BASAL IMPLANTOLOGI KREDS 2; 2016

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1 BASAL IMPLANTOLOGI KREDS 2; 2016 lars pallesen og klaus gotfredsen 1 Slide 2 TOPICS/MENU Indikationer for implantatbehandling Hvem kan og hvem bør ikke få implantater Ekstraktion hvornår og hvordan? Krav til udformning af implantatunderstøttede kroner Ekstensioner Komplikationer, tekniske hvad med bruksister? Peri-implantitis INDIKATIONER FOR IMPLANTATBEHANDLING Hvem kan og hvem bør ikke få implantater? 3 4 REHABILITERING (TEETH IN ONE HOUR). Hvad tror I er den største komplikation? 5 6 1

2 36-YEAR OLD SUBJECT, TEETH IN 1 HOUR? Anamnese 7 8 HISTORY TALKING I wantthe teeth out of mymouth Teeth do not fit together Speech problems (Phonetics) Cheek-biting Teeth fractures (Ceramic fractures) Teeth too yellow Implants scratches the cheek mucosa Teeth grinding in the night 9 HISTORY TALKING Difficult to relax Upset, irritable with others Depressed Embarrassed Less tolerant of others Difficulty doing jobs Life unsatisfying Drug abuse(cannabis for many years) ADHD (Attention Deficit/Hyperactivity Disorder) 10 CLINICALEXAMINATION (COMPLICATIONS) Ceramic and plastic fractures Vertical dimension to high Horisontal relation not stable Stable position only in RCP (retrudedcontact position) No comfortable MIP (maximal intercuspal position) Dual bite(multiple bite) the patient do not have any habitual occlusion::::: Phantom bite Narrowupper jaw and widelower jaw Implant surface exposure mucositis/(peri-implantitis) X-rays marginale bone loss 11 POOR DIAGNOSTIC POOR HISTORY TALKING Absolute Contraindication for oral surgery e.g. Highdosis i.v. bisphosphonate treatment Anticoagulant treatment with INR > 3.5 Ungoing radiation or chemotherapy Relative Neuropsychiatric disorders Abuse Insufficient communication/diagnostic Relative Medically compromised patients e.g. Immunosuppressed Bleeding disorders Uncontrolled Diabetes Crohn s Disease Other diseases/medicaments influencing bone metabolisme e.g. Hypo/Hyperthyreoidisme Long-term, high-dosis steroidtreatment Sever osteoporosis Heavy, long-term smoking 12 2

3 Tandlægebladet 2010, no. 1 (2):46-52 Implantatbehandling af den medicinsk kompromitterede patient Klaus Gotfredsen, Morten Schiødt, Osteoporose, +/- Antiresorptiv behandling Strålebehandling, - Kemoterapi, +/- Antitrombotisk behandling, +/- Diabetes, +/- Andre sygdomme og syndromer 13 Bestrålet patient 2000 Hvad tror I tandlægen har gjort? 14 Osteoradionecrosis 15 Failed implants 16 Mundtørre Patienter, Heriblandt Sjögren patienter 17 AND/OR TEETH: CONSENSUS STATEMENTS AND RECOMMENDATIONS. J ORAL REHAB 2008,35 (SUPPL): 2-8 Have implants a better prognosis than teeth with reduced marginal bone support? Statement: The survival rates of teeth in periodontal well-maintained patients are in general higher than that of implants (B) Can early extraction of teeth preserve bone for later implant placement? Statement: There is no evidence available to support such an aggressive approach (D) Comment: Untreatable, compromised teeth should, however, be extracted in order to preserve bone 18 3

4 MANGLENDE KNOGLEKVANTITET LOKALE FORHOLD MANGLENDE KNOGLEKVANTITET AGENESI AF +2 ØNSKER NY ERSTATNING 21 Hvilken protetiske erstatning skal vi vælge? AGENESIS AND A DEBONDED RBB REGIO Which treatment would you propose? 22-YEAR GIRL WITH A DEBONDED RBB REGIO 23 What is the risk of complications? (immediate or long-term?) Warrer K, Karring T, Gotfredsen K,: Periodontal ligament formation around different types of dental titanium implants. I: The selftapping screw type implant system. Journal of Clinical Periodontology 1993; 64:

5 Apical zone SPACE REQUIREMENT Regio: 2+2, 2-2, 1-1: 6.0 mm Other regions: 7.0 mm Cervical zone Regio: 2+2, 2-2, 1-1: Min. 6.5 mm Other regions: Min. 7.0 mm Coronal zone Premolars: 7-9 mm, Molars: 9-10 mm Width of the contra lateral tooth or Width of the ideal tooth in relation to the neighboring teeth Apical zone Cervical zone Coronal zone 25 NILS BOHR An expertis a person whohas made all the mistakes that canbe made in a verynarrowfield. 26 ANAMNESE: HVOR MANGE IMPLANTATER? Ønsker impl. som erstatning for manglende tænder i OK. August årig mand Arbejde: sanger Går regelmæssigt til tandlægen Får antidepressiv medicin. Oplever ikke mundtørhed. Ikke ryger

6 BEGRÆNSETPLADSTILTO IMPLANTATER: CASE REPLACEMENT 3,2+2,3 31 Slide 32 EKSTENSIONSBROER ERSTATTENDE 3+ (2+); +3 (+2) Ekstensionsbroer erstattende 3+ (2+); +3 (+2) Baseline Slide 33 Slide 34 Pjetursson B E, Brägger U, Lang N P and Zwahlen M. Comparison of survival and complication rates of tooth-supported fixed dental prostheses (FDPs) and implant-supported FDPs and single crowns (SCs). Clinical Oral Implants Research 2007;18:Suppl.3: OVERALL RESULTS Estimates Reconstruction Type Survival rate 5 - years 10 - years Conventional FDPs 93.8% 89.2% Cantilever FDPs 91.4% 80.3% Implant supported FDPs 95.2% 86.7% Implant supported SC 94.5% 89.4% Tooth-implant supported FDPs 95.5% 77.8% Resin bonded FDPs 87.7% 65.0% Pjetursson et al. 2007, Thoma et al in press and Pjetursson&Gotfredsen 2017 OVERALL RESULTS Estimates Reconstruction Type Survival rate 5 - years 10 - years Conventional FDPs 93.8% 89.2% Implant supported SC 96.3% 89.4% Resin bonded FDPs 91,4% 82,9% Pjetursson & Gotfredsen

7 FOR IMPLANTATBE HANDLING REGIO THANKYOUFOR ATTENTION 38 7