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Changed philosophy and practice of perio
Many of the “rules” of periodontal therapy have been changed forever, with a paradigm shift from the practice of saving teeth at all costs toward one that will consider the extraction of “maintainable” teeth to improve esthetics, function and long term success of implant restorations.
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osseointegration
intimate contact of vital bone and the implant surface WITHOUT intervening soft tissue
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Components of surgical assessment
- • Chief Complaint
- • Medical / Dental History
- • Review of Risk Factors
- • Clinical Examination
- • Diagnostic Imaging (FMX,PAs,Panoramic)
- (3D CBCT scan)
- • Treatment Planning
- (Implant Simulation Software)
- ( Surgical Guides)
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Implant risk factors
- Diabetes (poorly controlled)
- Bone Metabolic Disease
- (Osteoporosis)
- Bisphosphonates (Oral vs IV)
- Head & Neck Radiation
- Immunocompromised by
- Medications or Disease
- Psychologically Impaired
- Other Medications or
- Conditions that Adversely
- Affect Healing / Osteogenesis
- Current Infections
- Tobacco Use (Smoking)
- Substance Abuse
- Parafunctional Habits
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Components of Comprehensive Dental, Perio Exam
- Oral Pathology
- Condition of Restorations
- Mal-positioned Teeth
- Determine Overall and
- Dental Disease (caries)
- Periodontal Disease
- Occlusion / Stability
- Tooth Mobility / Fremitus
- Wear Facets (sign of bruxism)
- Individual Tooth Prognosis
- Plan for Extractions
- Evaluate Site(s) for Tooth
- Replacement with Implant(s)
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Anatomical Considerations
see slide 11 of 44
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Specific site Evaluation
- Anatomical Considerations
- Space (M-D, B-L,A-C)
- Tissue Quality (keratinized)
- Assess Available Bone
- Prosthetically-Driven Implant Position
- Esthetics
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Diagnostic Imaging
- Conventional 2D Imaging (panoramic, periapical)
- 3D CBCT Imaging
- Implant Simulation Software (Anatomage InVivo5, Materialise SIMPLANT)
- Computer-Generated Surgical Guides
- Surgical Navigation (future)
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3D CBCT Diagnostic Imaging
- Image anatomy in large, medium or
- small Field of View (FOV)
•view structures in B-L dimension
•view structures in any plane
- •clinician able to view and measure
- structures in multiple 3D directions
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