Practical Procedures in Implant Dentistry

Aodhan Docherty, BMedSci, BDent (Hons) (SYD), Grad Dip Clin Dent (Oral Implants) (SYD), PGDipClin (Orth) (CoL) Clinical Lecturer Australasian College of Dental Practitioners, Sydney, New South Wales, Australia

Jonathan Du Toit, BChD (UWC), MSc (Wits), Dip Oral Surg (CMFOS), Dipl Implantol (Frankfurt), MChD (OMP) (UP), FCD(SA) OMP Specialist in Periodontics and Oral Medicine Senior Lecturer Implant and Aesthetic Academy, Cape Town, South Africa

Tom Giblin, BSc (Syd) BDent (Hons) (Syd) CertPros (Texas), DICOI Clinical Lecturer Australasian College of Dental Practitioners Private practice, Sydney, New South Wales, Australia

Christopher C.K. Ho, BDS Hons (SYD), Grad Dip Clin Dent (Oral Implants) (SYD), M Clin Dent (Pros) (LON), D Clin Dent (Pros) (SYD), MRACDS (Pros), FIADFE, FPFA, FACD Head of Post Graduate School of Dentistry, Australasian College of Dental Practitioners, Sydney, New South Wales, Australia Clinical Lecturer Faculty of Dentistry, Oral and Craniofacial Sciences, King’s College London, London, UK Honorary Lecturer Faculty of Dentistry, University of Sydney, New South Wales, Australia Adjunct Associate Clinical Professor Faculty of Dentistry, University of Puthisastra, Phnom Penh, Cambodia

Kyle D. Hogg, DDS (Univ. of Michigan), AEGD (Univ. of Florida), MClinDent Prosthodontics (Lon) Post‐graduate Tutor and Clinical Lecturer King’s College London, Faculty of Dentistry, Oral and Craniofacial Sciences, London, UK

Louis Kei, BDSc Hons (Qld), MRACDS (GDP), DClinDent (Pros) (USyd), MRACDS (Pros) Clinical LecturerFaculty of Dentistry, University of Sydney, New South Wales, Australia

Jess Liu, DDS (NYUCD), MS (BU) Clinical Assistant Professor Director of the Implant Fellowship Henry M. Goldman School of Dental Medicine, Advanced Education Program Department of Periodontology, Boston, MA, USA

Anthony Mak, BDS (SYD), Grad Dip Clin Dent (Oral Implants) (SYD)) Private practice, Sydney, New South Wales, Australia

Tino Mercado, DMD, GCClinDent (Oral Path) (Qld), MDSc (Perio) (Qld), MRACDS (Perio), PhD, FPFA, FICD Associate ProfessorSchool of Dentistry, University of Queensland, Brisbane, Queensland, Australia

Sherif Said, BDS, MSD, CAGS, FRCD(C) Diplomate of the American Board of Periodontics Clinical Assistant Professor Department of Periodontology Henry M. Goldman School of Dental Medicine, Boston UniversityPrivate practice, Toronto, Canada

Lachlan Thompson,Dip. Dental Technology (Perth) Perth, Australia

Matthew K. Youssef, BHSc MDent (LaTrobe), PG Dip Implants (CSU) Private practice, Melbourne, Victoria, Australia

Don’t forget to visit the companion website for this book:

www.wiley.com/go/ho/implant‐dentistry

There you will find valuable material designed to enhance your learning, including:

Videos demonstrating clinical techniques and procedures.

Scan this QR code to visit the companion website.

Christopher C.K. Ho

The phenomenon of osseointegration has allowed for major improvements in both oral function and the psychosocial well‐being of edentulous patients. The improvement in quality of life may be life‐changing, allowing patients fixed replacement of teeth or, in cases of removable dental prostheses, significant improvement in retention and stability. In the 1950s, Swedish physician Per‐Ingvar Brånemark conducted in vivo animal experiments studying revascularisation and wound healing using optical titanium chambers in rabbit tibia. On removal of the titanium chambers it was discovered that bone was attached to the titanium. Subsequently, Brånemark dedicated his research to the study of bony integration. He defined osseointegration as ‘the direct structural and functional contact between ordered living bone and the surface of a load carrying implant’ [1].

Since those early days, progress in implant treatment has been remarkable, with many innovative and technological advances, including three‐dimensional (3D) imaging and computer‐aided design/computer‐aided manufacturing (CAD/CAM), new biomaterials, advances in implant configuration and connections, with surface modifications that have allowed improved surface reactivity for better bone–implant contact. Historically, specialist teams of surgeons and prosthodontist/restorative dentists undertook this therapy and achieved very high levels of success. However, with increasing numbers of implants and time in situ , as well as treatment by less‐experienced clinicians, there has been an increase in the number of complications encountered.

When implant treatment fails or a complication arises it can be extraordinarily disheartening for patients and clinicians alike. As well as significant costs there is the surgical morbidity of carrying out implant insertion with considerable time involvement. This leads to disappointment if treatment fails and may even lead to medico‐legal repercussions. No treatment is immune to failure, but proper management through comprehensive evaluation, diagnosis, and planning is paramount to success and minimising any complications. Along with careful case selection and planning, treatment should be performed with high levels of evidence‐based protocols and professional excellence and followed up with regular continuing care.

Since the introduction of moderately roughened implant surfaces and tapered, threaded implants the success of implants has become predictable, with very few failures occurring. The early failures are most likely due to surgical error, such as overheating of bone or not attaining sufficient primary stability due to over‐preparation. Most late failures occur as a result of peri‐implant infection or implant overload, and in the aesthetic zone due to insufficient soft or hard tissues around the implant. Extensive research has been conducted, combined with long‐term patient experience, allowing us to refine and improve the treatment protocols. There have been major developments in knowledge that have allowed significant improvements, including the following:

A prosthetically driven approach: Historically, a surgically driven approach was used in which implants were placed in the bony anatomy available. However, in cases of deficiency this resulted in final restorations that were compromised. A prosthetically driven approach is referred to as ‘backwards planning’; the final ideal tooth position is planned, and augmentation may need to be performed to allow the final implant to be in the optimal position.

Radiographic imaging: Cross‐sectional imaging with cone beam computed tomography (CBCT) scans in combination with the use of planning software allows 3D positioning for the prosthetically planned approach. Improved safety and predictability in implant insertion has resulted. The use of surgically guided templates to provide precise implant placement with alignment in the correct axis enhances predictability and reliability in placing implants that are bodily within bone, and with access alignment that may allow screw retention. It also allows the clinician to diagnose whether augmentation may need to be undertaken in either a simultaneous or staged approach with implant placement.