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  • 1

  • 2 3

    1 2553 500

    CG tool

  • 4 5

    ...

    !

    2552-2553

    ...!

    case...

    ...

    ...

    5

    9

    17

    23

    43

    49

    53

    57

    77

    80

    ...!

  • 6 7

    -

    () 28-292553

    -

    implant!

    80

    2553

    ...!...!

  • 8 9

    case...

  • 10 11

    endocrine,

    CVS,CA

    Plavic, Aspirin,

    warfarin

    implant

    minorsurgery

    implant

    implant

    implant

    (Psychosis)

    dementia

    multiple disorder

    Ideal

    implant

    case...

    osteoporosis

    failure rate

    implant

    Bisphosphonate

    implant

    osteoporosis

    case review

    osteoporosis risk factor

    implant

    Bisphosphonate

    osteonecrosis

    implant

    denture

    tissue

    complete denture

    denture

    design

    Implant

    supported overdenture

    Implant retained

    overdenture denture

    -

    denture

    stability

    movement extent

    tissuestrict

    implant

    checkocclusion

    complication

    tissue

    xerostomia implant

    case...

  • 12 13

    success rate

    protocol Bain andMoy 18

    osseointegration

    healing tissue

    hypocellular, hypovascular hypoxia osteoradionecrosis

    implant

    implant

    consensus

    complete denture

    implantfirstchoice

    ideal

    bone, soft tissue, denture

    implant

    preservebone

    implant

    overdenture

    space

    ball

    attachment

    implant

    case

    contraindication

    case...

    implant

    implant

    prosthesisdentureimplant

    denture denture

    loss VD VD duplicate

    surgical stent denture

    biteblock

    denture

    6

    13

    labial lingual

    topical

    explorer

    lateral

    cephalometrictangential

    view

    (alveoloplasty)

    surgical stent

    implant

    case...

  • 14 15

    protocol

    implant

    retainedandtissuesupported

    ove rden tu re

    extrusion

    cariesocclusion

    occlusion

    panoramic

    skull

    series PA skull

    mandible focus

    mandible PAmandible

    Keratinized alveolar mucosa

    keratinizedalveolarmucosaattachedgingiva

    attachedgingiva

    periodontalprobemucosaltissuevestibule

    attachedgingiva

    Iodinemucosakeratinized

    tissue

    case...

    attachedgingivaoralmucosa periodontalprobe

    keratinizedtissue

    LangLoeattachedgingiva2

    maintaingingivalhealthDorfman

    Tissueinflammationattachmentloss

    plaque bacteria

    attached gingiva plaque

    oralhygieneFGG

    flap

    softtissue

    attached gingiva free gingival

    graft implant

    attachedgingiva implant3 labiallingual attachedgingiva 1-1.5

    attached gingiva

    incisionstageII attachedgingiva attached gingivalabial lingual

    FGG stageII surgery6

    case...

  • 16 17

  • 18 19

    (plaque)

    resinacrylic

    resinacrylic attachment

    centricocclusion (slideincentric) clinicalremount

    Clinical remounting

    OVD

    ecentricocclusion clinicalremount

    OVD

    (clinical remount

    )

    (occlusal vertical dimension)

  • 20 21

    ( )

    (maximumconvexityoftongue)

    2/3retromolarpad

    PIP

    15.()

    (retention)

    (reline)overextension

    (stability)

    neutralzone

    (reline)

  • 22 23

    resin acrylic

    6

    8

    8

    Lingual side : Acrylic thickness

    Mucosal Crest to Occlusal Plane

    Acrylic thickness 6+ mm

    acrylic resin

    (flange)

    (flange)

    PIP

  • 24 25

    ...

  • 26 27

    bucco-

    lingual (

    flap)

    sharpridgepencil

    thin

    ( flap)

    sharp

    ridge

    mandible

    mandible

    sharpridge

    (longshankround

    bur)#6cortextwistdrill

    surgicalstentguide

    labiallingual 1

    (LeblebiciogluB,RawalS,MariottiA.Areviewofthefunctional andestheticrequirementsfordentalimplants.JADA2007:138; 321-329)

    ....

    surgicalstentguide

    labiallingual 1

    (LeblebiciogluB,RawalS,MariottiA.Areviewofthefunctional andestheticrequirementsfordentalimplants.JADA2007:138; 321-329)

    Vertical - midline20 caninefirstpremolar

    alveoloplasty

    1.fullthicknessflapknifeedge ridgeperiodontalprobe

    2.knifeedge (6)

    3.

    (knife edge ridge)

    ....

  • 28 29

    6

    implant

    10

    1.

    2. ball attachment transmucosalpart (

    22.35. 4.)

    3. 20

    alveoloplasty()5

    softtissueflabby

    tissuesofttissue

    keratinizedmucosasofttissue

    implant

    ....

    1.

    2.

    3.

    1.5

    ....

    1.pilotdrill(axis)

    2.finaldrill(axis)

    medio-lateral

    labio-lingualsurgicalstent

    1.surgicalstent

    2.(longshank roundbur)#6

    3.(pilotdrill)

    parallelpin

    4.

    5.parallelpin

    ( 20 )

  • 30 31....

    6.

    fixturemount(fixture)

    7.

    1.pilotdrill

    2.

    3

    cover screw

    fixturemount

    insert

    centrichandpiece drill

    final drill final drill 3.4.

    fixturemount coverscrewhealing bonejumping1

    fixturemount

    : 3( )

    : 5

    :10 13 ()

    1.roundbur cortex

    2.twristdrill drilldrill

    3.

    4. ( 2,000/)

    5. irrigate

    6.corticaltap

    ratchet

    (bonetapping)

    ....

  • 32 33

    1.800-1,200

    2.drill2.8finaldrilldrill3.4 cortex5

    (Perforation)

    1.

    1

    2. flap labiallingual periosteal

    retractor

    3.implant drill

    1. drill

    perforation

    final drill

    drill

    5.

    2. final drill

    flap

    ....

    drillfinaldrill

    3.4.insertimplantimplant

    -

    -

    -

    1.

    2.bonetapping

    1.

    2.probe

    finaldrill

    3.implantimplant 13implant10

    4.implant tapping

    implant

    implant

    ....

  • 34 35

    (dehiscence)

    implant platform

    platform

    6

    implant

    1

    flap

    implant 2 graft flap

    dehiscence 5

    ....

    fixture fixture mount (retaining screw)

    retaining screw

    screw driver

    1fixture mount retainingscrew

    arterialforcep

    fixture

    coverscrew

    2Screw

    soft tissue

    epinephrineinfiltration buccal

    lingual

    incision510 vasoconstriction

    periosteal retractortissue incision incision bonesupport

    stageIIcoverscrew

    fixturemountballattachment

    fixturemountballattrachment

    healingabutmentrelief

    flap

    osseointegration

    1

    disintegration

    ....

    implantroundburtre-

    phinebur

    implantimplant

  • 36 37....

    flapfull

    thickness lingual softtissue labial buccal mandible mentalismuscle incisionmuscle bleed

    5-10

    arterialforcep tissue

    bone

    (mentalforamen) 5 loop mandibularcanal mentalforamen

    bonedensity spongybone bleeding drill

    lingual plate lingualflap

    periostealretractor flap

    implant fixture mount

    platform

    fixturemount

    bleeding drill

    drill socket par-

    allel pin drill

    socketbleeddrill

    pilot drill

    implant

    implant

    fixturelockfixture

    mount

    1.Gemlockhexfixture mount fixture

    2.Gemlockimplant

    drill bleeding

    insert

    implant

    bleeding

    fixturemount

    guide

    ....

  • 38 39

    implant

    retaining screw

    ()

    screw driver

    screw

    screwdriver screw squareRatchet screwdriver screw screwdriver

    x-ray

    cover screw

    cover

    screw implant

    bone

    bonegrowth

    irritate tissue inflammation

    cover screw

    screwdriverretainingscrewfixturemount

    fixturearterialforcepfixturemount

    fixturemountinsert

    implantprimarystability ()fixture

    ....

    Birgit Junfin

    Glass(2005)

    edentulous

    case 8% error

    panoramic

    design

    implant

    surgicalstent stageIsurgery guide flap

    implant

    implant

    panoramic implant

    89.3%

    error

    position

    (unseen healing cap)

    surgical stage II

    mucosa softtissue cover screw

    flap coverscrew roundbur

    ....

  • 40 41

    healing abutment

    coverscrewsoft tissuebonecoverscrewfixture

    healingabutmentaxis

    healingabutmentrelief healingabutment

    healing abutment

    healingabutment

    healing abutment

    relief

    reliefarticulatingpaper

    healingabutment

    -

    labiallingual

    ()

    healingabutment

    reliefFitchecker

    reliefset