Tx Planning for Implant Dentistry NYU Protocols 2023-2024 PDF

Tx Planning for Implant Dentistry NYU DDS Protocols -- 2023-2024 Leila Jahangiri, BDS, DMD, MMSc Chair, Department of Prosthodontics Leila Jahangiri, BDS, DMD, MMSc Ira E. Klein Professor & Chair, Department of Prosthodontics 1. Case selection for simple fixed implant restorations 2. Case selecti...

Tx Planning for Implant Dentistry NYU DDS Protocols -- 2023-2024 Leila Jahangiri, BDS, DMD, MMSc Chair, Department of Prosthodontics Leila Jahangiri, BDS, DMD, MMSc Ira E. Klein Professor & Chair, Department of Prosthodontics 1. Case selection for simple fixed implant restorations 2. Case selection for two implant overdentures 3. Describe clinical and referral steps / protocols 4. Become familiar with resources and manuals available for pre-doctoral cases 1 Tx Planning for Implant Dentistry NYU DDS Protocols -- 2023-2024 Leila Jahangiri, BDS, DMD, MMSc Chair, Department of Prosthodontics Implant overdenture Single-unit implant restoration • Updated CDT codes • Addition of digital protocol for implant impressions/scanning • Enhanced manual with images • Prevention of accidental aspiration/ingestion • “Quick reference guides” 2 Tx Planning for Implant Dentistry NYU DDS Protocols -- 2023-2024 Leila Jahangiri, BDS, DMD, MMSc Chair, Department of Prosthodontics Average Age 90 100 75 80 60 40 38 47 Average Age 20 0 1800 1900 1996 2050 Year 40 % are edentulous In at least one arch US population 65+ 3 Tx Planning for Implant Dentistry NYU DDS Protocols -- 2023-2024 Leila Jahangiri, BDS, DMD, MMSc Chair, Department of Prosthodontics 1 Assessment + EHR forms 2 Consultation with a Surgeon 3 Surgical appointment and Assist 4 Surgeon’s OK to restore 5 Restore 4 Tx Planning for Implant Dentistry NYU DDS Protocols -- 2023-2024 1 Leila Jahangiri, BDS, DMD, MMSc Chair, Department of Prosthodontics Assessment - Attached mucosa Gently pull the lower lip 1 Assessment of the ridge width Assessment for a knife edge ridge 5 Tx Planning for Implant Dentistry NYU DDS Protocols -- 2023-2024 Leila Jahangiri, BDS, DMD, MMSc Chair, Department of Prosthodontics 1 Assessment of the ridge width 1 Assessment of the site Mental Foramen - the anterior exit of the mandibular canal and the inferior alveolar nerve. In cases of severe residual ridge resorption, the foramen occupies a more superior position. 6 Tx Planning for Implant Dentistry NYU DDS Protocols -- 2023-2024 1 Leila Jahangiri, BDS, DMD, MMSc Chair, Department of Prosthodontics Radiographic Assessment Minimum height of bone required is 2 mm more than the implant selected. Typically 10mm for 8mm; or 12 mm for 10mm implant 1 Assessment of the denture Alternately apply unilateral force to posterior occlusal surfaces There should be NO rocking. 7 Tx Planning for Implant Dentistry NYU DDS Protocols -- 2023-2024 1 Leila Jahangiri, BDS, DMD, MMSc Chair, Department of Prosthodontics Assessment & EHR form Assessment Form Located:  Under FORMS  PROS UG  PROS UG Implant Assess/Pros 1 Assessment & EHR form Two forms area available: 8 Tx Planning for Implant Dentistry NYU DDS Protocols -- 2023-2024 1 Leila Jahangiri, BDS, DMD, MMSc Chair, Department of Prosthodontics Assessment & EHR form 1. UG PROS– UG IMPLANT Assess/Pros 2. X-rays 3. Casts 4. At the bottom of the form is a location for CONSULTATION in the same form 2 Apt. for Surgical Consultation Faculty or an Administrator in Periodontology and Implant Dentistry will check daily for all “requests for consults” Assigns and communicates with resident within 1-2 days for SURGICAL CONSULTATION by PERIO, OMFS, IMPLANT FELLOW, PROS 9 Tx Planning for Implant Dentistry NYU DDS Protocols -- 2023-2024 Leila Jahangiri, BDS, DMD, MMSc Chair, Department of Prosthodontics On occasions for ridge assessment CBCT is necessary at an additional cost 2 Consultation for surgery • If they are healthy to have an extraction, they are healthy for implants • Controlled diabetes NOT a contraindication • Smoking NOT a contraindication - reduces success rate • Takes 1-2 hours, procedures performed under local • Discomfort for 1-2 days, similar to extraction PREDOCTORAL IMPLANTS MUST BE Straumann BLT 10 Tx Planning for Implant Dentistry NYU DDS Protocols -- 2023-2024 3 Leila Jahangiri, BDS, DMD, MMSc Chair, Department of Prosthodontics YOUR ROLE Surgical appointment • Follow the protocol for case selection • Pre-doc students are encouraged to assist • Follow up phone call to your patient (that night or next day) • See the patient within 2-7 days • Adjust denture to relieve pressure on the denture 3 Surgical appointment PG student in surgical area will order the implants and pick up the components 11 Tx Planning for Implant Dentistry NYU DDS Protocols -- 2023-2024 Leila Jahangiri, BDS, DMD, MMSc Chair, Department of Prosthodontics An implant has been placed Assess implant for restoration Assess implant for restoration 12 Tx Planning for Implant Dentistry NYU DDS Protocols -- 2023-2024 4 Leila Jahangiri, BDS, DMD, MMSc Chair, Department of Prosthodontics Surgeon’s OK to restore • This time period can range from 2-6 months. Typically 3 months is recommended for mandibular OD. • Surgeons will remove healing cap and replace with healing abutment. – Assess torque and write OK to restore. • May require additional denture adjustment 5 Pre- doc restore • Remove the healing abutment • Measure the tissue height to the head of the implant platform of EACH implant site • Determine a suitable size for each abutment • Complete the implant parts requisition form and drop off at CDL- 7th floor 13 Tx Planning for Implant Dentistry NYU DDS Protocols -- 2023-2024 5 Leila Jahangiri, BDS, DMD, MMSc Chair, Department of Prosthodontics restore Locator attachments for Nobel and Straumann are NOT interchangeable. • Follow the 5 step protocol • Every DDS student must treat an overdenture patient • DDS to discuss mandibular OD with all edentulous patients • Very high success rate and patient satisfaction 14 Tx Planning for Implant Dentistry NYU DDS Protocols -- 2023-2024 Leila Jahangiri, BDS, DMD, MMSc Chair, Department of Prosthodontics 1 Assessment & EHR forms 2 Consultation with a Surgeon 3 Surgical appointment and Assist 4 Surgeon’s OK to restore 5 Restore 15 Tx Planning for Implant Dentistry NYU DDS Protocols -- 2023-2024 1 Leila Jahangiri, BDS, DMD, MMSc Chair, Department of Prosthodontics Assessment of the site AXIUM Assessment Form X-rays Models Measurements 1 Assessment of the site Single teeth 16 Tx Planning for Implant Dentistry NYU DDS Protocols -- 2023-2024 1 Leila Jahangiri, BDS, DMD, MMSc Chair, Department of Prosthodontics Assessment of the Adjacent teeth RESTORATIVE CONDITION OF NEIGHBORING TEETH BONE CONDITION OF NEIGHBORING TEETH 17 Tx Planning for Implant Dentistry NYU DDS Protocols -- 2023-2024 1 Leila Jahangiri, BDS, DMD, MMSc Chair, Department of Prosthodontics Assessment of the site     1 Soft Tissue Bone Width Bone Height Assessment of the site 7 mm 7 mm Palpation     Palpation Soft Tissue Bone Width Bone Height Minimum space necessary 7 mm in three dimensions 18 Tx Planning for Implant Dentistry NYU DDS Protocols -- 2023-2024 1 Leila Jahangiri, BDS, DMD, MMSc Chair, Department of Prosthodontics Assessment of the site     1 Palpation Soft Tissue Bone Width Bone Height Assessment of the site 12 mm     Palpation Soft Tissue Bone Width Bone Height Indication for a CBCT 19 Tx Planning for Implant Dentistry NYU DDS Protocols -- 2023-2024 1 Leila Jahangiri, BDS, DMD, MMSc Chair, Department of Prosthodontics Assessment of the site occlusion Site assessment must take OCCLUSION into consideration  Inter arch Relationship – space 7 mm  Wear facets and parafunction 1 Assessment of the site Inter-arch relationship 7 mm 20 Tx Planning for Implant Dentistry NYU DDS Protocols -- 2023-2024 1 Leila Jahangiri, BDS, DMD, MMSc Chair, Department of Prosthodontics Assessment of the site Anatomical limitations  Nerves  Sinuses  Ridge Anatomy 21 Tx Planning for Implant Dentistry NYU DDS Protocols -- 2023-2024 1 Leila Jahangiri, BDS, DMD, MMSc Chair, Department of Prosthodontics Assessment & EHR form Two forms area available: Two forms area available: For “single” implant - select tab Single I Re Part Edent 22 Tx Planning for Implant Dentistry NYU DDS Protocols -- 2023-2024 2 Leila Jahangiri, BDS, DMD, MMSc Chair, Department of Prosthodontics Apt. for Surgical Consultation DDS student must do the following: 1. Assessment Form on EHR2. X-rays or CBCT with a justification 3. Models 4. Measurements SURGICAL CONSULTATION - as before PERIO, OMFS, IMPLANT FELLOW, ENDO, PROS 3 Surgical appointment Surgeon will order and pick up the components 23 Tx Planning for Implant Dentistry NYU DDS Protocols -- 2023-2024 Leila Jahangiri, BDS, DMD, MMSc Chair, Department of Prosthodontics Bone Types 1 2 3 4 Best bone Lekholm U, Zarb GA. Patient selection and preparation. In: Branemark PI. ZG, Albreksson T (eds), ed. Tissue-Integrated Prostheses: Osseointegration in Clinical Dentistry. Chicago, IL: Quintessence; 1985:199–209. Anterior Mandible Posterior Mandible Posterior Maxilla INCREASES 2 - 4 months 3 - 6 months 4 - 6 months 24 Tx Planning for Implant Dentistry NYU DDS Protocols -- 2023-2024 5 Leila Jahangiri, BDS, DMD, MMSc Chair, Department of Prosthodontics restore Implant parts for each SIZE of implant platform (width) are COLOR CODED  The color coding is NOT the same between different brands  It is the same for one manufacturer  For example all Regular Connection parts are same color 25 Tx Planning for Implant Dentistry NYU DDS Protocols -- 2023-2024 5 Leila Jahangiri, BDS, DMD, MMSc Chair, Department of Prosthodontics restore RESOURCES: • • • • Manual Brighspace – “NYU Quick Tips” ITI Departmentally approved Videos 26 Tx Planning for Implant Dentistry NYU DDS Protocols -- 2023-2024 Leila Jahangiri, BDS, DMD, MMSc Chair, Department of Prosthodontics 1. Follow the 5 step protocol 2. Predoctoral students must treat a pt. requiring an implant retained crown 3. Very high success rate and patient satisfaction 4. Competency will be in D4 (OSCE- objective structured clinical exam) 27 Tx Planning for Implant Dentistry NYU DDS Protocols -- 2023-2024 Leila Jahangiri, BDS, DMD, MMSc Chair, Department of Prosthodontics Maxillary anterior region 28