A ceramic implantologist has to be aware of the following topics:
- Do not implant in active perio-patients, know the micro-biology of your patients.
- There exists “healthy carriers” with Aa / Pg /Tf: they may provoke early loss.
- High Responders should take 3gram omega 3 fatty acids for 3 weeks pre-OP and 1 week post-OP.
- D blood values should be > 70ng/ml, take Vit. D according the protocol Vit. D.
- Ceramic implants osseointegrate only in healthy bone without residual ostitis.
- Socket Preservation with PRP or CGF reduces the risk of residual ostitis.
- Ozonising the prepared bone, reduces early loss in case off healthy carriers, see point 2.
- PRP or CGF on the implant surface during inserting enhances the quality of the osseointegration.
- Position the implant in the crown axis, noth off-set, if not possible, augment by e.g. bone splitting.
- Healing time is very individual, wait at least 10-12 weeks before testing with the periotester.
- Test osseointegration with a Perio-Tester, before starting further therapy, when insufficient values, wait.
- Canine guidance is very important, avoid implant crown cuspid contact during lateral movements.
Operation protocol and patient instruction
The success of a ceramic implantation is directly dependent upon the following guide lines:
- Rinse with CHX (0,12%), 3x a day for 1 minute: start 1 day pre-surgery till 7 days post-surgery.
- Day of surgery: rinse with CHX for 1 minute directly before surgery.
- Prevent contamination of the implant with e.g. vaseline on the patient lips or cotton hairs from surgery cloths. If you want to place the implant down again, put it back in the glass tube.
- Use sterile gloves when you put instruments in the hand piece (beware of latex allergie).
- Try to implant atraumatically, punch when possible.
- In case off punching, do palpate the bone before using anaesthesia.
- Be aware of implant position; place the implant axis through the crown centre line and not off set.
- Don’t insert ZV3 implants too deep, for more simple impression making.
- Drill intermitted with enough cooling and with low pressure, not over 800Rpm.
- Dense bone: do not under drill and use a tap.
- Do not torque over 35Ncm with 4,5mm and 5,0mm implants. With small diameter implants 3.5-4.1mm, do not torque over 30Ncm.
- In case off removable dentures prevent contact with implants in the early healing period.
- Don’t implant at once in both sides of the jaw, because then the patient cannot prevent chewing on the implants. Better go for a two stage approach.
- If you are forced to implant at once in a tooth less jaw, prevent any contact with dentures by using e.g. temporally implants.
- Instruct your patient to prevent: tongue pressure, chewing contact, electrical and manual tooth brush contact on the implant in the early healing period, for about 3 weeks.
- Carefully soft brushing after 3 weeks is allowed.
- During the first week post-surgery advise no sports over 60% off the maximum performance level.
- No fighting sports and sports with jumps, e.g. jogging, volleyball and gymnastics.
- No music with wind instruments for 14 days.
Communication with the dental technician
Take care of a functional canine guidance.
Realise a canine guidance with composite or ceramic veneers, if not possible use a night guard.
Posterior implant crowns should be immediate out of contact during any lateral movement.
Single ceramic implant crowns should be designed with a minimal infra occlusion.
Cuspid distance to the implant long axis should be smaller than in the natural teeth.
In case of bruxism or clinching, use a soft “Night Guard”