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Implant dentistry: Restoratively driven surgical practice
Surgical Clinics to substantiate the efficacy of these surgical methods. The following treatment factors will be discussed. I. Concomitant TMJ and orthognathic surgery A. Diagnosis and treatment planning 1) Clinical exam 2) Imaging 3) Decision making B. Surgical sequencing C. Disc repositioning 1) Disc dislocation 2) Idiopathic condylar resorption (ICR) D. Condylectomy for disproportionate growth 1) Condylar hyperplasia (high condylectomy) 2) Osteochondroma/osteoma (low condylectomy) E. Autogenous tissue replacement F. Total joint prosthesis Implementation of these techniques by the experienced, skilled surgeon, coupled with accurate diagnosis and treatment planning, can provide optimal functional and esthetic outcomes for our patients. References Wolford LM: Temporomandibular joint devices: Treatment factors and outcomes. Oral Surg Oral Med Oral Pathol 83:143, 1997 Mehra P, Wolford LM: The Mitek Mini Anchor for TMJ disc repositioning: Surgical technique and results. Int J Oral Maxillofac Surg 30:497, 2001 Wolford LM: Concomitant temporomandibular joint and orthognathic surgery. J Oral Maxillofac Surg (in press)
S212 Implant Dentistry: Restoratively Driven Surgical Practice Edmond Bedrossian, DDS, San Francisco, CA Practice: Due to their long-term stability, implant supported prosthesis have become accepted as a viable, and at times the recommended treatment for the edentulous alveolus. Proper initial evaluation and treatment planning of the implant patient is paramount to the long-term predictability and success of implants. It is imperative that the oral and maxillofacial surgeon be aware of the principles for treatment planning implant dentistry. The surgical principles are well understood by the oral surgeon. However, the lack of in-depth understanding of the restorative principles limits the growth of the implant practice for the oral and maxillofacial surgeon. The intention of this presentation is to review the evidencebased principles of implant dentistry and prosthetic parameters for single teeth. Partially edentulous as well as the fully edentulous patients will be reviewed. Abutment selection, abutment level vs fixture level impression techniques will be discussed. Custom abutments including the new ceramic abutments as well as screw retained vs cemented restorations will be compared and con94
trasted. Understanding these treatment planning principles allows for the long-term success of implant cases which in turn results in the growth of the oral and maxillofacial surgeon’s implant practice. References Huebner G: Int J Oral Maxillofac Implants 17: 2002 Simon H: Int J Oral Maxillofac Implants 18: 2003 Taylor T: Int J Oral Maxillofac Implants 16: 2001
S213 Ridge Expansion and Sinus Elevation: A Minimally Invasive Approach to Maxillary Reconstruction Daniel R. Cullum, DDS, Coeur d’Alene, ID Current implant therapy includes a number of techniques that allow for site development, implant placement and esthetic restoration with long-term function. Ridge expansion techniques have been developed to meet the ongoing challenge to improve results and shorten treatment time. Ridge expansion utilizes the biologic healing potential of bone, like an extraction site with simultaneous insertion of appropriate tooth size implant(s) to reproduce the functional proportions of the dentoalveolar complex. Miniflap or split-thickness flaps are used to preserve microvascular supply of the periosteum to the alveolus. With ridge expansion, a vascular “bone flap” is developed for implant placement and as necessary, allows transalveolar access to the sinus floor. Through this intrabony defect, sinus floor elevation can be completed at single or multiple adjacent sites using “osteotome,” “palatal infracture,” or “ridge pole” techniques. Significant sinus elevation of 7 to 9 mm can be obtained with implant placement. Sinus floor access can also be gained through the alveolar crest at an extraction site. Using a staged protocol, incremental sinus elevation can be completed with tooth removal in extraction sites and adjacent areas, and again in 8 weeks at implant placement. We will detail the various approaches including indications, contraindications, flap design, intraoperative decision making, and the management of complications. The role of split thickness flaps, free and pedicle grafts, and adjunctive periodontal “plastic” techniques will be demonstrated. Comparison with traditional techniques for block and particulate grafting, lateral wall sinus elevation, and osteotome sinus elevation will be reviewed. These minimally invasive techniques offer significant advantages, including excellent esthetics, minimal discomfort, faster healing, and eager patient acceptance. Experience in the use of “osteotomes” is helpful to reduce a significant learning curve. A practical approach to the introduction and progressive implementation of the techniques will be discussed. AAOMS • 2004
S212 Implant Dentistry: Restoratively Driven Surgical Practice Edmond Bedrossian, DDS, San Francisco, CA Practice: Due to their long-term stability, implant supported prosthesis have become accepted as a viable, and at times the recommended treatment for the edentulous alveolus. Proper initial evaluation and treatment planning of the implant patient is paramount to the long-term predictability and success of implants. It is imperative that the oral and maxillofacial surgeon be aware of the principles for treatment planning implant dentistry. The surgical principles are well understood by the oral surgeon. However, the lack of in-depth understanding of the restorative principles limits the growth of the implant practice for the oral and maxillofacial surgeon. The intention of this presentation is to review the evidencebased principles of implant dentistry and prosthetic parameters for single teeth. Partially edentulous as well as the fully edentulous patients will be reviewed. Abutment selection, abutment level vs fixture level impression techniques will be discussed. Custom abutments including the new ceramic abutments as well as screw retained vs cemented restorations will be compared and con94
trasted. Understanding these treatment planning principles allows for the long-term success of implant cases which in turn results in the growth of the oral and maxillofacial surgeon’s implant practice. References Huebner G: Int J Oral Maxillofac Implants 17: 2002 Simon H: Int J Oral Maxillofac Implants 18: 2003 Taylor T: Int J Oral Maxillofac Implants 16: 2001
S213 Ridge Expansion and Sinus Elevation: A Minimally Invasive Approach to Maxillary Reconstruction Daniel R. Cullum, DDS, Coeur d’Alene, ID Current implant therapy includes a number of techniques that allow for site development, implant placement and esthetic restoration with long-term function. Ridge expansion techniques have been developed to meet the ongoing challenge to improve results and shorten treatment time. Ridge expansion utilizes the biologic healing potential of bone, like an extraction site with simultaneous insertion of appropriate tooth size implant(s) to reproduce the functional proportions of the dentoalveolar complex. Miniflap or split-thickness flaps are used to preserve microvascular supply of the periosteum to the alveolus. With ridge expansion, a vascular “bone flap” is developed for implant placement and as necessary, allows transalveolar access to the sinus floor. Through this intrabony defect, sinus floor elevation can be completed at single or multiple adjacent sites using “osteotome,” “palatal infracture,” or “ridge pole” techniques. Significant sinus elevation of 7 to 9 mm can be obtained with implant placement. Sinus floor access can also be gained through the alveolar crest at an extraction site. Using a staged protocol, incremental sinus elevation can be completed with tooth removal in extraction sites and adjacent areas, and again in 8 weeks at implant placement. We will detail the various approaches including indications, contraindications, flap design, intraoperative decision making, and the management of complications. The role of split thickness flaps, free and pedicle grafts, and adjunctive periodontal “plastic” techniques will be demonstrated. Comparison with traditional techniques for block and particulate grafting, lateral wall sinus elevation, and osteotome sinus elevation will be reviewed. These minimally invasive techniques offer significant advantages, including excellent esthetics, minimal discomfort, faster healing, and eager patient acceptance. Experience in the use of “osteotomes” is helpful to reduce a significant learning curve. A practical approach to the introduction and progressive implementation of the techniques will be discussed. AAOMS • 2004