Dear colleagues, welcome to this short lecture.

I'm happy to discuss with you implant selection.

In the first slide you see a large number of implants,

and when we want to choose implants

we have a number of decisions we need to make.

So clinically from this large palate,

the question is which implant type should I use

in which clinical situation?

Let’s go in to some basics first.

On the right side, you see a so called two-piece implant

which consists of the endosseous part of the implant.

At the left side you see a one-piece implant,

you see that the transmucosal part is integrated

into the entire implant so the endosseous

and the transmucosal part make up the implant itself.

What does this mean?

Here you see the bone level,

the two-piece implant stops at the level of the bone

and the one-piece implant reaches through the soft tissues

to a level where we can see in the oral cavity.

I also indicate a reconstructive margin

with these blue lines.

Reconstructive margin at the two-piece implant

is at the level of the bone where as

at the one-piece implant,

it's 1mm, 2mm, or 3mm distant from the bone.

What does this now mean for clinical use?

Two more important words we need to define.

You see an implant on the left side

and you see the flap close at the right side,

and here the flap is sutured to cover the implant completely,

this is termed submerged healing,

so the implant is submerged underneath the soft tissues.

Here the flap is sutured

allowing the implant to penetrate into the oral cavity.

You see the flap raised on the left side

and you see the flap adapted around the neck

of the implant on the right side,

this is called transmucosal healing.

Submerged healing is preferred

when soft tissue borne temporaries are used.

Here, two-piece implants are preferred.

The reason being, it's easier to cover the implants

with the soft tissues,

and thus avoiding a removable temporary to transfer forces exerted onto the temporary

onto the heads of the implant,

and thus prevent osseointegration from occurring.

Additionally submerged implant is preferred

when later soft tissue interventions are planned.

Here again two-piece implants are preferred

in situations which are usually for esthetic nature.

Two-piece implants are preferred in the esthetic zone

because they allow more flexibility

for shaping the emergence profile.

Here you see a two-piece implant on the left

and a one-piece implant on the right side,

and marked again, the reconstructive margin.

Now we see the distance from the reconstructive margin

to the soft tissue margin on the left and the right side,

and you immediately see that with the two-piece implant

there's a larger distance available

which allows more flexibility.

Let me illustrate this with the image on the left,

you see an implant in site two,

the yellow circle indicates the top end of the implant,

these dotted lines indicate the form of the tooth

which needs to be reconstructed,

which of course is identical to the tooth adjacent to it.

You can also transfer these two dotted lines

on the right side of the image.

If I now soon propose an implant,

you will see that the yellow lines

indicate the distance available to form

this so called emergence profile.

So here two-piece implants are preferred.

They allow more possibilities for soft tissue management,

increase the prosthetic flexibility.

On the other hand one-piece implants

are indicated for transmucosal healing

when straightforward procedures are preferred.

Here you see a mandibular posterior area,

flap is raised, an implant is placed,

and the flap was adapted around the neck of the implant.

What about implant length?

Very obvious, short implants are placed

when the bone height is of low height.

As you can see on the right side

the radiographic image, on the left side the clinical image.

What about implant diameters?

There are some implants that are allow smaller diameters

than standard implants.

Narrow implants are placed in narrow spaces, very obvious.

I have so proposed the X-ray,

so you see two narrow implants

with narrow reconstructions for lower incisors.

What about cylindrical versus tapered implants?

A cylindrical implant on the left,

a tapered implant on the right.

The rationale for choosing tapered implants

or choosing this design is that they usually have

denser thread distribution, the threads reach closer

to the apex, they are more congruent with the bony bed,

and thus all these factors together

improve primary stability.

So tapered implants are placed into extraction sockets

because they show improved contact

in the bony walls of the alveolus.

This is true in anterior, as well as, posterior sides.

Let me conclude what we've seen

regarding implant selection.

Two-piece implants are used for submerged healing,

they're used to improve soft tissue management,

and they are used to improve the prosthetic flexibility.

One-piece implants in contrast are used

for transmucosal healing, and they are used

to simplify prosthetic protocols

because the implant shoulder is located close

to the mucosal margin.

Conical implants improve primary stability

due to the thread design and implant form.

Diameter reduced implants at sites with reduced gaps

and for minimally invasive surgery.

Thank you very much for your kind attention.

种植体的选择

口腔种植学（Implant Dentistry）

与讲师见面

种植体的选择

口腔种植学 （Implant Dentistry）

与讲师见面

口腔种植学（Implant Dentistry）