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(a) teeth (b) around implants typical of the Branemark system (c) the non-submerged ITI implant system
Frontal view of gingival fiber groups (A) Circular (B) Dentogingival (C) Dentoperiostal (D) Alveologingival
PDL
PDL
0.1 to 0.2 mm in width support the teeth in a viscoelastic manner
Cells
osteoblasts, osteoclasts,cementoblasts an cementoclasts, fibroblasts, epithelial rests of Malassez,undifferentiated mesenchymal cells, neurovascular elements... Fibers (collagen fibers, oxytalan fibers) Ground substance
extracellular constituents
collagen fiber
principal fibers
AC: alveolar crest fibers H: horizontal fibers OBL: oblique fibers PA: periapical fibers IR: interradicular fibers
Natural tooth
From the PDL to the connective tissue from the alveolar process to the PDL and then to the connective tissue from the alveolar process directly to the connective tissue
Blood supply-implant
time
After extraction
reason
complication
Recession of buccal gingiva tissue is a common occurrence implant exposure (esthetic problem)
Evaluation of the patients (soft) tissue biotype and bone thickness should be conducted at the time of Tx planning The thicker the native hard and soft tissue, the more abundant the blood supply that can be expected after implant placement
tooth loss resorption in a palatal direction ridge thinning The thin bone remaining on the facial aspect of the implant tends to be cortical, with significantly less vascularity After implant placement, the biological width must be reestablished
Bone loss to 1st implant thread
bone margin: located at the first thread The JE: on the abutment The join between abutment and implant head : is located within a zone of non-arranged connective tissue of about 1mm to 2 mm in width
roughened surface
within bone an integral part of the implant transmucosal collar located on the implant the implant/abutment join is located coronal to this level
smooth neck
JE
Bone
two-stage implant
vertical and horizontal bone loss occurring after abutment connection shifting the implant abutment junction inward and away from the peri-implant bone preservation of crestal bone (increase blood supply) support soft tissue
Platform-switching
Probing depth
natural teeth
health : probe penetrates the JE to some degree Inflammation: probe is stopped by the most coronal intact gingival connective tissue fibres, about 2 mm from the bone
Implant
sulcus depth is very much dependent upon the thickness of the soft tissue cuff generally deeper than around teeth the probe tip finishing short of the bone margin by about 2 mm
Probing depth
natural teeth
Implant
information questionable do not recommend probing radiographic assessment of bone levels digital pressure on soft tissue: bleeding or suppuration
> 10 Years:
a. Keep tooth and restore as indicated. a. Make independent implant restoration. b. If abutment must be included, make coping and retrievable prosthesis. c. Make tooth a "living pontic" by adding more implants or splinting to additional teeth. a. Extract and graft.
5-10 Years:
< 5 Years: