STi single tooth implant slide design 1 (1).pptx

single tooth implant

1. Slide for Sti Training

2. Topic : Soft tissue management (raising flap,suturing and tissue regeneration. Presenter : Dr. Ujwal Shrestha Date :

3. Introduction Restoration of lost function, aesthetics and harmony of dentition is the primary intention of implantology. It is achieved with a sound crestal bone stability and healthy peri-implant soft tissue. The periimplant area primarily comprises the crestal bone and the healthy soft tissue around it. They are considered necessary for the long-term success of implant-supported restorations. If these two parameters are respected, implant therapy can be a reliable treatment with an impressive outcome. The primary function of a soft tissue barrier around implants is to achieve an effective and protective barrier that protects the underlying bone and prevents access for microorganisms and their products. Reference : Font size 10…………………………………………………………………………………………………………………………………………………………………………….

4. Importance of soft tissue integration Anchorage of the implant to bone. Soft tissue seal around dental implants,equally important for long term clinical success. Understanding of both periodontal and peri-implant anatomy & biology.

5. Flap designing for dental Implant Usual surgical procedure of Dental Implant placement involve flapless or flap techniques. One of the primary step in implant placement is placement of incision for raising adequate flap. A good exposure of bone is required so as to place implant. Proper flap designing is necessary for avoiding any untoward complications post operatively such as bleeding, necrosis etc.

6. Principles of flap designing for Dental Implants Among various principles of Dental implant flap designing as given by Mohammed JA et al1 some important principles are mentioned:  Minimal amount of periosteum should be removed if necessary, as periosteum serve as major vascular supply to bone.  Vertical incisions if given should be oblique to ensure broad base of flap.  Important structures such as major blood vessels, nerves etc. should be preserved. Edges of flap should be clean which in turn helps in proper wound closure by primary intension. Flap should have adequate blood supply for nourishment. Such Flap should not be design which alters the vestibuler debth. Suturing of flap should cause no or minimum tension after approximation. In case of inadequate keratinized tissue crestal incision should be given more palatally. Tissue trauma should be avoided during manipulation of flap

7. Principles and Guidelines for Flap Design 1- Wide flap base for adequate blood supply Healing 3-Width of the flap must include at least one tooth on either side of the surgical sites. 2-Incisions should be over healthy solid bone . Avoid incision over the bony defects/ periapical lesion 4- Never incise through the inter-dental papilla either include or exclude the interdental papilla. 5- Avoid horizontal and severely angled vertical incision. O6U ‹#›

8. Principles and Guidelines for Flap Design 6- Full thickness flap should be raised to maintain the integrity of the periostium and promote bone healing. 8- Vertical incision must extend to allow the bone retractor to rest on solid bone . 7. Vertical incisions should be made parallel or slightly oblique to long axis of the teeth and placed in the bony concavities between the bony eminencies. O6U ‹#›

9. Types of flaps of Surgical flap 1. Full mucoperiosteal flaps Advantages: 1. Easy to reposition 2.Minimal number of sutures required. 2. Suitable for treating short roots. 3. Blood supply to flap is maximal. • Disadvantages : 1. Limited surgical access (single vertical incision). 2. Limited surgical access to expose the root apexes of long teeth (maxillary canine). 3. More difficult retraction. 4. Difficult Suturing between teeth. Triangular (one vertical releasing incision+ horizontal incision) B. Rectangular (two vertical releasing incisions + horizontal incision). Advantages: 1. Increased surgical access to the root apex. 2. Convenient for treating more than one teeth and large lesions. 3. Facilitate periodontal curettage. • Disadvantages: 1. Difficult in reapproximation 2. Difficult in post-surgical stabilization than triangular flap result in high potential for flap dislodgment. O6U ‹#›

10. Types of flaps of Surgical flap 1. Full mucoperiosteal flaps C. Trapezoidal (Broad-based rectangular). Vertical incisions making an obtuse angle with horizontal incision Indicated in repair of cervical defects : 1. Root perforation. 2. Root resorption. 3. Root caries. D. Horizontal/Gingival/Envelope (Intrasulcular incision no vertical releasing incision). O6U ‹#›

11. Types of flaps of Surgical flap 2 -Limited mucoperiosteal flaps It is formed by a curved incision in the alveolar mucosa and the attached gingiva. The incision begins in the alveolar mucosa extending into the attached gingival and then curved back into the alveolar mucosa. Advantage: 1-Simple to incise & reflect. 2-Gives direct access to root apex. 3-Patient able to maintain good oral hygiene. Disadvantage: 1. Minimal visibility. 2. Poor surgical access. 3. Placing the line of incision over the bony defect(wound cannot be closed over the sound bone). 4. Excessive force for retraction tearing at the corner. 5. Tension impaired healing 6. No reference points for replacing the flaps. A-Submarginal curved (Semilunar flap): O6U ‹#›

12. Types of flaps of Surgical flap 2-Limited mucoperiosteal flaps • Modification of rectangular flap. • Horizontal incision is scalloped and follows the contour of the marginal gingiva. B- Luebke-Ochsenbein (Submarginal scalloped rectangular) Disadvantages: 1. Vertical BV and collagen fibers are severed, resulting in more bleeding 2.Possibility of flap shrinkage, delayed healing, and scar formation. 2. Crossing any bony eminence by incision line result in delayed healing. Advantages: 1. Decrease the gingival recession Esthetics. 2. Good accessibility and excellent visibility to surgical site. 3. Simple to incise and reflect. O6U ‹#›

13. Flap reflection It is the process of separating the soft tissues (gingiva, mucosa and periosteum) from the surface of the alveolar bone. O6U ‹#›

14. Flap reflection Mucoperiosteal flaps It begins in the vertical incision few mm apical to the junction of the horizontal and vertical incision. Submarginal flaps Starts in horizontal since the horizontal incision is placed in the attached gingiva. 2 1 O6U ‹#›

15. Flap retraction Aim: Provides both visual and operative access to the periradicular and radicular tissues. Instruments: Endodontic tissue retractors (Arnes/ Seldon /Minnesota retractor. Proper retraction depends on: 1. Adequate extension of the flap incisions. 2. Proper reflection of the mucoperiostium. Principles of tissue retraction 1. Retractor should rest on sound bone with light pressure 2. Small groove by round bur can be cut in the bone to stabilize the retractor 3. Crushing tissue should be avoided 4. Sterile physiological saline is used to maintain tissue hydration . It is the process of holding in position the reflected soft tissues. O6U ‹#›

16. Importance of suturing Wound Healing: Proper suturing is essential for optimal wound healing after dental implant surgery. Tissue Adaptation: Suturing ensures precise alignment and adaptation of soft tissues. Reducing Complications: Well-executed sutures minimize the risk of postoperative complications, such as infection or dehiscence. Reference : Font size 10…………………………………………………………………………………………………………………………………………………………………………….

17. Choosing the Right Dental Implant Sutures The right suture varies depending on the goal of the procedure and the physical characteristics of the material in relation to the healing process. Physical characteristics to keep in mind include suture strength, knot security and wicking properties . Before selecting a specific suture, the clinician will first need to choose between resorbable and nonresorbable options Resorbable sutures dissolve in the body over time, while nonresorbable sutures require professional removal, usually about a week after surgery.

18. Cytoplast Sutures Cytoplast sutures are what many dental professionals use most frequently for bone grafts and dental implant procedures. Made from 100% polytetrafluoroethylene (PTFE), these nonresorbable monofilament sutures provide the flexibility and comfort typically associated with braided options.

19. Cytoplast sutures advantages Construction that prevents bacteria from wicking into the surgical site The flexibility to make sutures more comfortable for patients during recovery A white, dye-free material that makes finding and removing dental implant sutures easy High tensile strength and knot security to prevent wounds from reopening

20. Other Dental Implant Suture Materials Silk has historically been the most used suture material for many of these procedures. Unfortunately, studies have consistently suggested a connection between silk and cotton sutures and intense tissue inflammatory responses. As a multifilament thread, silk tends to suck bacteria and fluids into the wound site, increasing the likelihood of infection. To avoid complications, clinicians can choose PTFE sutures or comparable alternatives like nylon, polyester, polyethylene or polypropylene.

21. How Soon Can You Remove the Sutures? Dental implant recovery length varies from patient to patient, but these wounds typically heal within eight to 12 days of suture placement . A clinician can confidently remove the sutures to prevent reopening once the wound has sufficiently healed.

22. Guided Tissue Regeneration in Implant Dentistry:History Early Observations: The concept of GTR originated from neural regeneration studies in the 1940s, where compartmentalization was used to promote nerve regeneration. Application in Bone Regeneration: By 1957, the principle was applied to bone regeneration in dogs, showing that bone defects could be filled with new bone using a protective.

23. Guided Tissue Regeneration in Implant Dentistry:History Human GBR: In 1959, GBR was first used in humans for spinal fusion, laying the groundwork for current GBR techniques in implant dentistry. Research Contributions: Subsequent research, including dog studies and rat experiments, emphasized the importance of membranes in protecting against nonosteogenic soft tissue invasion and supporting bony regeneration.

24. In contemporary implant dentistry, Guided Bone Regeneration (GBR) plays a crucial role. It is recognized as an effective method for alveolar ridge augmentation and managing localized defects related to dental implant placement. By directing tissue regeneration, GBR contributes to restoring form, function, and esthetics, ultimately leading to more ideal implant placements .

25. Guided Bone Regeneration (GBR) Defect GBR success depends on factors such as defect width, intact bony walls, socket preservation, defect shape, and the presence of vertical components10. Techniques can be employed to enhance graft stability and space maintenance. • Figure 31-2 A, Single tooth defect sites are ideal for treatment with GBR. B, Multiple tooth defect is also treated predictably with GBR. C, Large, multiple tooth defect with significant alveolar deficiency. (A and B from Le B, Nielsen B: Esthetic implant site development, Oral Maxillofac Surg Clin North Am 27(2):283-311, 2015. C courtesy of Brady Nielsen, DDS, Los Angeles, CA.)

26. Indications for guided tissue regeneration Class II furcation or greater 2 or 3 wall vertical defects Exposed roots Alveolar ridge preservation Tooth mobility should not exceed class II

27. GTR Factors affecting success Systemic factors Level of oral hygiene Hypersensitivity or allergy to chlorhexidine Smoking Pregnant Membrane exposure Post-operative infection

28. Most common Methods Non-Absorbable Barrier Membrane Must have 2nd surgery to remove membrane Used first as a membrane Bioabsorbable Barrier Membrane No 2nd surgery Either animal derived or synthetic polymers Usually resorbs in 6-8 weeks

29. Step by Step Small incision is made and tissue is flapped back Debride defective area thoroughly Bone graft material is placed onto the defect Then the barrier membrane is placed Tissue flap is then sutured up covering the membrane The patient’s body resorbs the bone graft and lays down its own natural bone

30. Post – op guidelines Chlorhexidine rinse 4-6 weeks Antibiotic coverage - 14 days Gentle Brushing - 3 weeks Primary coverage for membranes Maintain excellent home care

31. Conclusion Missing bone and tissue can be restored to create a solid foundation for a beautiful smile. The procedure attempts to regenerate lost periodontal structures, lost bone, periodontal ligament and connective tissue attachment that supports the teeth. GTR is accomplished using biocompatible membranes, bone grafts and tissue stimulating proteins. These remarkable therapies have given many people a second chance to enjoy the benefits of their permanent teeth.