Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
PRACTICAL COURSE
CONTENTS
04. Anatomy
Modern Implantology
By Connection:
- External vs Internal
By Surgical position:
- Submerged vs Non-Submerged
By Surface Characteristics:
- Smooth vs Rough Surface vs Chemical Modification
By Body Design:
- One body implant (Solid) vs Two body implant (hollow)
- Parallel body vs Tapered Body
7
Surgical position
Submerged Non-Submerged
ONE BODY VS TWO BODY
ONE BODY TWO BODY
VS
Surface Characteristic
Smooth Surface
- Machined surface
Rough surface
- Sand blasted with Large grit and Acid
etching (SLA),
- resorbable blast media (RBM),
- Etching,
- Sintering
Chemical modification
- HA Coating,
- Oxidised
Implant Surfaces
Machined surface
eg. Branemark Implant Sand blasted with Large
grit and Acid etching
eg. Dentium, Straumann HA coating
eg. Steri-oss
Oxidized Surface
Anodizing
eg Nobel Direct
eg. Nobel Biocare
Sintering
Ti-Unite
eg. Endopore
SLA - the standard of rough surface
growth factor
BMP
collagen
peptide coating
DENTIUM - SUPERLINE
SUPERLINE
Easy Esthetics
Beautiful Teeth.
Superior esthetic biomaterials and
individualized applications.
Immediate Function
No healing time required prior to functioning.
Surfaces, designs, and procedures for maintaining
implant stability.
Focal
contact
Taper portion
Double threads
Bone expansion & Initial
Smooth and tight fixation
stability
Parallel portion
S.L.A. Surface S.L.A.
Distribute stress evenly
Successful early loading
F
23
Superline,
attractive implant system for
hard & soft tissue integration
Taper neck design give a strong primary stability
Attractive Implant System
for clinician
- Minimize GBR procedure
- No bone resorption due to even stress distribution
- Easy and well achievement of initial stability
- Faster Osseointegration
- Easy prosthetic procedures
- Reasonable Price
- Company Support & Service
Our patients want !
Short treatment time Few
injection Good esthetics Short
term provisional Reasonable Fee
Marginal Bone Stability
It is a key factor
for a way
to esthetic outcome
*Self guiding f2
allows simple assembling
*Tight relation f1 F
eliminates micro-motion,
less screw loosening
*Geometric locking
creates strength, rigid connection
*Conus surface
distributes load evenly
Platform switching
Platform switching:
A new concept in implant dentistry for controlling
postoperative crestal bone level
(RJ Lazzara & SS Porter IJPRD 2006)
Once exposed in the oral cavity following the
implant installation,
the coronal bones are remodeled.
ANATOMY
ANATOMY
A inferior alveolar nerve
B dentogingival nerve
C mental nerve
D incisor nerve ( anterior
inferior alveolar nerve )
A mental nerve
B dentogingival nerve
C incisor nerve ( anterior
inferior alveolar nerve )
ANATOMY
A posterior superior alveolar nerve
B anterior superior alveolar nerve
C infraorbital nerve
D lateral nasal nerve
Others
Osteoporosis
Age
Dental
Evaluation
General Considerations
Dental Examination
for Implant Therapy
General Considerations
Radiographic examinations
-Panorama, Full mouth series
Maximum intercuspation,
Centric relation and Occlusal interferences
-In case of partially edentulous patients, the existing
occlusion can be maintained or must be considered prior to
surgery in case improvement is necessary
Anterior guide
-In the absence of an anterior guide, implants in the
posterior may receive excessive lateral force.
-Excessive anterior guide may result in overload on the
implants in the anterior.
General wear facets and Other signs of parafunctional habits
-Implant prosthesis should be protected from other hazardous forces.
Interarch relationship
-Posterior Implants require about 7mm of space, and the anterior,
8~10 mm. In the case of implant-retained removable prosthesis, at least
12 mm space is required for the bar clip.
Adjacent teeth
-Single implants need at least 7 mm of space from the CEJ of the
mesial tooth to that of the distal tooth.
-The mesial inclination of the distal tooth must be addressed either
prosthetically or orthodontically.
-Adjacent teeth should not be exposed to infection sources;
otherwise, periodontal or endodontic treatment must be performed first.
Aesthetic evaluation
-The analysis of the smile line is essential in an implant treatment in
the upper anterior.
Attached gingiva
Edentulous gingival tissue should neither be inflamed nor
afflicted with pathogens.
Palpation
Palpate a ridge to check the existence of concavity or
exostosis.
In case of the lower posterior, check the concavity in the
lingual side, and in the upper anterior, that in the labial
side.
Radiographic
Diagnosis
Periapical Radiographs
Panoramic Radiographs
Lateral Cephalogram
Transparent sheets for implant selectio
C.T & Cone Beam
Periapical Radiographs
Distortion is minimised using the parallel technique.
The bone level of adjacent teeth must be visible.
The use of the grid enables direct length measurement.
Its main application is recall check.
Panoramic Radiographs
Bone quality, quantity and anatomical limitation may
be evaluated.
Distortion often occurs and varies by image.
The application of radiographic template using
radiopaque markers is recommended.
Lateral Cephalogram
During implant installation, the surgeon can check the
thickness of the cortical bones as well as the volume of
the buccolingual bones in the lower anterior or symphysis
grafting is required.
Implant length
Implant diameter
Implant position
Implant length
Determine the implant length based on bone
availability and calculate the available bone
height.
For implants in the lower posterior, perform
osteotomy with at least 2mm space away from
nerves.
Choosing a relatively long implant is
unnecessary given sufficient bone height.
A longer implant does not provide additional
support, instead making surgical cooling trickier.
Implant diameter
Measure the buccolingual ridge dimension. Set the
diameter with more than 1 mm of buccal and lingual bone
remain. If the ridge is narrow, expand with osteotome or
perform GBR and ridge splitting.
For the mesiodistal area, maintain 3mm distance between
implants and set the diameter such that there is at least
1.5mm distance between the implant and natural teeth.
Indications for small diameter ( 3.4) Implant
-Reduced inter-root space: The inter-root distance is less than 7mm.
-Thin alveolar crest
-Reduced mesio-distal prosthetic space
Indications for large diameter ( 4.3, 4.8) Implant
-Insufficient bone quality
Implant diameter
In case of posterior teeth, let the implant angulation tend
toward the center of the occlusal surface and face the
functional cusp of antagonist teeth.
In case of anterior teeth and cemented prosthesis, place
the implant along the axis toward the incisal edge.
If insertion into the ideal position is difficult, use a phased
approach through bone grafting prior to insertion.
Avoid damaging the adjacent teeth of the implant.
Maintain at least 1.5mm space between the implant and
adjacent teeth (PDL space of adjacent teeth + 1mm).
In case of multiple implants, maintain at least 3mm of
space among implants and place them parallel to each
other if possible.
TreatmentPlan
ning
,
Provisional fixed prosthesis
In case of good-quality bones like those in the lower
anterior, acryl fixed provisional prosthesis can be loaded right
after the insertion. Although this is the ideal method since no
pressure is applied on the insertion sites, its use should be
limited.
Personal oral hygiene and professional maintenance care are
necessary.
Other Solutions
Bonded bridge : Artificial or extracted tooth bonded to
adjacent teeth can replace removable appliances, although
removal and repositioning are trickier.
Small-diameter temporary implant
- Partial edentulism: Make a fixed provisional prosthesis by
inserting temporary implants around the final ones.
- Full edentulism: Provide the implants with support from the
denture to avoid applying pressure on the insertion site.
Additional considerations
For the healing period, provisional restoration should be
adjusted and relined.
3
Case Study 2 3
1
2
Case Study 3
2
Case Study 4
3
1
2
Case Study 5
3
2
4
Case Study 6
1
2
Case Study 7
1
2
Case Study 8
1
2
Case Study 9
1
3
2
4
Case Study 10
2
3
IMPLANT INTENSIVE
PRACTICAL COURSE
CONTENTS
05. Post-operation
IMPLANT SURGERY PROCEDURE
Pre-op
Local Anaesthesia
Surgery set-up
Incision
Drilling
Fixture placement
Suture
Post-op
PRE-OPERATION
CHX mouth rinse (about 1min)
Prophylactic antibiotics: Some evidence of
reduced early failure of dental implants due
to infection ( A.D.Pye et al. 2009)
Patient Management
- Talk about Procedure
- Sign Consents Form
ANAESTHESIA
: ENOUGH INJECTION
LIGNOSPANARTICA
INEINFILTRATIONBL
OCK
SEDATION
#12 , #15
BLADE
BLADE
HOLDER
SUTURE
TISSUE FORCEP
NEEDLE
HOLDER
SCISSORS
SURGICAL MOTOR
CHECK BEFORE START
SPARE HAND-PIECE
BODY FOOT
PEDAL TUBING
SALINE TUBING
HAND-PIECE
CHECK
FUNCTION
OPTIC
REAL TORQUE
SURGICAL SET
UP
SURGICAL SET
UP
103
Surgical Kit and
Implants
104
BONE GRAFT MATERIAL
BONE &
MEMBRANE
INCISION
MidcrestalLingual /
Palatal BeveledH-
incisionContinuousPa
pilla intactPapilla
depressed
Continuous Incision
108
Papilla intact
110
DRILLING CHECK POINT
PLATFORMDRILLING
LOCATIONBONE
DENSITYDRILLING ANGLE AND
DEPTHDRILLING SEQUENCES
PLATFORM
CURRETAGEROUND
BURPERIODONTAL ELEVATOR
DRILLING LOCATION
Adjacent to natural
toothAdjacent to
implantBounded saddleFree-end
saddleBuccolingual(Buccopalatal
) Guide pin to verify
relation to opposing
and adjacent teeth
: Functional cuspe
Adjacent to natural tooth
Consider available restorative space, bone and
proximal root positions
2mm to prevent food trap
< 1.5mm, risk of bone resorption
Consider opposing functional cusp!
Consider final prosthesis!
* The maxillary canine root is
often slanted 11 degrees distally A maxillary first
and has a distal curvature 32% premolar implant
of the time. When the implant is may need to be
placed parallel to the first parallel to the
premolar, it may inadvertently canine.
encroach upon the canine root.
When the implant is placed : When the implant is placed:
Long fixture installation (X) Shorter and bigger
fixture installation (O)
When the implant is placed
perpendicular to occlusal
surface Parallel to adjacent
teethBisecting angle
160
161
Paralleling pin insertion
: Verification of parallelism of implants
and relation to adjacent & opposing teeth
169
170
Initial drilling point is
imperative in lower 1st,2nd molar especially
-Not to locate too distally!
-Not too upright
2010.03.08 Pre-op
2010.03.09 Post-op
DRILLING DEPTH
SLIGHT OVER
PREPARATIONBEWARE OF
ANATOMICAL FEATURES: IAN,
SINUS, REAL
ETCLENGTH OF DRILL ?
X-RAY RATIO? NERVE? SINUS?
WHERE AM I?
182
Surgical Procedure
Fixture Installation
D1 ~ D2
(I)
( II )
D3 ~ D4
Wide Fixture Installation
5mm
SuperLine
4010 Fixture
[D.-4.0, L.-10mm]
Lindemann Guide Drill
(1,200rpm)
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
Lindemann Guide Drill
(1,000rpm)
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
Lindemann First Drill
(1,000rpm)
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
Lindemann First Drill
(1,000rpm)
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
Lindemann First Drill
(1,000rpm)
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
Lindemann First Drill
(1,000rpm)
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
3.6 Final Drill
(1,000rpm)
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
3.6 Final Drill
(1,000rpm)
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
4.0 Final Drill
(1,000rpm)
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
4.0 Final Drill
(1,000rpm)
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
4.0 Countersink (1,000rpm)
* When bone is dense, drill down to the top laser mark
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
4.0 Countersink (1,000rpm)
* When bone is dense, drill down to the top laser mark
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
Fixture [D.-4.0, L.-10mm] Installation
* During insertion, 35N.cm at 20rpm is recommended
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
Fixture [D.-4.0, L.-10mm] Installation
(0.5mm below the bone crest)
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
Fixture [D.-4.0, L.-10mm] Installation with Ratchet
(0.5mm below the bone crest)
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
Fixture [D.-4.0, L.-10mm] Installation with Ratchet
(Avoid over-torque of more than 70Ncm)
0.5mm
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
Lindemann First Drill
(1,000rpm)
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
Lindemann First Drill
(1,000rpm)
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
Lindemann First Drill
(1,000rpm)
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
Lindemann First Drill
(1,000rpm)
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
3.6 Final Drill
(1,000rpm)
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
3.6 Final Drill
(1,000rpm)
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
4.0 Final Drill
(1,000rpm)
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
4.0 Final Drill
(1,000rpm)
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
4.0 Countersink (1,000rpm)
* When bone is dense, drill down to the top laser mark
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
4.0 Countersink (1,000rpm)
* When bone is dense, drill down to the top laser mark
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
4.0 Countersink (1,000rpm)
* When bone is dense, drill down to the top laser mark
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
Fixture [D.-4.0, L.-10mm] Installation
* During insertion, 35N.cm at 20rpm is recommended
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
Fixture [D.-4.0, L.-10mm] Installation
(0.5mm below the bone crest)
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
Non-Submerged Protocol
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
Non-Submerged Protocol
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
Non-Submerged Protocol
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
Non-Submerged Protocol
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
Non-Submerged Protocol
Suture
Submerged Protocol
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
Submerged Protocol
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
Submerged Protocol
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
Submerged Protocol
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
Submerged Protocol
SuperLine Implantium
4010 Fixture 3810 Fixture
[D.-4.0, L.-10mm] [D.-4.0, L.-10mm]
Submerged Protocol
Suture
SURGICAL PROCEDURE
: SIMPLELINE
SimpleLine II
SOFX654310R
SimpleLine II
SOFX654310R
SimpleLine II
SOFX654310R
slim one body
clinical cases
Healing Abutment vs
Cover Screw
SIMPLE INTERRUPT
HORIZONTAL
VERTICAL
CONTINUOUS
CONTINUOUS INTERRUPT
8 FIGURE
CROSS
SLING 258
Simple Interrupted Suture
259
Figure 8 Modification
260
HAND-ON
DRILLING
IMPLANT PLACEMENT
SUTURE
261
262
01.Follow up
02.Temporary Prosthesis
03.Second Surgery
04.Intraoperative Complications
05.Failure
06.Loading Time
POST-OP INSTRUCTION
GUAZE PLACEMENT
MEDICATION - ANALGESIC, ANTIBIOTIC, CHX
ICE PACK
265
Wound healing mechanism
contraction
epitheliazation
connective tissue deposition
266
4 stages of healing
hemostasis
inflammation (2-5 days)
proliferation (2 days- 3 weeks)
remodeling
267
post-op gingivival recession
IN 1-2 WEEKS
CHECK WOUND HEALING
CHECK ANY LOSS OF SENSATION
CHECK ANY SIGNS OF INFECTION
SUTURE REMOVAL
WOUND DRESSING
TEMPORARY PROSTHESIS
TEMPORARY ABUTMENT
TEMPORARY REMOVABLE DENTURE
TEMPORARY BRIDGE (Splinting)
NO TEMPORARY RESTORATION
SECOND SURGERY
PUNCH or BUR
INCISION
HEALING ABUTMENT SELECTION
(SIZE, HEIGHT)
- Depend on Emergency profile
- 1mm bigger than implant nomally
AT LEAST 2 WEEKS BEFORE
IMPRESSION
Gingival Punch
274
275
INCISION
Buccal flap resorption
INCISION
: Pedicle formation
282
Neurosensory impairment
284
Dehiscence and fenestration of implants
Repositioning and
GBR necessary
285
Perforation of sinus or nasal cavity
Drilling modification
larger size implants
Osteotome / Bone expander
remove any implants with mobility
Fracture of implants or instruments
incorrect handling
too many sterilisation cycles
overheating
immediate removal of all the fragment in the
least traumatic fashion
291
Foreign bodies
Turbine hand-piece is
contraindicatedSymptoms: sudden swelling,
palpable crepitus in the soft tissueUsually
harmlessCold compressionProphylactic
antibiotic administration
Aspiration and swallowing of instruments
choking
chest X-ray
monitor
295
Immediate Implant
SimpleLine Surgical guide
Extraction
Atraumatic extraction
SimpleLine Surgical guide
Lindemann Drill
800~1,200rpm / 30~45N.cm
SimpleLine Surgical guide
Fixture Installation
Palatal engagement
SimpleLine : SOFX483812R
SimpleLine Surgical guide
Provisional Restoration
Dual Abutment Octa : SODAB4855
SimpleLine Surgical guide
Impression coping;
Fixture Level
Impression Coping Transfer 4.8
: SODTF4852
SimpleLine Surgical guide
Final prosthesis
Gingival Contouring with provisional restoration
SimpleLine Surgical guide
Final prosthesis
Gingival Contouring with provisional restoration
Failure of dental implants
Early failure
- inability of tissue to establish osseointegration
Late failure
- failure to maintain osseointegration
Early Failure
minimal bone loss
lack of osseointegration
due to the absence of bone
apposition and the formation of
scar tissue at BIC
more common than late failure
Early Failure
: Iatrogenic causes
surgical trauma
(overheating, compression
necrosis)
bacterial contamination
premature overloading
Early Failure
: other causes
Age and Sex
Systemic Diseases
Smoking
Type of Edentulism
Location
Bone Quality and Quantity
Implant Length and Diameter
Immunological and Genetic factors
Age and Sex
in most studies, not related
more failure 40-60 yo than over 60
: older age not contraindicative
(Noguerol et al.)
Systemic Diseases
more failure in diabetes
Crohns disease and osteoporosis
chemotherapy and radiotherapy
gastric, cardio, controlled diabetes 1, asthma,
blood pressure, hyperthyroidism,
hypercholesterolemia, etc not BRONJ(bisphosphate
related (Alsaai et al.)
related osseonecrosis on
the jaw):
BRONJ Intravenous-contraincated
Oral-3yrs,
6mths cessation
Implant Dimension
length and diameter has no significant effect
on early failure
Late Failure
Periimplantitis
Implant overloading
Malposition or overangulation of implants
Implant fracture
Loading Time
Immediate Loading
Early Loading
Delayed Loading
Conventional: 3~6 months
Stability Measurement (ISQ)
Percussion test
Impact Hammer Method (Periotest, Dental
mobility checker)
Pursed oscillation waveform
Resonance Frequency Analysis
(Osstell, Implomate)> 65 ISQ
Osstell(ISQ)
Thank you
333
IMPLANT INTENSIVE
PRACTICAL COURSE
CONTENTS
01.Prosthesis Part
03.Prosthesis Procedure
- Screw Abutment
- Ball Abutment
- Magnetic Abutment
- Positioner
05.Delivery of Superstructures
Prosthesis Part
Various type of
approach for loading
(Cover screw submerged, (implant with perimucosal (restoration placed at the time
healing abutment, of the implant placement)
then uncovering surgery) no uncovering surgery)
Ti-customized abut. Zirconia-customized abut.
2 months after surgery
Provisional restoration in situ
Consideration for peri-implant esthetics
customized zirconia-titanium abutments
Consideration for peri-implant esthetics
Final prosthesis in situ
6 month following prosthesis insertion
6 month following prosthesis insertion
Cement Retained Restoration Screw Retained Restoration
Dual
Combi
Direct-Casting
Dual Milling
SCRP is possible
SUPERLINE
CONNECT
IN THE
PATIENT
MOUTH
FOR TAKING
IMPRESSION
TAKE
IMPRESSION
WITH
IMPRESSION
COPING
Combi Abutment
- Combi Abutment is used in case the procedure goes desirably and is unnecessary to
take out the abutment.
- After Abutment is selected, Abutment Level Impression is taken.
- If the abutment selection is made in the mouth, gauge the thickness of mucosa with the
depth gauge to measure the gingival height thus allowing the appropriate abutment
height.
- Fixture Connection Part and Prosthetic Part are one piece.
- For recovery of single tooth, tighten abutment screw to 20~35Ncm (retighten again
before seating final prosthesis to prevent inaccurate impression of the rotating abutment)
Dual Abutment
-It is possible to taken an impression at both fixture level and abutment level.
(A dual abutment is compatible with a combi abutment)
- For fixture Level impressions,
the abutment selection takes place on the master model.
- For abutment level impressions,
the same prosthetic procedure apply to both dual and combi abutments.
- A precise positioning jig for abutment is required.
- Either Hex or Non-hex may be used, according to clinicians preference.
Dual Milling Abutment
9. Implant over-dentures
- Ball abutment
- Transfer Type
(Dual abutment Multi units)
Remove Cover screws
Remove Healing abutments
Insert Impression copings (transfer type) into Fixtures
Take Impression [closed tray]
Remove the Impression copings from oral cavity
and connect it with Analogs firmly
Insert the connected Impression copings and Analogs
into the impression
Pour the soft gum silicone and trim
Master cast
Master model
Measure gingival height with Depth gauge
Select abutments with proper diameter and gingival height
Positioning jig
Wax-up
Cut-back
Metal framework
Opaque
Porcelain build-up
Final prosthesis
[Tighten it to 25~30N.cm and Re-tighten after 15minutes]
Fixture level impression
- Pick up Type
(Dual abutment Multi units)
Remove Healing abutments
Insert Impression copings (pick-up) into Fixtures
Take impression [open tray]
Unscrew Impression coping screws
before removing the impression tray
Pour the soft gum silicone and trim
Master cast
Master model
Measure gingival height with Depth gauge
Select abutments with proper diameter and gingival height
Positioning jig
Wax-up
Cut-back
Metal framework
Opaque
Porcelain build-up
Final prosthesis
[Tighten it to 25~30N.cm then Re-tighten after 15 minutes]
Abutment level impression
(Combi abutment Multi units)
Remove Cover screws
Remove Healing abutments
Select suitable Combi abutments, then torque down at 25~30N.cm
[Re-tighten after 15 minutes]
Connect Impression copings over the Abutment firmly
[Snap-on]
click
Take Impression [closed tray]
Fabricate provisional restorations, or use Comfort caps
Connect Lab analogs into Impression copings
[Match flat side of both analog & coping]
Pour the soft gum silicone and trim
Master cast
Master model
Connect Burn-out cylinders
Wax-up
Cut-back
Metal framework
Opaque
Porcelain build-up
Final prosthesis
Fixture level impression
- Transfer Type
Master model
Modification
Modification
Abutment after milling process
Positioning jig
Wax up
Cut-back
Metal framework
Opaque
Porcelain build-up
Final prosthesis
[Tighten it to 25~30N.cm then Re-tighten after 15 minutes]
Clinical Case
2008.02.13
2008.05.13
2008.06.14
2008.12.05
Photo view
G.B.R.
Fixture Installation
2nd Surgery
Zirconia Coping
Fixture level impression
- Transfer Type
09.09.18 pre-op
Key-point :
Selection of proper implant position
12ixx22i vs x11i21ix
09.09.18 post-op
Zirconia
Prosthesis
Final Setting
Master model
Gold-cylinders on the Screw abutment analogs
[Tighten it to 10N.cm with Ti-Retaining screw]
Consider the distance of opposing teeth,
modify cylinder to its proper height if needed
Wax-up
Cut-back
Completed gold framework
Opaque
Porcelain build-up
Final prosthesis
[Tighten it to 10N.cm with Ti-Retaining screw]
Screw abutment (SCRP)
- Zirconia prosthesis
Remove Healing abutments
Select and insert appropriate Screw abutments
[Tighten it to 25~30N.cm then Re-tighten after 15 minutes]
Take impression [closed tray]
+
Remove the impression copings from oral cavity
and connect it with analogs firmly
Insert the connected Impression copings and Analogs
into the impression
Pour the soft gum silicone and trim
Master cast
Master model
Connect Titanium cylinders
Master model
Tray resin copping made
Tray resin copping made
+
Tray resin framework buccal view
1.5~2.0mm
+
Tray resin framework occlusal view
Buccal : 1.0~1.5mm
Lingual : 0.5mm
Mock-up tray resin framework completed
+
Ready for mounting on a copy milling machine
Ready for mounting on a copy milling machine
+
Milled zirconia block completed
Rainbow substructure
+
Zirconia core
+
Porcelain build-up
+
Final Zirconia Prosthesis
[Tighten it to 10N.cm]
+
Clinical Case I
Screw Abutment Zirconia Prosthesis
2008.08.27 Pre-op
2008.09.03 Post-op
09.07.18 pre-op
Key-point :
1. How to restore patients masticatory
function as early as possible.
2. Proper implant position and occlusal
design considering opposing dentition.
09.07.18 post-op
09.09.23 Final Prosthesis
Implant over-dentures
- Ball abutment
Ball abutments
Insert Ball abutments into fixtures
Insert Ball abutments into fixtures
Cover the Comfort caps onto abutments
Cover the Comfort caps onto abutments
Take impression
Insert Analogs into the impression tray
[Impression coping embedded in impression tray]
After Analogs insertion
Fabricate denture in common method
Connect Female sockets with Analogs
Examine the interference between inner surface
of female sockets and Ball analogs
Connect Female sockets with Analogs
Apply the resin with a brush
into the denture inner surface
Position the denture into the model
and wait for initial setting
After resin setting, trim the resin excess
and polish the denture
After resin setting, trim the resin excess
and polish the denture
Implant over-dentures
- Magnetic Abutment
Insert Implant keepers into Fixtures
Seat Magnetic assay on the Implant keeper
Examine the interference
between denture and magnetics.
Relief of denture inner surface.
Examine the Interference
between denture and magnetics
Apply the resin on the relief area of denture.
Position the denture into the mouth.
After resin setting, polish the denture.
Position the denture into the mouth.
After resin setting, polish the denture.
Clinical Case
2009.09.04 Post-op
Clinical Case
- Passive fit ?
- Radiographic Assessment
- Adjust or Remake
4. Occlusal Adjustment
After cementation
Occlusal Design
Lateral Force
- No Lateral contact
Screw-Retained Restoration
- Occlusal screw fixation
- Horizontal or transversal screw fixation
Cement-Retained Restoration
- Retrievability ???
GIC
e.g. Fuji IX, Ketac Cem
Cemented Retained Restoration
SCRP (Screw and Cement Retained Prosthesis
- It is used as a cementation repair method when:
A screw type restoration helps to simplify prosthesis repair, including insertion and removal
of the prosthesis if necessary.
Cement type restoration tend to have a stable occlusion and may enhance the adaptability.
However the weak point is that it cannot be removed after permanent cementation.
1. Gingival recession
3. Peri-implant Infection
03.Prosthesis Procedure
- Screw Abutment
- Ball Abutment
- Magnetic Abutment
- Positioner
05.Delivery of Superstructures
Prosthesis Part
Various type of
approach for loading
(Cover screw submerged, (implant with perimucosal (restoration placed at the time
healing abutment, of the implant placement)
then uncovering surgery) no uncovering surgery)
Ti-customized abut. Zirconia-customized abut.
2 months after surgery
Provisional restoration in situ
Consideration for peri-implant esthetics
customized zirconia-titanium abutments
Consideration for peri-implant esthetics
Final prosthesis in situ
6 month following prosthesis insertion
6 month following prosthesis insertion
Cement Retained Restoration Screw Retained Restoration
Dual
Combi
Direct-Casting
Dual Milling
SCRP is possible
SUPERLINE
CONNECT
IN THE
PATIENT
MOUTH
FOR TAKING
IMPRESSION
TAKE
IMPRESSION
WITH
IMPRESSION
COPING
Combi Abutment
- Combi Abutment is used in case the procedure goes desirably and is unnecessary to
take out the abutment.
- After Abutment is selected, Abutment Level Impression is taken.
- If the abutment selection is made in the mouth, gauge the thickness of mucosa with the
depth gauge to measure the gingival height thus allowing the appropriate abutment
height.
- Fixture Connection Part and Prosthetic Part are one piece.
- For recovery of single tooth, tighten abutment screw to 20~35Ncm (retighten again
before seating final prosthesis to prevent inaccurate impression of the rotating abutment)
Dual Abutment
-It is possible to taken an impression at both fixture level and abutment level.
(A dual abutment is compatible with a combi abutment)
- For fixture Level impressions,
the abutment selection takes place on the master model.
- For abutment level impressions,
the same prosthetic procedure apply to both dual and combi abutments.
- A precise positioning jig for abutment is required.
- Either Hex or Non-hex may be used, according to clinicians preference.
Dual Milling Abutment
9. Implant over-dentures
- Ball abutment
- Transfer Type
(Dual abutment Multi units)
Remove Cover screws
Remove Healing abutments
Insert Impression copings (transfer type) into Fixtures
Take Impression [closed tray]
Remove the Impression copings from oral cavity
and connect it with Analogs firmly
Insert the connected Impression copings and Analogs
into the impression
Pour the soft gum silicone and trim
Master cast
Master model
Measure gingival height with Depth gauge
Select abutments with proper diameter and gingival height
Positioning jig
Wax-up
Cut-back
Metal framework
Opaque
Porcelain build-up
Final prosthesis
[Tighten it to 25~30N.cm and Re-tighten after 15minutes]
Fixture level impression
- Pick up Type
(Dual abutment Multi units)
Remove Healing abutments
Insert Impression copings (pick-up) into Fixtures
Take impression [open tray]
Unscrew Impression coping screws
before removing the impression tray
Pour the soft gum silicone and trim
Master cast
Master model
Measure gingival height with Depth gauge
Select abutments with proper diameter and gingival height
Positioning jig
Wax-up
Cut-back
Metal framework
Opaque
Porcelain build-up
Final prosthesis
[Tighten it to 25~30N.cm then Re-tighten after 15 minutes]
Abutment level impression
(Combi abutment Multi units)
Remove Cover screws
Remove Healing abutments
Select suitable Combi abutments, then torque down at 25~30N.cm
[Re-tighten after 15 minutes]
Connect Impression copings over the Abutment firmly
[Snap-on]
click
Take Impression [closed tray]
Fabricate provisional restorations, or use Comfort caps
Connect Lab analogs into Impression copings
[Match flat side of both analog & coping]
Pour the soft gum silicone and trim
Master cast
Master model
Connect Burn-out cylinders
Wax-up
Cut-back
Metal framework
Opaque
Porcelain build-up
Final prosthesis
Fixture level impression
- Transfer Type
Master model
Modification
Modification
Abutment after milling process
Positioning jig
Wax up
Cut-back
Metal framework
Opaque
Porcelain build-up
Final prosthesis
[Tighten it to 25~30N.cm then Re-tighten after 15 minutes]
Clinical Case
2008.02.13
2008.05.13
2008.06.14
2008.12.05
Photo view
G.B.R.
Fixture Installation
2nd Surgery
Zirconia Coping
Fixture level impression
- Transfer Type
09.09.18 pre-op
Key-point :
Selection of proper implant position
12ixx22i vs x11i21ix
09.09.18 post-op
Zirconia
Prosthesis
Final Setting
Master model
Gold-cylinders on the Screw abutment analogs
[Tighten it to 10N.cm with Ti-Retaining screw]
Consider the distance of opposing teeth,
modify cylinder to its proper height if needed
Wax-up
Cut-back
Completed gold framework
Opaque
Porcelain build-up
Final prosthesis
[Tighten it to 10N.cm with Ti-Retaining screw]
Screw abutment (SCRP)
- Zirconia prosthesis
Remove Healing abutments
Select and insert appropriate Screw abutments
[Tighten it to 25~30N.cm then Re-tighten after 15 minutes]
Take impression [closed tray]
+
Remove the impression copings from oral cavity
and connect it with analogs firmly
Insert the connected Impression copings and Analogs
into the impression
Pour the soft gum silicone and trim
Master cast
Master model
Connect Titanium cylinders
Master model
Tray resin copping made
Tray resin copping made
+
Tray resin framework buccal view
1.5~2.0mm
+
Tray resin framework occlusal view
Buccal : 1.0~1.5mm
Lingual : 0.5mm
Mock-up tray resin framework completed
+
Ready for mounting on a copy milling machine
Ready for mounting on a copy milling machine
+
Milled zirconia block completed
Rainbow substructure
+
Zirconia core
+
Porcelain build-up
+
Final Zirconia Prosthesis
[Tighten it to 10N.cm]
+
Clinical Case I
Screw Abutment Zirconia Prosthesis
2008.08.27 Pre-op
2008.09.03 Post-op
09.07.18 pre-op
Key-point :
1. How to restore patients masticatory
function as early as possible.
2. Proper implant position and occlusal
design considering opposing dentition.
09.07.18 post-op
09.09.23 Final Prosthesis
Implant over-dentures
- Ball abutment
Ball abutments
Insert Ball abutments into fixtures
Insert Ball abutments into fixtures
Cover the Comfort caps onto abutments
Cover the Comfort caps onto abutments
Take impression
Insert Analogs into the impression tray
[Impression coping embedded in impression tray]
After Analogs insertion
Fabricate denture in common method
Connect Female sockets with Analogs
Examine the interference between inner surface
of female sockets and Ball analogs
Connect Female sockets with Analogs
Apply the resin with a brush
into the denture inner surface
Position the denture into the model
and wait for initial setting
After resin setting, trim the resin excess
and polish the denture
After resin setting, trim the resin excess
and polish the denture
Implant over-dentures
- Magnetic Abutment
Insert Implant keepers into Fixtures
Seat Magnetic assay on the Implant keeper
Examine the interference
between denture and magnetics.
Relief of denture inner surface.
Examine the Interference
between denture and magnetics
Apply the resin on the relief area of denture.
Position the denture into the mouth.
After resin setting, polish the denture.
Position the denture into the mouth.
After resin setting, polish the denture.
Clinical Case
2009.09.04 Post-op
Clinical Case
- Passive fit ?
- Radiographic Assessment
- Adjust or Remake
4. Occlusal Adjustment
After cementation
Occlusal Design
Lateral Force
- No Lateral contact
Screw-Retained Restoration
- Occlusal screw fixation
- Horizontal or transversal screw fixation
Cement-Retained Restoration
- Retrievability ???
GIC
e.g. Fuji IX, Ketac Cem
Cemented Retained Restoration
SCRP (Screw and Cement Retained Prosthesis
- It is used as a cementation repair method when:
A screw type restoration helps to simplify prosthesis repair, including insertion and removal
of the prosthesis if necessary.
Cement type restoration tend to have a stable occlusion and may enhance the adaptability.
However the weak point is that it cannot be removed after permanent cementation.
1. Gingival recession
3. Peri-implant Infection