objective: long term stability (by good vascularization)by:tension and pressurefree surgerycombined with: A-PRF/I-PRF:>Fibrin releases grow factors for about 1wPRF has 10-15 d transformation timeThe more you put in to the site the more tissue you will get. because by pressing the clot-membranes you get more vessels.There is no necessity to cover the PRF, but with add. collagen membranes you will get more attached gingiva (AG) A-PRFaugment white cell% (monocytes) and BMP-2 out of them, which is on the bottom of the clot: by means of reducing the rpm of the centrifuge 1500 @8′ =A-PRFthe exudate (separating fluid of the clot in the box)is full of fibronectinanticoagulated patients:clotting takes more time, so leave the fluid few minutes more inside the tubes I-PRF has more leukocytes1-2% are mesemchymal stem cellscentrifuge 800 rpm–> pain relief of arthrosis by injecting I-PRF –> no desinfectant before putting PRF on infected sites! the PRF brings vessels… After the 5. day the matrix is beeing set,with the PRF it’s at the very beginningBioOss collagen is better because there the vessels grow fasterangiogenesis faster = resistance to infection so best would be a mix of Collagen (faster growth) and bone ( keeping the buccal structure) and PRF…mp3 i.e. has collagen inside but on the long term it s not so good.you have to adapt the protocol of a procedure if you change a product/medicament!statements:
- it s not the amount of a drug but the continuous flow (drop by drop) that makes it function
- first prepare the flap/volume then fill up – not vv
- buccally always overbuild the site
- better vascular integration if lesser pressure
- Use deep (apical) mattress sutures and leave 3 weeks in place!! (helps keeping the AG)
Does:
- put multiple implants on same depth and buccal position
- put guiding pin into the for. inzisivum to parallel the implants
- one time treatment: abutments beeing set and left in, without ever removing them:
- leaving the bone alone – so no boneloss
- the temporary is to be the gide for the soft tissue
- no membranes only A/PRF
- mandibula: relieve tension: in regio molars push the fibers of the mylohyoideus down (leaving the periosteum in place) gives you 1-2cm tension free flap… (The color is more reddish helps to discriminate it)
- vertical augmentation with splinting ti-plates („miniplast“) to insure the volume
- without putting bony plates buccally!
- decorticating holes/scratching bone helps to release growth factors
Don’ts
- Cut only the depth of your scalpel blade to shine through (Dr. Surmenian)
GBR: A-PRF cutted mixed with BioOss then a couple of drops of I-PRF over it to fix it. then A-PRF grafts over it and Mucoderm under it to improve attached level of gingivaImpression:splints the transfer copings with acrylic, then takes impression over all: palatial must be integrated it on the impression – for lab transfer of soft silicon impression made previously. (impression combined with bite registration)sinus lift lateral1st put a PRF membrane into the sinusmix granules with cutted PRFplus drops of exudate (outtabox)(the residing fluid in the tubes is to be discarded)if the schneiderian membrane tears use 2 membranes of PRF but use with BioOss together to keep the volume if you do not implant simultaneously if the sinus isn’t narrow you should use a volume holder = BioOssuse I -PRF to stick the granules together (especially when having the membrane teared)statementremove the window bone and replace it afterwards is better then putting the bone inside, if it’s to small put it there as well, rotate it or put chips of it onto the filling material(–> long term stability)Sinuslift Summers technique use PRF first ev. without artificial boneRecession coverage with PRF/ tunnel techniqueleave a part of the PRF uncovered and make mattress suturesfull thickness flap („vesta“ techn)PRF for wound closuresocket preservation-implantation aft 3-4months already do not put tension onto the mucosatissue resorption is only the result of insufficient blood supplyfill up of gaps at immediate implantation Big Bone Loss Treatment!make it in two steps! instead of overbuilding , having to much tension , hampering the wound closure…Don’t force the nature! long term stability will be betterBlood Measuring:Problems: check cholesterol <1,40 g/l LDL before the surgery!! <4.4.mmol/lhigh cholesterol (cholesterol metabolism happens inside the osteocytes so bone metabolism is badsurgery is always contaminateduse 50 mg pure metronidazole to reduce infection !( = half a caps.) to improve vascularization, so you will improve bone formation(also usable for socket preservation tech.)We avoid the sun due to prevention of cancer: leeds to a lack of vitamin D less 30 microgr/l bad for our surgeryand probably leads to Depressions, ev to Parkinson’s alsoA „good smoker“ is a man with low LDL and high Vit DJOMI 2/13 Choukroun et alsupplement the Vit D and you lower LDLwithout any lab control after 65y of age supplement it!low Vit level patient:before op 100’000 UI oral, and 2 w after op (1viole) TENSION and PRESSURE“the most important cause of failure is bio mechanical resorption“reasons of pressure and tension on tissue?the mucosathe implantsi.e.khoury no pressure behind the bony platesti-mesh: below the mesh no pressureTension_______tensionfree flap!!!!!!apical mattress techniquevery apical from the margin into the mobile mucosa 1,5cm from the marginif you pull the lip the flap may not move. You put that many sutures until the flap doesn’t move anymoreotherwise cut the surrounding mucosa, or even the deeper lying musselsotherwise you may be sure to loose bone! you must not overbuild, suturing tension free is sufficientbone loss around implants due to tension /no AG the most frequent Position is the Premolars regionmake a vestibuloplasty as soon you see a PI Pressure________by compressive Implantsthe most sensible zone is the crestal, so esp. here no pressureHigher vascularization, overdrivlling /0.5mm = more width, not more!better place narrow implants , lesser damage of the bone/cutting tissuethat’s why the old Straumann is that successfulIf possible better simultaneous implantation! less traumatic to the tissuessuture material: Glycon Resorba; monofilament, long left cutted ends