Immediate Loading Implants

 Immediate Loading Implants:

Several classifications of implant loading:

 • Immediate occlusal loading refers to full functional occlusal loading of an implant within 2 weeks of placement.

 • Early occlusal loading refers to functional loading between  2 weeks and 3 months of implant placement.

 • Nonfunctional immediate restoration refers to implant  prostheses placed within 2 weeks of implant placement  with no direct functional occlusal loading

• Nonfunctional early restoration refers to implant prostheses delivered between 2 weeks and 3 months from implant placement.

 • Delayed occlusal loading refers to the restoration of an implant more than 3 months after placement.

Immediate Loading for Single-Tooth Restoration

•  Studies of single-tooth restoration and immediate loading have shown good success rates. 
• on these single-tooth restorations placed into immediate occlusion via provisionalization with success rates similar to those implants restored with light or no occlusal forces. 
• The presence of a provisional  crown throughout the healing phase,  which allowed the sculpting of the interdental papilla and the attached gingiva. 
• Given the recent advances and research in this area.However, the immediate  loading of a single-tooth restoration is clearly a viable option  for  patients.

Immediate Loading of the Fixed Prostheses 

•  Research in the area of fixed or multiple-tooth replacement with immediate loading has been divided into prostheses  placed in the mandible and those placed in the maxilla. In  the early studies of mandibular multi-tooth restorations with  immediate loading, one technique placed additional or interim  implants to initially support the prosthesis while the remaining implants underwent the healing phase. 
•  In the edentulous or partially edentulous maxilla, significantly more implants must be placed to obtain primary stability of an immediately loaded prosthesis. Although many studies have suggested a requirement of 8 to 12 implants, several studies have shown similar success rates with 5 to 8 implants.The literature debates, with varying results, the surface morphology of implants best suited to placement in  the decreased bone density of the maxilla.
• Immediate loading in both the edentulous or partially edentulous maxilla and mandible is a viable treatment option. 

Immediate Loading of Over-Denture Prostheses 

•  No studies exist that display true immediate loading protocols  for over-denture prostheses as defi ned earlier. However, there  is support for early occlusal loading with over-dentures. True  immediate loading in these cases may not be possible due to  the need for prosthetic development of bar attachments in many instances. A recent study placing over-dentures into occlusal loading at 4 days supported by a bar system showed  high success rates. 
• Early functional loading in these studies referred to a  protocol usually consisting of implant loading at approximately 3 weeks with either a ball attachment or bar-clip assembly. Immediate early functional loading referred to placement  of the prosthesis within 5 days. In the studies that attempted  the earliest functional loading the bar-clip attachment was the restorative method of choice. 
•   The majority of the opposing dentitions in these studies were complete dentures and some implant-supported prostheses; there was little difference in success rates between these opposing dentitions. 
• Studies have also suggested that implants for early loading with over-dentures should be splinted with the bar-clip  attachment to prevent axial rotation and micromotion. However, given the success rates with early loading of ball  attachment implants it cannot be factually stated that splinting these implants is a requirement for success. 
•  A flapless procedure was done with the placement of six one-piece, single-stage implants from which an immediate impression was taken for a bar constructed that day, passively placed to support  a clip-retained full lower denture. 

Immediate Placement and Loading of Implants in Extraction Sites 

• The overall reasoning behind immediate restoration of these implants is to aid in restoration of soft tissue aesthetics by gingival contouring as well as removing the need for temporary removable  prostheses. 

Flapless Dental Implants

Flapless or incision less or minimally invasive in combination with dental
implants.

• Current literature with regard to the efficacy and effectiveness of flapless surgery for endosseous dental implants is quite favouring.
• The available data on flapless technique indicate high implant survival overall(approximately 98.6%)
• In the late 1970s, Brånemark established the use of extensive surgical flaps to visualize the surgical field during implant surgery.
• However,flap elevation is always associated with some degree of morbidity and discomfort, and requires suturing to close the surgical wound.
• Surgeons use either rotary instruments or a tissue punch to perforate the gingival tissues to gain access to bone.

Flapless surgery has several potential advantages,
including
(1) Reduction of complications at the patient level, ie, swelling and pain,
(2) Reduction of intraoperative bleeding,
(3) Reduction of surgical time and need for suturing,
(4) Preservation of soft and hard tissues, and
(5) Maintenance of blood supply.

Despite these advantages, the flapless technique also has several shortcomings.
These may include
(1) The inability of the surgeon to visualize anatomical landmarks and vital structures,
(2) An inability to ideally visualize the vertical endpoint of the implant placement (too shallow/too deep),
(3) Decreased access to the bony contours for alveoloplasty .
                                                                     Pre Operative

                                                                      Occlusal View

Intra Operative -Minimal /No Bleeding

After Implant Placement

Occlusal View

Temporarization

Significant reduction in immediate postoperative discomfort, duration of discomfort, facial edema, and the use of analgesics when flapless surgery was performed flapless surgery may have benefits in decreasing patient discomfort in the immediate postoperative period.


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FLAPLESS DENTAL IMPLANT PLACEMENT IN INDIA

FLAPLESS DENTAL IMPLANT PLACEMENT IMMEDIATELY AFTER EXTRACTION

Flapless BCS IMPLANT placed immediately after extraction of periodontally weakened tooth and provisional restoration given in 2 days.


                                              FURTHER DETAILS, VISIT US AT:
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Failed Two Piece Implant Replaced By Wide BCS (Bicortical) Implant For a Smoker

Failed 2 piece Implant in premolar region.

                                                       Retrieved the two piece Implant

                                                                   Wide  BCS Implant

                                                                During Implant placement

                                    Immediate replacement with Single piece wide BCS Implant.

For patients willing to get Implant treatment,

Visit us at: 

http://www.drmurugavel.in/

dr_mrgvl@yahoo.co.in

INFRA CANAL BASAL IMPLANT (BOI) PLACEMENT ( Below Inferior Alveolar Nerve )

Placement of CRESTAL Implants in the atropied distal mandible is difficult.
Few procedures for enlarging the bone volume increase the risks of the overall treatment and they reduce therby the predictability and the acceptance.. Cases of severe atropy in distal mandible cannot be solved by using crestal Implants with a reasonable chances of success.
                      So, treating the atropied mandible through use of BASAL IMPLANTS are available.They require special techniques which are briefly discussed here with clinical photos which was done by us.

When the vertical bone height is 3-4mm above the mandibular nerve canal, there is indication for placement of INFRA CANAL BASAL IMPLANT (BOI) PLACEMENT.
 It is the done by placing the Base Plates below the Mandibular Nerve.

INDICATIONS: 

• Severe atropy, when the mandible has a vertically reduced bone height of 3 - 4 mm above the Inferior alveolar nerve where crestal implants are not applicable.

• Patient not willing for removable conventional dentures and wanting for fixed teeth replacement.

TECHNIQUE:

•  The full thickness flap is prepared on centre of the alveolar crest. 
• The most distal implant must be placed in the area of 2nd molar.
• First osteotomy with a hard metal cutter( horizontal cutter) at sufficient speed is made. This cut should reach the bundle of nerve and vessels.
• The more distal the implant position is chosen, the more likelly the nerve located favourably.
• The second osteotomy is done vertically from the vestibular side. The vertical cutter 1.6mm diameter or 1.9mmd is used
• This cut almost reaches the area of mandibular nerve: the safety distance can only be 1mm or less.
• Typical Implant for this procedure are basal implants with a base plate diameter of 9mm or 10 mm or Implants with two base plates of 7-10 mm each.
• It is necessary to choose implants with a long vertical part, as vertical bone growth along the implant must be expected.

The slots created for osteotomy will heal quickly and in some cases new woven bone generation inside the mandible will occur.

ADVANTAGES: 

• Patient acceptance to go in for fixed teeth replacement rather than the conventional prosthesis.
• Can be immediately loaded with prosthesis.
• Safe and effective.
• Design is simple, single piece Implant.
• Maintainence is simple. 
• Due to thin and polished nature of the vertical implant parts, no peri implant infections can possibly develop.
• No need for bone transplant or augmentation procedures.
• Bone remains in its original shape and height. 
• No need to localize or dislocate the nerve.

                                              CASE PRESENTATION: 1

                                                           DURING OSTEOTOMY

                                 

                                           DURING BOI IMPLANT PLACEMENT

                                            CASE PRESENTATION - 2 

                                                                      PRE OP OPG

POST OP OPG

                                                            FOR FURTHER DETAILS:
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                                 http://www.drmurugavel.in/                                                                                           
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CORTICALIZATION WITH KOS IMPLANTS

Compression screw Implants (KOS)  are not considered to be Basal Implants. 

In conical Implants high insertion torques concentrate on the flat or rounded  apex area, whereas pressure distributes evenly over the whole vertical Implant area in conical implants and not in the apex of the Implants.

This pressure distribution is EFFECTIVE.

Furthermore spongeous bone becomes condensed whenever compression screw implants are inserted.

The process of condensing is described as CORTICALIZATION.

During this corticalization, the flow through the osteons is cut off, osteons are destroyed and compressed and they can no longer be the source of osteonal remodelling but only the target of osteons travelling from unaffected bone areas.

Since this takes more time( depending on the distance from the point of the initiation of a secondary osteon to the Implant surface), the time-span for carrying out prosthetical work on KOS Implants is increased.

Nevrthless, Immediate splinting( and therby loading) is still the safest way of handling KOS and BCS Implants.

DIFFERENCE BETWEEN SINGLE PIECE IMPLANTS & TWO PIECE IMPLANTS

SINGLE PIECE IMPLANT	TWO PIECE IMPLANT
·         Implant and abutment are fused. They are manufactured as one piece.	·         Implant and abutment are separate. The abutment is either cemented or cold welded. If abutment is secured with a screw onto the implant, then it is considered to be 3 piece.
·         Design is simple, no joints, single piece.	·         Design is complex, 2 parts joint by screw.
·         Single sitting surgical procedure and very often flapless (no open surgical procedure). Implant procedures are less time consuming than that required for bridgework.	·         Very often more complex surgical procedures are necessary, spread over 2 or 3 sittings in a period of 3-6 months. ( Implant placement, healing screw placement and abutment placement.
·         A wide range of sizes and designs are available. Suits various bone types and measurements. The design even help to avoid bone augmentation and sinus lifts.	·         Limited size and designs are available thereby limiting their application.
·         Immediate Loading- ie; patient can be given crowns / bridges the very next day.	·         Delayed loading- very often a waiting period of minimum 3 months is necessary after loading the implant with prosthesis.
·         Much cost effective when compared with 2 or 3 piece implants.	·         Expensive with respective to cost of implants as well as time taken for treatment procedures.
·         From patient point of view, less complex treatment procedure, less number of sittings, crowns / bridges can be cemented on a day or two.	·         From patient point of view, more number of sittings, Crowns/ bridges cemented only after 3 months after healing phase. Expensive.
·         There is no screw loosening since there is no separate abutment-screw-implant assembly.	·         Screw loosening is very common. Being 2 piece, the relation between root portions and abutment can present many problems.
·         Maintenance is very simple. Being 1 piece, strength provided by implant is excellent and there is no separate root portion and abutment portion.	·         Maintenance is more complex. Very often screw has to be tightened at periodic intervals as there will be micro movement between implant and abutment.

FLAPLESS DENTAL IMPLANT PLACEMENT IN INDIA

Flapless Implant Placement is the Placement of Implants into the bone without soft tissue flap reflection.

ADVANTAGES OF FLAPLESS IMPLANT PLACEMENT: 

                                    When dental Implants are placed by raising the mucoperiosteal flap, there is an associated boneloss at the site.  Leaving the periosteum intact on buccal and lingual aspects of the ridge maintains a better blood supply to the site, reducing the likelihood of resorption.

Flapless technique may be considered in conjunction with either single stage or Immediate loading.

Many ADVANTAGES for both the patient and the surgeon:

• Minimally Invasive.
• Accelerated post surgical healing.
• Reduced operative time.
• Increased patient comfort and satisfaction.
• Decreased bone resorption.
• Minimized bleeding and no sutures.
• Ridge contour can be preserved.        

Missing right premolar replaced by FLAPLESS IMPLANT PLACEMENT.

                                   For more details: visit us at:
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SCREW LOOSENING AND SCREW FRACTURE

SCREW LOOSENING AND SCREW FRACTURE:

One of the important complication in 2 piece or 3 piece Implants.

Adverse occlusal forces can result in mechanical complications of implants.
While unacceptably high incidences of mechanical failures have been reported for the 2-stage external hex screw type Implant systems.

what is Screw Loosening: 
                                    Due to improper occlusal forces, the screw connecting the Implant and Abutment get loosen. This is screw loosening.

What is Screw Fracture:
                                 After screw loosening, metal fatigue may result in screw facture or fixture fracture and causes loss of Implant.

Causes of Screw Loosening and Screw Fracture:
                      screw-joint stability involves 3 most important factors:

1.Adequate pre-load:
                            Application of correct torque to an Implant screwis translated into a pre-load that holds the components together.
Pre-load is the only force that will resist the patients functional occlusal forces inorder to keep the abutment from separating from the implant.

If the pre-load exceeded by occlusal force, the screw will loosen.

2. Fit of the Mating Implant components:
                          Improper positioning or fixation of the abutment with the Implant.

3.Screw Design:
                    There is an  Anti rotational feature of Implant abutment interface. If there is no precise anti-rotational feature, screw will loosen.  

Management of screw loosening:
              For a 2 piece or a 3 piece Implant :        
                     8 degree Morse taper, 45 degree bevel on the implant shoulder  has minimized the risk of screw loosening.   

Design of standard diameter solid screw ITI implant and material used in its fabrication has minimized fixture fracture.

Use of Single Piece Implant System:

•       Single piece implant being a single component structure has no joints or a connecting screw.
• There is no screw and hence no screw loosening or fracture.
• No crestal bone loss.
• No marginal leakage between the implant components.
• Procedure can be done flapless and can be immediately loaded.
• patient comfort.
• Mimics the natural teeth in its construction.

                                          visit us at:

                                    http://www.acdeimplants.org/

                                                                                                                                                                            

INFERIOR ALVEOLAR NERVE INJURY DURING IMPLANT PROCEDURE

Inferior alveolar nerve(IAN) injury is one of the most serious complications in Implant Dentistry. Some reports show traumatic injury to IAN following implant procedure is found in 17.75% of cases.
Injury to IAN can cause alteration of sensation in varying degrees from mild numbness to loss of pain sensation to complete loss of perception of stimulation.

                                               
ETIOLOGY:
 Nerve Injury can occur during local anaesthesia, implant osteotomy and during implant placement.
For dental practitioners, thorough understanding of anatomy, surgical procedures and implant system along with proper planning of treatment is essential to reduce the complications.
.Methods to locate IAN during treatment planning includes conventional radiography and CT e  and frequent IOPA radiographs should be taken.

PREVENTION:
              Proper presurgical planning, timely diagnosis and treatment are the key to avoid nerve injury.

• Slippage of drill due to lower resistance of spongy bone.. Therefore use of drill guards to prevent over penetration of drills.
• 2mm safety zone should be made between apical part of implant and upper border of IAN canal.
• Using infiltation instead of IAN block, so the patient will feel pain if drill approaches the IAN canal and gives an indication to stop drilling.
• Frequent intra oral  peri apical radiographs with presence of drills in the osteotomy site should be taken.

DENTAL IMPLANT COURSE IN INDIA-BY DR.MURUGAVEL

Missing Left Upper & Lower Molars

Lower arch

During Implant Placement

After Implant Placement

In Occlusion

for patients interested in getting implant treatment can contact 

  dr_mrgvl@yahoo.co.in

visit us at..

http://drmurugavel.in/

http://www.acdeimplants.org/

Replacement Of Missing Lower Front Teeth With BCS Implants

Missing Lower Incisors 31,32 & 41, 42

Placement of  BCS Implant in 42 region

After Placement of  BCS Implant in 32 region

 Implant placed in 32 & 42 region

For patients willing to get implant treatment can contact

dr_mrgvl@yahoo.co.in

visit us at:

drmurugavel.in

www.acdeimplants.org

Dental Implants course In India- by Dr. Murugavel

Missing premolar- 24

Occlusal View of missing teeth

During Flapless KOS implant placement in 24 region

After Implant Placement

Occlusal View

Patients willing to get implant treatment can contact

dr_mrgvl@yahoo.co.in

visit us at:

http://www.drmurugavel.in 

http://www.acdeimplants.org/