Tải bản đầy đủ - 0 (trang)
7 Timing of Implant Site Preparation

7 Timing of Implant Site Preparation

Tải bản đầy đủ - 0trang

3  Indications for Augmentation Prior to/at Implant Placement



69



a



b



c



d



Fig. 3.18  Dentofacial evaluation extraoral and intraoral for diagnoses. (a, b) The whole symmetrical dentofacial balance must be checked and problems identified. (c, d) For example, this is

an implant case for #8 due to a root fracture. The intraoral examination alone may not be sufficient

for us to make an accurate diagnosis. It is necessary to make a treatment plan based on a comprehensive examination including a facial diagnosis and to give a thorough explanation of the plan to

the patient



70



S. Suzuki et al.



a



b



c



d



e



f



g



h



Fig. 3.19  Augmentation-only case (bone graft). (a–c) Clinical photographs maxillary canine and

central incisor with vertical root fractures and extracted roots. (d–g) For this patient, access to the

facial undercut of alveolar bone was from the vestibule to allow grafting of bovine bone particles

and a resorbable membrane. (h) Socket augmentation using bovine bone during the same surgery.

(i, j) Achieving horizontal tissue volume for proper implant position and hard tissue maintenance



3  Indications for Augmentation Prior to/at Implant Placement



i



71



j



Fig. 3.19 (continued)



a



b



d



c



e



f



Fig. 3.20  Augmentation-only case (soft tissue graft). (a) Frontal view, lack of papillae distal to

maxillary left central incisor unfavorable conditions for implantation at #10. (b–d) Palatal CTG to

#10 using VISTA technique. (VISTA (vestibular incision subperiosteal tunnel access)) [71]. (e)

After CTG papillae reconstruction and improvement of biotype. (f) Final implant restoration delivered on maxillary left lateral incisor with good soft tissue and bone support



72



a



S. Suzuki et al.



b



d



e



g



h



j



k



m



c



f



i



l



n



o



Fig. 3.21  Augmentation with simultaneous implant placement (bone and soft tissue graft). (a–c)

Frontal view: Maxillary right central incisor had a vertical root fracture and was needed to be

extracted. (d, e) The tooth was extracted using a conventional method. (f) There was a labial bone

defect due to a vertical root fracture. (g, h) Implant placed in the three-dimensionally correct position. (i) The alveolar bone was augmented with bovine bone. (j, k) Connective tissue was harvested

from palate and grafted to the implant site. (l) Frontal view, provisional restoration delivered after

the surgery. (m) Clinical photograph of the definitive restoration fabricated. (n) Panoramic radiograph showing the implant position. (o) A 3-year post-op smile



On one hand, building an ideal implant site environment with augmentation procedures will give us an advantage for implant surgery especially for the major

reconstruction cases, but on the other hand, there are issues such as a prolonged

treatment duration, multiple invasive surgeries may be necessary, and increased

financial burden.



3  Indications for Augmentation Prior to/at Implant Placement



a



73



b



c



d



e



f



g



Fig. 3.22  Treatment of a large bone defect with failure of previous implant. (a) Malpositioned

implant and mucogingival problem at #10. (b) Initial radiograph. Bone loss around implant, and

the implant had to be removed. (c, d) After implant removal, there was a significant vertical and

horizontal bone defect and deficient keratinized tissue. The patient declined further augmentation

surgeries. (e) Bone reduction to prepare a flat bone table where two implants were placed. (f)

Clinical photograph of final ceramic restoration with prosthetic soft tissue. (g) A 6-year post-op

smile. Screw-retained restoration delivered



74



S. Suzuki et al.



a



b



c



d



Fig. 3.23  Full-arch treatment. (a, b) A 53-year-old female patient with severe periodontal disease; most teeth with poor—hopeless—prognosis. The patient had difficulty eating because of

mobility and pain. She requested full-arch treatment. All the remaining upper teeth were extracted,

and four implants were placed to deliver a fixed implant restoration. The same treatment was provided for the mandible [72, 73]. (c) Clinical photograph of the definitive prostheses, with prosthetic soft tissue. (d) A 5-year post-surgery radiograph



2. Augmentation with Simultaneous Implant Placement

The biggest benefit of placing implant at the time of augmentation is the reduction of the treatment duration. With the conventional sequential method, we have to

wait for 4–8 months for the grafted site to mature before implant placement.

Although this approach will give us a potential benefit of shorter treatment time,

there is a risk of graft infection that may involve the implant and lead to the infection of the implant surface. This, therefore, should be considered a relatively difficult procedure.

The authors believe the following factors to be the keys to success for implant

placement with simultaneous augmentation.

1. Case selection

2. Proper flap design

3. Releasing incisions

4. Primary closure with appropriate suturing techniques

5. Perioperative management



3.8



Resective Concept for Implant Site Preparation



There is also a way to performing implant site preparation by resecting bone and

gingiva rather than augmenting them. This technique requires the use of a superstructure with prosthetic soft tissues. This may be necessary for the following reasons:



3  Indications for Augmentation Prior to/at Implant Placement



a



b



c



e



75



d



f



Fig. 3.24  Treatment with minimal surgical trauma. (a) A 78-year-old female patient. Her maxillary

anterior bridge has failed due to root fractures of the abutment teeth. The patient would not accept any

major surgical procedures. After removing the failed bridge and extracting the roots, alveoloplasty was

performed for an aesthetic implant restoration with prosthetic soft tissue. Four implants were placed

immediately, and a fixed provisional restoration was delivered on the same day. (b) Initial radiograph:

insufficient bone and soft tissue to support an ideal implant restoration. (c) Aesthetic problems with her

smile. (d) Clinical photograph of the definitive implant restoration with pink porcelain. The restoration is

screw-retained. (e) Radiographic view. The implants at 5 years. (f) Patient smile with prosthesis in place



1. Cases with a severe bone loss:

–– Due to trauma or congenital defects

–– From previous major implant failure (difficult to recover by surgery)

2. Full-arch implant cases (or similar treatment concept)

–– Based on the patient’s requirement and/or due to its necessity

3. Need to avoid surgical trauma (less invasive surgery is required)

–– Systemic illness

–– Based on the patient’s requirement

If we choose to provide a superstructure with prosthetic soft tissue, we should be

aware of the position of the transition line between natural and artificial gingiva,



Tài liệu bạn tìm kiếm đã sẵn sàng tải về

7 Timing of Implant Site Preparation

Tải bản đầy đủ ngay(0 tr)

×