RATIONALE

FOR
DENTAL IMPLANTS

WHAT MAKES IMPLANT

DENTISTRY UNIQUE:

It restores the patient to normal contour,

function, comfort, esthetics, speech and
health regardless of the atrophy, disease or
injury of the stomatognathic system
It is the most natural method to replace a
tooth rather than preparing adjacent teeth
and joining them together with a prosthesis

SINGLE TOOTH REPLACEMENTFPD

Estimated mean life span of FPD (50%

survival) reported at 10 years.
Caries most common cause of FPD failure.
15% of FPD abutments require endodontics.
Failure of abutment teeth of FPD 12% at 10
years and 30% at 15 years.
80% of teeth adjacent to missing teeth have
no or minimal reastoration.

SINGLE TOOTH IMPLANTSADVANTAGES

High success rate (above 97% for 10 years)

Decreased risk of caries of adjacent teeth
Improved ability to clean the proximal surfaces of the
adjacent teeth
Decreased risk of endodontic problems on adjacent
teeth
Improved esthetics of adjacent teeth
Improved maintenance of bone in the edentulous area
Decreased cold or contact sensitivity of adjacent
teeth
Psychological Advantages
Decreased abutment tooth loss

CONSEQUENCES OF BONE LOSS

IN FULLY EDENTULOUS PATIENTS

Decreased width of supporting bone

Decreased height of supporting bone
Prominent mylohyoid and internal oblique ridges with
increased sore spots
Progressive decrease in keratinized mucosa surface
Muscle attachment near crest of ridge
Elevation of prosthesis with contraction of mylohyoid
and buccinator muscles
Loss of basal bone
More active role of tongue in mastication
Loss of anterior ridge and nasal spine, causing
increased denture movement and sore spots during
function

SOFT TISSUE CONSEQUENCES

OF EDENTULISM

Attached, keratinized gingiva is lost as bone is lost

Unattached mucosa for denture support causes
increased soft spots
Thickness of tissue decreases with age and
systemic disease causes more sore spots for
dentures
Tongue increase in size, which decreases denture
stability
Tongue has more active role in mastication, which
decreases denture stability
Decreased neuromuscular control of jaw in the
elderly patients

ESTHETIC CONSEQUENCES OF
BONE LOSS

Decreased facial height

Deepening of vertical lines in lip and face
Chin rotates forward- gives a prognathic look
Loss of tone in muscles of facial expression
Deepening of nasolabial groove

NEGATIVE EFFECTS OF
REMOVABLE PROSTHESIS

Bite force is decreased from 200 psi to 50 psi

15 year denture wearers have reduced bite
force to 6 psi
Masticatory efficiency is decreased
Gastrointestinal disorders
Food selection is limited
Healthy food intake is dicreased

ADVANTAGES OF IMPLANT
SUPPORTED PROSTHESES

Maintain bone
Restore and maintain occlusal vertical dimension
Maintain facial esthetics (muscle tone)
Improve esthetics, phonetics, occlusion and masticatory
performance
Increase prostheses success
Reduce size of prostheses
Improved stability and retention of removable prostheses
Increase survival times of prostheses
No need to alter adjacent teeth
More permanent replacement
Improve psychological health

GENERAL PRINCIPLES

The purpose of this phase is to reduce bone tissue

by maximum possible way according to the
implant surface, providing primary implant
stability micro motion preventing and reducing
the risk of integration failure. One should avoid
overheat that cause the osteocytes death, using
sharp tools, equipment intermittent preparation
drills and abundant irrigation with saline. Drills
application technique is extremely important,
especially when working in very dense bone
tissue, for example the seam area of the
mandible.

Manufacturers produce a variety of drills systems with external

or internal cooling supply (or two options at the same time).
Both systems used properly provide good cooling of the surgical
field. In most implant systems range includes drills that allow
for a gradual increase in bone bed, ensuring correct orientation
of the implant and prevent overheating as well as excessive
preparation of the bone bed. Drills may vary in length, diameter
according the implant size. As a rule a diameter of the last drill
is slightly less than the implant diameter. This provides a good
primary stability upon installation. In very dense bone can be
pre- sliced for easy implant insertion. Accelerated introduction
of the implant To the narrow bed can cause overheating, partial
immersion of the implant and bone fracture. To improve
primary stability if possible, the implant should be placed
between the cortical bones. This is usually achieved in the
apical and coronal areas, but you can use the buccal and lingual
plates. In cases where the work is carried out over the lower
alveolar first, the use of lower field mandible is highly risky.
The upper jaw may be used bicortical principle of stability using
the bottom of the sinuses and nasal cavity. Note that only the
apical portion of the implant can be fixed to the cortical plate.

EQUIPMENT FOR IMPLANTATION

PREPARATION

Most installation systems have a different

speed and torque, but they do not have
specific differences in the device. Osteotomy
is usually carried out at 2000 rpm . /min to
avoid overheating. Bed preparation and
subsequent introduction of the implant
osteotomy or cutting is performed at a speed
of 25 vol./min with the restriction torque to
40 N/cm depending on the bone density.

BASIC TOOLS:

surgical wipes, dental surgical hoses, dental

probe, dental mirror, scalpel, needle holders
and suture, various retractors, gauze
The submission of physiological cooling can
be implemented as by filing internal and
external; both options together are also
possible.

CONSISTENCY IN THE USE OF

DRILLS

After tilting flap mounted surgical template.

Sterile surgical pencil should note the
location of the implant in the bone tissue is
then formed primary bed using a small
spherical boron

IRRIGATION: EXTERNAL AND

INTERNAL. TARGETS OF
IRRIGATION:

Preventing working part of the tool

overheating, and therefore, bone
overheating;
Constantly wash bone chips and clean the
working part of drills.