Implantdentistry and related topics

Adhesivelly cemented full ceramic restorations

2011-10-21T07:39:00.000-07:00

To save or to extract?

2011-08-02T02:36:00.000-07:00

An other case...

2011-03-23T13:43:00.000-07:00

27 years yound female.

Medical history nil relevant.

Preoperative x-ray

12 weeks after extraction

X – ray post surgery showing two BioHorizons 3,5mm x 12mm internal taper

Inserted in area 46 and 47

Picture showing the master model at delivery session – abutments attached to mounting guide.

Intraoral clinical picture showing the healthy and mature gum profile before prosthetic loading.

Intraoral clinical picture showing the fitted restoration.

Intraoral clinical picture showing the bite situation and the optimal hygiene access areas

X-ray to check the correct fit.

Implant supported prosthodontics

2011-03-23T13:37:00.000-07:00

69 years old male.

Medical history nil relevant.

Tooth 36 lost about 18 years ago. Tooth 35 lost about 10 weeks prior to fixture installation.

Fixtures installation in local anesthesia, crestal incison, ful flap raised, use of conventional surgical guide, drill protocol according manufacturer, fixtures inserted by hand, excellent primary stability, bone B-w, vestibular graft (BioOss) covered by membrane (BioGide), wound lips tightly closed by suture.

Suture removal after 14 days.

II nd stage surgery after 3 months. Local anesthesia, full flap raised, healing caps, wound lips sutured around.

Suture removal after 14 days.

Temporary abutments and temporary crowns to modelate mergence profile.

6 weeks later impression and FGP registration.

2 weeks later prosthetic loading.

X-ray performed after fixture installation.

Proof of healthy gum surroundings and prosthetic loading.

Clinical picture showing butments in situ.

Restoration delivered from the lab, splinted crowns PFM – high precious metal – occlusal screw access open – abutment mounting guide.

Clinical picture to demonstrate perfect aesthetic and functional integration into remaing dentition and excellent hygiene accessabilty.

Restore the posterior lower jaw with implant supported restorations

2010-11-28T00:25:00.000-08:00

Immediate implant placement and consecutive loading

2010-10-31T00:47:00.000-07:00

Prosthetic restoration on tooth 22 was compromised due to extremly reduced remaining coronal dimensions

Alveola measurments after extraction

Implant screwed in alveola

Original crown adjusted to be fixed on temporary abutment. Occlusion adjusted to avoid loading.

Temporary restoration in situ.

Radiographs showing the correct position of the implant.

2010-09-03T06:27:00.000-07:00

Wurzelbehandlung Zahn 26 - 4 Kanäle

2010-09-03T06:09:00.001-07:00

Full smile rehabilitation

2010-08-30T12:57:00.000-07:00

"All On Four" - the prosthetic result

2010-08-30T12:37:00.000-07:00

Extraction and immediate implant placement - toowth crown used as temporary

2010-08-30T12:02:00.000-07:00

Implantdentistry and related topics: Guided surgery - "All On Four" - "Teeth In An Hour"

2010-08-30T11:02:00.000-07:00

www.drsteier.de

Guided surgery - "All On Four" - "Teeth In An Hour"

2010-08-30T11:01:00.000-07:00

Implantdentistry and related topics: Perimplantitis - ein erfolgreiches Behandlungskonzept

2010-08-14T08:18:00.001-07:00

www.drsteier.de

Implantdentistry and related topics: Perimplantitis - ein erfolgreiches Behandlungskonzept

2010-08-14T08:18:00.000-07:00

Implantdentistry and related topics: Perimplantitis - ein erfolgreiches Behandlungskonzept

Perimplantitis - ein erfolgreiches Behandlungskonzept

2010-08-14T08:07:00.000-07:00

In einem besonders interesanntem Interview hat Herr Prof. Dr. Mombelli
gegenüber der Dental Tribune Germany zum Thema Periimplantitis die Diagnose,
Krankheitsursache sowie Behandlungswerdegang erläutert.
Dieses Interview können Sie unter folgendem Link nachlesen:

http://www.dental-tribune.com/articles/content/id/1137/scope/news/region/germany

An der Medizinischen Hochschule Hannover werden neue Wege zur Therapie beschritten:

http://www.mh-hannover.de/8156.html

Die Universität Mainz arbeitet intensiv an der Erforschung von körpereigenen Wachstumsfaktoren:

http://www.unimedizin-mainz.de/Prothetik/Weibrich/Images/Artikel/ZZI_2002_18_S84-90.pdf

HighTech ist besonders gefragt zur Elimination und Reduktion von Biofilm (Biofilm Engineering):

- Diodenlaser:

http://www.ivoclarvivadent.us/odyssey/

- Photoaktivierte Desinfektion:

http://www.zp-aktuell.de/praxis/parodontologie/story/vergleichende-untersuchungen-verschiedener-photodynamik-systeme.html

- Elektrochemisch aktivierte Desinfektion:

http://www.puricore.com/markets_dental.aspx

Treating a case of internal resorption

2010-07-27T02:50:00.000-07:00

RCT tooth 36 - single session

2010-07-15T03:47:00.000-07:00

RCT on tooth 47 - one canal - single session

2010-07-15T03:44:00.000-07:00

Wurzelkananlbehandlung in einer Sitzung / single session RCT

2010-07-08T04:27:00.000-07:00

Direct composite restoration

2010-06-16T12:35:00.000-07:00

The final result

Rebuiling the occlusal relief

Application of GIC and rebuilding the missing wall

Preoperative clinical situation

Root canal treatment

2010-06-10T12:22:00.000-07:00

Root canal treatment

2010-06-10T12:20:00.000-07:00

Root canal treatment

2010-06-10T12:17:00.000-07:00

Minimal invasive tooth extraction of an aterior tooth and immediate implant placementtClinica

2010-06-08T08:42:00.000-07:00

Tooth 11 with failing RCT, adhesive post and core, crown decementation

A 3 dimensional x-ray (CBCT ) was taken to evaluate available bone

The 3 dimensional reconstructions shows demonstrates a CAP

To preserve as much bone as possible an atraumatic extraction was preformed

Bone spreadding and implant insertion

X-ray showing the final result.

Internal sinus elevation - immediate implant placement - socket grafting

2010-05-21T08:09:00.000-07:00

Bone grafting - upper jaw

2010-05-19T07:42:00.000-07:00

Internal sinus elevation

2010-05-19T07:14:00.000-07:00

Sinus elevation using the minimal invasive balloon technique

2010-05-19T04:31:00.000-07:00

Prosthetic driven implant placement

2010-05-18T05:20:00.000-07:00

"Comp up technique" for optimal anatomy in posterior direct adhesive restorations

2010-05-18T03:41:00.000-07:00

Crestal bone stability with implants placed in previous sinus elevated area - long term recall

2010-05-16T09:07:00.001-07:00

Guided bone regeneration using autologue bone graft for the aesthetic area.

2010-05-16T08:11:00.000-07:00

Clinical picture showing how graft recipient area is adjusted for optimal graft fit and passive imobilization.

Tooth loss means bone loss. Vertical and horizontal bone regeneration can be very challenging.

The most predictable procedure is bone grafting.

This case has been solved using bone graft from ramus mandibulae of the patient.

Aesthetic and functional restoration with implant supported crowns

2010-05-16T08:05:00.001-07:00

Clinical picture of implant supported crowns

Preoperative clinical pictures of fractured anterior teeth

Wax up of study casts for correct treatment planning

2010-05-16T07:57:00.000-07:00

The buccal wax up preview

The ready waxed up study casts mounted in the articulator

Study casts before and after wax up

The "Comp up technique" used for direct posterior adhesive restorations

2010-05-11T02:55:00.000-07:00

Patient treatment decision tree

2010-05-11T02:13:00.000-07:00

Chronic Apical Periodontitis with sufficient orthograde RCT

CAP persistence (Mah TF, O Toole GA. Mechanisms of biofilm resistance to antimicrobial agents. Trends Microbiol 2001;56:672-7 / Russel AD. Biocide use and antibiotic resistance: the relevance of laboratory findings to clinical and environmental situation. Lancet Infect Dis 2003; 3:794-803)
Factors influencing Periapical Wound Healing:
1. Infection
2. Foreign bodies
3. Systematic disease
4. impaired host s immune system
Treatment options
1. Surgical retreatment
1.1 Surgical Retreatment RCT without graft
1.2 Surgical Retreatment with guided bone regeneration
Evidence for both procedures is controversial.
Evidence available for the use of autogenous bone graft.
Evidence available for the use of growth factors (PRGF).
2. Extraction
2.a Without socket preservation
Risk of bone resorption ==> buccal bone plate to resorp faster (first 3 months)
2.b With socket preservation
Evidence available to support procedure.
2.1 No further treatment
2.2 Removable device
2.3 Bridge
2.4 Implant

No further treatment

Benefits
"0"

Disadvantages
Bone resorption
Function limitations
Aesthetics issues
Tilting of neighbough teeth
Extrusion of antagonist teeth

Removable device

Benefits
Fast
Reduced costs

Disadvantages
Bone resorption
Function limitations
Aesthetic issues
Reduced retention

Bridge

Benefits
Time saving
Costs

Disadvantages
Bone resorption
Aesthetic issues
Removal of healthy tooth structure (adjacents teeth) long term ==> creates problems?

Implant

Benefits
Maintain bone
Preventive treatment measure

Disadvantages
Costs
Prolonged treatment time
Optional graft needed
Temporization

Clinical value of 3 dimensional x-ray (CbCT) for root canal treatment

2010-05-07T13:00:00.000-07:00

Restoring a previous endodontic treated tooth with a direct adhesiv restoration

2010-05-07T12:48:00.001-07:00

Root canal treatment tooth 17

2010-05-07T11:09:00.000-07:00

24 months recall x-ray

Postoperative x-ray control of the preformed root canal obturation

Intraoperative x-ray
Root canal obturation control tooth 17

Trauma case

2010-05-06T04:03:00.000-07:00

Clinical picture showing the end result once teeth 11 and 21 received their definitive full ceramic restorations.

X-rays showing the preoperative - postoperative situation as well as control of the root canal performed on tooth 21 (as well due to trauma).

Details of the CbCT to show the missing buccal bone plate.

CbCT reconstruction shoing the lack of bone due to extraction and trauma.

Preoperative CbCT after traumatic tooth loss position 11 (FDI).

Endodontics - simply rewrite history

2010-04-30T13:55:00.001-07:00

Reading the dentin using magnification, light and of course ultrasonics...
...and the final result!

Decayed teeth treated with direct adhesive restorations

2010-04-30T13:49:00.001-07:00

...aesthetic harmony!

...and immediatly after restoration ...

Direct clinical pictures showng decayed upper molars...

Once you remove a crown... you never know what you find beneath!

2010-04-30T13:39:00.001-07:00

Direct clinical pictures after crown removal.

Upper left x-ray showing a leaking crown with decay affecting the pulp integrity.

Upper right x-ray showing the tooth after crown removal and preformed adhesiv pre-endodontic build up.

Lower x-ray showing tooth with performed root canal treatment.

There always are chances...

2010-04-30T13:32:00.000-07:00

Can chronic apical periodontitis really heal?

2010-04-30T13:25:00.000-07:00

2010-04-29T11:28:00.001-07:00

Preoperative x-ray showing the clinical situation (all three upper right molars missing - opposing arcade having all three molars).

Master model showing the newly regained gum relief.

Direct clinical picture showing the nice modelation of the the gum - interdental papilae.

The lab work before seating.

The screw reatined crowns in place before closing the access cavity.

The aesthetic harmony!

X-ray control to check the fit of the rstorations.

A combination of cemented and screw reatained way of crown cemebtation

2010-04-25T06:44:00.000-07:00

How to avoid failures while seating implant retained crowns?

Incident:

Formation of cement cushion between abutment and crown.

Disadvantage:

Crown can not be seated in full.

How to avoid?

By adequate crown venting - the occlusal acces of the crown will allow evacuation of cement.

Incident:

Abutment screw gets loos over time.

Disadvantage:

Decementation of crown may be difficult to almost impossible resulting in need of destruction.

How to avoid?

Occlusal open crown will allow for future abutment screw tightening.

2010-04-17T06:04:00.000-07:00

Preoperative x-ray showing the failing teeth.

Intraoral picture showing the preoperative clinical situation.

The wound was covered with PRGF once implants have been inserted and bone graft performed.

Control x- ray proving the perfect position of the implants.

Immediate temporaries

Patient received immediate temporaraies once the surgical procedure was completed.