CNUH , OMFS Dept. of OMFS, School of Dentistry Dept. of OMFS, School of Dentistry Chonnam National University Chonnam National University 2007.4.7 2007.4.7 Surgical considerations in the Surgical considerations in the edentulous patients for implant edentulous patients for implant installation installation
Indication for extraction (NIH)Dept. of OMFS, School of Dentistry Chonnam National University Medical consultation Treatment plan Simpler operation CNUH , OMFS Radiographic Examination Pathology Ridge shape or quality CNUH , OMFS Diagnostic Cast Jaw relation Wax-up, surgical stent
CNUH , OMFS Jaw Relation Cl I Cl II CNUH , OMFS Post-op 2 yrs ball type & short head for overdenture Temporary denture ( ) Temporary fixed bridge Temporary implant CNUH , OMFS Osteoporosis Control 16 75.9 11.9 69.5 82.2 RBM 10 87.1* 5.3 83.3 91.0 HA 8 95.4** 2.9 93.0 97.8 SLA 6 86.0* 3.5 82.4 89.7 Table 1. Percentage of bone-implant contact ratio in cortical bone of tibia (%) *; p<0.05, **; p<0.01, SD; standard deviation Table 2. Percentage of bone-implant contact ratio in marrow space of tibia (%) N Mean SD Minimum Maximum Control 8 29.6 5.4 25.1 34.1 RBM 8 36.7 10.3 28.0 45.3 HA 6 76.1** 15.0 60.4 91.8 SLA 8 45.1 15.0 32.5 57.6 **; p<0.01, SD; standard deviation CNUH , OMFS Minimal drilling Nasal cavity Maxillary sinus Incisive foramen Vertical alveolar bone height : more than 10 mm Small diameter fixture Veneer (saddle) bone graft Alveolar distraction CNUH , OMFS (Ridge expansion effect : 1 ~ 2 mm) Immediate implantation Radiographs progression (Ridge expansion effect : 3 ~ 5 mm) Healing period : 4 ~ 5 months. Provisional occlusal loading : 3 ~ 5 months Success rate : 85 ~ 98 % CNUH , OMFS Split-Crest Technique Intraoperative photographs Radiographs progression Peri-implant defects (fenestration, dehiscence) CNUH , OMFS (Ridge augmentation effect : 3 ~ 10 mm) Choice of graft material : Significant less resorption than particulate bone Post-op 5mon CNUH , OMFS Postoperative Radiographs Implant installation (Iliac BG + 5 months) Implant + 4 months (Iliac BG + 10 months) CNUH , OMFS Zygomaticoalveolar implant Vertical alveolar distraction (?) Chonnam Univ. Hospital (Oh) 2nd step 3 - 4 mo later CNUH , OMFS Indication : Use particulated bone graft : Use block bone graft Stable initial implant fixation No maxillary sinus infection Implant installation on #12i-16i, 22i-26i Temporary implant (4X) installation Implant installation on the lower jaw & temporary implant CNUH , OMFS Unstable initial implant fixation CNUH , OMFS PMH: HTN & DM (Med. for 10 yrs) Imp: Edentulous state on #14-17, #24-27, #37-47, & chronic severe periodontitis 04. 2.23. Ext of #11-13, 21-23, implant on #32i-36i, #42i-46i, 04. 8. 7. Implant on #12i-16i, #22i-26i 05. 1.20. 2nd Surg. Onlay bone graft on Rt alveolous, Implant on #32i-36i, #42i-46i, Post-op 5mo CNUH , OMFS Mental nerve Veneer (saddle) bone graft Imp: Full edentulous state on both jaws HxPi: 04. 6.17. Implant on #32i,33i,42i,43i for bar-retained overdenture Imp: Atrophic ridge on both side of lower posterior, Edentulous state on # 34-37 05. 1.12. Rt IAN reposition, implant on #44i, 45i, 46i, & Lt alveolar DO device delivery CNUH , OMFS Dental CT Findings : 2005. 1. 6. (pre-op) : 4mm, 5mm IAN Repositioning & DO IAN Repositioning & DO In the edentulous patients, 1. Many factors, such as jaw relation, inter-arch space, remaining bone, anatomical structures, soft tissue and so on, should be considered. 2. In old patients, general condition is primarily considered. The simple and safe implantation techniques are usually recommended.