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Indications and
contraindications in oral implantology
Associate professor, doctor of medicine, maxillofacial
surgeon, implantolog.
Head of department propedeutic dentistry and
dental implantology
Nicolae Chele
CHIŞINĂU
MOLDOVA
Dental implantology is a part of
plastic / esthetic oral surgery, because
due to implant insertion is created an
oclusal rehabilitation with different
prosthetic constructions, these
reestablish more phisiologically the
chewing, phonetics, the oral confort and
the esthetics.
The
development
history of
dental
implantology
Itsupposes that the first implants
and dental transplantations were
used in Egipt.
In 1931, on Las Mouertos plateau,
Republic of Honduras, doctor D.
Popenoe has found an fragment of
mandible from 6th century a.Ch. In 31,
41, 42 teeth socket were found dental
implants made from mussels shells.
In 1998, a goup of researchers have found
a 30 year old woman’s skull (France), that
lived in the first century, having a metallic
dental implant in the socket of a superior
canine
Another
revolution in the
history of dental
implantology was the
discovery and the
usage of Titanium as
a biomaterial
The titanium as a
biomaterial in
implantology
Brånemark's discovery of
osseointegration revolutionized the realm of
implant dentistry and brought it from being a
shunned field into one that became
recognized and incorporated into] dental
school curricula and training programs.
Prior to the discovery of osseointegration,
dental implant technology consisted of blade
and transosteal implants
Blade implants, introduced in 1967, consisted of a metal blade that was
placed within a bony incision that subsequently healed over the horizontally
situated piece of metal but allowed a vertical segment to perforate the healed
surface. Transosteal implants, the application of which was strictly limited to the
mandible, consisted of a number of screws which were inserted into the inferior
aspect of the mandible, some of which extended through and through into the oral
cavity.
Both of these implant types relied on mechanical retention, as it was
heretofor unknown that metal could be fused into the bone. With the advent of
osseointegration, however, rootform endosteal implants became the new standard
9
in implant technology.
Brånemark's serendipitous discovery of osseointegration occurred
in 1952 during vital microscopy studies in rabbits using titanium
optic chambers. He and his team found that titanium oculars placed
into the lower leg bones of rabbits could not be removed from the
bones after a period of healing. He then developed and tested a type
of dental implant utilizing pure titanium screws, which he termed
fixtures.
Although the field of implantology was eschewed by dental
academia until that time, the "extensive and weighty documentation
of implant efficacy and safety" and "early replication by reliable,
independent researchers" resulted in the widespread embrace of
implantology by the dental community.
Brånemark's son, Rickard, has taken this success and is
developing orthopedic prostheses in the form of artificial arms and
legs anchored to the human skeleton.
The romanian researcher, Dorin Bratu, divides the evolution
of dental implantology in 5 stages:
The medieval period – 1001-1799
The fundamental period – starts in XIXth century when has
appeared the Maggiolo dissertation, named “The dental art
handbook”
The premodern period – starts in 1913, when Greenfield
presented at the Philadelphia academy a study about an iridium-
platinum cylindrical implant
The modern period – starts at the end of 1938 year when it
begun the usage of stainless materials (chromium, cobalt,
molybdenum)
The contemporary period – dates till nowadays and it begun
once biomaterials and the osseointegration phenomena were
discovered by Branemark
The development of dental
implantology in Moldova
The first internship of implantology
was held in Caunas city, ex Lithuanian
Socialist Sovietic Reupublic, in 1986.
13
25 years is a lot of
time or not?
The first plate form implant was introduced
in a new created socket on the maxilla in
1987 year, 23 July
In 1990, professor B. Heinrich came
and taught a course about the blade-
implant inoculation technique.
After finishing the lessons, some
specialists like A. Păulescu, T.Popovici,
Gh. Nicolau, I.Şeptelici a.a begun to
practice implantology.
After the unraveling USSR, the possibility of
developing dental implantology raised, and in 1995-
1997, another specialists like V.Topală, D. Şcerbatiuc, in
professor’s Burchel clinic from Germany, G. Nicolau
profesor’s Postata clinic from Czech Republic, N. Chele
in profesor’s Bayer clinic – Germany, started to make
internship in this field.
In 1998 were brought in our country the first single
step surgery implant (CTИ ол Rusia) and the last
generation of two step surgery implant (Alpha Bio) by
N. Chele.
At this moment work a large number of stomatologists
like C. Gligor, D,Sârbu. F. Gheorghiţa, I. Dabija, in this
domain.
DENTAL
IMPLANTS
TYPES AND CLASSIFICATION
INTRODUCTION
IMPLANTATION – is defined as
insertion of any object or a
material , which is alloplastic in
nature either partially or
completely into the body for
therapeutic , experimental ,
diagnostic or prosthetic purpose .
- ANUSAVICE
ADVANTAGES OF IMPLANT
Two steps
surgical
implants
The component parts of two steps
surgical implants
The surgical parts
Individual
Standard
straight
angulate
Straight Abutments :
Short straight;
Long straight;
Standard short straight
abutments
Standard angulated abutments :
Abutments:
Angulated at 150
Angulated at 250
Angulated at 350
Short angulated at 150;
impression trays
The laboratory Components
local
relative
general
absolute
The local relative
contraindications are:
Poor oral hygiene
the existance
of radicular
residues
Diseases of oral mucosa
Stomatitis,
bacterial
Infections,
ulcers, lupus
erythematosus,
pemphigus,
alergies
Local inflamatory
pocesses
parodontitis,
gingivitis,
stomatitis
Poor narrow bone
Bone defects,
narrow bone,
porous bone
Qualitatively thin bone
Large interdental spaces and dental migrations.
Pathological occlusion
General relative
contraindications
Neoplasme or precancerous stages
Postradiotherapy status
Endocrinopathies (acromegaly)
Granulomatous diseases (tuberculosis,
sarcoidosis)
Pregnancy
The absolute contraindications are:
biphosfstasis therapy;
echtodermal dysplasia;
treatment by an surgeon-implantologist without any
practice;
type II diabetes (decompensated stage);
prolonged treatment with imunosupresor medicine;
blood diseases and bleeding disorders (leukemia,
hemophilia);
Regional malignant tumors;
tumoral metastasis;
diseases of oral mucosa
Psychic diseases.
Fumatul, narcomania,
alcoolismul
Important factors that
influence the osseointegration
of implants
The compound of the implant’s body
The surface of the implant
The overheating of the bone
The contamination of the implant
The initial stability
The quality of the bone
The loading of the implant
The planning of the surgical-
prosthetic treatment
The financial aspect
Every doctor must evaluate all the
benefits, the price of the all treatment
with an eye to patient’s investments for a
long time.
Reasons for presentation
Incidenţa cariilor
- Fosa canină
- Sinusurile maxilare
- Apertura piriformă
Vom examina următoarele zone:
-
- Protuberanţa mentonieră
- Depresiunea fosei sublinguale
- Canalul mandibular
- Foramenul mentonier
Planificarea tratamentului
Planificarea tratamentului
The surgical-prosthetic
treatment includes two
clinical steps and a
technical one
The clinical surgical step
ANESTEZIA
Osul nu are o inervaţie senzitivă proprie
(Bert, Picard, Toubae), de aceea în
implantologia orală
se practică anestezia loco-regională.
Etapele inserţiei implanturilor dentare endoosoase:
Clinică
De laborator
Alegerea lingurilor de amprentare
Aplicarea transferului
Amprentarea
Ajustarea carcasului metalic
Aplicarea şi fixarea bonturilor
protetice
Ajustarea carcasului metalic
Fixarea lucrării protetice pe
implante.
D-za: Parodontită marginală cronică
generalizată forma medie.
Edentaţie parţială intercalată la maxilarul
superior şi inferior.
Planificarea tratamentului
Extr. 21; 31; 46; 47.
Inserarea implantelor
Augumentarea defectului osos cu material
osos aloplastic
Aplicarea suturilor
Radiografia de control
Edentaţie parţială terminală la maxilarul
superior
Parodontită apicală cronică exacerbată.
Odontectomia
chiuretajul
Augumentarea alveolei
Instalarea implantului și aplicarea
abutmentului
Formarea papilei interdentare
Încărcarea imediată
Suturarea plagii se efectuiază cu fir
atraumatic de grosimia 3-4 mm.
La 7-10 zile de la intervenţie se îndepărtează firele.