helical implant placement

There are many kinds of spiral implants, but the implantation procedures are basically the same. Now take the Swedish Br?nemark system as an example, which is as follows: Surgical instruments: The surgical instruments of Brnemark implants are mainly powered and drilled. 1. The power part includes a fast (1500~2000r/min) motor phone and a slow (15r/min) motor phone. 2. Bone tools (Fig. 10.1.4.1.2-2) Spherical grinding drill, primary crack drill, directional expansion split drill, secondary split drill, shoulder grinder, tapping drill, orientation rod, depth gauge, Implant fixture connector (Fixture Mount). Treating diseases: dental diseases Indication 1. The upper jaw is missing teeth and the mandibular anterior teeth are missing. Full mouth missing teeth, especially suitable for those who have obvious atrophy of the alveolar ridge or intolerance of the active denture base. 2. As a fixing device for the prosthesis of the right ear, the jaw, the mask and the like. Contraindications General contraindications are the same as leaf-shaped implants. In addition, it is not suitable for the implantation of the mandibular posterior molar, because this part is easy to damage the mandibular canal, and the oral cavity of the molar region is small and difficult to operate. Severely absorbed jaws should not be directly implanted, and bone grafting should be performed at the same time to avoid fracture due to weak bone or through the maxillary sinus and mandibular canal. Preoperative preparation This method is used for delayed planting, and implants should be performed 4 months after surgery. For mandibular total denture prostheses, the distance between the two pupils should be determined before surgery to determine the number of implants and their spacing. In addition to comprehensive examination of the patient's general condition, such as blood, blood pressure, pulse, respiration, electrocardiogram, chest fluoroscopy, liver and kidney function, etc., the size of the jaw, the shape of the jaw, and the jaw, dentition or jaw should be examined. The occlusal relationship of the dyke, the distance between the jaws, etc., and the size of the jaw bone, the ratio of cortical bone and cancellous bone, the presence or absence of inflammation of the maxillary sinus, the position of the sinus floor, the position of the pupil and the mandibular canal are obtained through X-ray films. The upper and lower jaw plaster model should also be taken to transfer the patient's oral and maxillofacial relationship to the jaw frame, and the position, number and distribution of implant placement should be determined on the plaster model. Teeth should be thoroughly examined and treated, routinely cleaned before surgery, and 2% iodine or 0.2% iodophor should be used for oral disinfection, but 7% ethanol must be used for deiodination because iodine is harmful to metal implants. Surgical procedure First surgery (1) Incision and dissection: A curved incision is made at a position about 1 cm from the labial side of the alveolar crest, and an auxiliary incision perpendicular to the pupil can be made before the pupil. After the mucosa was dissected, the mucosa was separated sharply from the submucosa to the alveolar crest for about 0.5 cm, and then the periosteum was cut. Then all the alveolar processes are exposed along the bone surface, paying attention to protecting the periosteal flap and the phrenic nerve. (2) Preparation of the bone socket: At the predetermined position, the cylindrical bone socket corresponding to the implant is prepared on the jaw bone from the alveolar crest to the lower margin of the mandibular body or the maxillary sinus floor according to the design direction. That is to say, first use a spherical drill to make a hole with a diameter of 2mm; then use a first-stage split drill to enlarge, then use the directional enlarged drill to enlarge the 1/2 part of the outer edge of the talus, and finally expand the whole process with the secondary split drill, that is, one up and down. Bone fossa. (3) Expanding the upper end of the bone socket: The upper end of the implant retaining nail is slightly thicker than the thread body. In order to comply with it, the upper mouth is enlarged by the shoulder grinding (Fig. 10.1.4.1.2-6). All of the above drilling operations require uninterrupted local cooling of the borehole with saline. In order to make several implants parallel to each other, the bone drilling process uses a directional rod as a direction indicator. (4) Tapping: A certain length of tapping drill is mounted on a slow electric mobile phone, and slowly taps into the tubular bone groove at a speed of 15-20 rpm to the bottom, and then reverses and exits. The direction of the tapping drill is required to be consistent with the axis of the cavity, especially when the drill bit is initially placed, it should be noted that it cannot be skewed. Otherwise, it will not only change the parallel relationship between the implants, but also damage the instruments. (5) Screw in the implant retaining nail: Install the pre-selected implant retaining nail on the slow motorized mobile phone, and its long axis should be consistent with the long axis of the bone socket, so that the thread of the bone socket is 15-20r/min. The speed is slowly screwed in until the bottom. After tightening, remove the phone and tighten with a hand wrench. The implant retaining nail is required to be in place, screwed and fixed, but can not damage the bone socket thread. The upper end can be struck by a metal rod-shaped instrument. If a crisp metal knocking sound is emitted, it means that the position is fixed and satisfactory. Finally screw in the cover nut. (6) Closing the wound: the mucosal periosteum is sutured once. The wound was tightly sutured and the gauze was pressed for 1 h after surgery. (7) Postoperative treatment: After 7 days, the suture should be disassembled and the original removable denture should be worn. However, a part of the implant implant site should be grounded in the base tissue as a buffer to avoid crushing the mucosa. 2. Second surgery After the first operation, it should be reviewed frequently. Generally, it should be reviewed once every 2 to 3 weeks, including wound healing and mucosal conditions. The upper jaw should go through 6 months; the lower jaw can be used for the second operation in 4 months, and the abutment is installed. . (1) Incision and dissection: an arc-shaped incision is made on the top of the screw to conform to the alveolar ridge. The mucosa and periosteum are cut at one time, and the nut is completely exposed along the bone surface. (2) Mounting abutment: Clean the surface of the implant, remove the covering screw, and completely remove all bone tissue and soft tissue on the surface with a rotating knife and a small peeling. It is required that no other substances, including foreign bodies, bone slag or soft tissue, are allowed during the assembly of the implant, otherwise the screw structure will be loose and the healing will be affected. Then select the base of the corresponding height according to the thickness of the soft tissue of the mucosa, align the bottom hexagonal hole with the protrusion of the hexagon at the upper end of the implant retaining nail, and firmly tighten the abutment screw with the metal rod-shaped instrument. Knocking on the abutment, such as making a crisp knock on the metal, proves that the connection is in place. Then screw in the healing cap. (3) suture wound: the mucoperiosteal flap is reset, and the suture is tightly sutured, especially around the abutment. The gap should not be left behind, so that the mucous membrane is tightly surrounded, so as to strive for the healing of the mucosa. Finally, the surface of the wound is covered with gauze, and the intermaxillary pad is gauze, which makes it bite for 1 h. complication 1. Wound splitting and suturing is too tight or too loose, especially in the case of infection, it is more likely to cause local wound splitting, should be debrided and re-sewed in time to avoid implant exposure. 2. Hemorrhage due to mucosal dissection injury or submucosal dissection is extensive, especially after poor postoperative pressure, are prone to submucosal or subcutaneous hemorrhage, when the implant wears out of the lower mandible, hemorrhage can occur under the armpit. Generally can be absorbed after a few days, can be used for early postoperative cold compress, late hot compress. Due to systemic factors, those with bleeding tendency should be treated with coping. 3. The lower lip numbness is caused by the direct trauma of the sacral nerve or implant during the peeling injury. The former can be recovered, the latter should remove the implant and re-select the implant. 4. Mandibular fractures. 5. The maxillary sinus is punched through.

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