praktekum fk unissula 2

7/26/2019 Praktekum Fk Unissula 2

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ENTO MAXILLO FACIAL

SYSTIM DIGESTIV BAGIAN ATAS

TULANG RAHANG DG GIGI GELIGI

MUSKULUS VASKULARISASI

INNERVASI

LYMPHATIK

GLD. SALIVARII


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TULANG RAHANG

MAXILLA

PROCESSUS ALEOLARIS G GIGI GELIGI

TUBER MAXILLA

SINUS MAXILLARIS

ARCUS ZYGOMATICUS

FORAMEN INFRA ORBITALIS

PALATUM URUM: FPRAMEN PALATINUS

INSISIVUS

PALATUM MOLLE


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MANDIBULA

PROCESSUS CONDYLOIDEUSA: TMJ

CORONOIDEUS

RAMUS MANDIBULA CORPUS MANDIBULA

TUBEROSITAS MENTALIS

FORAMEN MENTALIS

FORAMEN MANDIBULARIS


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MUSKULUS

GERAKAN MASTIKASI

MEMBENTUK ROMAN MUKA

INNERVASI

MOTORIS

SENSIBEL

VASCULARISASI

NUTRISWI

AYA TAHAN TUBUH


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GIGI GELIGI

10 GIGI ECI UI

ERUPSI UMUR 6 BULAN

ERUPSI PENUH UMUR TAHUN

GG INSISIVUS ! 1 GG KANINUS " MOLAR TIAP # SEGM

UMUR 6 TAHUN LUXASI AN IGANTI GIGI PERMANEN

$ GIGI PERMANEN

ERUPSI UMUR 6 TAHUN

BERAKHIR G MOLAR KE TIGA

GG INSISIVUS " 1 GG KANINUS ! GG PREMOLAR

$ GG MOLAR TIAP # SEGMEN


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FUNGSI GIGI GELIGI

MASTIKASI

INSISIVUS : MEMOTONG

KANINUS : MENYOBEK

PRE MOLAR AN MOLAR : MENGHALUSKAN

FONETIK

KOSMETIK



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TULANG RAHANG


TEMPAT KEDUDUKAN GIGI GELIGI

ORIGO DAN INSERSIO MUSKULUS

MUSKULUS


PENGGERAK MAN IBULA

PERLEKATAN SYSTEM VASKULER INNERVASI


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SYSTEM NERVORUM

MOTORIS PENGGERAK MUSKULUS

SENSIBEL PERASAAN

SYSTEMA VSKULER

NUTRISI

IMMUNITAS


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KELAINAN TIAP KOMPONEN

CARIES GIGI

DEMINERALISASI OLEH LINGKUNGAN ASAM MENIMBUL KERUSAKAN PADEA EMAIL SAMPAI RONGGA PULPA

CARIES SUPERTISIALIS : MELIBATKAN EMAIL

CARIES MEDIA : MENGENAI DENTIN

HYPER AEMI PULPA

CARIES PROPUNDA : MENGANAI PULPA PULPITIS

GANGREN


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A%&'()* +&% J&,*%-&% P%+/0/%- G*-*


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P,&2&%&% D%'&2 C&,*3


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P,&2&%&% C&,*3


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PENJALARAN CARIES GIGI

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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VIRULENSI MIKRO ORGANISME

KUALITAS MAMPU INVASIV

EFEK MERUSAK HOST

DG PRODUKSI

ENZYM LITIK

ENDO TOXIN EXO TOXIN

GANGGU PERTAHANAN

HUMORAL DAN SELLULAR


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BARIER PERTAHANAN

TULANG ALVEOLAR

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 SUBCUTANCELLULITIS4PHLEGMOON MANDIBULA

LUDWIG ANGINA

MEDIASTINITIS


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PHLEGMOON MANDIBULA 4 CELLULITIS

RADANG JARINGAN SELLULLAR

DIFFUS " BERKEMBANG CEPAT ! TANPA BATAS

KAUSA HYALURONIDASE

PALPASI KERAS TIDAK ADA FLUKTUASI

MEN JADI ABSCES " LUDWIG ANGINA

MEDIASTINITIS " CAVERNOUS 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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P%56&,&% *%703* -*-*


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SUB MUKUS ABSCES


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PHLEG MOON MANDIBULA


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SUB CUTAN ABSCES


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LU WIG ANGINA


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TRACHEOS TOMY


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PENYEBARAN INFEKSI GIGI


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SALIVA

GLD8 PAROTIS

GLD.SUB MANDIBULA

GLD SUB LINGUAL

PELUMAS

DAYA TAHAN


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KELAINAN SALIVA

HYPER SALIVASI

XERO STOMIA

SYALOLITIS

SYALOLIT

KISTA

MUCOCEL RANULA


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MUCOCEL


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ENUKLEASI MUCOCEL


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RANULA


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LINGUA

PROSES DEGLUTASI

MOTORIS

SENSIBEL: PERASA

OS LINGUA

FRENULUM LINGUAE

MACRO4MICRO GLOSIA

INFEKSI TUMOR


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PAPIL LI AH

T+9 )&;&) 9&9*2&:

P&9*2& C*,;/)


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BAGIAN KERAS

INFEKSI: OSTEITIS " OSTEOMYELITIS

KISTA : RADIKULAR 8 RESIDUAL8 DENTIGEROUS

TUMOR : AMELOBLASTOMA8 CARSINOMA

TRAUMA

GIGI ALVEOLUS

MAXILLA 8 MANDIBULA


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TRAUMA

TRAUMA JARINGAN LUNAK

TRAUMA JARINGAN KERAS

TRAUMA GIGI

TRAUMA TULANG RAHANG


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TRAUMA

JARINGAN LUNAK

1.CONTUSIO

BENTURAN BEN A TUMPUL

LUKA TERTUTUP

TERJA I PEN ARAHAN KULIT AN

SUBCUTAN SBG ECHIMOSIS

AKAN HILANG SETELAH = JAM


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.ABRASI

TRAUMA BERUPA GESEKAN

KULIT TERKELUPAS BER ARAH

$.LACERASI

AKIBAT BEN A TAJAM

JARINGAN ROBEK

ANGKAL4 ALAM

MENGENAI PEMB. ARAH4SYARAF


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.PENETRASI

KARENA BEN A TAJAM

ALAM

MELIBATKAN

RONGGA MULUT

HI UNG

SINUS MAXILLARIS


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>.LUKA TEMBAK

TEMBAKAN SENJATA API

TERTINGGAL4PERFORASI

6.LUKA BAKAR

AKIBAT API8CAIRAN4LOGAM PANAS

CAIRAN KIMIA8LISTRIK8MATAHARI

GEJALA KLINIS


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GEJALA KLINIS

TRAUMA DENTOMAXILLOFACIAL

1.RASA SAKIT SPONTAN

.MAL OKLUSI GIGI

$.PEMBENGKAKAN

.ECHIMOSIS

>.KREPITASI

6.HYPERSALIVASI

?. EFORMITAS ROMAN MUKA


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TRAUMA GIGI GELIGI

ISERTAI PEN ARAHAN8PEMBENGKAKAN

LACERASI JARINGAN LUNAK

1.FRAKTUR EMAIL4 ENTIN4PULPA

.AVULSI

$.IMPAKSI

.LUXASI


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TRAUMA

TULANG RAHANG

1.FRACTUR ALVEOLUS

.FRACTUR MAXILLA

$.FRACTUR MAN IBULA

.FRACTUR TULANG LAINNYA

YANG JAUH LETAKNYA

TATA LAKSANA FRAKTUR TULANG RAHANG


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REPOSISI

MENGEMBALIKAN KEDUA UJUNG FRAGMEN BERPEDOMAN PADA OKLUSI GIGI

IMMOBILISASI WIRING PLATING

MOBILISASI

TUMOR


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TUMOR

TUMOR JINAK JARINGAN LUNAK

EPULIS : TUMOR PD GINGIVA

E. GRAVIDARUM

TUMOR TULANG RAHANG

OSTEOMA

AMELOBLASTOMA


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KISTA

KISTA JARINGAN LUNAK GLD SALIVARII

MUCOCEL

RANULA

KISTA JARINGAN KERAS

KISTA RESIDUAL

KISTA RADIKULAR

KISTE DENTIGEROUS

M/;(;2


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M/;(;2

R&%/2&


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R&%/2&

P%-&%-0&'&% M/;(;2


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P%-&%-0&'&% M/;(;2

M/;(;2


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M/;(;2

M 0 2 * 0 2 2 + @


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M&;&) 02&*%&% 02%&, 2/+&@

K2&*%&% 9,0)6&%-&%T*+&0 &+&%5& 1 &'&/ 26*@ 02, 2/+&@.

S&2/,&% 0;*24 ','/'/9.

K2&*%&% 7/%-3*

S0,3* 6 : S*&2(,,@&S0,3* 6 : A3*&2(,,@&

O63',/03*4 9%5/)6&'&% &2*,&% 2/+&@8 &0*6&' : K&20/2/6@% (,-&%*08 0(2&93 0,% '0&%&%4 +3&0&% &, 30*'&,

M/;(;2 : '+ 9+ 02 2/+&@ )*%(,.R&%/2& : '+ 9+ 02 2/+&@ )&5(,.

F/%-3* 3&2*


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F/%-3* 3&2*


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R&%/2&

K2&*%&% 02%&, 2/+&@


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K2&*%&% 02%&, 2/+&@

M&;&) 02%&,

2/+&@

M&5(,

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S/6)&%+*6/2&, :

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2*+&@ 39 '-@ ;(,9.

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P,20&'&% 7,% L*%- D0' 2*+&@ 7,% L*%- P+0


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P,20&'&% 7,%. L*%-. D0' 2*+&@ 7,%. L*%-. P+0

G,&0&% 2*+&@ ',6&'&3 -&%- 6*;&,&8 2&0'&3*.

T@4 7,%;'()5.

B&-*&%" 6&-*&% L*+&@


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B&-*&% 6&-*&% L*+&@

KELAINAN LIDAH


76/509

KELAINAN LIDAH

P%+&@/2/&% O,-&% 0()9&0 +*2&9*3* 9*'2

3/&)(3& 6,2&9*3.

F/%-3*: 6*;&,&8 9%2&%&%89%-;&9.

B&-*&%" 6&-*&% L*+&@


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B&-*&% 6&-*&% L*+&@

KELAINAN LIDAH


78/509

KELAINAN LIDAH

P%+&@/2/&% O,-&% 0()9&0 +*2&9*3* 9*'2

3/&)(3& 6,2&9*3.

F/%-3*: 6*;&,&8 9%2&%&%89%-;&9.


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H,93 L&6*&2*3


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S'()&'*'*3


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E;*3* 9,-%&%;5 '/)(,


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E;*3* 9,-%&%;5 '/)(,

P,-%&%;5 '/)(,


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P%56&,&% *%703* -*-*


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5 - -

K&20/2/3


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P,&2&%&% C&,*3


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A%&'()* +&% J&,*%-&% P%+/0/%- G*-*


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P,&2&%&% D%'&2 C&,*3


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P%56&,&% *%703* -*-*


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DIABETES


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HEMOFILIA


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PHLEGMOON MANDIBULA


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P%56&,&% *%703* -*-*


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P,&2&%&% D%'&2 C&,


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GIGI IMPLAN


350/509


351/509

Implant Guidelines

What is a dental implant?

Biomaterialsmost commonly usedcommercially pure (CP) titanium

titanium-aluminum-vanadium alloy

(Ti-6Al-!) - stron"er # used $% smallediameter implants


352/509

Implant Guidelines

What is a dental implant?Titanium

li"ht$ei"ht&iocompati&lecorrosion resistant

(dynamic inert o'ide layer)stron" # lo$-priced


353/509

Implant Guidelines

What is a dental implant?i'ture types

A coatedTi sur*ace modi*iedtap or sel*-tappin"scre$ or press *it


354/509

Implant Guidelines


+,sseointe"rationBr.nemar/ - late 01234s

direct structural # *unctionalconnection &et$een ordered5 livin"

&one # sur*ace o* a load-carryin"implant


355/509

Implant Guidelines


+,sseointe"rationsimilar so*t-tissue relationship to

natural dentition (sulcular epithelium)

hemi-desmosome li/e structures

connect epithelium to titaniumsur*ace


356/509

Implant Guidelines


+,sseointe"rationcircum*erential and perpendicular

connective tissue

no connective tissue insertion

no intervenin" harpey4s *i&erattachment


357/509

Implant Guidelines


+,sseointe"ration&one-implant inter*aceosteo&lasts in close pro'imity

to inter*ace

separated *rom implant &y thinamorphous proteo"lycan layer

osseointe"ration - hi"hly predicta&le


358/509

Implant Guidelines


+,sseointe"ration&one-implant inter*aceosteo&lasts in close pro'imity

to inter*ace

separated *rom implant &y thinamorphous proteo"lycan layerosseointe"ration - hi"hly predicta&le


359/509

Implant Guidelines


+,sseointe"ration&one-implant inter*aceo'ide layer continues to "ro$-

(7333 A at 6 yrs) - mineral ion interaction

increase in tra&ecular pattern&one deposition # remodelin" in

response to stress


360/509

Implant Guidelines


+,sseointe"ration&one-implant inter*aceo'ide layer continues to "ro$-

(7333 A at 6 yrs) - mineral ion interaction

increase in tra&ecular pattern&one deposition # remodelin" in

response to stress


361/509

Implant Guidelines


Components # terminolo"ycopin" or prosthesis scre$ (top)copin"analo"

implant &odya&utment

trans*er copin" (indirect or direct)


362/509

Implant Guidelines


Components # terminolo"yhy"iene scre$a&utment

*or scre$5 cement or attachment

second sta"e permucosal a&utmen*irst sta"e cover scre$implant &ody or *i'ture (&ottom)


363/509

Implant Guidelines


364/509

Implant Guidelines


8odern typesimplants are small-standard a&utment- usually 9:;


365/509

Implant Guidelines


8odern typeslen"ths- typically ran"e *rom a&out

; to 02mm

=avy uses +e'ternal he' "ood research literature a&le to &e maintained

(9i or =o&el Biocare systems)


366/509

Implant Guidelines

What is a dental implant?8odern types (=o&el Biocare)

i'turestandard

8/ II


367/509

Implant Guidelines


A&utmentstandardCera,ne>sthetiCone8irusConeAn"ulated 0; (ne$) or 93


368/509

Implant Guidelines


tandardno anti-rotational propertiescan use *or multiple unitscan use *or hy&rid dentures


369/509

Implant Guidelines


Cera,nesin"le tooth esthetic replacementa&utment attached to *i'ture $%

restoration cemented to a&utmentaccommodation *or *i'ture misali"nmen

can provisionali@e


370/509

Implant Guidelines


>sthetiConeesthetic P restorationsmachined "old cylinder a&utment allo$

cro$n mar"in to seat close to *i'ture($ithin 0mm)


371/509

Implant Guidelines


8irusConeesthetic P restorationsuse $hen decreased vertical hei"ht

allo$s :


372/509

Implant Guidelines


An"ulated a&utment 0; or 93use to achieve &etter esthetic result

$here complicated anatomy e'istsuse i* less than ideal *i'ture placement

use $here esthetic cervical mar"inreuired


373/509

Implant Guidelines


Cera,ne>sthetiCone8irusConeAn"ulated a&utments

All come $ith narro$5 re"ular or $ideplat*orms (=P5 P5 WP)


374/509

Implant Guidelines

What is a dental implant?8odern types (9i)

i'tures8icro8iniplant8iniplanttandard

Wide iameter

( sur*ace area to use $here vertical hei"ht)


375/509

Implant Guidelines


i'turesIC> (incremental cuttin" ed"e)

super sel*-tappin" implantuses tapered cuttin" *lutes

allo$s more placement controlrapid &one en"a"ement # implant

sta&ili@ation


376/509

Implant Guidelines


A&utments>P (conical) - (esthetic pro*ile)Gold DCEA-typeT$o-piece a&utment postTA (standard)Pre-An"led=e$ Gold tandard F (@ero rotation)


377/509

Implant Guidelines


Gold DCEA-type a&utmentscre$-retained at *i'ture levelnon-se"mented a&utmentscre$-retained cro$n to implant

uses lar"er scre$ &ecause it runs all th$ay to the *i'ture


378/509

Implant Guidelines


Gold DCEA-type a&utmentthin &uccal-lin"ual tissues

limited inter-occlusal distance

(as little as :


379/509

Implant Guidelines


>P (conical) - (esthetic pro*ile)scre$-retained cro$n to the a&utment"old cylindernon-parallel implant placementsin"le or multiple unitsminimum ;mm inter-occlusal distance

reuired


380/509

Implant Guidelines


T$o-piece a&utment postnon-rotationalcement-retained cro$n to the a&utmentsimplicity o* treatment - chairside

preparationuse $hen access to posterior re"ion $%scre$ driver is limited


381/509

Implant Guidelines

What is a dental implant?What4s ne$?(9i)

Prep-Tite Postsscre$ retained a&utmentstandard impression procedurecemented restoration6 taper $ith 9 vertical "roovesmultiple collar hei"hts


382/509

Implant Guidelines

What 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 loaded a*ter 7 monthsclaim 12:


383/509

Implant Guidelines

What is a dental implant?emem&erH:

or P4splan *or scre$-retained restorationsno anti-rotational propertiesal$ays use at least 7 *i'tures $hen

restorin" posterior spaces not &ound &ynatural teeth


384/509

Implant Guidelines

What is a dental implant?Advanta"es

no preparation o* tooth%adJacent teeth&one sta&ili@ation # maintenanceretrieva&ility improvement o* *unctionpsycholo"ical improvement


385/509

Implant Guidelines

What is a dental implant?isadvanta"es

ris/ o* scre$ loosenin"ris/ o* *i'ture *ailure len"th o* treatment timeneed *or multiple sur"erieschallen"in" esthetics


386/509

Implant Guidelines

Consultation AppointmentTreatment plannin" phase

Diagnosis begins with a complete

patient evaluation"uidelines *or +decision-ma/in"

processtreat the +entire patientrestore *orm5 *unction # esthetics


387/509

Implant Guidelines


pro&lem list # patient desiresinitial evaluation

chie* complaintmedical%dental history revie$ intra%e'traoral e'amevaluation o* e'istin" prosthesis


388/509

Implant Guidelines


initial evaluationdia"nostic impressions%articulated castradio"raphs - panoramic and periapical

(CT scan or tomo"raphy - as indicated)photo"raphs


389/509

Implant Guidelines


treatment options%in*ormed consent

e'planation o* lon"-term commitmen

restorative - sur"ical Joint consult

t$o-sta"e sur"erystage Istage II


390/509

Implant Guidelines


t$o-sta"e sur"ery(use o* clear acrylic sur"ical stent is

mandatory)

stage I -implant *i'ture placement $%cover scre$ (le*t su&mer"ed)


391/509

Implant Guidelines


stage I - healin" phase9 month minimum (mandi&le ) - usually

months *or posterior re"ions6 month minimum (ma'illa) - usually 6-1

months *or all re"ions


392/509

Implant Guidelines


stage II - uncoverin" # placement o*transmucosal healin" a&utment

healin" phase-6 $ee/s *or so*t tissue healin"


393/509

Implant Guidelines


restorative phasemaintenance and re"ular recall

*ee # payment policy

"oal to restore *orm5 *unction #esthetics


394/509

Implant Guidelines

Treatment plannin" phase Pro&lem list # treatment considerations

teethperiodontium

radio"raphic analysis

sur"ical analysis

esthetic analysis


395/509

Implant Guidelines


occlusal analysisadvs%disadvs o* proposed treatment

re*errals%specialty consults

appointment seuencin"

treatment alternatives


396/509

Implant Guidelines


teethperiodontium


sur"ical analysis

esthetic analysis


397/509

Implant Guidelines


teeth - num&er # e'istin" conditionpro"nosis o* remainin" teethsi@e5 shape # diameter o* e'istin"

dentition

tooth # root an"ulations # pro'imitymesiodistal $idth o* edentulous space


398/509

Implant Guidelines


teeth - num&er # e'istin" conditionminimum 6-;mm &et$een teeth to

*acilitate implant placement

(&ased on 9mm *i'ture)

K 0:


399/509

Implant Guidelines


teeth - num&er # e'istin" conditionmore than 03mm mesiodistal space -

sin"le tooth implant notrecommended

(multiple a&utments should &e splinted)


400/509

Implant Guidelines


teethperiodontium


sur"ical analysis

esthetic analysis


401/509

Implant Guidelines


periodontium- &one supportEe/holm # Far& classi*ication

quality- &est - thic/ compact cortical&one $%core o* dense tra&ecularcancellous &one

&est re"ion - mandi&ular symphysisLpoorest in posterior re"ions


402/509

Implant Guidelines


periodontium- &one supportquantity- reuired *or implant -6mm &uccal-lin"ual $idth $%su**icient

tissue volume

2mm interradicular &one $idth03mm alveolar &one a&ove IA= canal or&elo$ ma'illary sinus


403/509

Implant Guidelines


periodontium- &one supportquantity- reuired *or implant - i* inadeuate &one support may need

rid"e or site au"mentation

ramus or chin "ra*t (auto"ra*t)BA (allo"ra*t)Bio-,ss('eno"ra*t)


404/509

Implant Guidelines


periodontium- &one supportplace implants minimum o* 7mm *romIA= canal or &elo$ ma'illary sinus

cro$n%root ratiomo&ility*urcationspro&in" depths


405/509

Implant Guidelines


periodontiummuco"in"ival pro&lemsneed su**icient tissue volume to recreat

"in"ival papillaneed some attached "in"iva to maintain

peri-implant sulcus0st year post-op &one resorption M 0mm

Ncrest o* &one optimal 7- 9mm &elo$ C>


406/509

Implant Guidelines


periodontiummuco"in"ival pro&lemsplace implant 7-9mm apical to *ree

"in"ival mar"in o* adJacent toothrecreates &iolo"ic $idth o* peri-implant

sulcusNso*t tissue hei"ht 7mm or K mm may

create challen"e


407/509

Implant Guidelines


periodontiumoral hy"iene - important pre # post

systemic mani*estations - ie: dia&eticsare predisposed to delayed healin"

destructive ha&its - smokingiscontraindicated - delayed or inadeuatetissue healin" # osseointe"ration noted


408/509

Implant Guidelines


teethperiodontium


sur"ical analysis

esthetic analysis


409/509

Implant Guidelines


radio"raphic analysisperiapical patholo"y

radiopaue%radiolucent re"ions

adeuate vertical &one hei"ht

adeuate space a&ove IA= or &elo$ma'illary sinus


410/509

Implant Guidelines


radio"raphic analysisadeuate interradicular area

&one uality # uantity

radio"raphs - panoramic and periapical

(CT scan or tomo"raphy - as indicated)


411/509

Implant Guidelines


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

o* anatomic structures


412/509

Implant Guidelines


radio"raphic analysis-radio"raphic stent- (can dou&le as

sur"ical stent)acrylic stent $ith lead &eads or &all

-&earin"s (


413/509

Implant Guidelines


radio"raphic analysis-distortion (common to all Q-rays)

Panore' M 7


414/509

Implant Guidelines


teethperiodontium


sur"ical analysis

esthetic analysis


415/509

Implant Guidelines


sur"ical analysis-sur"ical "uide stent- None o* the

most critical *actors *or o&tainin" an idealsur"ical # esthetic resultused durin" *i'ture installation as "uide

*or optimal B%E and 8% positionuse o* &uccal channel drill "uide allo$s

improved access # visi&ility


416/509

Implant Guidelines


sur"ical analysis-implant len"th%diameter

determined &y uantity o* &one apical toe'traction site

use lon"est implant sa*ely possi&le

diameter dictated &y correspondin" rooanatomy at crest o* &one


417/509

Implant Guidelines


sur"ical analysistreatment options

immediate- place implant at time o*tooth e'traction

delayed immediate- 2-03 $ee/ delay

delayed- 1-03 months or lon"er immediate $ill not allo$ &one resorption5 &udelayed allo$s &one *ill *or sta&ili@ation


418/509

Implant Guidelines


sur"ical analysisproper sur"ical techniue durin"implant placement is critical

minimal heat "eneration important

; Celsius *or one minute or lessprovides most predicta&le healin"response


419/509

Implant Guidelines


teethperiodontium


sur"ical analysis

esthetic analysis


420/509

Implant Guidelines


esthetic analysissmile line - hi"h in ma'illaL lo$ in

mandi&le

lip shape - *ull !s: thin

e'istin" rid"e de*ect - i* visi&le $%hi"h smile line $ill need au"mentation


421/509

Implant Guidelines


esthetic analysisimplant emer"ence pro*ile (963)restored implant should appear to

+"ro$ or emer"e *rom the "in"ivavery natural # desira&le in appearanceavoid +tomato on a stic/ cro$ns or

periodontal pro&lems may develop


422/509

Implant Guidelines







423/509

Implant Guidelines


occlusal analysisimprovement o* *unction and%or

esthetics (?)para*unctional ha&its

can &e destructiveteeth lost to occlusal trauma orpara*unction - less success $% implants


424/509

Implant Guidelines


occlusal analysisdia"nostic casts

(mounted to determine opposin" occlusion

rid"e $idth

e'istin" inter-arch vertical space0-0


425/509

Implant Guidelines


occlusal analysisma'illo-mandi&ular relationsJa$ classi*icationsClass II may have "reatest &ene*it

Class III reuires sur"ical intervention


426/509

Implant Guidelines







427/509

Implant Guidelines


advs%disadvs o* proposed treatmentare as individual as the case &ein"

treatment plannedcostpatient desiresclinician a&ilitiesetc:


428/509

Implant Guidelines







429/509

Implant Guidelines


re*errals%specialty consultscan pro"nosis &e improved $ith (?)R

orthodonticsperiodontal therapy

endodontic therapy


430/509

Implant Guidelines


re*errals%specialty consultspre-prosthetic sur"ery e'tractions

rid"e contourin" or e'ostosis remova

osteotomy &one or so*t tissue au"mentation


431/509

Implant Guidelines


occlusal analysis

advs%disadvs o* proposed treatment





432/509

Implant Guidelines


appointment seuencin"len"th o* treatment time

need *or multiple sur"eries


433/509

Implant Guidelines


occlusal analysis

advs%disadvs o* proposed treatment





434/509

Implant Guidelines


treatment alternatives*i'ed partial denturesremova&le partial denturesresin-&onded *i'ed partial dentures

orthodonticsdo nothin"


435/509

Implant Guidelines

Treatment plannin" phase Indications

"ood "eneral healthadeuate &one uality # volumeappropriate occlusion # Ja$ relations ina&ility to $ear conventional prosthesisun*avora&le num&er%location o* a&utmentsin"le tooth loss


436/509

Implant Guidelines

Treatment plannin" phaseContraindications

unrealistic patient e'pectationsalcohol%dru" dependence (smo/in")para*unctional ha&itspsycholo"ical *actorsanatomical *actors inadeuate rid"e%interarch dimensions immunosuppression


437/509

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


438/509

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


439/509

Implant Guidelines

8aintenance Criteria *or success

8aintenance and ecall

y"iene Aids

Pro&lems


440/509

Implant Guidelines

8aintenance Primary "oal is to protectand

maintain +tissue-inte"rationL

good oral hygieneis a /ey

element


441/509

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;


442/509

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 Consensusevelopment Con*erence


443/509

Implant Guidelines



y"iene Aids

Pro&lems

G


444/509

Implant Guidelines

8aintenance Criteria *or successR

(most important is "ood dia"nosis)no peri-implantitisno associated radio"raphic

radiolucency

mar"inal &one loss 0:3-0:


445/509

Implant Guidelines


tissue inte"rationR &one%so*t tissue+osseointe"rationa&sence o* mo&ilityno pro"ressive so*t tissue chan"es o

&one losssta&le clinical attachment level

I l t G id li


446/509

Implant Guidelines


a&sence o* &leedin" uponpro&in"%e'cessive pro&in" depths

a&sence o* discom*ort

success rate varies $ith &one uality

loadin" dynamics5 etc:

I l t G id li


447/509

Implant Guidelines


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

I l t G id li


448/509

Implant Guidelines



y"iene Aids

Pro&lems

I l t G id li


449/509

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 and

esthetics li*etime maintenance commitment

I l t G id li


450/509

Implant Guidelines


(requency o& recall immediate post-delivery7 hoursone $ee/t$o $ee/s (re-torue i* needed)6 months&i-annual or annual evaluation

I l t G id li


451/509

Implant Guidelines


)linical arameters o& Evaluationoral hy"iene includin" plaue inde' implant sta&ility (evaluate mo&ility)retrieva&ilityperi-implant tissue healthcrevicular pro&in" depths

I l t G id li


452/509

Implant Guidelines


)linical arameters o& Evaluation&leedin"radio"raphic assessment (serial)

crestal &one level # inte"rity o*attachment systems

proper torue on scre$ Jointsocclusion

Implant Guidelines


453/509

Implant Guidelines

)linical arameters o& Evaluation oral hy"iene (plaue inde')

plaue is 0 etiolo"ic *actor in tissue

destruction (peri-implant and natural toothrevie$ oral hy"iene instructionmonitor throu"h plaue indices

same reuirements as *or natural teeth

use neutral sodium *luorides

Implant Guidelines


454/509

Implant Guidelines

)linical arameters o& Evaluation implant sta&ility (evaluate mo&ility)

may &e the key indicatoro* *i'ture health

minimal mo&ility $% osseointe"rated*i'turesR 0;-


455/509

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 prosthesisearly *ailure detection $ill minimi@e *i&rou

tissue @one si@e # may allo$ placement o*$ider diameter *i'ture

Implant Guidelines


456/509

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-implant

attachment M (detrimental)perimucosal /eratini@ed tissue is &est

Implant Guidelines


457/509

Implant Guidelines

)linical arameters o& Evaluation crevicular pro&in" depths

most accurate means o& detecting per

implant 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

Implant Guidelines


458/509

Implant Guidelines

)linical arameters o& Evaluation &leedin"

controversy as to si"ni*icance o* B,P at

peri-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$n

recommend continued use o* peri-implantsulcus pro&in" to monitor implant success

Implant Guidelines


459/509

Implant Guidelines

)linical arameters o& Evaluation radio"raphic assessment

one o* most valua&le measures o* implant

successo* 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

Implant Guidelines


460/509

Implant Guidelines


compare &ony chan"es $ith sta&le

landmar/s - implant threads - (one-hal* thread U 3:9mm)

compare hori@ontal%vertical implantdimensions &et$een serial radio"raphs

periapical radio"raphs U 7:< -


461/509

Implant Guidelines


bone level determination should be based

only upon standardi+ed periapicalradiographsthreads o* implant must appear sharp #

$ell-delineated on Q-ray to &e accurateQ-ray &eamR direct V1 *rom line

perpendicular to lon" a'is o* implant/eep *ilm parallel # close to implant

Implant Guidelines


462/509

Implant Guidelines


recommend /!p o* not 63 (&est 6


463/509

Implant Guidelines


uality in *ilm development is paramount

post-op radio"raphic intervalsR not &et$een *i'ture placement to a&utment

connection one $ee/ a*ter a&utment insertion immediately *ollo$in" *i'ed prosthesis

insertion5 then 6 months later annually *or *irst 9 years5 then every 7 years

Implant Guidelines


464/509

Implant Guidelines


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

Implant Guidelines


465/509

Implant Guidelines


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)

Implant Guidelines


466/509

Implant Guidelines


>8>8B> HHH

>ndosseous implants may losee'tensive amounts o* &one support

$ithout sho$in" rather o&vious

radio"raphic chan"es or increase in

mo&ility detecta&le in periodontally

involved teeth

Implant Guidelines


467/509

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

Implant Guidelines


468/509

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

Implant Guidelines


469/509

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 onlyLno contact in lateral e'cursions

no contact in 8I5 &ut $ith hard clench $illhold shim stoc/ (:3330)

Implant Guidelines


470/509

Implant Guidelines



y"iene Aids

Pro&lems

Implant Guidelines


471/509

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 use

Titan- or ultrasonic scalers unless specianon-metal tips used

Implant Guidelines


472/509

Implant Guidelines


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

Implant Guidelines


473/509

Implant Guidelines


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 discretio

o* dentistL may &e use*ul i* limited manualde'terity

Implant Guidelines


474/509

Implant Guidelines


chlorhe'idine - use durin" peri-sur"icalperiods or as needed i* episodes o* acuteso*t tissue in*lammation occur

*luoride rinses or "els -use neutralsodium *luoride to avoid dama"e to

titanium *i'tures that may occur $ithacidulated types

Implant Guidelines


475/509

Implant Guidelines



y"iene Aids

Pro&lems

Implant Guidelines


476/509

p

8aintenance Pro&lemsR

so*t tissue reactions*ractured or loosened scre$s*ailin" or *ailed *i'ture&ro/en attachments% components

Implant Guidelines


477/509

p

Pro&lemsRso*t tissue reactions

most common due to loose scre$s

poor 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

Implant Guidelines


478/509

p

Pro&lemsRso*t tissue reactions

treatmentR

remove o**endin" scre$5 ti"htena&utment # reinsert prosthesisrein*orce oral hy"ieneso*t-tissue auto"ra*t

replacement o* *ailed implant

Implant Guidelines


479/509

p

Pro&lemsR*ractured or loosened scre$s

0st suspicion $hen complaint o* +loose

implant 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'

Implant Guidelines


480/509

p

Pro&lemsR*ailin" or *ailed *i'ture

*ailin" implant !s *ailedimplant+implantitis !s

periodontal disease

Implant Guidelines


481/509

p

Pro&lemsR*ailin" or *ailed *i'ture

*ailin" implant

clinical si"nsR pro"ressive crestal&one lossL so*t tissue poc/etin"L B,

$% possi&le purulenceL tenderness to

percussion or torue

Implant Guidelines


482/509

p

Pro&lemsR*ailin" or *ailed *i'ture *i'ture loss

*ailin" implant

causesR sur"ical compromises (&onoverheatin"5 lac/ o* initial sta&ility)Lnonpassive superstructuresL too rapinitial loadin"L *unctional overloadL

inadeuate scre$ Joint closureLin*ection

Implant Guidelines


483/509

p


*ailin" implant

treatmentRremove 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

Implant Guidelines


484/509

p


*ailedimplant

clinical si"nsR mo&ilityL +dullpercussion soundL peri-implantradiolucency

(connective tissue implant

encapsulation may not &e visi&le onradio"raph)

Implant Guidelines


485/509


*ailed implant (most noted at ta"e II)

causesR sur"ical compromises (&onoverheatin"5 lac/ o* initial sta&ility)Lnonpassive superstructuresL too rapinitial loadin"L *unctional overloadL

inadeuate scre$ Joint closureLin*ection

Implant Guidelines


486/509


*ailed implant (most noted at ta"e II)treatmentR

removal o* implant

Implant Guidelines


487/509


+implantitis !s periodontitis

clinical si"nsRsimilar clinicalpresentation $% same patho"enic

microor"anisms

causesRpoor oral hy"ieneL &acteriaLcause may &e un/no$n (?)

Implant Guidelines


488/509


+implantitis !s periodontitis

treatmentRconsults to provider - considerrema/e or "uided tissue re"enerationetc:

interim - remove prosthesis #

a&utments # irri"ate area $% CQLdisin*ect components # reinsert

Implant Guidelines


489/509

Pro&lemsR&ro/en attachments% components

remove o**endin" attachment

(i* possi&le) and replace orprovisionali@e

&e care*ul not to dama"e e'ternal he' o

scratch titanium *i'ture or a&utment

Implant Guidelines


490/509

Case election Implant recommended

replacement o* teeth X7;501 # 93 Implant not recommended

replacement o* tooth X72s


491/509

Case X0

Implant Guidelines


492/509

Implant recommended 6 y%o male presented $ith *ailin"

=CT X7; and severe locali@ed

periodontitis tooth deemed hopeless and

e'tracted

Implant Guidelines


493/509

Implant recommended :3 ' 02mm =o&elpharma *i'ture

placed

Implant Guidelines


494/509

Implant recommended Cera-,ne a&utment restored $ith

cemented (Setac Cem) P8 cro$n


495/509

Case X 7

Implant Guidelines


496/509

Implant recommended 90 y%o *emale presented $ith

missin" X01 # 935 and retained

X0; # 97 (third molars)

Implant Guidelines


497/509

Implant recommended mesial-an"ulated X02 # 90 $ith

inadeuate mesial-distal and

interarch spacin" due to super-erupted opposin" X 9 # 0

Implant Guidelines


498/509

Implant recommended &uccal-lin"ual rid"e $idths in areas

o* missin" X01 and X93 also

de*icient

Implant Guidelines


499/509

Implant recommended teeth X 0; # 97 e'tracted and

&ilateral ramus "ra*ts placed at

edentulous sites (X01 # 93)

Implant Guidelines


500/509

Implant recommended molar upri"htin" o* teeth X02 # 90

completed to create adeuate

space *or implants

Implant Guidelines


501/509

Implant recommended


502/509

Implant recommended restoration o* *i'tures $ith scre$-

retained non-se"mented DCEA

a&utments $% P8 cro$ns

Implant Guidelines


503/509

Implant recommended restoration o* teeth X 9 # 0 $ith

P8 cro$ns to re-esta&lish proper

occlusal plane


504/509

Case X 9

Implant Guidelines


505/509

Implant not recommended 9 y%o male presented $ith past

history o* supernumerary X72

=oteR dilacerated root to mesial onX72

Implant Guidelines


506/509

Implant not recommended edentulous site presented $ith

inadeuate *acial &one5 and

inadeuate spacin" e'isted&et$een X7; # 72 root apices toallo$ implant placement

Implant Guidelines


507/509

Implant not recommended a*ter t$o years o* orthodontic

therapy5 X72 *ailed to move to

*acilitate implant placement

Implant Guidelines


508/509

Implant not recommended edentulous area restored $ith a

resin-&onded *i'ed partial denture

(BP X7;-72)


509/509

YD>TI,= ???

D BIG>

praktekum fk unissula 2

Documents