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Implant Guidelines
Treatment plannin" phase Pro&lem list # treatment considerations
appointment seuencin"len"th o* treatment time
need *or multiple sur"eries
-
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Implant Guidelines
Treatment plannin" phase Pro&lem list # treatment considerations
occlusal analysisadvs%disadvs o* proposed treatment
re*errals%specialty consults
appointment seuencin"treatment alternatives
-
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364/439
Implant Guidelines
Treatment plannin" phase Pro&lem list # treatment considerations
treatment alternatives*i'ed partial denturesremova&le partial denturesresin-&onded *i'ed partial denturesorthodonticsdo nothin"
-
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Implant Guidelines
Treatment plannin" phase Indications
"ood "eneral healthadeuate &one uality # volumeappropriate occlusion # Ja$ relations ina&ility to $ear conventional prosthesis
un*avora&le num&er%location o* a&utmentsin"le tooth loss
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Implant Guidelines
Treatment plannin" phaseContraindications
unrealistic patient e'pectationsalcohol%dru" dependence (smo/in")para*unctional ha&itspsycholo"ical *actors
anatomical *actors inadeuate rid"e%interarch dimensions immunosuppression
-
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Implant Guidelines
Treatment plannin" phaseContraindications (relative)
(need sur"ical intervention)ramus "ra*t
inadeuate &one at implant sitee'cessive &ony concavities
sinus li*t or IA= transposition inadeuate vertical space *or implant
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Implant Guidelines
Treatment plannin" phase +,sseointe"rated implants can &e
placed in the irradiated mandi&les o*
selected patients $ithout hyper&aric
o'y"en treatment =iini5 Deda5 Seller5 Worthin"tonL Experience with
Osseointegrated Implants laced in Irradiated !issues in "apan
and the #nited $tates5 Intl O ,ral 8a'illo*ac Implants 0112L
09R3;-00
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Implant Guidelines
8aintenance
Criteria *or success 8aintenance and ecall
y"iene Aids
Pro&lems
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Implant Guidelines
8aintenance
Primary "oal is to protectandmaintain +tissue-inte"rationL
good oral hygieneis a /ey
element
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Implant Guidelines
8aintenance +Implant patients should &e
thorou"hly instructed inmaintenance therapy $ith theunderstandin" that the patientserves as co-therapist
Grant et al5 eriodontics% in the !radition o&
'ottlieb and Orban5 ed 6: t: Eouis5 C! 8os&y Co5
01225 pp03;
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1225 pp 3 < 31
Implant Guidelines
8aintenance +Any practitioner $ishin" to
practice dental implantolo"y must&e /no$led"ea&le concernin"postinsertion maintenance o* theimplant
0122 =ational Institutes o* ealth Consensus
evelopment Con*erence
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Implant Guidelines
8aintenance
Criteria *or success 8aintenance and ecall
y"iene Aids
Pro&lems
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Implant Guidelines
8aintenance Criteria *or successR(most important is "ood dia"nosis)
no peri-implantitisno associated radio"raphic
radiolucencymar"inal &one loss 0:3-0:
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Implant Guidelines
8aintenance Criteria *or successR
tissue inte"rationR &one%so*t tissue+osseointe"ration
a&sence o* mo&ilityno pro"ressive so*t tissue chan"es o
&one losssta&le clinical attachment level
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Implant Guidelines
8aintenance Criteria *or successR
a&sence o* &leedin" uponpro&in"%e'cessive pro&in" depths
a&sence o* discom*ort
success rate varies $ith &one ualityloadin" dynamics5 etc:
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Implant Guidelines
8aintenance Criteria *or successR
anticipated success rate o*
1; anterior mandi&leL 13 ma'illaL
decreases in posterior uadrants
due to poorer &one uality (03 yrs)&est &oneR "ood cortical $ith some
cancellous *or vascular supply
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Implant Guidelines
8aintenance
Criteria *or success 8aintenance and ecall
y"iene Aids
Pro&lems
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Implant Guidelines
8aintenance 8aintenance # ecallR
(our elementshome-care re"imenperiodic recalls rein*orcin" re"imenstrict adherence to recall schedule #
veri*ication o* *unction5 com*ort5 andesthetics li*etime maintenance commitment
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Implant Guidelines
8aintenance 8aintenance # ecallR
(requency o& recall immediate post-delivery7 hoursone $ee/
t$o $ee/s (re-torue i* needed)6 months&i-annual or annual evaluation
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Implant Guidelines
8aintenance 8aintenance # ecallR
)linical arameters o& Evaluationoral hy"iene includin" plaue inde' implant sta&ility (evaluate mo&ility)retrieva&ilityperi-implant tissue healthcrevicular pro&in" depths
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Implant Guidelines
8aintenance 8aintenance # ecallR
)linical arameters o& Evaluation&leedin"radio"raphic assessment (serial)
crestal &one level # inte"rity o*
attachment systemsproper torue on scre$ Jointsocclusion
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Implant Guidelines
)linical arameters o& Evaluation oral hy"iene (plaue inde')
plaue is 0 etiolo"ic *actor in tissuedestruction (peri-implant and natural toothrevie$ oral hy"iene instructionmonitor throu"h plaue indices
same reuirements as *or natural teethuse neutral sodium *luorides
-
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Implant Guidelines
)linical arameters o& Evaluation implant sta&ility (evaluate mo&ility)
may &e the key indicatoro* *i'ture healthminimal mo&ility $% osseointe"rated
*i'turesR 0;-
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Implant Guidelines
)linical arameters o& Evaluation retrieva&ility
*ailin" implant may &e mas/ed i* connecteto same prosthesis
important to remove P to evaluateannual removal recommended *or multiple
unit prosthesis
early *ailure detection $ill minimi@e *i&routissue @one si@e # may allo$ placement o*$ider diameter *i'ture
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Implant Guidelines
)linical arameters o& Evaluation peri-implant tissue health
visual inspectionR si"ns o* pathoses? Alterations in color5 contour # consistencyalveolar mucosa may surround implant #
appear more erythematous than "in"ivatissue movement $hen adJacent tissues
retracted may a**ect so*t-tissue-implantattachment M (detrimental)perimucosal /eratini@ed tissue is &est
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Implant Guidelines
)linical arameters o& Evaluation crevicular pro&in" depths
most accurate means o& detecting perimplant destruction *use plastic pro&es)pro&in" measurements closely
appro'imate actual &one levelsavoid durin" *irst 9 months a*ter a&utment
connection to avoid dama"in" $ea/epithelial attachmentmay &e di**icult i* threads supra-osseous
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Implant Guidelines
)linical arameters o& Evaluation &leedin"
controversy as to si"ni*icance o* B,P atperi-implant inter*aceB,P may precede clinical si"ns o*
in*lammationB,P # radio"raphic chan"es are most val
indicators o* peri-implant &rea/do$nrecommend continued use o* peri-implant
sulcus pro&in" to monitor implant success
-
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Implant Guidelines
)linical arameters o& Evaluation radio"raphic assessment
one o* most valua&le measures o* implantsuccesso* value $hen
cannot pro&e area due to constricted implantnec/5 and
to assess *uture mo&ility $ithout P removal to accurately determine amount o* &one loss ia&sence o* increased crevicular depth
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Implant Guidelines
)linical arameters o& Evaluation radio"raphic assessment
compare &ony chan"es $ith sta&lelandmar/s - implant threads - (one-hal* thread U 3:9mm)
compare hori@ontal%vertical implantdimensions &et$een serial radio"raphs
periapical radio"raphs U 7:< -
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Implant Guidelines
)linical arameters o& Evaluation radio"raphic assessment
bone level determination should be basedonly upon standardi+ed periapicalradiographs
threads o* implant must appear sharp #$ell-delineated on Q-ray to &e accurate
Q-ray &eamR direct V1 *rom lineperpendicular to lon" a'is o* implant/eep *ilm parallel # close to implant
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Implant Guidelines
)linical arameters o& Evaluation radio"raphic assessment
recommend /!p o* not 63 (&est 6
-
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Implant Guidelines
)linical arameters o& Evaluation radio"raphic assessment
uality in *ilm development is paramountpost-op radio"raphic intervalsR
not &et$een *i'ture placement to a&utmentconnection
one $ee/ a*ter a&utment insertion
immediately *ollo$in" *i'ed prosthesisinsertion5 then 6 months later annually *or *irst 9 years5 then every 7 years
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Implant Guidelines
)linical arameters o& Evaluation radio"raphic assessment
e'pect 0:3mm mar"inal &one loss durin"*irst year postinsertionL V3:0mm per yearanticipated therea*ter
"reater &one loss o&served in ma'illa
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Implant Guidelines
)linical arameters o& Evaluation radio"raphic assessment
rapid &one loss seen i*R *ractured *i'ture initial osseous trauma at insertion *i'ture over-ti"htenin" occlusal trauma poor adaptation o* prosthesis to a&utment
+normal physiolo"ic response plaue-associated in*ection (peri-implantitis)
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Implant Guidelines
)linical arameters o& Evaluation radio"raphic assessment
>8>8B> HHH
>ndosseous implants may lose
e'tensive amounts o* &one support
$ithout sho$in" rather o&vious
radio"raphic chan"es or increase inmo&ility detecta&le in periodontally
involved teeth
-
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Implant Guidelines
)linical arameters o& Evaluation proper torue on scre$ Joints
loosened scre$s are the most commonpro&lem
can result in locali@ed in*lammation5 looserestorations5 and discom*ort
i* re-toruin" a loose a&utment - care not tstrip or +round-o** the he'
e'cessive *orce can *racture scre$%implanor create increased stresses in the &one
-
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Implant Guidelines
)linical arameters o& Evaluation occlusion
e'cessive *orce concentrations - result ine'tensive &one loss and implant *racture 8AO, CAD>R poor a&utment prosthesis
adaptation poor *orce distri&ution # improperly planned
occlusal schemes also *actors
recommend anterior "uidance NN B>T"roup *unction%&alanced occlusion also
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Implant Guidelines
)linical arameters o& Evaluation occlusion
"oal to prevent lateral *orces on posteriorimplants concentrated in cervical area
relationship &et$een para*unctional activit# increased mar"inal &one loss
ideal is +li"ht centric occlusion onlyL
no contact in lateral e'cursionsno contact in 8I5 &ut $ith hard clench $illhold shim stoc/ (:3330)
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Implant Guidelines
8aintenance
Criteria *or success 8aintenance and ecall
y"iene Aids
Pro&lems
-
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Implant Guidelines
8aintenance y"iene AidsR
plastic scalers- ,=E - *ora&utmentscalin" to prevent easy a&rasion o* so*ttitaniumL use in only one direction startin"at the "in"iva (&est are *rom 9i)
ultrasonic scalers- =, - do not useTitan- or ultrasonic scalers unless specianon-metal tips used
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Implant Guidelines
8aintenance y"iene AidsR
prophy Jets- use $ith caution
*ine prophy pasteor *lour o* pumice-,S -use $ith &lue ru&&er tips or ru&&erprophy cups
uper-loss or Post-care- nylon *i&ersthread *or interpro'imal use &et$eena&utments and under e'tensions
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Implant Guidelines
8aintenance y"iene AidsR
end-tu*ted # small interdental&rushes(Pro'i&rushes) -*or cleanin"&uccal # lin"ual a&utment sur*acesL allmetal sur*aces must &e nylon coated
electric tooth&rushes -use at discretioo* dentistL may &e use*ul i* limited manualde'terity
-
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Implant Guidelines
8aintenance y"iene AidsR
chlorhe'idine - use durin" peri-sur"icalperiods or as needed i* episodes o* acuteso*t tissue in*lammation occur
*luoride rinses or "els -use neutral
sodium *luoride to avoid dama"e totitanium *i'tures that may occur $ithacidulated types
-
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Implant Guidelines
8aintenance
Criteria *or success 8aintenance and ecall
y"iene Aids
Pro&lems
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Implant Guidelines
8aintenance Pro&lemsR
so*t tissue reactions*ractured or loosened scre$s*ailin" or *ailed *i'ture
&ro/en attachments% components
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Implant Guidelines
Pro&lemsRso*t tissue reactions
most common due to loose scre$spoor oral hy"iene can lead to
+peri-implantitis - may result in
pro"ressive &one loss
lac/ o* attached peria&utment so*t tissu*ailed or *ailin" implants
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Implant Guidelines
Pro&lemsRso*t tissue reactions
treatmentRremove o**endin" scre$5 ti"htena&utment # reinsert prosthesis
rein*orce oral hy"ieneso*t-tissue auto"ra*t
replacement o* *ailed implant
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Implant Guidelines
Pro&lemsR*ractured or loosened scre$s
0st suspicion $hen complaint o* +looseimplant or discom*ortuse correct scre$driver *or scre$ head
$ithout e'cess *orce or can +round o**he'
i* retrievin" (+teasin" out) *racturedscre$ caution not to dama"e he'
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Implant Guidelines
Pro&lemsR*ailin" or *ailed *i'ture
*ailin" implant !s *ailedimplant
+implantitis !s
periodontal disease
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Implant Guidelines
Pro&lemsR*ailin" or *ailed *i'ture
*ailin" implantclinical si"nsR pro"ressive crestal
&one lossL so*t tissue poc/etin"L B,
$% possi&le purulenceL tenderness to
percussion or torue
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Implant Guidelines
Pro&lemsR*ailin" or *ailed *i'ture *i'ture loss
*ailin" implantcausesR sur"ical compromises (&on
overheatin"5 lac/ o* initial sta&ility)Lnonpassive superstructuresL too rapinitial loadin"L *unctional overloadLinadeuate scre$ Joint closureLin*ection
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Implant Guidelines
Pro&lemsR*ailin" or *ailed *i'ture *i'ture loss
*ailin" implanttreatmentRremove and replace $ith lar"er
diameter *i'tureL or treat in*ection
# re- evaluate
interim - remove prosthesis #a&utments # irri"ate area $% CQLdisin*ect components # reinsert
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Implant Guidelines
Pro&lemsR*ailin" or *ailed *i'ture *i'ture loss
*ailedimplantclinical si"nsR mo&ilityL +dull
percussion soundL peri-implantradiolucency
(connective tissue implantencapsulation may not &e visi&le onradio"raph)
-
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415/439
Implant Guidelines
Pro&lemsR*ailin" or *ailed *i'ture *i'ture loss
*ailed implant (most noted at ta"e II)causesR sur"ical compromises (&on
overheatin"5 lac/ o* initial sta&ility)Lnonpassive superstructuresL too rapinitial loadin"L *unctional overloadLinadeuate scre$ Joint closureLin*ection
-
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Implant Guidelines
Pro&lemsR*ailin" or *ailed *i'ture *i'ture loss
*ailed implant (most noted at ta"e II)treatmentR
removal o* implant
-
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Implant Guidelines
Pro&lemsR*ailin" or *ailed *i'ture *i'ture loss
+implantitis !s periodontitisclinical si"nsRsimilar clinical
presentation $% same patho"enic
microor"anisms
causesRpoor oral hy"ieneL &acteriaLcause may &e un/no$n (?)
-
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Implant Guidelines
Pro&lemsR*ailin" or *ailed *i'ture *i'ture loss
+implantitis !s periodontitistreatmentRconsults to provider - consider
rema/e or "uided tissue re"enerationetc:
interim - remove prosthesis #a&utments # irri"ate area $% CQLdisin*ect components # reinsert
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Implant Guidelines
Pro&lemsR&ro/en attachments% components
remove o**endin" attachment(i* possi&le) and replace or
provisionali@e
&e care*ul not to dama"e e'ternal he' oscratch titanium *i'ture or a&utment
-
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Implant Guidelines
Case election Implant recommended
replacement o* teeth X7;501 # 93
Implant not recommended
replacement o* tooth X72s
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Case X0
-
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Implant Guidelines
Implant recommended 6 y%o male presented $ith *ailin"
=CT X7; and severe locali@edperiodontitis
tooth deemed hopeless ande'tracted
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Implant Guidelines
Implant recommended :3 ' 02mm =o&elpharma *i'ture
placed
-
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Implant Guidelines
Implant recommended Cera-,ne a&utment restored $ith
cemented (Setac Cem) P8 cro$n
-
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Case X 7
-
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Implant Guidelines
Implant recommended 90 y%o *emale presented $ith
missin" X01 # 935 and retainedX0; # 97 (third molars)
-
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Implant Guidelines
Implant recommended mesial-an"ulated X02 # 90 $ith
inadeuate mesial-distal andinterarch spacin" due to super-erupted opposin" X 9 # 0
-
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Implant Guidelines
Implant recommended &uccal-lin"ual rid"e $idths in areas
o* missin" X01 and X93 alsode*icient
-
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Implant Guidelines
Implant recommended teeth X 0; # 97 e'tracted and
&ilateral ramus "ra*ts placed atedentulous sites (X01 # 93)
-
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Implant Guidelines
Implant recommended molar upri"htin" o* teeth X02 # 90
completed to create adeuatespace *or implants
-
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Implant Guidelines
Implant recommended
-
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Implant Guidelines
Implant recommended restoration o* *i'tures $ith scre$-
retained non-se"mented DCEAa&utments $% P8 cro$ns
-
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Implant Guidelines
Implant recommended restoration o* teeth X 9 # 0 $ith
P8 cro$ns to re-esta&lish properocclusal plane
-
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Case X 9
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Implant Guidelines
Implant not recommended 9 y%o male presented $ith past
history o* supernumerary X72 =oteR dilacerated root to mesial on
X72
-
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Implant Guidelines
Implant not recommended edentulous site presented $ith
inadeuate *acial &one5 andinadeuate spacin" e'isted&et$een X7; # 72 root apices toallo$ implant placement
-
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Implant Guidelines
Implant not recommended a*ter t$o years o* orthodontic
therapy5 X72 *ailed to move to*acilitate implant placement
-
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Implant Guidelines
Implant not recommended edentulous area restored $ith a
resin-&onded *i'ed partial denture(BP X7;-72)
-
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