Dental Teeth TOOTH IMPLANT MAINTENANCE And REPAIR PowerPoint Presentation on CD For Sale

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Dental Teeth TOOTH IMPLANT MAINTENANCE And REPAIR PowerPoint Presentation on CD :
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TITLE: Implant Maintenance and Repair, 62 slides

SLIDE TOPICS, SUBTOPICS and CONTENTS:

Implant Maintenance and Repair

The purpose of this presentation is to provide the basic knowledge to perform proper maintenance and minor repairs to patients that have been restored with dental implants.

Slides 1 thru ## are a basic introduction providing essential information when performing an evaluation on an implant patient.

Slides ## to ## identify the materials and methods to performing proper maintenance check - ups.

Slides ## to ## describe clinical situations that may present themselves. Diagnosis through treatment is emphasized.

Osseointegration

Dynamic process

Healing phase: 0 - 12 months

Remodeling phase: 3 - 18 months

Steady state: 18 months ---

Osseointegration
a dynamic process

Maintenance and Recall

Annually

periapical radiographs should be taken to monitor the crestal bone levels. (crestal bone can be at the level of the first thread in one year with 0.1mm continued loss to approximately 1. 5 mm total bone loss)

remove and reinsert screw retained implant prostheses every 2 years unless indicated otherwise.

Replace prosthesis with new retaining screws if removed.

Cemented restorations are usually permanent (nonretrievable).

Recall focus

Occlusion - verify there are no excursive contacts. Should not hold shimstock. Better to be out of occlusion

Oral hygiene - same requirements as for natural teeth.

Soft tissue health - periodontal probing for evidence of disease.

Screw joint torque - check for loosened screws (most common problem).

Integrity of attachments - applies to overdenture / overpartials.

Stability of implants - must be stable (non mobile) to be successful

Maintenance and Recall

Screw retained prosthesis

Remove prosthetic retention screws

Screw access holes are usually sealed with a layer of cotton pellet, silicone plug or gutta percha the acrylic or composite resin.

Expose the screw by drilling carefully through the resin.

Remove the screw (slot or hex) with the appropriate screw driver.

Throat drapes are highly recommended.

Check for implant mobility and retorque abutments to 20 Ncm. (hand tighten as much as possible with finger abutment driver if no torque control device is available)

Clean and polish abutments (Do not remove)

Reseat restoration using new gold retaining screws.

Tighten screws as if doing nuts on the lugs of an automobile - place all screws back with minimal torque. Then work back and forth across the arch until all are tightened to 10 Ncm. (hand torque with appropriate hand screw driver if no torque controller is available)

Maintenance and Recall

Screw retained prosthesis (cont.)

Temporary reinsertion

fill access holes with small cotton pellet and polyvinylsiloxane impression material or putty.

Long-term reinsertion

fill access hole with small cotton pellet over the head of the screw, followed by warm gutta percha and only 1-2 mm of acrylic or composite resin.

Cemented restorations

Single unit

usually nonretrievable and not removed for maintenance.

Multiple unit (usually not indicated)

carefully tap off with crown remover, check for mobile implants and retorque abutment screws.

Replace restoration with provisional luting media, and recheck occlusion.

Hygiene Aids

Super - floss

End tufted brushes

Proxy brushes

Tarter control dentrifices

Mechanical instruments

Peridex

Soft Tissue Relationship

Similar to teeth

No Sharpeys fibers

Hemidesmosomal attachments

Circumferential and perpendicular connective tissue

Problems in the field

Fractured/loosened screws

Fixture loss

Poor oral hygiene

Soft tissue reactions

Broken attachments

Fractured components

Problems in the field

Fractured/loosened screws

Fixture loss

Poor oral hygiene

Soft tissue reactions

Broken attachments

Fractured components

Fractured or loosened screws

Usually results in localized inflammation, loose restorations and discomfort.

First suspicion when patient complains of discomfort or loose implant.

Prosthetic gold retaining screws have either a slot or hex head.

Abutment screws require a hex abutment driver, large slot, hex or square driver.

Standard and conical (estheticone) abutments have a raised hex and require a wrench that fits over this hex.

All other abutment screws have the slot, hex or square depression inside the screw head.

Loose single tooth abutments are true emergencies. Continued rotation can risk rounding the corners of the hex on the implant, causing a loss in anti-rotation.

Problems in the field

Fractured/loosened screws

Fixture loss

Poor oral hygiene

Soft tissue reactions

Broken attachments

Fractured components

Fixture loss
(Must differentiate between “failing” and “failed”)

Failing Implant

Clinical signs:

progressive bone loss

soft tissue pocketing and crestal bone loss

bleeding on probing with possible purulence

tenderness to percussion or torque forces

Causes:

overheating of bone at the time of surgery or lack of initial stability.

Nonpassive superstructures

inadequate screw joint closure

functional overload

periodontal infection (peri-implantitis)

Fixture loss

Failing Implant

Treatment:

Interim: remove prosthesis and abutments

irrigate with Peridex

ultrasonic and disinfect all components

reinsert assuring proper screw torque

recheck passive fit of framework and occlusion

Failed Implant

Clinical signs:

Mobility

verify fixture mobility by removing any abutments and superstructures first.

A “Dull” percussion sound has been associated with a failed implant

Peri-implant radiolucency can be a radiographic finding

often this is not evident on an X-ray

Fixture loss

Failed Implant

Causes

surgical compromise (overheating bone and initial lack of stability).

Nonpassive superstructures.

Inadequate screw joint closure

Too rapid initial loading

Functional overload

Periodontal infection (“peri-implantitis”)

Treatment

removal of the implant

Problems in the field

Fractured/loosened screws

Fixture loss

Poor oral hygiene

Soft tissue reactions

Broken attachments

Fractured components

Problems in the field

Fractured/loosened screws

Fixture loss

Poor oral hygiene

Soft tissue reactions

Broken attachments

Fractured components

Soft tissue reactions

Often seen with split thickness skin grafts or lack of periabutment keratinized tissue

Soft tissue inflammation most commonly due to loose screw joints.

Remove the offending screws, tighten the abutments and reinsert the prosthesis.

Poor oral hygiene: soft tissue inflammation often referred to “peri-implantitis”. Etiology similar to natural teeth (plaque, lack of attached tissue, etc.) May result in progressive bone loss.

Failing or failed implants.

Problems in the field

Fractured/loosened screws

Fixture loss

Poor oral hygiene

Soft tissue reactions

Broken attachments

Fractured components

Broken Attachments

Plastic bar clip

damaged or broken

cut along long axis with sharp knife and remove.

Missing

replace by inserting a new clip into denture base receptacle

if unavailable, contact Command Implant Coordinator

Metal bar clip

damaged or broken (replacement clip available)

remove the clip and perforate the denture base carefully for intraoral pick up replacement.

Block out under the bar with wax, seat the denture and position a new clip through access in denture base.

Use autopolymerizing acrylic resin with “bead brush” technique to fill in access and connect clip to denture base. Polish , disinfect and deliver.

Always confirm seating of denture after repair and evaluate occlusion.

Broken Attachments

Metal bar clip

Damaged or broken (replacement clip not available)

remove all remnants of the clip from the denture base.

block out under the bar with wax

reline the clip area of the denture with a resilient chairside reline material (viscogel).

Intact clip with no retention

carefully bend the leaves of the clip toward the bar with a thin instrument.

Reseat the denture to confirm increased retention.

Recheck occlusion.

Stud attachments

treatment is similar to clips

tease out “O” ring with an explorer and replace as needed.

Fractured housing can be treated like a clip replacement.

Problems in the field

Fractured/loosened screws

Fixture loss

Poor oral hygiene

Soft tissue reactions

Broken attachments

Fractured components

Fractured components

Screw retained prosthesis

Fractured resin or prosthetic tooth

remove prosthesis and repair as if a conventional prosthesis.

If the prosthesis is a hybrid, remove in the same manner as for a maintenance appointment.

Cemented Prosthesis

Multiple unit restoration

carefully tap off the restoration with crown remover and repair as indicated.

Single unit restoration

if no screw access, drill an access through the occlusal surface to the abutment screw and remove the restoration.

Repair or fabricate provisional as indicated.

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