Kuliah Peny.gilut

8/18/2019 Kuliah Peny.gilut

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I I

IN IVA

MUKOSA ORAL

LIDAH

LANDULA SLIVARII

TULAN RAHAN

RON A MULUT


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ANATOMI GIGI


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INFEKSI ODONTO EN JARIN AN

KERAS

CARIES

DEMINERALISASI JARIN AN KERAS I I

PH ASAM

LUBAN

CARIES SUPERFISIALIS

MELIBATKAN EMAIL


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CARIES MEDIA

MELIBATKAN DENTIN

HYPERAEMI PULPA

STIMULUS TEMPERATUR

SENSASI LINU


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PULPITIS

MELIBATKAN PULPA I I

SAKIT SPONTAN

SEIRAMA DETAK JANTUN

PARSIALIS /TOTALIS

IRADIASI SAKIT/REFER PAIN


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AN REN

KEMATIAN PULPA

TIDAK ADA RASA SALIT

PERUBAHAN WARNA

PERIODONTITIS

RADAN SERABUT PERIODONTIUM


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OSTEOMYELITIS

RADAN SUMSUM TULAN

RASA SAKIT SEPERTI MENDIDIH

FRA MEN TULAN :SQUESTER


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CARIES I I

KEADAAN I I BERLUBAN

AKIBAT PROSES DE

MINERALI SASI EMAIL YAN

MELUAS KE BA IAN

LAINNYA


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DENTAL PLAQUE


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DENTAL CARIES


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PERJALANAN [ROSES KARIES


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PERJALANAN PROSES KARIES


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KALKULUS

SCALLING MANUAL


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SCALLING MANUAL


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ELECTRIC SCALLIN


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BRUSHIN


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HOME CARE


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FLOSSIN


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DENTAL FLOSS


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PERAWATAN SYARAF I I


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PERAWATAN SYARAF GIGI


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PENJALARAN CARIES I I

INFEKSI ODONTOGEN

TERLOKALISIR PADA APEX GIGI

MENYEBAR KE JARINGAN SEKITAR PENYEBARAN SYSTEMIS

HEMATOGEN

LYMFOGEN


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BARIER PERTAHANAN

TULANG ALVEOLAR

PERIOSTEUM

MUSKULUS

FASIA


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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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LUDWIG ANGIMA

INFEKSI BILATERAL

SUBMENTUM – SUBMANDIBULAR – SUBLINGUAL

TIDAK ADA FLUKTUASI LIDAH TERDORONG KEATAS DAN BELAKANG

EDEMA GLOTIS

DEHYDRASI – SEPTIKEMI - MEDIASTINITIS


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TRACHEOS TOMY


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PENATA LAKSANAAN


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PENATA LAKSANAAN

TERAPI MEDIKAMENTOSA TERAPI KAUSA – ANTI MIKROBA

TERAPI SYMPTOMATIK ANALGETIKA – ANTI INFLMASI

ANTI PYRETIKA


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TERAPI SUPPORTIF

TERAPI NUTRISI

KARBOHYDRAT

PROTEIN LEMAK

ROBORANSIA

ELECTROLIT


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IN IVA

JARINGAN LUNAK

MENUTUPI GIGI DAN TULANG RAHANG

INFEKSI : GINGIVITISTUMOR JINAK : EPULIS


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LANDULA SALIVARII

GLD! PAROTIS

GLD"SUB MANDIBULA

GLD SUB LINGUAL

PELUMAS MASTIKASI

DAYA TAHAN INFEKSI


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ANATOMI GLD SALIVARII


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ANATOMI GLD" SALIVARII

MACAM LD"SALIVARII

MAYOR

PAROTIS

SUB MANDIBULARSUBLINGUAL

M#$%&

P' ()*%+, ()). 0#0#!1#1#&! 0,,.)( 2 #',34


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MUCOCEL


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FRENULUM LIN UAE


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TRAUMA

JARINGAN LUNAK WAJAH CONTUSIO – ABRASIO – LACERASIO - PENETRASIO

LUKA TEMBAK – LUKA BAKAR

CAIRAN KIMIA – MATAHARI - LISTRIK TRAUMA GIGI

FRAKTUR RAHANG


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CONTUSIO


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8"

ABRASI


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TRAUMA BERUPA ESEKAN

KULIT TERKELUPAS BERDARAH

9" LACERASI

AKIBAT BENDA TAJAM

JARIN AN ROBEK

DAN KAL/DALAM

MEN ENAI PEMBLH DRH/ SYARAF


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" LUKA TEMBAK

TEMBAKAN SENJATA API

TERTIN AL/PERFORASI


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;" LUKA BAKAR

AKIBAT API!CAIRAN/LO AM PANAS

CAIRAN KIMIA! LISTRIK! MATAHARI


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MUSKULUS

ERAKAN MASTIKASI

MEMBENTUK ROMAN MUKA

INNERVASI

MOTORIS

SENSIBEL

VASCULARISASI

NUTRISWI

DAYA TAHAN TUBUH


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I I ELI I

5< I I DECIDUI

ERUPSI UMUR ; BULAN

ERUPSI PENUH UMUR 8 TAHUN

8 INSISIVUS – 5 KANINUS - 8 MOLAR TIAP = SE M

UMUR ; TAHUN LUXASI DAN DI ANTI I I PERMANEN

98 I I PERMANEN

ERUPSI UMUR ; TAHUN

BERAKHIR D MOLAR KE TI A

8 INSISIVUS - 5 KANINUS – 8 PREMOLAR

9 MOLAR TIAP = SE MEN


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TULAN RAHAN


TEMPAT KEDUDUKAN GIGI GELIGI

ORIGO DAN INSERSIO MUSKULUS

MUSKULUS


PEN ERAK MANDIBULA

PERLEKATAN SYSTEM VASKULER INNERVASI

SYSTEM NERVORUM


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SYSTEM NERVORUM

MOTORIS PEN ERAK MUSKULUS

SENSIBEL PERASAAN

SYSTEMA VSKULER

NUTRISI

IMMUNITAS

KELAINAN TIAP KOMPONEN


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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

PENJALARAN CARIES I I


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INFEKSI ODONTOGEN

TERLOKALISIR PADA APEX GIGI

MENYEBAR KE JARINGAN SEKITAR PENYEBARAN SYSTEMIS

HEMATOGEN

LYMFOGEN

PERKEMBANGAN INFEKSI


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JARINGAN KERAS PULPITIS

GANGRENE

PERIODONTITIS

OSTEITIS

OSTEOMYELITIS


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RANULA


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PAPIL LIDAH


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T'0 6 (,>,( 0,0#,:

P,0#, C#&>)(?,,.,"

P,0#, F)$@#%&(#+"

P,0#, F##%&(#+P,0#, F%#,.,"


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TRAUMA


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JARIN AN LUNAK

•5"CONTUSIO

• BENTURAN BENDA TUMPUL

• LUKA TERTUTUP

•

TERJADI PENDARAHAN KULIT DAN

• SUBCUTAN SB ECHIMOSIS

• AKAN HILAN SETELAH 67 JAM

•


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GEJALA KLINIS

TRAUMA DENTOMAXILLOFACIAL


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TRAUMA DENTOMAXILLOFACIAL

•5"RASA SAKIT SPONTAN

•8"MAL OKLUSI I I

•9"PEMBEN KAKAN

•6"ECHIMOSIS

•"KREPITASI

•;"HYPERSALIVASI

•

"DEFORMITAS ROMAN MUKA

TRAUMA I I ELI I


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•

DISERTAI PENDARAHAN!PEMBEN KAKAN

• LACERASI JARIN AN LUNAK

•5"FRAKTUR EMAIL/DENTIN/PULPA

•8"AVULSI

•9"IMPAKSI

•6"LUXASI

TRAUMA


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TULAN RAHAN

•

5"FRACTUR ALVEOLUS

•8"FRACTUR MAXILLA

•9"FRACTUR MANDIBULA

•6"FRACTUR TULAN LAINNYA

• YAN JAUH LETAKNYA

TATA LAKSANA FRAKTUR TULANG RAHANG


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REPOSISI MENGEMBALIKAN KEDUA UJUNG FRAGMEN BERPEDOMAN PADA OKLUSI GIGI

IMMOBILISASI

WIRING PLATING

MOBILISASI


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TUMOR


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TUMOR JINAK JARINGAN LUNAK EPULIS : TUMOR PD GINGIVA

E" GRAVIDARUM

TUMOR TULANG RAHANG OSTEOMA

AMELOBLASTOMA

KISTA


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KISTA JARINGAN LUNAK GLD SALIVARII MUCOCEL

RANULA

KISTA JARINGAN KERAS KISTA RESIDUAL

KISTA RADIKULAR

KISTE DENTIGEROUS

M)>%>


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R,$),


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P$@,$@*,.,$ M)>%>


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M,>,( *,#$,$ *$,& )',3

K # * 1


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T#',* ,',$, 5 ,.,) 1#3 *& )',3"

S,)&,$ *>#/ .&.).)0"

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M)>%> : .' 0' * )',3 (#$%&"R,$), : .' 0' * )',3 (,%&"

F)$@+# +,#?,


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P)$>)&/ 0)(,+ : 1%)+ (,*,$,$! 0' #',

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B)&"

B,*.%+.,.#*

B,*.+#'"

R,$),


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K,#$,$ *$,& )',3


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T#$@,"S)1(,$'#1),& :

+)1(%3#%#' '# 13

#',3 2 +0 .@3 >%&0"

(,$' +0 &@@@ 2 7"


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B,@#,$- 1,@#,$ L#',3


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KELAINAN LIDAH


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P$',3)),$ O&@,$ *%(0,* '#,0#+# 0#.

+),(%+, 1&,0#+"

F)$@+#: 1#>,&,! 0$,$,$!0$@>,0"

B,@#,$- 1,@#,$ L#',3


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KELAINAN LIDAH


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P$',3)),$ O&@,$ *%(0,* '#,0#+# 0#.

+),(%+, 1&,0#+"

F)$@+#: 1#>,&,! 0$,$,$!0$@>,0"


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H&0+ L,1#,#+


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S.%(,.#.#+


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E>#+# 0&@$,$> .)(%&


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P&@$,$> .)(%&


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P$1,&,$ #$*+# @#@#


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K,*))+


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P&,,$,$ C,+


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A$,.%(# ',$ J,$@,$ P$')*)$@ G#@#


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P&,,$,$ D$., C,+


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P$1,&,$ #$*+# @#@#


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DIABETES


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HEMOFILIA


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PHLEGMOON MANDIBULA


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P$1,&,$ #$*+# @#@#


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P&,,$,$ D$., C,&


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I I IMPLAN


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Implant Guidelines

What is a dental implant?•Biomaterials

–most commonly used –commercially pure (CP) titanium

–titanium-aluminum-vanadium alloy

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


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Implant Guidelines

What is a dental implant?•Titanium

–li"ht$ei"ht –&iocompati&le –corrosion resistant

(dynamic inert o'ide layer)

–stron" # lo$-priced


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Implant Guidelines

What is a dental implant?•i'ture types

–A coated –Ti sur*ace modi*ied –tap or sel*-tappin" –

scre$ or press *it


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Implant Guidelines

What is a dental implant?• +,sseointe"ration

–Br.nemar/ - late 01234s

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

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


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Implant Guidelines


–similar so*t-tissue relationship tonatural dentition (sulcular epithelium)

–hemi-desmosome li/e structures

connect epithelium to titaniumsur*ace


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Implant Guidelines


–circum*erential and perpendicularconnective tissue

–no connective tissue insertion

–

no intervenin" harpey4s *i&erattachment


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Implant Guidelines


–&one-implant inter*ace –osteo&lasts in close pro'imity

to inter*ace –separated *rom implant &y thin

amorphous proteo"lycan layer –osseointe"ration - hi"hly predicta&le


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Implant Guidelines


–&one-implant inter*ace –osteo&lasts in close pro'imity

to inter*ace –separated *rom implant &y thin

amorphous proteo"lycan layer –osseointe"ration - hi"hly predicta&le


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Implant Guidelines


–&one-implant inter*ace –o'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


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Implant Guidelines


–&one-implant inter*ace –o'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


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Implant Guidelines

What is a dental implant?•Components # terminolo"y

–copin" or prosthesis scre$ (top) –copin" –analo"

» implant &ody»a&utment

–trans*er copin" (indirect or direct)


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Implant Guidelines

What is a dental implant?•Components # terminolo"y

–hy"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)


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Implant Guidelines


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Implant Guidelines

What is a dental implant?•8odern types

–implants are small - –standard a&utment - usually 9:;


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Implant Guidelines

What is a dental implant?•8odern types

–len"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)


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Implant Guidelines

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

–i'tures –tandard

–8/ II


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Implant Guidelines


–A&utments –tandard –Cera,ne –>sthetiCone

–8irusCone –An"ulated 0; (ne$) or 93


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Implant Guidelines


–tandard –no anti-rotational properties –can use *or multiple units –can use *or hy&rid dentures


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Implant Guidelines


–Cera,ne –sin"le tooth esthetic replacement –a&utment attached to *i'ture $%

restoration cemented to a&utment

–accommodation *or *i'ture misali"nmen –can provisionali@e


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Implant Guidelines


–>sthetiCone –esthetic P restorations –machined "old cylinder a&utment allo$

cro$n mar"in to seat close to *i'ture

($ithin 0mm)


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Implant Guidelines


–8irusCone –esthetic P restorations –use $hen decreased vertical hei"ht –allo$s :


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Implant Guidelines


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

$here complicated anatomy e'ists –use i* less than ideal *i'ture placement

–use $here esthetic cervical mar"inreuired


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Implant Guidelines


–Cera,ne –>sthetiCone –8irusCone –An"ulated a&utments

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


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Implant Guidelines

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

–

i'tures –8icro8iniplant –8iniplant –tandard –

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


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Implant Guidelines


–

i'tures –IC> (incremental cuttin" ed"e)» super sel*-tappin" implant»uses tapered cuttin" *lutes»

allo$s more placement control»rapid &one en"a"ement # implantsta&ili@ation


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Implant Guidelines


–

A&utments –>P (conical) - (esthetic pro*ile) –Gold DCEA-type –T$o-piece a&utment post –TA (standard)

–Pre-An"led –=e$ Gold tandard F (@ero rotation)


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Implant Guidelines


–

Gold DCEA-type a&utment –scre$-retained at *i'ture level –non-se"mented a&utment –scre$-retained cro$n to implant

–

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


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Implant Guidelines


–

Gold DCEA-type a&utment –thin &uccal-lin"ual tissues

– limited inter-occlusal distance

(as little as :


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Implant Guidelines


–

>P (conical) - (esthetic pro*ile) –scre$-retained cro$n to the a&utment –"old cylinder –non-parallel implant placement –sin"le or multiple units

–minimum ;mm inter-occlusal distancereuired


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Implant Guidelines


–

T$o-piece a&utment post –non-rotational –cement-retained cro$n to the a&utment –simplicity o* treatment - chairside

preparation

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


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Implant Guidelines

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

–Prep-Tite Posts»scre$ retained a&utment»standard impression procedure»cemented restoration»

6 taper $ith 9 vertical "rooves»multiple collar hei"hts


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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 months»claim 12:


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Implant Guidelines

What is a dental implant?•emem&erH:

–or P4s –plan *or scre$-retained restorations –no anti-rotational properties –al$ays use at least 7 *i'tures $hen

restorin" posterior spaces not &ound &ynatural teeth


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Implant Guidelines

What is a dental implant?•Advanta"es

–no preparation o* tooth%adJacent teeth –&one sta&ili@ation # maintenance –retrieva&ility – improvement o* *unction

–psycholo"ical improvement


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Implant Guidelines

What is a dental implant?•isadvanta"es

–ris/ o* scre$ loosenin" –ris/ o* *i'ture *ailure – len"th o* treatment time –need *or multiple sur"eries

–challen"in" esthetics


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Implant Guidelines

Consultation Appointment •Treatment plannin" phase

“Diagnosis begins with a complete patient evaluation”

–"uidelines *or +decision-ma/in"process

–treat the +entire patient –restore *orm5 *unction # esthetics


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Implant Guidelines


–pro&lem list # patient desires –initial evaluation

–chie* complaint –medical%dental history revie$

– intra%e'traoral e'am –evaluation o* e'istin" prosthesis


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Implant Guidelines


–initial evaluation –dia"nostic impressions%articulated cast –radio"raphs - panoramic and periapical

(CT scan or tomo"raphy - as indicated) –

photo"raphs


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Implant Guidelines


–treatment options%in*ormed consent –e'planation o* lon"-term commitmen

–restorative - sur"ical Joint consult –t$o-sta"e sur"ery

–stage I –stage II


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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)


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Implant Guidelines


–stage I - healin" phase –9 month minimum (mandi&le ) - usually

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

months *or all re"ions


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Implant Guidelines


–

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

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


438/554

Implant Guidelines


–

restorative phase –maintenance and re"ular recall

–*ee # payment policy

–"oal to restore *orm5 *unction #

esthetics


439/554

Implant Guidelines

Treatment plannin" phase• Pro&lem list # treatment considerations

–

teeth –periodontium

–radio"raphic analysis

–sur"ical analysis

–esthetic analysis


440/554

Implant Guidelines


–

occlusal analysis –advs%disadvs o* proposed treatment

–re*errals%specialty consults

–appointment seuencin"

–treatment alternatives


441/554

Implant Guidelines


–

teeth –periodontium





442/554


443/554

Implant Guidelines


–

teeth - num&er # e'istin" condition –minimum 6-;mm &et$een teeth to*acilitate implant placement

(&ased on 9mm *i'ture)

–K 0:


444/554

Implant Guidelines


–

teeth - num&er # e'istin" condition –more than 03mm mesiodistal space -sin"le tooth implant not recommended

–(multiple a&utments should &e splinted)

I l t G id li


445/554

Implant Guidelines


–teeth

–periodontium




I l t G id li


446/554

Implant Guidelines


–periodontium - &one support –Ee/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


447/554

I l t G id li


448/554

Implant Guidelines


–periodontium - &one support –quantity - 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)


449/554

I l t G id li


450/554

Implant Guidelines


–periodontium

–muco"in"ival pro&lems –need su**icient tissue volume to recreat

"in"ival papilla –need some attached "in"iva to maintain

peri-implant sulcus

–0st year post-op &one resorption M 0mm Ncrest o* &one optimal 7- 9mm &elo$ C>

I l t G id li


451/554

Implant Guidelines


–periodontium

–muco"in"ival pro&lems –place implant 7-9mm apical to *ree

"in"ival mar"in o* adJacent tooth –recreates &iolo"ic $idth o* peri-implant

sulcus –Nso*t tissue hei"ht 7mm or K mm may

create challen"e

I l t G id li


452/554

Implant Guidelines


–periodontium –oral hy"iene - important pre # post –systemic mani*estations - ie: dia&etics

are predisposed to delayed healin"

–destructive ha&its - smoking iscontraindicated - delayed or inadeuatetissue healin" # osseointe"ration noted

Implant Guidelines


453/554

Implant Guidelines


–teeth

–periodontium




Implant Guidelines


454/554

Implant Guidelines


–radio"raphic analysis –periapical patholo"y

–radiopaue%radiolucent re"ions

–adeuate vertical &one hei"ht

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

Implant Guidelines


455/554

Implant Guidelines


–radio"raphic analysis –adeuate interradicular area –&one uality # uantity

–radio"raphs - panoramic and periapical

(CT scan or tomo"raphy - as indicated)

Implant Guidelines


456/554

Implant Guidelines


–radio"raphic analysis –radio"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) # localeo* anatomic structures

Implant Guidelines


457/554

Implant Guidelines


–radio"raphic analysis -

–radio"raphic stent - (can dou&le assur"ical stent)

–acrylic stent $ith lead &eads or &all-&earin"s (


458/554

Implant Guidelines


–radio"raphic analysis -

–distortion (common to all Q-rays) –Panore' M 7


459/554

Implant Guidelines


–teeth

–periodontium




Implant Guidelines


460/554

Implant Guidelines


–sur"ical analysis -

–sur"ical "uide stent - None o* themost critical *actors *or o&tainin" an idealsur"ical # esthetic result –used durin" *i'ture installation as "uide

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

improved access # visi&ility

Implant Guidelines


461/554

Implant Guidelines


–sur"ical analysis -

–implant len"th%diameter –determined &y uantity o* &one apical to

e'traction site –use lon"est implant sa*ely possi&le –

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

Implant Guidelines


462/554

Implant Guidelines


–sur"ical analysis –

treatment 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

Implant Guidelines


463/554

Implant Guidelines


–sur"ical analysis –proper sur"ical techniue durin"

implant placement is critical

–minimal heat "eneration important – ; Celsius *or one minute or less

provides most predicta&le healin"response

Implant Guidelines


464/554

Implant Guidelines


–teeth

–periodontium




Implant Guidelines


465/554

Implant Guidelines


–esthetic analysis –smile 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

Implant Guidelines


466/554

Implant Guidelines


–esthetic analysis –implant emer"ence pro*ile (963)

–restored implant should appear to+"ro$ or emer"e *rom the "in"iva

–very natural # desira&le in appearance

–avoid +tomato on a stic/ cro$ns orperiodontal pro&lems may develop

Implant Guidelines


467/554

Implant Guidelines


–occlusal analysis

–advs%disadvs o* proposed treatment –re*errals%specialty consults


–

treatment alternatives

Implant Guidelines


468/554

Implant Guidelines


–occlusal analysis –improvement o* *unction and%or

esthetics (?) –para*unctional ha&its

–can &e destructive –teeth lost to occlusal trauma or

para*unction - less success $% implants

Implant Guidelines


469/554

Implant Guidelines


–occlusal analysis –dia"nostic casts

(mounted to determine opposin" occlusion

–rid"e $idth –

e'istin" inter-arch vertical space0-0


470/554

Implant Guidelines


–occlusal analysis –ma'illo-mandi&ular relations

Ja$ classi*ications –Class II may have "reatest &ene*it –Class III reuires sur"ical intervention

Implant Guidelines


471/554

Implant Guidelines





–


Implant Guidelines


472/554

Implant Guidelines


–advs%disadvs o* proposed treatment –are as individual as the case &ein"

treatment planned»cost»patient desires

»clinician a&ilities»etc:

Implant Guidelines


473/554

Implant Guidelines





–


Implant Guidelines


474/554

Implant Guidelines


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

»orthodontics»periodontal therapy»endodontic therapy

Implant Guidelines


475/554

Implant Guidelines


–re*errals%specialty consults»pre-prosthetic sur"ery e'tractions

rid"e contourin" or e'ostosis remova

osteotomy &one or so*t tissue au"mentation

Implant Guidelines


476/554

p





–


Implant Guidelines


477/554

p


–appointment seuencin" –len"th o* treatment time

–need *or multiple sur"eries

Implant Guidelines


478/554

p





–


Implant Guidelines


479/554

p


–treatment alternatives –*i'ed partial dentures –remova&le partial dentures –resin-&onded *i'ed partial dentures –orthodontics –do nothin"

Implant Guidelines


480/554

p

Treatment plannin" phase• Indications

–"ood "eneral health

–adeuate &one uality # volume –appropriate occlusion # Ja$ relations – ina&ility to $ear conventional prosthesis –un*avora&le num&er%location o* a&utment –

sin"le tooth loss


481/554

Implant Guidelines


482/554

p

Treatment plannin" phase•Contraindications (relative)

–(need sur"ical intervention)

–ramus "ra*t – inadeuate &one at implant site –e'cessive &ony concavities

–sinus li*t or IA= transposition –

inadeuate vertical space *or implant

Implant Guidelines


483/554

p

Treatment plannin" phase• +,sseointe"rated implants can &e

placed in the irradiated mandi&les o*

selected patients $ithout hyper&arico'y"en treatment

=iini5 Deda5 Seller5 Worthin"tonL Experience withOsseointegrated Implants laced in Irradiated !issues in "apan

and the #nited $tates5 Intl O ,ral 8a'illo*ac Implants 0112L09R3;-00

Implant Guidelines


484/554

p

8aintenance• Criteria *or success

• 8aintenance and ecall

• y"iene Aids

• Pro&lems

Implant Guidelines


485/554

8aintenance• Primary "oal is to protect and

maintain +tissue-inte"rationLgood oral hygiene is a /ey

element

Implant Guidelines


486/554

8aintenance• +Implant patients should &e

thorou"hly instructed in

maintenance 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;


487/554

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 Consensus

evelopment Con*erence

Implant Guidelines


488/554



• y"iene Aids

•

Pro&lems

Implant Guidelines


489/554

8aintenance• Criteria *or successR(most important is "ood dia"nosis)

–no peri-implantitis –no associated radio"raphic

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


490/554

8aintenance• Criteria *or successR

–tissue inte"rationR &one%so*t tissue

+osseointe"ration –a&sence o* mo&ility –no pro"ressive so*t tissue chan"es o

&one loss

–sta&le clinical attachment level

Implant Guidelines


491/554


–a&sence o* &leedin" upon

pro&in"%e'cessive pro&in" depths –a&sence o* discom*ort

–success rate varies $ith &one ualityloadin" dynamics5 etc:

Implant Guidelines


492/554


–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 somecancellous *or vascular supply

Implant Guidelines


493/554



• y"iene Aids

•

Pro&lems

Implant Guidelines


494/554

8aintenance• 8aintenance # ecallR

–(our elements –home-care re"imen –periodic recalls rein*orcin" re"imen –strict adherence to recall schedule #

veri*ication o* *unction5 com*ort5 andesthetics

– li*etime maintenance commitment

Implant Guidelines


495/554


–(requency o& recall – immediate post-delivery –7 hours –one $ee/ –t$o $ee/s (re-torue i* needed) –

6 months –&i-annual or annual evaluation


496/554

Implant Guidelines


497/554


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

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

–proper torue on scre$ Joints –occlusion

Implant Guidelines


498/554

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

–plaue is 0 etiolo"ic *actor in tissuedestruction (peri-implant and natural tooth

–revie$ oral hy"iene instruction –monitor throu"h plaue indices

–same reuirements as *or natural teeth –use neutral sodium *luorides

Implant Guidelines


499/554

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

–may &e the key indicator o* *i'ture health –minimal mo&ility $% osseointe"rated

*i'turesR 0;-


500/554

)linical arameters o& Evaluation• retrieva&ility

–*ailin" implant may &e mas/ed i* connecteto same prosthesis

– important to remove P to evaluate –annual removal recommended *or multiple

unit prosthesis –early *ailure detection $ill minimi@e *i&rou

tissue @one si@e # may allo$ placement o*

$ider diameter *i'ture

Implant Guidelines


501/554

)linical arameters o& Evaluation• peri-implant tissue health

–visual inspectionR si"ns o* pathoses? – Alterations in color5 contour # consistency

–alveolar mucosa may surround implant #appear more erythematous than "in"iva

–tissue movement $hen adJacent tissuesretracted may a**ect so*t-tissue-implantattachment M (detrimental)

–perimucosal /eratini@ed tissue is &est


502/554

Implant Guidelines


503/554

)linical arameters o& Evaluation• &leedin"

–controversy as to si"ni*icance o* B,P atperi-implant inter*ace

–B,P may precede clinical si"ns o*in*lammation

–B,P # radio"raphic chan"es are most valindicators o* peri-implant &rea/do$n

–

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

Implant Guidelines


504/554

)linical arameters o& Evaluation• radio"raphic assessment

–one o* most valua&le measures o* implantsuccess

–o* value $hen – cannot pro&e area due to constricted implant

nec/5 and – to assess *uture mo&ility $ithout P removal – to accurately determine amount o* &one loss i

a&sence o* increased crevicular depth

Implant Guidelines


505/554


–compare &ony chan"es $ith sta&lelandmar/s - implant threads - – (one-hal* thread U 3:9mm)

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

–periapical radio"raphs U 7:< -


506/554


–bone level determination should be basedonly upon standardi+ed periapical

radiographs –threads o* implant must appear sharp #

$ell-delineated on Q-ray to &e accurate –Q-ray &eamR direct V 1 *rom line

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

Implant Guidelines


507/554


–recommend /!p o* not 63 (&est 6


508/554


–uality in *ilm development is paramount –post-op radio"raphic intervalsR

– not &et$een *i'ture placement to a&utmentconnection

– 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


509/554


–e'pect 0:3mm mar"inal &one loss durin"*irst year postinsertionL V 3:0mm per yearanticipated therea*ter

–"reater &one loss o&served in ma'illa

Implant Guidelines


510/554


–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


511/554


–>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 periodontallyinvolved teeth

Implant Guidelines


512/554

)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 t

strip or +round-o** the he' –e'cessive *orce can *racture scre$%implan

or create increased stresses in the &one


513/554

Implant Guidelines


514/554

)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 $ill

hold shim stoc/ (:3330)

Implant Guidelines


515/554


• 8aintenance and ecall• y"iene Aids

•

Pro&lems

Implant Guidelines


516/554

8aintenance• y"iene AidsR

–plastic scalers - ,=E - *or a&utment

scalin" 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 useTitan- or ultrasonic scalers unless specia

non-metal tips used

Implant Guidelines


517/554


–prophy Jets - use $ith caution

–*ine prophy paste or *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


518/554


–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 discretioo* dentistL may &e use*ul i* limited manual

de'terity

Implant Guidelines


519/554


–chlorhe'idine - use durin" peri-sur"ical

periods or as needed i* episodes o* acuteso*t tissue in*lammation occur

–*luoride rinses or "els - use neutralsodium *luoride to avoid dama"e totitanium *i'tures that may occur $ithacidulated types

Implant Guidelines


520/554


• 8aintenance and ecall• y"iene Aids

•

Pro&lems

Implant Guidelines


521/554

8aintenance• Pro&lemsR

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

Implant Guidelines


522/554

Pro&lemsR –so*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


523/554

Pro&lemsR –so*t tissue reactions

–treatmentR»remove o**endin" scre$5 ti"hten

a&utment # reinsert prosthesis»rein*orce oral hy"iene»so*t-tissue auto"ra*t

»replacement o* *ailed implant

Implant Guidelines


524/554

Pro&lemsR –*ractured or loosened scre$s

–0st suspicion $hen complaint o* +looseimplant or discom*ort

–use correct scre$driver *or scre$ head$ithout e'cess *orce or can +round o**he'

– i* retrievin" (+teasin" out) *ractured

scre$ caution not to dama"e he'


525/554

Implant Guidelines


526/554

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


527/554

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 overloadLinadeuate scre$ Joint closureL

in*ection

Implant Guidelines


528/554


–*ailin" implant»treatmentR»remove 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


529/554


–*ailed implant

»

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

»(connective tissue implantencapsulation may not &e visi&le onradio"raph)

Implant Guidelines


530/554


–*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 overloadLinadeuate scre$ Joint closureL

in*ection

Implant Guidelines


531/554


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

treatmentR»removal o* implant

Implant Guidelines


532/554


– +implantitis !s periodontitis

»

clinical si"nsRsimilar clinicalpresentation $% same patho"enicmicroor"anisms

»causesRpoor oral hy"ieneL &acteriaL

cause may &e un/no$n (?)

Implant Guidelines


533/554


– +implantitis !s periodontitis»treatmentR»consults to provider - consider

rema/e or "uided tissue re"enerationetc:

» interim - remove prosthesis #a&utments # irri"ate area $% CQL

disin*ect components # reinsert

Implant Guidelines


534/554

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' oscratch titanium *i'ture or a&utment

Implant Guidelines


535/554

Case election• Implant recommended

–

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

–replacement o* tooth X72s


536/554

Case X0

Implant Guidelines


537/554

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

=CT X7; and severe locali@ed

periodontitis• tooth deemed hopeless and

e'tracted

Implant Guidelines


538/554

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

placed

Implant Guidelines

I l d d


539/554

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

cemented (Setac Cem) P8 cro$n


540/554

Case X 7

Implant Guidelines

I l t d d


541/554

Implant recommended• 90 y%o *emale presented $ith

missin" X01 # 935 and retained

X0; # 97 (third molars)

Implant Guidelines

I l t d d


542/554

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

inadeuate mesial-distal and

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

Implant Guidelines

I l t d d


543/554

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

o* missin" X01 and X93 also

de*icient

Implant Guidelines

I l t d d


544/554

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

&ilateral ramus "ra*ts placed at

edentulous sites (X01 # 93)


545/554

Implant Guidelines

I l t d d


546/554

Implant recommended•


547/554

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

retained non-se"mented DCEA

a&utments $% P8 cro$ns

Implant Guidelines

Implant recommended


548/554

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

P8 cro$ns to re-esta&lish proper

occlusal plane


549/554

Case X 9

Implant Guidelines

Implant not recommended


550/554

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

history o* supernumerary X72

• =oteR dilacerated root to mesial onX72

Implant Guidelines



551/554

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



552/554

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

therapy5 X72 *ailed to move to

*acilitate implant placement

Implant Guidelines



553/554

Implant not recommended• edentulous area restored $ith a

resin-&onded *i'ed partial denture

(BP X7;-72)

YD>TI,= ???


554/554

YD>TI,= ???

D BIG>

Documents

Kuliah Peny.gilut