Practical Procedures in Implant Dentistry

"Master the fundamentals and intricacies of implant dentistry with this comprehensive and practical new resource Practical Procedures in Implant Dentistry delivers a comprehensive collection of information demonstrating the science and clinical techniques in implant dentistry. Written in a practical and accessible style that outlines the principles and procedures of each technique, the book offers clinical tips and references to build a comprehensive foundation of knowledge in implantology. Written by an international team of contributors with extensive clinical and academic expertise, Practical Procedures in Implant Dentistry covers core topics such as: Rationale and assessment for implant placement and restoration, including the diagnostic records and surgical considerations required for optimal planning and risk management; Incision design considerations and flap management, with an essential knowledge of regional neuro-vascular structures; Implant placement, encompassing the timing of the placement, bone requirements and understanding the importance of the peri-implant interface for soft tissue stability; Impression techniques, loading protocols, digital workflows and the aesthetic considerations of implants Prosthetic rehabilitation of single tooth implants to fully edentulous workflows, including discussions of soft tissue support, biomechanics and occlusal verification Perfect for both general dental practitioners and specialists in implant dentistry, Practical Procedures in Implant Dentistry is also a valuable reference to senior undergraduate and postgraduate dental students"-- Provided by publisher Cover Title Page Copyright Page Contents Foreword List of Contributors About the Companion Website Chapter 1 Introduction References Chapter 2 Patient Assessment and History Taking 2.1 Principles 2.1.1 Medical History 2.1.2 Medications and Allergies 2.1.3 Past Medical History 2.1.3.1 Cardiovascular Disorders 2.1.3.2 Diabetes Mellitus 2.1.4 Age 2.1.5 Smoking 2.1.6 Osteoporosis and Bisphosphonate Therapy 2.1.7 Radiotherapy 2.1.8 Dental History 2.1.9 Social History 2.2 Tips References Chapter 3 Diagnostic Records 3.1 Principles 3.1.1 Diagnostic Imaging and Templates 3.1.1.1 Three-Dimensional Imaging 3.1.1.2 Templates 3.1.2 Guided Surgery 3.1.3 Diagnostic Records 3.1.3.1 Articulated Study Models 3.1.3.2 Photographic Records 3.2 Procedures 3.2.1 Template Design 3.2.1.1 Traditional Templates 3.2.1.2 Digital Templates 3.2.2 Photography 3.3 Tips References Chapter 4 Medico-Legal Considerations and Risk Management 4.1 Principles 4.1.1 Informed Consent 4.2 Procedures 4.2.1 Dental Records 4.3 Tips Reference Chapter 5 Considerations for Implant Placement: Effects of Tooth Loss 5.1 Principles 5.1.1 Local Site Effects of Tooth Loss 5.1.2 Effects of Tooth Loss on the Individual Level 5.1.3 Effects of Tooth Loss on the Population Level 5.2 Procedures 5.3 Tips References Chapter 6 Anatomic and Biological Principles for Implant Placement 6.1 Principles 6.1.1 Osteology 6.1.2 Innervation and Vascular Supply 6.1.3 Musculature 6.2 Procedures 6.3 Tips References Chapter 7 Maxillary Anatomical Structures 7.1 Principles 7.2 Maxillary Incisive Foramen and Canal 7.2.1 Importance in Oral Implantology 7.3 Nasal Cavity 7.3.1 Importance in Oral Implantology 7.4 Infraorbital Foramen 7.4.1 Importance in Oral Implantology 7.5 Maxillary Sinus 7.5.1 Importance in Oral Implantology 7.6 Greater Palatine Artery and Nerve 7.6.1 Importance in Oral Implantology References Chapter 8 Mandibular Anatomical Structures 8.1 Principles 8.2 Mental Foramen and Nerve 8.2.1 Importance in Oral Implantology 8.3 Mandibular Incisive Canal and Nerve 8.3.1 Importance in Oral Implantology 8.4 Genial Tubercles 8.4.1 Importance in Oral Implantology 8.5 Lingual Foramen and Accessory Lingual Foramina 8.5.1 Importance in Oral Implantology 8.6 Sublingual Fossa 8.6.1 Importance in Oral Implantology 8.7 Submental and Sublingual Arteries 8.7.1 Importance in Oral Implantology 8.8 Inferior Alveolar Canal and Nerve 8.8.1 Importance in Oral Implantology 8.9 Lingual and Mylohyoid Nerves 8.9.1 Importance in Oral Implantology 8.10 Submandibular Fossa 8.10.1 Importance in Oral Implantology 8.11 Mandibular Ramus 8.11.1 Importance in Oral Implantology References Chapter 9 Extraction Ridge Management 9.1 Principles 9.2 Osteoconductive Materials for Ridge Management 9.3 Biologically Active Materials for Ridge Management 9.4 Influence of Buccal Wall Thickness on Ridge Management References Chapter 10 Implant Materials, Designs, and Surfaces 10.1 Principles 10.2 Implant Bulk Materials 10.2.1 Pure Titanium Used for Implant Bulk Material 10.2.2 Titanium Alloys Used for Implant Bulk Material 10.2.3 Zirconia Used for Implant Bulk Material 10.2.4 Other Materials as Bulk Implant Material 10.3 Implant Surface Treatments 10.4 Implant Design 10.4.1 Implant Body Shape Design 10.4.2 Implant Thread Design 10.4.3 Implant Connection Designs 10.4.4 Which Implant Connections Are Better and Why? 10.5 Summary References Chapter 11 Timing of Implant Placement 11.1 Principles 11.1.1 Classification for Timing of Implant Placement 11.1.2 Immediate Placement 11.1.3 Delayed Implant Placement 11.1.3.1 Resolution of Local Infection 11.1.3.2 Dimensional Changes of the Alveolar Ridge 11.2 Procedures 11.2.1 Systemic Risk Factors 11.2.2 Local Risk Factors 11.2.3 Biomaterials 11.2.4 Socket Morphology 11.2.5 Flapless Protocol 11.2.6 Clinician Experience 11.2.7 Adjunctive Procedures with Implant Placement 11.2.7.1 Simultaneous Bone Augmentation with Implant Placement 11.2.7.2 Adjunctive Soft Tissue Grafting 11.2.8 Selecting the Appropriate Treatment Protocol 11.3 Tips References Chapter 12 Implant Site Preparation 12.1 Principles 12.2 Assessing Implant Sites and Adjacent Teeth 12.2.1 Periodontal Charting 12.2.2 Assessment of Gingival Biotype and Attached Mucosa 12.2.3 Photography 12.2.4 Aesthetic Assessment 12.2.5 Radiography 12.2.6 Occlusal Analysis 12.2.7 Endodontic Status of Adjacent Teeth 12.3 Site Preparation 12.3.1 Grafting – Sinus, Buccal, Soft Tissue 12.3.2 Occlusion 12.3.3 Adjacent and Opposing Teeth 12.3.4 Crown Lengthening and Gingivectomy 12.3.5 Orthodontics and Site Preparation 12.3.6 Provisional Phase References Further Reading Chapter 13 Loading Protocols in Implantology 13.1 Principles 13.1.1 Definitions 13.1.2 Conventional Loading 13.1.3 Early Loading 13.1.4 Progressive Loading 13.1.5 Immediate Loading 13.2 Procedures 13.2.1 Selecting a Loading Protocol 13.2.2 Methods of Evaluation of the Primary Stability for Immediate Loading 13.3 Tips References Chapter 14 Surgical Instrumentation 14.1 Principles 14.1.1 Mirror, Probe, and Tweezers 14.1.2 Scalpel Handles 14.1.3 Scalpel Blades 14.1.4 Curettes 14.1.5 Needle Holders 14.1.6 Periosteal Elevators 14.1.7 Retractors 14.1.8 Depth Probe 14.1.9 Tissue Forceps/Pliers 14.1.10 Mouth Props/Bite Blocks 14.1.11 Scissors 14.1.12 Extraction Forceps, Periotomes and Elevators 14.1.13 Kidney Dish 14.1.14 Surgical Kit, Electric Motor, 20:1 Handpiece, and Consumables 14.1.15 Grafting Well 14.2 Optional Instrumentation 14.2.1 Rongeurs 14.2.2 Benex 14.2.3 Bone Harvesters 14.2.4 Anthogyr Torq Control 14.2.5 Piezosurgery 14.3 Tips Chapter 15 Flap Design and Management for Implant Placement 15.1 Principles 15.1.1 Neurovascular Supply to Implant Site 15.1.2 Flap Design and Management 15.1.3 Types of Flap Reflection 15.2 Procedures 15.2.1 Tissue Punch 15.2.2 Envelope Flap 15.2.3 Triangular (Two-Sided) and Trapezoidal (Three-Sided) Flap 15.2.4 Papilla-Sparing Flap 15.2.5 Buccal Roll 15.2.6 Palacci Flap 15.3 Tips References Chapter 16 Suturing Techniques 16.1 Principles 16.1.1 Types of Sutures 16.1.1.1 Absorbable Sutures 16.1.1.2 Non-absorbable Sutures 16.1.2 Suture Adjuncts 16.1.3 Suture Size 16.1.4 Needle 16.2 Procedures 16.2.1 Simple/Interrupted Sutures 16.2.2 Continuous/Uninterrupted Suture 16.2.3 Mattress Sutures 16.2.3.1 Horizontal Mattress 16.2.3.2 Vertical Mattress 16.2.4 Suture Removal 16.3 Tips Chapter 17 Pre-surgical Tissue Evaluation and Considerations in Aesthetic Implant Dentistry 17.1 Principles 17.2 The Influence of Tissue Volume on Peri-implant ‘Pink’ Aesthetics 17.3 Tissue Volume Availability and Requirements 17.3.1 Hard Tissue Requirements 17.3.2 Soft Tissue Requirements 17.4 Pre-operative Implant Site Assessment 17.5 Key Factors in Diagnosis of the Surrounding Tooth Support Prior to Extraction 17.5.1 Integrity of the Interproximal Height of Bone 17.5.2 Essential Criteria Evaluation Prior to Extraction 17.5.3 Integrity of the Buccal Plate of Bone 17.6 Tips 17.7 Conclusion References Chapter 18 Surgical Protocols for Implant Placement 18.1 Principles 18.1.1 Implant Positioning 18.2 Procedures 18.2.1 One-Stage versus Two-Stage Protocols 18.2.2 Post-operative Management Protocols 18.3 Tips References Chapter 19 Optimising the Peri-implant Emergence Profile 19.1 Principles 19.1.1 The Peri-implant Emergence Profile 19.2 Procedures 19.2.1 Single-Stage versus Two-Stage Implant Surgery 19.2.2 Buccal Roll Flap 19.2.3 Pouch Roll Technique 19.2.4 Apically Repositioned Flap 19.2.5 Buccally Repositioned Flap 19.2.6 Free Gingival Graft 19.3 Tips References Chapter 20 Soft Tissue Augmentation 20.1 Principles 20.1.1 Types of Oral Soft Tissue 20.1.2 Anatomical Considerations for Harvesting Autogenous Soft Tissue Grafts 20.1.2.1 Hard Palate 20.1.2.2 Tuberosity 20.1.2.3 Buccal Attached Gingiva of Maxillary Molars 20.1.3 Soft Tissue Substitutes 20.1.3.1 Allogenic Origin 20.1.3.2 Xenograft Origin 20.1.4 Purpose of Soft Tissue Graft (Periodontal Plastic Surgery) 20.1.4.1 Aesthetic Purpose 20.1.4.2 Functional Purpose 20.2 Procedures 20.2.1 Techniques 20.2.1.1 Harvesting the Palatal Tissue Graft as a Free Gingival Graft and Connective Tissue Graft 20.2.1.2 Root Coverage 20.2.1.3 Soft Tissue Augmentation Prior to Bone Grafting 20.2.1.4 Soft Tissue Graft to Gain Keratinised Tissue 20.3 Tips References Further Reading Chapter 21 Bone Augmentation Procedures 21.1 Principles 21.1.1 Why is Bone Grafting Necessary? 21.1.2 Defect Topography Classification 21.1.3 Requirements for Successful Tissue Grafting 21.1.4 Materials Used for Augmentation 21.1.4.1 Autogenous Bone 21.1.4.2 Membranes 21.1.4.3 Membrane Fixation Systems 21.2 Procedures 21.2.1 Bone Graft with Non-resorbable Membrane 21.2.2 Autogenous Bone Graft 21.3 Tips References Chapter 22 Impression Taking in Implant Dentistry 22.1 Principles 22.1.1 Impression Techniques Used in Implant Dentistry 22.1.1.1 Abutment Level Impressions 22.1.1.2 Implant Level Impressions 22.1.2 Customised Impression Copings 22.1.3 Multiple Unit Impressions 22.2 Procedures 22.2.1 Implant Level Impression 22.2.2 Digital Impressions 22.3 Tips References Chapter 23 Implant Treatment in the Aesthetic Zone 23.1 Principles 23.1.1 General Considerations 23.1.1.1 Lip Contour and Length 23.1.1.2 Tooth Display at Repose and in Broad Smile 23.1.1.3 Smile Line 23.1.1.4 Teeth Length, Shape, Alignment, Contour, and Colour 23.1.1.5 Gingival Display, Gingival Zeniths, and Papillae of Maxillary Anterior Teeth 23.1.1.6 Width of Edentulous Space 23.1.1.7 Gingival Biotype 23.1.2 Major Deficiencies in Hard and Soft Tissues 23.2 Procedures 23.2.1 Assessment of Gingival Biotype 23.2.2 Clinical Management 23.2.3 Timing of Implant Placement 23.2.4 Thickness of Soft Tissues 23.3 Tips References Chapter 24 The Use of Provisionalisation in Implantology 24.1 Principles 24.1.1 Prosthetically Guided Tissue Healing 24.2 Procedures 24.2.1 Direct Techniques 24.2.2 Indirect Techniques 24.3 Tips Reference Chapter 25 Abutment Selection 25.1 Principles 25.1.1 Custom Abutments 25.1.2 Prefabricated (Stock) Abutments 25.1.3 Material Selection 25.1.4 Abutment Design 25.2 Procedures 25.3 Tips References Chapter 26 Screw versus Cemented Implant-Supported Restorations 26.1 Principles 26.1.1 Retrievability 26.1.2 Aesthetics 26.1.3 Passivity 26.1.4 Hygiene (Emergence Profile) 26.1.5 Reduced Occlusal Material Fracture 26.1.6 Inter-arch Space 26.1.7 Occlusion 26.1.8 Health of Peri-Implant Tissue 26.1.9 Provisionalisation 26.1.10 Clinical Performance 26.2 Procedures 26.2.1 Screw-Retained Restoration 26.2.2 Cement-Retained Restoration 26.2.3 Lateral Set-Screw (Cross-Pinning) 26.2.4 Angle Screw Correction/Bi-axial Screws 26.3 Tips References Chapter 27 A Laboratory Perspective on Implant Dentistry 27.1 The Shift from Analogue to Digital 27.2 Standards in Manufacturing Today 27.3 The Importance of Implant Planning for the Laboratory 27.4 Digital Planning to Manage Aesthetic Cases 27.5 Scanning for Implant Restorations 27.6 Digital Data Acquisition for Full Arch Cases 27.7 Inserting Full Arch Cases at Surgery 27.8 Tips Chapter 28 Implant Biomechanics 28.1 Principles 28.1.1 Forces and their Nature 28.1.1.1 Pressure = Force/Area 28.1.1.2 Impulse = Force/Time 28.1.1.3 Compressive, Tensile, and Shear Forces 28.1.1.4 Application to Materials and Occlusion 28.1.1.5 Incline Plane Mechanics (Normal Force) 28.1.2 Beams 28.1.3 Levers 28.1.4 Cantilevers 28.1.5 Bone Reference Further Reading Chapter 29 Delivering the Definitive Prosthesis 29.1 Principles 29.1.1 Soft Tissue Support 29.1.2 Occlusal Verification 29.1.3 Aesthetic Evaluation 29.1.4 Torque Requirement for Delivery 29.1.5 Cementation Technique and Material Selection – Cemented Crowns 29.1.6 Screw Access Channel Management – Screw-Retained Crowns 29.1.7 Pink Porcelain 29.2 Procedures 29.2.1 Delivering a Cement-Retained Crown – Chairside Copy Abutment Technique 29.2.1.1 Creating a Polyvinyl Siloxane Copy Abutment 29.2.1.2 Delivering a Cement-Retained Crown Using a Copy Abutment Technique 29.3 Tips References Chapter 30 Occlusion and Implants 30.1 Principles 30.1.1 Excessive Forces on Dental Implants 30.1.2 Bruxism and Implants 30.2 Procedures 30.2.1 Clinical Occlusal Applications 30.3 Tips References Chapter 31 Dental Implant Screw Mechanics 31.1 Principles 31.1.1 Factors Affecting Implant Screw Joint Stability 31.1.1.1 Preload 31.1.1.2 Embedment Relaxation (Settling Effect) 31.1.1.3 Screw Material and Coating 31.1.1.4 Screw Design 31.1.1.5 Abutment/Implant Interface Misfit 31.1.1.6 Abutment/Implant Interface Design 31.1.1.7 Functional Forces 31.1.1.8 Number of Implants 31.1.1.9 Torque Wrench 31.2 Procedures 31.2.1 Techniques for Retrieving a Fractured Screw 31.2.1.1 The Ultrasonic Scaler Technique 31.2.1.2 Screwdriver Technique 31.2.1.3 Manufacturer Rescue Kits 31.3 Tips References Chapter 32 Prosthodontic Rehabilitation for the Fully Edentulous Patient 32.1 Principles 32.1.1 Number of Implants for Full Arch Implant Rehabilitation 32.1.1.1 Removable Overdenture 32.1.2 Fixed Implant-Supported Bridgework 32.2 Procedures 32.2.1 Occlusal Vertical Dimension 32.2.2 Phonetics 32.2.3 Swallowing 32.2.4 Facial Appearance 32.2.5 Impression Taking 32.2.6 Abutment Selection 32.2.7 Prosthodontic Options for Fixed Bridgework 32.2.8 Occlusion 32.3 Tips References Chapter 33 Implant Maintenance 33.1 Principles 33.1.1 Radiographic Analysis 33.2 Procedures 33.3 Tips References Chapter 34 The Digital Workflow in Implant Dentistry 34.1 Components and Steps of the Digital Implant Workflow 34.1.1 Digital Diagnostic Impression 34.1.2 Cone Beam Computed Tomography 34.1.3 Digital Implant Treatment Planning 34.1.4 The Digital Surgical Guide 34.1.5 Pre-surgical Fabricated Temporary Prosthesis 34.1.6 Guided Implant Surgery 34.1.7 Implant Digital Impressions 34.1.8 Manufacturing of the Customised Prosthesis References Chapter 35 Biological Complications 35.1 Principles 35.1.1 Attachment Differences 35.1.2 Crestal Bone Loss 35.1.3 Peri-implant Disease 35.1.3.1 Prevalence of Peri-implant Diseases 35.1.3.2 Risk Factors in Peri-implant Disease 35.2 Procedures 35.2.1 Treatment of Peri-implant Disease 35.2.1.1 Methods of Decontamination 35.2.2 Treatment of Peri-implant Mucositis 35.2.3 Treatment of Peri-implantitis 35.2.3.1 Non-surgical Therapy for Peri-implantitis 35.2.3.2 Surgical Therapy for Peri-implantitis 35.2.4 Recommendations 35.2.5 Supportive Care 35.3 Tips References Chapter 36 Implant Prosthetic Complications 36.1 Principles 36.1.1 Incidence of Prosthetic Complications 36.1.1.1 Implant-Supported Single Tooth Crowns and Implant-Fixed Dental Prostheses 36.1.1.2 Full Arch Implant-Fixed Dental Prostheses 36.1.2 Aetiology of Prosthetic Complications 36.1.2.1 Mechanical Overloading 36.1.2.2 Cement Excess 36.1.2.3 Proximal Contact Loss 36.2 Procedures 36.2.1 Occlusion 36.2.2 Unfavourable Implant Position 36.2.3 Anterior Implants 36.2.4 Implant Fracture 36.2.5 Screw Loosening 36.2.6 Abutment Screw Fracture 36.2.7 Stripped Screw Head 36.2.8 Passive Fit 36.2.9 Mechanical and Biological Complications of Framework Misfit 36.2.10 Impression Technique 36.2.11 Gingival Fistula 36.2.12 Prevention of Prosthetic Complications 36.3 Tips References Index EULA **Master the fundamentals and intricacies of implant dentistry with this comprehensive and practical new resource** __Practical Procedures in Implant Dentistry__ delivers a comprehensive collection of information demonstrating the science and clinical techniques in implant dentistry. Written in a practical and accessible style that outlines the principles and procedures of each technique, the book offers clinical tips and references to build a comprehensive foundation of knowledge in implantology. Written by an international team of contributors with extensive clinical and academic expertise, __Practical Procedures in Implant Dentistry__ covers core topics such as: * Rationale and assessment for implant placement and restoration, including the diagnostic records and surgical considerations required for optimal planning and risk management * Incision design considerations and flap management, with an essential knowledge of regional neuro-vascular structures * Implant placement, encompassing the timing of the placement, bone requirements and understanding the importance of the peri-implant interface for soft tissue stability * Impression techniques, loading protocols, digital workflows and the aesthetic considerations of implants * Prosthetic rehabilitation of single tooth implants to fully edentulous workflows, including discussions of soft tissue support, biomechanics and occlusal verification