dental implants sanjay chauhan pg diploma in implant dentistry ( france ) pg certificate in...

Dental Implants

Sanjay CHAUHAN• PG Diploma in Implant Dentistry ( France )• PG Certificate in Endodontics ( IGNOU )• B.D.S. ( Govt Dental College – Goa )

Not just Implantology but the Science behind it .

Dedicated to my Mentor Professor Dr. Manuel Chanavaz

INSPIRATION

www.dentaleduindia.com

1st Module : Let’s get started with Dental Implants

Didactics and Two Hands-on


Rationale , Evolution & Scope of Oral Implantology

• What are the aims & objectives of oral rehabilitation by means of dental implants and bone reconstructive surgeries ?• What is Wolff’s law ? What are its clinical implications in

Implantology ?• Anatomical consequences of edentulism in mandible and

maxilla .• Historical review and evolution of dental implants from

blade form to contemporary endosseous root form implants .


Philosophy of contemporary Implant Surgery

• Definition of Oral Implantology ?• ASA Classification ? Its significance in Implantology ?• What is alveolar bone ?• What is occlusal plateau ?• What are Preprosthetic Surgeries ?• What are absolute contraindications for implants ?• What are relative contraindications for implants ?• French volumetric classification of available bone by

Professor Manuel Chanavaz ( Quantitative ) .• Classification of bone based on density by Carl E Misch

( Qualitative ) • What is osteointegeration ? • What are primary & secondary interferences ?


• What do you mean by confidential medical questionnaire ?• What are tests of primary intention ?• What are tests of secondary intention ?• CLINICAL EXAMINATION ????• Medical imaging ?

• Medications of special interest to implant dentistry ?

• IOPA• OPG• Medical grade C.T. scan• C.B.C.T . Scan• Dentascan ?• Dicom – dire format ?• Interactive CT scan

• Bisphosphonates• Anticoagulant medication• Herbal supplements


• Lifestyle related factors . . .

• Calcium metabolism ?• Osteoporosis ? Primary & Secondary osteoporosis ?• GTR ?• PRF ?

• Tobacco• Alcohol• Obesity• Sports• Drug addiction• Psychological diseases


Treatment Planning

• Definition of treatment planning ?• What are the objectives of treatment planning ?• Oral rehabilitation using endosseous implants in general

practise ???• Oral rehabilitation using endosseous implants in general

practise with bone grafts ???• Oral rehabilitation using endosseous implants in general

practise with bone grafts in hospital ???• Oral rehabilitation using endosseous implants and

extensive bone grafts & orthognathic procedures in hospital ???• Oral rehabilitation using endosseous implants and

extensive bone grafts & orthognathic procedures and tissue graft in hospital ???


• What are the ideal goals of modern dentistry ?• What are the advantages of a single tooth implant ?• What are the disadvantages of a single tooth implant ?• What are the factors that influence treatment planning ?• What is the minimum age at which implant can be inserted

in males and females and why ?• Which are the conditions that must be ideal to get desirable

aesthetics of implants ?• How far an implant should be from adjacent tooth and

why ?• What should be the minimum gap between the two

implants and why ?• How far an implant should be from a neurovascular

bundle ?• How far an implant should be from maxillary sinus ?• How far an implant should be from floor of the nose ?• Two stage implant ? One stage implant ? Immediate

loading implants ?


Asepsis , Sterilization & Disinfection

• Define asepsis ?• What is the difference between asepsis & sterilization ?• What is cross contamination ?• What are nosocomial infections ?• What is the difference between the bacteriostatic &

bactericidal ?• Modalities of sterilization ?• Autoclaving ?• Standard international protocol of sterilization ?• Standard international operation theatre protocol ?


1st Hands-on .... ASEPSIS

• Cleaning , packing & sterilization of instruments .• Arrangement & management of surgical disposables .• Scrub suit for doctor & patient .• International protocol for scrubbing .• How to wear surgical gloves ? • How to drape the patient ?• Management of trolleys ?• How to connect suction and handpiece for implant motor ?• How to administer LA without hampering the asepsis ?• Role of operating surgeon , assistant , mentor & circulating

nurse ?• Brief idea about implant placement under conscious

sedation and under GA ?


Dental Implants

• Types of dental implants ? ( Endosseous & Subperiosteal )• Implant body & prosthetic abutment ?• Implant body

• Implant design of endosseous root form Implant 1. Implant length2. Implant diameter3. Implant shape / Macrogeomatry4. Surface characteristics

5. Crest module consideration & design of apex

• Crest module • Body• Apex

1. External hex2. Internal hex

1. Thread pitch2. Thread shape3. Thread depth


• Surgical placement of implant ?• Sub-gingival healing & trans-gingival healing ?• 2nd stage surgery ?• Healing abutment / healing screw / gingival former ?• Impression coping / impression post ?

• Permanent Abutment

1. Transfer coping2. Pick-up coping

1. Abutment for screw retention2. Abutment for cement retention3. Abutment for attachment

1. Straight abutment2. Angled abutment


Diagnostic Casts & Surgical Template

• Surgical stent / Surgical guide ?• Radiographic stent ?• Computer guided implant placement ?• Computer assisted design & manufacturing of surgical

guides ?• Surgical navigation / Electronic surgery ?

2nd Hand-on ....Implant Placement in dummy mandible

• Introduction to armamentarium of surgical & prosthetic kit .• Introduction to implant motor / Physiodispenser .• Introduction to surgical guide .• Osteotomy on dummy mandible with sequential drilling .• Introduction to external & internal irrigation .• Implant placement on dummy mandible .• Placement of cover screw .• Introduction to prosthetic components .• Basic idea of impression procedure in Implant dentistry ?

1. Transfer type of impression coping2. Pick-up type of impression coping

1. Implant level impression2. Abutment level impression


2nd Module : Implant Prosthodontics

Didactics and Hands-on


Prosthetic Options in Implant Dentistry

• PROSTHETIC CLASSIFICATION ( Carl E Misch – 1989 )

• FP-1 • FP-2• FP-3• RP-4• RP-5

• Kennedy's Classification ?• Applegate’s Modifications ?• What is crown height space ? • What are the measures that are to be done when CHS

increases ?


Bone Density : A key determinant for treatment planning

• Misch Bone density classification scheme ...

• CT determination of bone density . ‘ Tomodensitometry ’• What is the effect of bon density on treatment plan ?• Key implant position & number ?

• D1• D2• D3• D4• D5


Implant Body Size : A biomechanical & Aesthetic Rationale

• Forces applied to the dental implants may be characterised in terms of 5 distinct factors ..

• Short v/s long implants ?• Narrow v/s wide implants ?• Implant diameter criterion ?• Implant length criterion ?

1. Magnitude2. Duration3. Direction4. Type5. Magnification


Preimplant Prosthodontics

• 5 initial elements that should be assessed in sequence and treated when indicated ...

1. Maxillary anterior tooth position2. Existing occlusal vertical dimensions3. Mandibular incisal edge position4. Maxillary occlusal plateau5. Mandibular occlusal plateau


• Specific criterion ....

1. Lip line2. Maxillo-mandibular relationship3. Existing occlusion4. CHS5. TMJ status6. Extraction of hopeless teeth7. Existing prosthesis8. Arch form : Ovoid , Tapering , Square9. Natural tooth adjacent to implant site10. Soft tissue evaluation of implant site


Implant Prosthodontics

• PROSTHODONTIC REVIEW of the patient .• FPD impression V/S Implant impression .• Wolff’s Law...Clinical Implications .• Hex design of Implant ..External hex & Internal hex .• Cement retained restorations & screw retained restorations

.• Implant level screw retained & abutment level screw

retained restorations .• An introduction to all the prosthetic components .• Transgingival & Subgingival healing .• When to do 2nd stage surgery .• Healing abutment / healing screw / gingival former .• Abutment diameter selection .• Impression procedure & Interocclual record registration . • Implant level impression & Abutment level impression .• Closed tray impression & Open tray impression .


• Transfer coping / Impression coping .• When to use transfer impression coping ?• When to use pick up impression coping ?• Impression technique overview . • Impression materials for implant dentistry .• Impression trays .• Tray adhesives .• Manipulation of elastomeric impression materials .• Protect cap .• Incorporation of soft tissue contours around implants .• Screw retained implant supported prosthesis .• Cement retained implant supported prosthesis .• Convertible abutments .• ABUTMENT : Height & Angulation selection .• Single piece & two piece abutment .• CAD – CAM prosthesis .• Precision attachment in Implants .


• O – ring / Ball attachment .• Locator attachment .• Hadder bar & Dolder bar .• Single tooth replacement & multiple teeth replacement . • Complete implant supported prosthesis .• Implant supported overdentures ..Mandible & Maxilla .• Implant supported fixed prosthesis .. Mandible &

Maxilla .


• Partial edentulous condition

1. Single tooth / Multiple teeth2. Maxillary / Mandibular3. Anterior / Posterior 4. Implants are parallel / non parallel5. Connection : External hex / internal

hex6. Screw retained / Cement retained

prosthesis


Mandibular implant supported overdentures

• Agony of mandibular denture .... ?• Mandibular implant supported overdentures ..

Advantages ?• Mandibular implant supported overdentures ..

Advantages ?• Implant supported overdentures v/s fixed prosthesis ?• Mandibular Overdentures ...Treatment options

• Overdenture -1.• Overdenture -2.• Overdenture -3 A.• Overdenture -3 B• Overdenture - 4.• Overdenture - 5 .


Edentulous Mandible : Treatment plan for fixed restoration

• Advantages of fixed prosthesis in Mandible .• Disadvantages of fixed prosthesis in Mandible .• Mandibular Dynamics ??????? • Treatment options for fixed prosthesis ?

• Treatment Option - 1.• Treatment Option - 2.• Treatment Option -3.• Treatment Option - 4.• Treatment Option - 5.


Maxillary arch implant considerations : Fixed & IODs

• Premaxilla compromised anatomical conditions .• Premaxillary arch form .. Square , Ovoid , Tapering .• Premaxilla partial edentulous ... Treatment plan ?• Premaxilla complete edentulous ...Treatment plan ?• Posterior maxilla partial edentulous ...Treatment plan ?• Posterior maxilla complete edentulous ...Treatment plan ?• Completely edentulous maxilla ...Treatment plan ?• Key implant positions ?• Implant dimensions ...Length & Diameter ?• Maxillary Implant supported over dentures ...Treatment

options .... RP -5 , RP - 4 .• Maxillary Implant supported fixed prosthesis ?• Special considerations for edentulous posterior maxilla ?


Single Tooth Replacement

• Disadvantages of replacing 2nd Mandibular molar ?• Local contraindications for a single tooth implant ?• Implant placement in mandibular molar region ?• Implant placement in mandibular premolar region ?• Implant placement in mandibular canine region ?• Implant placement in mandibular incisor region ?• Implant placement in maxillary molar region ?• Implant placement in maxillary premolar region ?• Implant placement in maxillary canine region ?• Implant placement in maxillary incisor region ?


Second Stage Surgery

• Uncovery and management of complications ?• Surgical failure ?• Osseous healing failure ?• Early loading failure ?• Intermediate loading failure ?• Late failure ?• Criterion for evaluation of successful implant at 2nd stage

Uncovery ?• Reasons for greater Crestal bone loss around a

prematurely exposed implant ?• Causes of bone loss at 2nd stage surgery ?• Resolution of bone loss at Uncovery ?• Rigid fixation determination ?


• Prosthetic review of the case ?• Mounted articulated study casts ?• Two situations

1. Partially edentulous2. Complete edentulous

1. Mandible / Maxilla2. Implant supported over denture or Implant & soft tissue supported over denture or Implant supported fixed prosthesis

3rd Hands-on ...Implant Prosthodontics


• Prosthodontically driven case selection?• Live demonstration of stage Two surgery .• Management of complication at stage Two surgery . • Temporisation .• Abutment selection ?• Platform switching ?• Loading protocol ?• Impression techniques ? • Implant occlusion ?• Lab communication ?• Prosthesis insertion ?• Establishing occlusion ?• Instructions to the patient for maintenance ?• Follow up schedule ?


3rd Module : Surgical Stage

Didactics and Two Hands-on


Bone Physiology , Metabolism & Biomechanics

• What are functions of bone ?• What is modelling ?• What is remodelling ??? A.-R.-Q.-F.-M.• Remodelling cycle ?• B.M.U. / Cutting filling cones ?• Osteoblasts & Osteoclasts ?• Activation ? Activators ?• What is one ‘ Sigma ’ ? Explain it ...• Composition of bone ?• Osteoinduction ?• Osteoconduction ?• Density of bone : Effect on surgical approach & healing ?


Periosteum

• What is Periosteum ?• How periosteum is connected to cortical & medullary

bone ?• Histology of periosteum ?• Functions of periosteum ?• Which main function of periosteum is of prime importance

to an Implantologist ?• Blood supply to the bone cortex ?• Blood supply of bone as a whole ?• From where the periosteum gets blood supply ?• What are the protective mechanism of periosteum if its

damaged ?• What are the causes of periosteal destruction ?• What are the consequences of damage of periosteal blood

supply ?


Healing

• What is healing ?• What are the factors that effect healing ?• Define healing . • What is the purpose of healing ?• Effect of osseous healing on the behaviour of soft tissue ?• What are different phases of healing ?• What is primary healing ?• What is definitive healing ?• What is reactive healing ?• What is one ‘ SIGMA ’ ?• How many days it takes to form a woven bone ?• How many days does it take to form a lamellar bone ?• When a bone can bear a load ?• What are the ideal conditions for healing ?


• What are the principal phases of surgical healing ?• Healing in ...

• How to successfully manage post extraction socket ?• What is the standardized protocol of healing after

curettage ?• What is the standard protocol of healing after fracture ?• Conditions required for success of implant surgery ?• Conditions required for the success of graft ?

• Endocrine deficiency• Arthritis


Bone Expansion & Compaction

• Define compaction & expansion of bone .• What is the ultimate aim of bone expansion ?• What is the effect of bone expansion on density of bone ?• What is the meaning of word ‘ Compaction Expansion ’ ?• What is the scientific basis of compaction expansion ?


4th Hands-on ...Soft tissue management & suturing ( Animal Cadaver )

• Review of asepsis & gowning .• Analysis & interpretation of radiographic & CT scans

including measurement techniques of bone volumes .• Basic surgical techniques ..( on animal cadavers )

• Flap design .• Incision pattern .• Meticulous handling of periosteum

.• Flap retraction .• Suturing .

• Suturing with needle holder• Hand suturing

5th Hands-on ..Live Surgery of Implant placement .... One by mentor , one by participant

• Case Presentation & Treatment planning by participant ?• Briefing of surgery by the participant ?• Review & live demonstration of international OT

protocol ?• Preparation & arrangement of armamentarium ?• Patient’s preparations ?• Administration of L.A. without hampering asepsis ?• Flap design ?• Incision ?• Flap retraction ?• Sequential osteotomy ?• Implant placement ?• Placement of cover screw & suturing ?• Post – operative instructions ?• Debriefing of surgery ?• Healing without antibiotics ?

dental implants sanjay chauhan pg diploma in implant dentistry ( france ) pg certificate in...

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