1. Dr. Angelo C. Trödhan Center for Facial Esthetics Clinic OA Dr. Angelo C. Trödhan Dr. Izabela Schlichting www.perfectsmileandface.comwww.perfectsmileandface.com www.kieferchirurgie.at www.parodontose.atwww.kieferchirurgie.atwww.parodontose.at

2. Dr. Angelo C. Trödhan Center for Facial Esthetics Clinic OA Dr. Angelo C. Trödhan Dr. Izabela Schlichting WorkShop Implantology How to manage soft tissues and immediate loading Non invasive methods

3. Dr. Angelo C. Trödhan PART I Basic Principles of Anatomy Physiology Atraumaticy

4. Dr. Angelo C. Trödhan Basic Principles Soft Tissue is the Issue But the Bone makes the tone Use autraumatic surgical Procedures whenever Possible Use the Tissues Regenerative Capacities whenever Possible COPY NATURE

5. Dr. Angelo C. Trödhan Physiology of Regular Alveola Vs. Implant Site („Bony Aspects“) Alveolar Bone Root Periodontal Ligament Crown Length Root Lenght NO Periodontal Ligament Dental Implant: Bone RESORBS on Pressure Bone GROWS on Pull of the Perio-Ligament OVERLOAD of Implant is ALWAYS RESORPTION !

6. Dr. Angelo C. TrödhanCONCLUSION Simple cylindrical Implants ALWAYS have to be: LONGER than the natural tooth WIDER than the natural tooth to achieve the same SURFACE like the replaced tooth OR You have a screw design that gives MORE surface to the Implant than the replaced tooth and DISTRIBUTES FORCES better. Then the Implant Is primarily stable and can be loaded IMMEDIATELY

7. Dr. Angelo C. Trödhan BONE Physiology Bone heals/regenerates/is prevented from resorption by: The Periosteum (basal cells of Sinus membrane are periost-like) Stabilized Blood Coagulum CALLUS (Haver´s/Volkmann vessels) Microfractures in the Spongiosa Bone speed up Bone Healing TWO TIMES !

8. Dr. Angelo C. Trödhan CONCLUSION WHENEVER POSSIBLE: Keep the Periosteum in place and intact ! (don´t denude the bone) Set microfractures in the spongiosa By Bone Condensing and Bone Spreading !

9. Dr. Angelo C. Trödhan BONE Quality Is hard to determine Can be measured by Bone-Densiometry (expensive !) Can be approximately determined by CT Most reliably felt by the hand of the Implantologist !

10. Dr. Angelo C. Trödhan BONE Atrophy Reduces Implant Length and width Forces us to put Implants in non- anatomical Positions and angles Makes Bone augmentation necessary

11. Dr. Angelo C. Trödhan BONE Augmentation The Less The more Success Primarily Bone Spreading and Condensing / Sinuslift If necessary Bone Distraction Free Grafts as little as possible

12. Dr. Angelo C. Trödhan Soft Tissue/Gingiva Is supported by the Bone and Periosteum Free Gingiva is supported by the natural crown / Implant Neck / Prosthetic Crown

13. Dr. Angelo C. Trödhan Keep Biological Width 1,5 – 2,3 mm If You reduce the gingiva You reduce Bone

14. Dr. Angelo C. Trödhan Keep Biological Width 1,5 – 2,3 mm If You reduce the gingiva You reduce Bone: „Brushing“- Recessions at Natural Teeth

15. Dr. Angelo C. Trödhan PART II Basic Principles of Pre-Surgical Diagnosis in everyday praxis

16. Dr. Angelo C. Trödhan See Me, Feel Me, Touch Me, Heal me ! From The WHO – Musical „Tommy“

17. Dr. Angelo C. Trödhan SEE, TOUCH, FEEL ! You have to TOUCH before You understand

18. Dr. Angelo C. Trödhan Inspection of the Future Implant-Site LOOK ! Configuration of Gingiva and Alveolar Crest, Angulation of adjacent teeth, Oral Hygiene TOUCH and FEEL ! Configuration of Alveolar Crest (Indentions, Height) on buccal/palate/lingual sites IMAGINE ! How You will proceed Surgically PLAN ! What other investigations do You need for atraumatic surgery and immediate loading ?

19. Dr. Angelo C. TrödhanRadiography Panoramic X-Ray with 5mm metal balls for measurement (it also tells You the thickness of the mucosa especially in the maxilla) Intraoral X-Ray

20. Dr. Angelo C. Trödhan Maximum Security: intra-OP digital Radiography

21. Dr. Angelo C. Trödhan Maximum Security: intra-OP digital Radiography

22. Dr. Angelo C. Trödhan Sometimes a Dental CT is helpful

23. Dr. Angelo C. Trödhan On a Cast-Model You can simulate the Operation

24. Dr. Angelo C. Trödhan Cardinal Principle of WHERE to place Implants for good cosmetic results Midline of Alveolar Crest Palate connection line Future cosmetic line Implant Position

25. Dr. Angelo C. Trödhan How Much Bone will I have ? The „Golden Rule“ Mandible: Measure the Alveolar Crest and subtract 2mm Maxilla: Measure the alveolar Crest and divide it by two and subtract another 2mm (You will wonder how thick the mucosa is in the upper jaw and how little bone You have !)

26. Dr. Angelo C. Trödhan PART III Decision making

27. Dr. Angelo C. Trödhan After clinic Investigation, radiography and Cast- model Planning You Know: The bone height and width All esthetic necessities Which size of Implant You will insert Where You will insert the Implant

28. Dr. Angelo C. Trödhan Q1-IMPLANT 2 4 Q-IMPLANT ® standard Neck = 4mm Q-IMPLANT ® short Neck = 2mm Variable Insertion Depth Length 8 mm 10 mm 12 mm 14 mm Diameter 3.5 mm 4.5 mm

29. Dr. Angelo C. Trödhan SurfOss II Surface...... Not only Titanium !!!

30. Dr. Angelo C. Trödhan Single Part Implant System Copys the natural shape of the root

31. Dr. Angelo C. Trödhan Single Part Implant System Copys the natural shape of the root Selfcutting screw-design

32. Dr. Angelo C. Trödhan Single Part Implant System Copys the natural shape of the root Selfcutting screw-design Bone Trap

33. Dr. Angelo C. Trödhan Single Part Implant System Copys the natural shape of the root Selfcutting screw-design Bone Trap Variable Insertion Depths for better prosthetic and esthetic handling

34. Dr. Angelo C. Trödhan Single Part Implant System Copys the natural shape of the root Selfcutting screw-design Bone Trap Variable Insertion Depths for better prosthetic and esthetic handling

35. Dr. Angelo C. Trödhan NO Abuttments Q-MultiCap for: Provisional Crown Impression Crown-Base

36. Dr. Angelo C. Trödhan Simple Instruments Pilot-Drill 1,5 Form-Drill 3,5/4,5 Insertion Wheel Insertion-Handle

37. Dr. Angelo C. Trödhan Q-Implant-Box

38. Impression & Preparation like on a natural tooth

39. Dr. Angelo C. Trödhan MultiCap

40. OP - SCHEME Punch or CutPilot-DrillForm-Drill 3,5mm Form-Drill 4,5mm (if Q1/4,5 is Chosen) Insertion Suture (if necessary)Provisional

41. Dr. Angelo C. Trödhan Single Tooth Traumatic loss of front teeth WITHOUT fracture of the alveolar ridge (11/21: luxated, 22: crown fractured)

42. Dr. Angelo C. Trödhan Immediate Implant-Insertion after extraction – Single tooth

43. Dr. Angelo C. Trödhan Immediate Implant-Insertion after extraction - Bridge

44. Dr. Angelo C. Trödhan Immediate Implant-Insertion after extraction – Single Tooth

45. Dr. Angelo C. Trödhan Immediate Implant-Insertion after extraction – Single Tooth

46. Dr. Angelo C. Trödhan One Week Later …

47. Dr. Angelo C. Trödhan Radiographic follow up …

48. Dr. Angelo C. Trödhan Gingiva after 2 Years

49. Dr. Angelo C. Trödhan Single Tooth Immediate Implant-Insertion after extraction

50. Dr. Angelo C. Trödhan Edentulous Maxilla

51. Dr. Angelo C. Trödhan Q2-Implant … when angulation does not fit … or two stage implantation is mandatory

52. Dr. Angelo C. Trödhan Q2-Abuttments platescrew, Ginigvaformer Straight crown-bases Angle-Abuttments 15 degrees Q1-Head

53. Dr. Angelo C. Trödhan Q2 – Single Stage Implantation

54. Dr. Angelo C. Trödhan Q2: 2-stage Implantation

55. Dr. Angelo C. Trödhan Q3-Implant: affordable rigid Fixation of total prosthesis

56. Dr. Angelo C. Trödhan Prosthesis without gum base

57. Dr. Angelo C. Trödhan Anchors can be inserted in the old prosthesis ! Gaumenfrei

58. Dr. Angelo C. Trödhan Solution for complicated Cases (Marcoumar-Patients)

59. Dr. Angelo C. Trödhan Rigid fixation of lower Prosthesis at uncompetable Prize

60. Dr. Angelo C. Trödhan I thank You For Your Attention Dr. Angelo Trödhan troed@aon.at www.perfectsmileandface.com