kuliah pakar fkg unissula 3

7/26/2019 Kuliah Pakar Fkg Unissula 3

1/435

AUTO BIOGRAPI

RUSDIMA UDI

CIREBONJ 17 MEI 1943

FKG UGM 1972

PPDGS I B.H. UGM 1993

FK UNISSULA


2/435

GAWAT DARURAT PHLEGMOON MANDIBULA

GAWAT DARURAT PENYAKIT SYSTEMIS

INFEKSI ODONTOGEN

TERLOKALISIR PADA APEX GIGI

MENYEBAR KE JARINGAN SEKITAR

PENYEBARAN SYSTEMIS

HEMATOGEN LYMFOGEN


3/435

PERTAHANAN TUBUH

HUMORAL

IMMUNOGLOBULIN

KOMPLEMEN SELLULER

LEUKOSIT MONOSIT LIMFOSIT

MAKROFAG ! PMN


4/435

"IRULENSI MIKRO ORGANISME

KUALITAS MAMPU IN"ASI"

EFEK MERUSAK HOST

DG PRODUKSI EN#YM LITIK

ENDO TOXIN EXO TOXIN

GANGGU PERTAHANAN

HUMORAL DAN SELLULAR


5/435

BARTER PERTAHANAN

TULANG AL"EOLAR

PERIOSTEUM

MUSKULUS

FASIA


6/435

PERKEMBANGAN INFEKSI

JARINGAN KERAS PULPITIS

GANGRENE PERIODONTITIS

OSTEITIS

OSTEOMYELITIS


7/435

JARINGAN LUNAK

PERIKORONITS

ABSCES SUB MUKUS

ABSCES SUBCUTAN

CELLULITIS$PHLEGMOON MANDIBULA

LUDWIG ANGINAMEDIASTINITIS


8/435

PHLEGMOON MANDIBULA $ CELLULITIS

RADANG JARINGAN SELLULLAR

DIFFUS ! BERKEMBANG CEPAT TANPA BATAS KAUSA HYALURONIDASE

PALPASI KERAS TIDAK ADA FLUKTUASI

MEN JADI ABSCES ! LUDWIG ANGINA

MEDIASTINITIS ! CA"ERNOUS SINUS THROMBOSIS


9/435

LUDWIG ANGIMA

INFEKSI BILATERAL

SUBMENTUM SUBMANDIBULAR SUBLINGUAL

TIDAK ADA FLUKTUASI LIDAH TERDORONG KEATAS DAN BELAKANG

EDEMA GLOTIS

DEHYDRASI SEPTIKEMI ! MEDIASTINITIS


10/435

A%&'()* +&% J&,*%-&% P%+/0/%- G*-*


11/435

P,&&%&% D%'& C&,*


12/435

P%5&,&% *%60* -*-*


13/435


14/435


15/435


16/435


17/435


18/435


19/435


20/435


21/435


22/435


23/435


24/435


25/435


26/435


27/435


28/435


29/435


30/435


31/435


32/435


33/435


34/435


35/435


36/435


37/435


38/435


39/435


40/435


41/435


42/435


43/435


44/435


45/435


46/435


47/435


48/435


49/435


50/435


51/435


52/435


53/435


54/435


55/435


56/435


57/435


58/435


59/435


60/435


61/435


62/435


63/435


64/435


65/435


66/435


67/435


68/435


69/435


70/435


71/435


72/435


73/435


74/435


75/435


76/435


77/435


78/435


79/435


80/435


81/435


82/435


83/435


84/435


85/435


86/435


87/435


88/435


89/435


90/435


91/435


92/435


93/435


94/435


95/435


96/435


97/435


98/435


99/435


100/435


101/435


102/435


103/435


104/435


105/435


106/435


107/435


108/435


109/435


110/435


111/435


112/435


113/435


114/435


115/435


116/435


117/435


118/435


119/435


120/435


121/435


122/435


123/435


124/435


125/435


126/435


127/435


128/435


129/435


130/435


131/435


132/435


133/435


134/435


135/435


136/435


137/435


138/435


139/435


140/435


141/435


142/435


143/435


144/435


145/435


146/435


147/435


148/435


149/435


150/435


151/435


152/435


153/435


154/435


155/435


156/435


157/435


158/435


159/435


160/435


161/435


162/435


163/435


164/435


165/435


166/435


167/435


168/435


169/435


170/435


171/435


172/435


173/435


174/435


175/435


176/435


177/435


178/435


179/435


180/435


181/435


182/435


183/435


184/435


185/435


186/435


187/435


188/435


189/435


190/435


191/435


192/435


193/435


194/435


195/435


196/435


197/435


198/435


199/435


200/435


201/435


202/435


203/435


204/435


205/435


206/435


207/435


208/435


209/435


210/435


211/435


212/435


213/435


214/435


215/435


216/435


217/435


218/435


219/435

DIABETES


220/435


221/435


222/435


223/435


224/435

HEMOFILIA


225/435


226/435


227/435


228/435

PHLEGMOON MANDIBULA


229/435


230/435


231/435

P%5&,&% *%60* -*-*


232/435

P,&&%&% D%'& C&,


233/435


234/435


235/435


236/435


237/435


238/435


239/435


240/435


241/435


242/435


243/435


244/435


245/435


246/435


247/435


248/435


249/435


250/435


251/435


252/435


253/435


254/435


255/435


256/435


257/435


258/435


259/435


260/435


261/435


262/435


263/435


264/435


265/435


266/435


267/435


268/435


269/435


270/435


271/435


272/435


273/435


274/435


275/435

GIGI IMPL N


276/435


277/435

Implant GuidelinesWhat is a dental implant?

Biomaterialsmost commonly used

commercially pure (CP) titanium


278/435

titanium-aluminum-vanadium alloy(Ti-6Al-!) - stron"er # used $% smallediameter implants


Titaniumli"ht$ei"ht&iocompati&le


279/435

corrosion resistant(dynamic inert o'ide layer)stron" # lo$-priced


i'ture typesA coatedTi sur*ace modi*ied


280/435

tap or sel*-tappin"scre$ or press *it


+,sseointe"rationBr.nemar/ - late 01234s

direct structural # *unctional


281/435

connection &et$een ordered5 livin"&one # sur*ace o* a load-carryin"implant


+,sseointe"rationsimilar so*t-tissue relationship to

natural dentition (sulcular epithelium)


282/435

hemi-desmosome li/e structuresconnect epithelium to titaniumsur*ace


+,sseointe"rationcircum*erential and perpendicular

connective tissue


283/435

no connective tissue insertionno intervenin" harpey4s *i&er

attachment


+,sseointe"ration&one-implant inter*ace

osteo&lasts in close pro'imity

to inter*ace


284/435

separated *rom implant &y thinamorphous proteo"lycan layer

osseointe"ration - hi"hly predicta&le



osteo&lasts in close pro'imity

to inter*ace


285/435

separated *rom implant &y thinamorphous proteo"lycan layer

osseointe"ration - hi"hly predicta&le



o'ide layer continues to "ro$-

(7333 A at 6 yrs) - mineral ion interaction


286/435

increase in tra&ecular pattern&one deposition # remodelin" in

response to stress



o'ide layer continues to "ro$-

(7333 A at 6 yrs) - mineral ion interaction


287/435

increase in tra&ecular pattern&one deposition # remodelin" in

response to stress


Components # terminolo"ycopin" or prosthesis scre$ (top)copin"analo"


288/435

implant &odya&utment

trans*er copin" (indirect or direct)


Components # terminolo"yhy"iene scre$a&utment

*or scre$5 cement or attachment

d t l & t


289/435

second sta"e permucosal a&utmen*irst sta"e cover scre$implant &ody or *i'ture (&ottom)

Implant Guidelines


290/435


8odern typesimplants are small-

standard a&utment- usually 9:;


291/435

$ide-&ody or $ide-plat*orm- up to6:3mm


8odern typeslen"ths- typically ran"e *rom a&out

; to 02mm

=avy uses +e'ternal he'


292/435

=avy uses +e'ternal he' "ood research literature a&le to &e maintained

(9i or =o&el Biocare systems)


8odern types (=o&el Biocare)i'tures

tandard

8/ II


293/435

8/ II


8odern types (=o&el Biocare)A&utments

tandardCera,ne>sthetiCone


294/435

>sthetiCone8irusConeAn"ulated 0; (ne$) or 93


8odern types (=o&el Biocare)tandard

no anti-rotational propertiescan use *or multiple unitscan use *or hy&rid dentures


295/435

can use *or hy&rid dentures


8odern types (=o&el Biocare)Cera,ne

sin"le tooth esthetic replacementa&utment attached to *i'ture $%

restoration cemented to a&utment


296/435

restoration cemented to a&utmentaccommodation *or *i'ture misali"nmen

can provisionali@e


8odern types (=o&el Biocare)>sthetiCone

esthetic P restorationsmachined "old cylinder a&utment allo$

cro$n mar"in to seat close to *i'ture


297/435

cro$n mar"in to seat close to *i'ture($ithin 0mm)


8odern types (=o&el Biocare)8irusCone

esthetic P restorationsuse $hen decreased vertical hei"htallo$s


298/435

allo$s :


299/435

use i* less than ideal *i'ture placementuse $here esthetic cervical mar"in

reuired


8odern types (=o&el Biocare)Cera,ne>sthetiCone8irusConeAn"ulated a&utments


300/435

An"ulated a&utments All come $ith narro$5 re"ular or $ide

plat*orms (=P5 P5 WP)


8odern types (9i)i'tures8icro8iniplant8iniplant

tandard


301/435

tandardWide iameter

( sur*ace area to use $here vertical hei"ht)


8odern types (9i)i'turesIC> (incremental cuttin" ed"e)

super sel*-tappin" implant

uses tapered cuttin" *lutes


302/435

uses tapered cuttin" *lutesallo$s more placement controlrapid &one en"a"ement # implant

sta&ili@ation


8odern types (9i)A&utments>P (conical) - (esthetic pro*ile)Gold DCEA-typeT$o-piece a&utment postTA (standard)


303/435

TA (standard)Pre-An"led=e$ Gold tandard F (@ero rotation)


8odern types (9i)Gold DCEA-type a&utment

scre$-retained at *i'ture levelnon-se"mented a&utment

scre$-retained cro$n to implantl & it ll th


304/435

scre$ retained cro$n to implantuses lar"er scre$ &ecause it runs all th

$ay to the *i'ture


8odern types (9i)Gold DCEA-type a&utment

thin &uccal-lin"ual tissues

limited inter-occlusal distance

(as little as :


305/435

(as tt e as < )sin"le or multiple units


8odern types (9i)>P (conical) - (esthetic pro*ile)scre$-retained cro$n to the a&utment"old cylindernon-parallel implant placementsin"le or multiple units


306/435

" pminimum ;mm inter-occlusal distance

reuired


8odern types (9i)T$o-piece a&utment post

non-rotationalcement-retained cro$n to the a&utment

simplicity o* treatment - chairsidepreparation


307/435

p yp puse $hen access to posterior re"ion $%

scre$ driver is limited


What4s ne$?(9i)Prep-Tite Posts

scre$ retained a&utmentstandard impression procedure

cemented restoration6 t ith 9 ti l


308/435

6 taper $ith 9 vertical "roovesmultiple collar hei"hts


What4s ne$?(9i),sseotite (+clot retentive sur*ace)

speci*ic micro-topo"raphic acid-etched implant sur*ace desi"n !s:

machined-sur*ace implantsin"le sta"e implant


309/435

psin"le sta"e implant loaded a*ter 7 monthsclaim 12:


310/435

yrestorin" posterior spaces not &ound &ynatural teeth


Advanta"esno preparation o* tooth%adJacent teeth&one sta&ili@ation # maintenanceretrieva&ility improvement o* *unction


311/435

psycholo"ical improvement


isadvanta"esris/ o* scre$ loosenin"ris/ o* *i'ture *ailure len"th o* treatment timeneed *or multiple sur"eries


312/435

challen"in" esthetics

Implant GuidelinesConsultation Appointment

Treatment plannin" phaseDiagnosis begins with a complete

patient evaluation

"uidelines *or +decision-ma/in"process


313/435

processtreat the +entire patientrestore *orm5 *unction # esthetics


Treatment plannin" phasepro&lem list # patient desires

initial evaluationchie* complaintmedical%dental history revie$


314/435

intra%e'traoral e'amevaluation o* e'istin" prosthesis


Treatment plannin" phaseinitial evaluation

dia"nostic impressions%articulated castradio"raphs - panoramic and periapical

(CT scan or tomo"raphy - as indicated)photo"raphs


315/435

photo"raphs


Treatment plannin" phasetreatment options%in*ormed consent

e'planation o* lon"-term commitmen

restorative - sur"ical Joint consultt$o-sta"e sur"ery


316/435

" " ystage Istage II


Treatment plannin" phaset$o-sta"e sur"ery

(use o* clear acrylic sur"ical stent ismandatory)

stage I -implant *i'ture placement $%(l *t & d)


317/435

cover scre$ (le*t su&mer"ed)


Treatment plannin" phasestage I - healin" phase

9 month minimum (mandi&le ) - usually months *or posterior re"ions

6 month minimum (ma'illa) - usually 6-1months *or all re"ions


318/435

months *or all re"ions


Treatment plannin" phasestage II - uncoverin" # placement o*

transmucosal healin" a&utment

healin" phase


319/435

-6 $ee/s *or so*t tissue healin"


Treatment plannin" phaserestorative phase

maintenance and re"ular recall

*ee # payment policy

"oal to restore *orm5 *unction #


320/435

esthetics

Implant GuidelinesTreatment plannin" phase

Pro&lem list # treatment considerationsteeth

periodontium

radio"raphic analysis

sur"ical analysisth ti l i


321/435

esthetic analysis


Pro&lem list # treatment considerationsocclusal analysis

advs%disadvs o* proposed treatment

re*errals%specialty consults

appointment seuencin"t t t lt ti


322/435

treatment alternatives



periodontium


sur"ical analysisth ti l i


323/435

esthetic analysis


Pro&lem list # treatment considerationsteeth - num&er # e'istin" condition

pro"nosis o* remainin" teethsi@e5 shape # diameter o* e'istin"

dentitiontooth # root an"ulations # pro'imity


324/435

toot # oot a "u at o s # p o tymesiodistal $idth o* edentulous space



minimum 6-;mm &et$een teeth to*acilitate implant placement

(&ased on 9mm *i'ture)K 0:


325/435

;mm *rom center o* implant - to centero* implant *or edentulous area



more than 03mm mesiodistal space -sin"le tooth implant notrecommended

(multiple a&utments should &e splinted)


326/435



periodontium


sur"ical analysisesthetic analysis


327/435

esthetic analysis


Pro&lem list # treatment considerationsperiodontium- &one supportEe/holm # Far& classi*ication

quality- &est - thic/ compact cortical&one $%core o* dense tra&ecularcancellous &one

&est re"ion - mandi&ular symphysisL


328/435

&est re"ion - mandi&ular symphysisLpoorest in posterior re"ions


Pro&lem list # treatment considerationsperiodontium- &one support

quantity- reuired *or implant -6mm &uccal-lin"ual $idth $%su**icient

tissue volume2mm interradicular &one $idth03mm alveolar &one a&ove IA= canal or


329/435

03mm alveolar &one a&ove IA= canal or&elo$ ma'illary sinus



quantity- reuired *or implant - i* inadeuate &one support may need

rid"e or site au"mentationramus or chin "ra*t (auto"ra*t)BA (allo"ra*t)


330/435

BA (allo"ra*t)Bio-,ss('eno"ra*t)



place implants minimum o* 7mm *romIA= canal or &elo$ ma'illary sinus

cro$n%root ratio

mo&ility*urcations


331/435

pro&in" depths


Pro&lem list # treatment considerationsperiodontiummuco"in"ival pro&lems

need su**icient tissue volume to recreat"in"ival papilla

need some attached "in"iva to maintainperi-implant sulcus0st year post-op &one resorption M 0mm


332/435

0st year post-op &one resorption M 0mm

Ncrest o* &one optimal 7- 9mm &elo$ C>


Pro&lem list # treatment considerationsperiodontiummuco"in"ival pro&lems

place implant 7-9mm apical to *ree"in"ival mar"in o* adJacent tooth

recreates &iolo"ic $idth o* peri-implantsulcusNso*t tissue hei"ht 7mm or K mm may


333/435

so*t tissue hei"ht 7mm or K mm maycreate challen"e


Pro&lem list # treatment considerationsperiodontiumoral hy"iene - important pre # post

systemic mani*estations - ie: dia&eticsare predisposed to delayed healin"

destructive ha&its - smokingiscontraindicated - delayed or inadeuate


334/435

contraindicated - delayed or inadeuatetissue healin" # osseointe"ration noted


Pro&lem list # treatment considerations

teeth

periodontium




335/435

esthetic analysis

Implant Guidelines

Treatment plannin" phase Pro&lem list # treatment considerations

radio"raphic analysisperiapical patholo"y

radiopaue%radiolucent re"ions

adeuate vertical &one hei"htadeuate space a&ove IA= or &elo$


336/435

pma'illary sinus

Implant Guidelines


radio"raphic analysisadeuate interradicular area

&one uality # uantity

radio"raphs - panoramic and periapical(CT scan or tomo"raphy - as indicated)


337/435

Implant Guidelines


radio"raphic analysisradio"raphs- aid to determine amount

o* +space# &one availa&le

CT (computed tomo"raphy) scan - "ives

more accurate # relia&le assessment o*

&one (uality5 uantity # $idth) # locale


338/435

&one (uality5 uantity # $idth) # locale

o* anatomic structures

Implant Guidelines


radio"raphic analysis-radio"raphic stent- (can dou&le as

sur"ical stent)acrylic stent $ith lead &eads or &all

-&earin"s (


339/435

allo$s more accurate radio"raphicinterpretation

Implant Guidelines


radio"raphic analysis-distortion (common to all Q-rays)

Panore' M 7


340/435

Eateral Ceph M 2Periapical M 7:


341/435

y

Implant Guidelines


sur"ical analysis-sur"ical "uide stent- None o* the

most critical *actors *or o&tainin" an idealsur"ical # esthetic result

used durin" *i'ture installation as "uide*or optimal B%E and 8% position

use o* &uccal channel drill "uide allo$s


342/435

use o* &uccal channel drill "uide allo$simproved access # visi&ility

Implant Guidelines


sur"ical analysis-implant len"th%diameter

determined &y uantity o* &one apical toe'traction site

use lon"est implant sa*ely possi&lediameter dictated &y correspondin" roo

anatomy at crest o* &one


343/435

anatomy at crest o* &one

Implant Guidelines


sur"ical analysistreatment options

immediate- place implant at time o*tooth e'traction

delayed immediate- 2-03 $ee/ delaydelayed- 1-03 months or lon"er immediate $ill not allo$ &one resorption5 &u


344/435

p 5delayed allo$s &one *ill *or sta&ili@ation

Implant Guidelines


sur"ical analysisproper sur"ical techniue durin"

implant placement is critical

minimal heat "eneration important ; Celsius *or one minute or less

provides most predicta&le healin"


345/435

response

Implant Guidelines


teeth

periodontium




346/435

Implant Guidelines


esthetic analysissmile line - hi"h in ma'illaL lo$ in

mandi&le

lip shape - *ull !s: thine'istin" rid"e de*ect - i* visi&le $%

hi h il li ill d t ti


347/435

hi"h smile line $ill need au"mentation

Implant Guidelines


esthetic analysisimplant emer"ence pro*ile (963)

restored implant should appear to+"ro$ or emer"e *rom the "in"iva

very natural # desira&le in appearanceavoid +tomato on a stic/ cro$ns or

periodontal pro&lems may develop


348/435

periodontal pro&lems may develop

Implant Guidelines


occlusal analysisadvs%disadvs o* proposed treatment


appointment seuencin"treatment alternatives


349/435

Implant Guidelines


occlusal analysisimprovement o* *unction and%or

esthetics (?)para*unctional ha&its

can &e destructiveteeth lost to occlusal trauma or

* ti l % i l t


350/435

para*unction - less success $% implants

Implant Guidelines


occlusal analysisdia"nostic casts

(mounted to determine opposin" occlusion

rid"e $idthe'istin" inter-arch vertical space

0 0


351/435

0-0


352/435

Implant Guidelines






353/435

Implant Guidelines


advs%disadvs o* proposed treatmentare as individual as the case &ein"

treatment plannedcostpatient desiresclinician a&ilitiesetc


354/435

etc:

Implant Guidelines






355/435

Implant Guidelines


re*errals%specialty consultscan pro"nosis &e improved $ith (?)R

orthodontics

periodontal therapyendodontic therapy


356/435

Implant Guidelines


re*errals%specialty consultspre-prosthetic sur"ery

e'tractions

rid"e contourin" or e'ostosis remova osteotomy

&one or so*t tissue au"mentation


357/435

&one or so*t tissue au"mentation

Implant Guidelines






358/435

Implant Guidelines


appointment seuencin"len"th o* treatment time

need *or multiple sur"eries


359/435

Implant Guidelines






360/435

Implant Guidelines


treatment alternatives*i'ed partial denturesremova&le partial denturesresin-&onded *i'ed partial denturesorthodonticsdo nothin"


361/435

Implant Guidelines

Treatment plannin" phase Indications

"ood "eneral healthadeuate &one uality # volumeappropriate occlusion # Ja$ relations ina&ility to $ear conventional prosthesis

un*avora&le num&er%location o* a&utmentsin"le tooth loss


362/435

Implant Guidelines

Treatment plannin" phaseContraindications

unrealistic patient e'pectationsalcohol%dru" dependence (smo/in")para*unctional ha&itspsycholo"ical *actors

anatomical *actors inadeuate rid"e%interarch dimensions immunosuppression


363/435

pp

Implant Guidelines

Treatment plannin" phaseContraindications (relative)

(need sur"ical intervention)ramus "ra*t

inadeuate &one at implant sitee'cessive &ony concavities

sinus li*t or IA= transposition inadeuate vertical space *or implant


364/435

Implant Guidelines

Treatment plannin" phase +,sseointe"rated implants can &e

placed in the irradiated mandi&les o*

selected patients $ithout hyper&aric

o'y"en treatment

=iini5 Deda5 Seller5 Worthin"tonL Experience withOsseointegrated Implants laced in Irradiated !issues in "apanand the #nited $tates5 Intl O ,ral 8a'illo*ac Implants 0112L

09R3;-00


365/435

Implant Guidelines

8aintenance

Criteria *or success 8aintenance and ecall

y"iene Aids

Pro&lems


366/435

Implant Guidelines

8aintenance

Primary "oal is to protectandmaintain +tissue-inte"rationL

good oral hygieneis a /ey

element


367/435

Implant Guidelines

8aintenance +Implant patients should &e

thorou"hly instructed inmaintenance therapy $ith theunderstandin" that the patientserves as co-therapist

Grant et al5 eriodontics% in the !radition o&

'ottlieb and Orban5 ed 6: t: Eouis5 C! 8os&y Co5

0122 pp03;


368/435

01225 pp03;


369/435

Implant Guidelines

8aintenance


y"iene Aids

Pro&lems


370/435

Implant Guidelines

8aintenance Criteria *or successR(most important is "ood dia"nosis)

no peri-implantitisno associated radio"raphic

radiolucencymar"inal &one loss 0:3-0:


371/435

Implant Guidelines

8aintenance Criteria *or successR

tissue inte"rationR &one%so*t tissue+osseointe"ration

a&sence o* mo&ilityno pro"ressive so*t tissue chan"es o

&one losssta&le clinical attachment level


372/435

Implant Guidelines


a&sence o* &leedin" uponpro&in"%e'cessive pro&in" depths

a&sence o* discom*ort

success rate varies $ith &one ualityloadin" dynamics5 etc:


373/435

Implant Guidelines


anticipated success rate o*

1; anterior mandi&leL 13 ma'illaL

decreases in posterior uadrants

due to poorer &one uality (03 yrs)&est &oneR "ood cortical $ith some

cancellous *or vascular supply


374/435

Implant Guidelines

8aintenance


y"iene Aids

Pro&lems


375/435

Implant Guidelines

8aintenance 8aintenance # ecallR

(our elementshome-care re"imenperiodic recalls rein*orcin" re"imenstrict adherence to recall schedule #

veri*ication o* *unction5 com*ort5 andesthetics li*etime maintenance commitment


376/435

Implant Guidelines


(requency o& recall immediate post-delivery7 hoursone $ee/

t$o $ee/s (re-torue i* needed)6 months&i-annual or annual evaluation


377/435

Implant Guidelines


)linical arameters o& Evaluationoral hy"iene includin" plaue inde' implant sta&ility (evaluate mo&ility)retrieva&ilityperi-implant tissue healthcrevicular pro&in" depths


378/435

Implant Guidelines


)linical arameters o& Evaluation&leedin"radio"raphic assessment (serial)

crestal &one level # inte"rity o*

attachment systemsproper torue on scre$ Jointsocclusion


379/435

Implant Guidelines

)linical arameters o& Evaluation oral hy"iene (plaue inde')

plaue is 0 etiolo"ic *actor in tissuedestruction (peri-implant and natural toothrevie$ oral hy"iene instructionmonitor throu"h plaue indices

same reuirements as *or natural teethuse neutral sodium *luorides


380/435

Implant Guidelines

)linical arameters o& Evaluation implant sta&ility (evaluate mo&ility)

may &e the key indicatoro* *i'ture healthminimal mo&ility $% osseointe"rated

*i'turesR 0;-


381/435

Implant Guidelines

)linical arameters o& Evaluation retrieva&ility

*ailin" implant may &e mas/ed i* connecteto same prosthesis important to remove P to evaluateannual removal recommended *or multiple

unit prosthesis

early *ailure detection $ill minimi@e *i&routissue @one si@e # may allo$ placement o*$ider diameter *i'ture


382/435


383/435

Implant Guidelines

)linical arameters o& Evaluation crevicular pro&in" depths

most accurate means o& detecting perimplant destruction *use plastic pro&es)pro&in" measurements closely

appro'imate actual &one levelsavoid durin" *irst 9 months a*ter a&utment

connection to avoid dama"in" $ea/epithelial attachmentmay &e di**icult i* threads supra-osseous


384/435

Implant Guidelines

)linical arameters o& Evaluation &leedin"

controversy as to si"ni*icance o* B,P atperi-implant inter*aceB,P may precede clinical si"ns o*

in*lammationB,P # radio"raphic chan"es are most val

indicators o* peri-implant &rea/do$nrecommend continued use o* peri-implant

sulcus pro&in" to monitor implant success


385/435

Implant Guidelines

)linical arameters o& Evaluation radio"raphic assessment

one o* most valua&le measures o* implantsuccesso* value $hen

cannot pro&e area due to constricted implantnec/5 and

to assess *uture mo&ility $ithout P removal to accurately determine amount o* &one loss ia&sence o* increased crevicular depth


386/435

Implant Guidelines


compare &ony chan"es $ith sta&lelandmar/s - implant threads - (one-hal* thread U 3:9mm)

compare hori@ontal%vertical implantdimensions &et$een serial radio"raphs

periapical radio"raphs U 7:< -


387/435

Implant Guidelines


bone level determination should be basedonly upon standardi+ed periapicalradiographs

threads o* implant must appear sharp #$ell-delineated on Q-ray to &e accurate

Q-ray &eamR direct V1 *rom lineperpendicular to lon" a'is o* implant/eep *ilm parallel # close to implant


388/435

Implant Guidelines


recommend /!p o* not 63 (&est 6


389/435

Implant Guidelines


uality in *ilm development is paramountpost-op radio"raphic intervalsR

not &et$een *i'ture placement to a&utmentconnection

one $ee/ a*ter a&utment insertion

immediately *ollo$in" *i'ed prosthesisinsertion5 then 6 months later annually *or *irst 9 years5 then every 7 years


390/435

Implant Guidelines


e'pect 0:3mm mar"inal &one loss durin"*irst year postinsertionL V3:0mm per yearanticipated therea*ter

"reater &one loss o&served in ma'illa


391/435

Implant Guidelines


rapid &one loss seen i*R *ractured *i'ture initial osseous trauma at insertion *i'ture over-ti"htenin" occlusal trauma poor adaptation o* prosthesis to a&utment +normal physiolo"ic response plaue-associated in*ection (peri-implantitis)


392/435

Implant Guidelines


>8>8B> HHH >ndosseous implants may lose

e'tensive amounts o* &one support

$ithout sho$in" rather o&vious

radio"raphic chan"es or increase inmo&ility detecta&le in periodontally

involved teeth


393/435

Implant Guidelines

)linical arameters o& Evaluation proper torue on scre$ Joints

loosened scre$s are the most commonpro&lemcan result in locali@ed in*lammation5 loose

restorations5 and discom*ort i* re-toruin" a loose a&utment - care not t

strip or +round-o** the he'e'cessive *orce can *racture scre$%implan

or create increased stresses in the &one


394/435

Implant Guidelines

)linical arameters o& Evaluation occlusion

e'cessive *orce concentrations - result ine'tensive &one loss and implant *racture 8AO, CAD>R poor a&utment prosthesis

adaptation poor *orce distri&ution # improperly planned

occlusal schemes also *actors

recommend anterior "uidance NN B>T"roup *unction%&alanced occlusion also


395/435

Implant Guidelines

)linical arameters o& Evaluation occlusion

"oal to prevent lateral *orces on posteriorimplants concentrated in cervical area

relationship &et$een para*unctional activit# increased mar"inal &one loss

ideal is +li"ht centric occlusion onlyL

no contact in lateral e'cursionsno contact in 8I5 &ut $ith hard clench $illhold shim stoc/ (:3330)


396/435

Implant Guidelines

8aintenance


y"iene Aids

Pro&lems


397/435

Implant Guidelines

8aintenance y"iene AidsR

plastic scalers- ,=E - *ora&utmentscalin" to prevent easy a&rasion o* so*ttitaniumL use in only one direction startin"at the "in"iva (&est are *rom 9i)

ultrasonic scalers- =, - do not useTitan- or ultrasonic scalers unless specianon-metal tips used


398/435

Implant Guidelines


prophy Jets- use $ith caution

*ine prophy pasteor *lour o* pumice-,S -use $ith &lue ru&&er tips or ru&&erprophy cups

uper-loss or Post-care- nylon *i&ersthread *or interpro'imal use &et$eena&utments and under e'tensions


399/435

Implant Guidelines


end-tu*ted # small interdental&rushes(Pro'i&rushes) -*or cleanin"&uccal # lin"ual a&utment sur*acesL allmetal sur*aces must &e nylon coated

electric tooth&rushes -use at discretioo* dentistL may &e use*ul i* limited manualde'terity


400/435

Implant Guidelines


chlorhe'idine - use durin" peri-sur"icalperiods or as needed i* episodes o* acuteso*t tissue in*lammation occur

*luoride rinses or "els -use neutral

sodium *luoride to avoid dama"e totitanium *i'tures that may occur $ithacidulated types


401/435

Implant Guidelines

8aintenance


y"iene Aids

Pro&lems


402/435

Implant Guidelines

8aintenance Pro&lemsR

so*t tissue reactions*ractured or loosened scre$s*ailin" or *ailed *i'ture

&ro/en attachments% components


403/435

Implant Guidelines

Pro&lemsRso*t tissue reactions

most common due to loose scre$spoor oral hy"iene can lead to

+peri-implantitis - may result in

pro"ressive &one loss

lac/ o* attached peria&utment so*t tissu*ailed or *ailin" implants


404/435

Implant Guidelines

Pro&lemsRso*t tissue reactions

treatmentRremove o**endin" scre$5 ti"htena&utment # reinsert prosthesis

rein*orce oral hy"ieneso*t-tissue auto"ra*t

replacement o* *ailed implant


405/435

Implant Guidelines

Pro&lemsR*ractured or loosened scre$s

0st suspicion $hen complaint o* +looseimplant or discom*ortuse correct scre$driver *or scre$ head

$ithout e'cess *orce or can +round o**he'

i* retrievin" (+teasin" out) *racturedscre$ caution not to dama"e he'


406/435

Implant Guidelines

Pro&lemsR*ailin" or *ailed *i'ture

*ailin" implant !s *ailedimplant

+implantitis !s

periodontal disease


407/435

Implant Guidelines

Pro&lemsR*ailin" or *ailed *i'ture

*ailin" implantclinical si"nsR pro"ressive crestal

&one lossL so*t tissue poc/etin"L B,

$% possi&le purulenceL tenderness to

percussion or torue


408/435

Implant Guidelines

Pro&lemsR*ailin" or *ailed *i'ture *i'ture loss

*ailin" implantcausesR sur"ical compromises (&on

overheatin"5 lac/ o* initial sta&ility)Lnonpassive superstructuresL too rap

initial loadin"L *unctional overloadLinadeuate scre$ Joint closureLin*ection


409/435

Implant Guidelines


*ailin" implanttreatmentRremove and replace $ith lar"er

diameter *i'tureL or treat in*ection

# re- evaluate interim - remove prosthesis #

a&utments # irri"ate area $% CQLdisin*ect components # reinsert


410/435

Implant Guidelines


*ailedimplantclinical si"nsR mo&ilityL +dull

percussion soundL peri-implantradiolucency

(connective tissue implantencapsulation may not &e visi&le onradio"raph)


411/435

Implant Guidelines


*ailed implant (most noted at ta"e II)causesR sur"ical compromises (&on

overheatin"5 lac/ o* initial sta&ility)Lnonpassive superstructuresL too rap

initial loadin"L *unctional overloadLinadeuate scre$ Joint closureLin*ection


412/435

Implant Guidelines


*ailed implant (most noted at ta"e II)treatmentR

removal o* implant


413/435

Implant Guidelines


+implantitis !s periodontitisclinical si"nsRsimilar clinical

presentation $% same patho"enic

microor"anisms

causesRpoor oral hy"ieneL &acteriaLcause may &e un/no$n (?)


414/435

Implant Guidelines


+implantitis !s periodontitistreatmentRconsults to provider - consider

rema/e or "uided tissue re"enerationetc:

interim - remove prosthesis #a&utments # irri"ate area $% CQLdisin*ect components # reinsert


415/435

Implant Guidelines

Pro&lemsR&ro/en attachments% components

remove o**endin" attachment(i* possi&le) and replace or

provisionali@e

&e care*ul not to dama"e e'ternal he' oscratch titanium *i'ture or a&utment


416/435

Implant Guidelines

Case election Implant recommended

replacement o* teeth X7;501 # 93

Implant not recommended

replacement o* tooth X72s


417/435

Case X0


418/435

Implant Guidelines

Implant recommended 6 y%o male presented $ith *ailin"

=CT X7; and severe locali@edperiodontitis

tooth deemed hopeless ande'tracted


419/435

Implant Guidelines

Implant recommended :3 ' 02mm =o&elpharma *i'ture

placed


420/435

Implant Guidelines

Implant recommended Cera-,ne a&utment restored $ith

cemented (Setac Cem) P8 cro$n


421/435

Case X 7


422/435

Implant Guidelines

Implant recommended 90 y%o *emale presented $ith

missin" X01 # 935 and retainedX0; # 97 (third molars)


423/435

Implant Guidelines

Implant recommended mesial-an"ulated X02 # 90 $ith

inadeuate mesial-distal andinterarch spacin" due to super-erupted opposin" X 9 # 0


424/435

Implant Guidelines

Implant recommended &uccal-lin"ual rid"e $idths in areas

o* missin" X01 and X93 alsode*icient


425/435

Implant Guidelines

Implant recommended teeth X 0; # 97 e'tracted and

&ilateral ramus "ra*ts placed atedentulous sites (X01 # 93)


426/435

Implant Guidelines

Implant recommended molar upri"htin" o* teeth X02 # 90

completed to create adeuatespace *or implants


427/435

Implant Guidelines

Implant recommended


428/435

Implant Guidelines

Implant recommended restoration o* *i'tures $ith scre$-

retained non-se"mented DCEAa&utments $% P8 cro$ns


429/435

Implant Guidelines

Implant recommended restoration o* teeth X 9 # 0 $ith

P8 cro$ns to re-esta&lish properocclusal plane


430/435

Case X 9


431/435

Implant Guidelines

Implant not recommended 9 y%o male presented $ith past

history o* supernumerary X72 =oteR dilacerated root to mesial on

X72


432/435

Implant Guidelines

Implant not recommended edentulous site presented $ith

inadeuate *acial &one5 andinadeuate spacin" e'isted&et$een X7; # 72 root apices toallo$ implant placement


433/435

Implant Guidelines

Implant not recommended a*ter t$o years o* orthodontic

therapy5 X72 *ailed to move to*acilitate implant placement


434/435

Implant Guidelines

Implant not recommended edentulous area restored $ith a

resin-&onded *i'ed partial denture(BP X7;-72)


435/435

YD>TI,= ???

D BIG>

kuliah pakar fkg unissula 3

Documents