What's the tissue response after implant placement?
• Initial implant wound
• Following days
– Blood clot>granulation tissue>vascular invasion
• 1 week - osteoclast invasion
• 2 weeks – early woven bone
• 4 weeks – 1st phase of true integration
• 4 months fully matured remodelling
What are the different surfaces available for implants?
– Grit blasting
– Blasting and etching
– Hydroxyapatite coated
– Oxidized surfaces
– Titanium plasma sprayed surface
What's the purpose of altering the surfaces of implants?
• To provide better initial stability in bone
• Greater contact area for integration
• Surface that retains better blood clot
• Stimulation of bone healing process
What are the two structural surface types of implants?
– Surface structure without a dominating direction.
– Other processes such as turning or milling produces a surface that has a distinct regular pattern
What radiographical examination is done when placing implants?
– Intra oral views
– Panoramic views (magnification 25%)
• Secondary views
– CT scans
– Allow segmental measuring jaws
– Identifies structures such as nerves
What are the different types of quality of bone?
What are the different quantities of bone?
• A: – most of the alveolar ridge is present
• B: – moderate residual ridge resorption has occurred
• C: – advanced residual ridge resoption has occurred and only basal bone remains
• D: – minimal to moderate resorption of basal bone has occurred
• E: – extreme resorption of the basal bone has occurred
What is bone height best measured in?
What is the concept of guided tissue regeneration (GTR)
• Placement of a barrier membrane
• Creation of a secluded space beneath membrane
• Space can only be invaded by bone cells
• Creation of new bone
• PTFE / Gortex / Collagen
• Draped or pinned
When would you do a sinus lift procedure?
• When there's insufficient bone / pneumatisation
There are two types:
• Internal sinus lift • Lateral sinus lift
Why may you need to carry out ridge augmentation?
Rebuilding the original height and width of the alveolar ridge is not medically necessary, but may be required for dental implant placement, or for aesthetic purposes. Dental implants require bone to support their structure, and a ridge augmentation can help rebuild this bone to accommodate the implant.
How can ridge augmentation be carried out?
• Autogenous – Graft harvested from elsewhere in the patient
– Graft harvested from another patient • Mineralised irradiated sterilised freeze dried
– Synthetic bone substitutes
• Xenograft – Harvested form another species
Where are the sites harvested from?
– From within the implant preparation site
– From the mandibular ramus
– From the mandibular symphasis
– From the tibia
– From the iliac crest
– Vascularised free flaps
What are block bone grafts / endosteal grafts?
Block bone grafts:
– Good incorporation
– Less volume loss
– Shorter healing times
– Better bone quality
– Require a high vascular state of the recipient tissues.
What are the advantaes and disadvantages of tibia bone grafts?
– GA / LA
– 30 – 40 minutes
– 20 –40 cm3 noncompressed cancellous bone
– Minimal blood loss
– Immediate post op weight bearing
– Minimal bruising & scarring
– Unable to obtain block bone
– Patients with a history of knee injury / trauma
– Patients with advanced rheumatoid or degenerative arthritis
– Patients with metabolic bone disease
What are the advantages and disadvantages of an iliac crest graft?
– Block and cancellous bone available
– Large quantities
– Relatively accessible
– Small scar
– Hospital admission for GA
– Short term altered gate
– Bleeding potential
– Post op pain