lp10 implantologie
DESCRIPTION
LP10 ImplantologieTRANSCRIPT
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Implante de forma radiculara
Incarcarea osoasa progresiva
Densitatea osoasa - Influenta asupra
tratamentului
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Implante de forma radiculara
• design-ul utilizat curent
• 1809 - implant din Au (Maggiolo)
• 1887 - implant din portelan armat cu tije Pt acoperite cu Pb (Harris)
• 1900 - implante din Al, arama, Cu, Ag, Au, otel
• 1909 - implant din Ir - Pt (Greenfield)
• 1938 - implant din Cr - Co chirurgical (Strock)
• 1940 - “fuziunea” Ti - os (Bothe)
• 1960 - osteointegrarea (Branemark)
• actual - > 50 tipuri
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Implante de forma radicularaInsertia chirurgicala
• etape
• incizia mucoperiostului - palpare pentru zone subminate
• evitarea structurilor nervoase
• lateral de muchia crestei (lingual)
• decolarea lambourilor - expunerea elementelor anatomice
• pregatirea osului crestal
• eventuala osteoplastie
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Implante de forma radicularaInsertia chirurgicala
• pregatirea cavitatii implantului - obtinerea fixarii rigide
• fara trauma - racire, 2000 rotatii / minut
• 47 grade Celsius - 1 minut - necroza osoasa
• osul putin dens - rotatii mici
• osul dens - rotatii mai
• pauze
• freza pilot - marcheaza pozitia (globulara)
• freze de diametre crescatoare
• minimum 6 - 7 mm intre centrele cavitatilor
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Implante de forma radicularaMarcarea orificiilor
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Implante de forma radicularaPregatirea cavitatilor
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Implante de forma radicularaInsertia chirurgicala
• utilizarea gutierei chirurgicale pentru stabilirea pozitiei si angulatiei
• crearea cavitatii (gaurire) cu freze calibrate
• paralelizare
• aplicare sub nivelul crestei la bruxisti, dupa osteoplastie, in os poros
• implante cu colet evazat - bizotare os (doar in corticala)
• tarodare - doar in os dur (autofiletante)
• insertie
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Implante de forma radicularaParalelizarea cavitatilor
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Implante de forma radicularaAdancirea implantelor (countersink)
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Implante de forma radicularaInsertia chirurgicala
• PRP
• surub de acoperire faza I / unguent
• sutura etansa a plagii
• “decompresia” protezei - reconturare pentru excluderea micromiscarilor implantului
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Implante de forma radicularaInsertia chirurgicala
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Implante de forma radiculara Descoperirea
• etapa de descoperire
• evaluare implant
• deziderate:– fixare rigida– pozitie corecta – mucoasa fixa – grosimea gingiei periimplantare < 3 mm – asimptomatic
• evaluare radiologica - fara resorbtie crestala
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Implante de forma radicularaDescoperirea
• descoperire cu incizie clasica
• electrotom
• freze trepan mucos
• laser
• insurubare extensii perimucoase - suruburi de vindecare
• modelarea sulcus periimplantar
• restaurarea defectului osos (resorbtie) - amanare 4 luni
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Implante de forma radicularaDescoperirea
• constatarea lipsei osteointegrarii - explantare• mobilitatea implantului • alternative dupa explantare:
– lucrare cu stalpi mai putini– implant cu diametru mai mare– implant in alta locatie– reconstructia cavitatii si implantare in etapa II
• evaluarea mucoasei• grosime: 2 - 3 mm• latime - plastie
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Implante de forma radicularaAmprentarea
• dupa vindecarea tesuturilor periimplantare - amprentarea
• insurubarea adaptoarelor de transfer
• amprenta preliminara pentru lingura individuala
• etapele protetice sunt decalate cu cate 1 saptamana - pana la 4 saptamani in functie de densitatile osoase
• os dens - etapele se succed la 1 saptamana
• os poros - etape distantate pentru maturarea progresiva a osului
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Implante de forma radicularaAmprentarea
Pregatirea lingurii individuale pentru amprenta
Insurubarea analogurilor de transfer pentru amprentarea indirecta
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Implante de forma radicularaIncarcarea osoasa progresiva
• esecul implantelor - incarcare mecanica prea rapida - in os imatur
• suprastructuri neadaptate
• conceptul incarcarii osoase progresive - maturare os la interfata
• proces dependent de densitatea osoasa
• creste sarcina aplicata implantelor dupa descoperire
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Implante de forma radicularaIncarcarea osoasa progresiva
• Etape incarcare osoasa progresiva:
– vindecare initiala
– descoperire
– suruburi acoperire / vindecare + amprenta preliminara
– amprenta finala
– probe
– aplicare provizorie
– aplicare definitiva
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Implante de forma radicularaIncarcarea osoasa progresiva
• amprenta preliminara pentru lingura individuala
• lingura individuala decupata in dreptul implantelor
• amprenta finala cu adaptoarele de transfer insurubate
• metoda directa - desurubare in timpul prizei
• remontarea in lingura a analogului de implant
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Implante de forma radicularaAmprentarea
Amprentarea directa
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Implante de forma radicularaIncarcarea osoasa progresiva
• amprenta antagonistilor
• inregistrarea ocluziei
• bonturi (abutments) prefabricate slefuite sau turnate
• proba machetei
• inregistrarea functiei / esteticii
• marcarea pozitiei marginii incizale a frontalilor superiori si conturul lor vestibular
• inchiderea marginala importanta pentru tesuturile moi si cement
• ocluzia functionala - ! ! parafunctii
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Implante de forma radicularaIncarcarea osoasa progresiva
Mezostructura Conectarea cu bara
Lucrare tip F 3
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Implante de forma radicularaIncarcarea osoasa progresiva
• instruire alimentatie moale, progresiv completa
• in densitati mici, dieta moale pastrata mai mult timp
• igiena excelenta, controlata periodic
• cimentarea sau insurubarea lucrarii
• la lucrarile insurubate - incarcarea osoasa progresiva este dificila
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Densitatea osoasa Influenta asupra tratamentului
• efectul densitatii asupra:
– planificarea terapeutica
– designul implantului
– etapa chirurgicala
– fixarea rigida primara
– timpul de vindecare
– incarcarea osoasa progresiva
• nu poate fi influentata in prealabil de medic
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Densitatea osoasa Influenta asupra tratamentului
• evaluata preliminar radiografic• CT• intraoperator• examinarea corticalei + spongioasei
• 1926 - MacMillan - observa trabecularitatea in conjunctie cu fortele masticatorii
• densitatea scade in timp dupa pierderea dintelui• categorii osoase diferite in functie de densitatea osoasa
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Densitatea osoasa Influenta asupra tratamentului
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Densitatea osoasa Influenta asupra tratamentului
• 4 grupe de densitate - D1, D2, D3, D4
• D1 - dens compact
• D2 - poros compact
• D3 - grosier trabecular
• D4 - fin trabecular
• repartitia anatomica (relativa !), planul terapeutic, considerente chirurgicale, timpul de vindecare
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Densitatea osoasa D 1 • os foarte dens, compact (stejar)• osul simfizei mentoniere - creasta reziduala interforaminala• special pe versantele laterale• datorita originilor muschilor si torsiunii mandibulei• vascularizatie redusa (depinde de periost)• histologic: lamelar, intens mineralizat (0,6 microni/zi)• suporta forte mari• contact implant - os = 80 %• dificil de gaurit, tarodat, trauma termica, multe freze• vindecare - 5 luni
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Densitatea osoasa D 2
• combinatie intre os dens compact - poros compact
• similar lemnului de pin
• osul regiunilor mandibulare laterale (uneori si anterior)
• conditii excelente de osteointegrare
• vascularizatie foarte buna
• os reticular + lamelar
• contact implant - os = 70 %
• cantitatea de os in contact cu implantul creste cu incarcarea progresiva
• vindecare scurta - 4 luni
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Densitatea osoasa D 2
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Densitatea osoasa D 3
• combinatie intre os poros compact - fin trabecular• similar lemnului de pluta• osul regiunilor maxilare anterioare (uneori si mandibulare laterale) • prelucrare si gaurire foarte facila, putine freze, fara tarod sau
countersink• risc perforare, supradimensionare cavitate• vascularizatie excelenta• contact implant - os = < 50 %• cantitatea de os in contact cu implantul creste cu angrenarea corticalei
nazale, sinusale• vindecare - 6 luni
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Densitatea osoasa D 4 • os fin trabecular• densitate foarte mica (stiropor)• osul regiunilor maxilare posterioare• usor de prelucrat, dificil de obtinut fixare rigida• freze mai inguste decat implantul• implante autotarodante sau press - fit• avantaje press - fit• contact os - implant = 25 %• implante suplimentare pentru cresterea densitatii• vindecare lunga - 8 luni • nu se aplica lucrari cu extensii• in D3 si D4 - implante acoperite cu HA
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Densitatea osoasa D 4