Professional Documents
Culture Documents
For Ideal
Implant Placement”
implant concepts
Implants - surgical procedure driven by prosthetics
Bone is the first requirement (sets the tone)*
Surgeons focus - 3-D bone to imp relationship
Soft tissue depends on bone (is the issue)*
Missing bone is the limiting factor for esthetics
Imp-tooth & imp-imp distance is critical
Lacks of esthetics is unacceptable
Esthetic Hierarchy
Restoration
Soft Tissue Form
Implant Placement
Site Development
Why An Implant?
Segment the case
Decrease future costs
Increase strength of the restoration
Preserve bone
Patient able to floss
Cosmetics
Psychological health
Implant Advantages
Maintenance of bone
Improved stability of prosthesis
Improved proprioception
Increased support
Direct occlusal loads
No caries or endo
Improved psychological health
Loss of teeth
Decreased V.D.
Increased nasal-labial fold
Prominent chin
Pointed nose
Witch‘s profile
Which Graft
Nothing
Bone Graft?
o Autograft, allograft, xenograft, synthograft, combograft
Membrane?
o Non-resorbable, Resorbable – bovine, porcine, human, synth
Growth factors
o PRGF, PRP, Emdogain, rhPDGF-BB (Gem 21),rhBMP-2(Infuse)
Soft tissue graft?
o Autograft, Allograft, Xenograft
All or some combination of the above
Extraction Facts
General DDS extract 23 million teeth/year
First year – 25% loss of bony width
First year – multiple extractions 4 mm loss of vertical
Years 2 to 3 – 40% bone loss
Post-extraction changes
Tooth removal spurs external bone resorption
o Horizontal 3 - 6 mm
o Vertical 1 - 2 mm
Must minimize loss
o Via grafting extraction site
o Termed “socket preservation” or “ridge preservation”
o Atraumatic extraction techniques
Why a membrane?
Resorbable
Collagen
o Bovine
Achilles tendon
Pericardium
o Porcine
o Human
Pericardium
Acelleular dermis
Fascia Lata
PLA/PGA
PRGF
Non-resorbable
Expanded PTFE
(e-PTFE Gortex)
o Plain
o Titanium re-enforced
Non-expanded PTFE
o (n-PTFE Teflon)
Incision Design
Sulcular circumferential incision
To adjacent palatal line angles
Extend 1 tooth distally
Vertical radicular bone
Perpendicular to bone
At right angle to mesial tooth
Full thickness reflection past MGJ
Explore the buccal plate
Membrane Preparation
Soak in sterile saline or
patient’s blood for 3 - 5 min
Trim (template provided)
Use only curved scissors
Do not tack
Closure
Replace flap
Maintain anatomy
Tack vertical with gore
Close vertical (5-0) gut
Pack collacote plug or CTG
Close socket with gore
No pressure on wound
Orthodontics
Tooth movement moves bone
Vertical defects can be reduced
Bone can be leveled
Potential implant sites created
Radiographic evaluation of marginal bone loss at tooth surfaces facing single Branemark implants
Decreased horizontal distance between implant and tooth correlated to increased bone loss
What is Osseoguard ?
Type I Bovine Collagen
Bovine Achilles Tendon
U.S.D.A Certified
Australian Bovine Source
Manufactured in U.S. by Collagen Matrix Inc
Immediate Temporization
• Primary stability a must
• Dense cortical bone preferred
• Instability > micromovement
• Instability > fibrous ecapsulation
• Within 48 hours of implant surgery
Immediate occlusal loading of Osseotite implants in the lower edentulous jaw. A multicenter
prospective study
• 325 Osseotite implants inserted & loaded
• Temp prosthesis delivered within 4 hours
• Final delivered in 6 months
• Implant Success: 99.4% 12-60 months post insert
• Crestal bone loss similar to that reported for standard delayed loading protocols.
He is a frequent lecturer throughout the United States and abroad. His diverse lecture topics include
cosmetic periodontics, dental esthetics, periodontal surgical technique, diagnosis and treatment planning,
dental implant surgery, advanced hard and soft tissue grafting, sinus grafting, and practice management.
Dr. Sonick is the founder and director of the Fairfield County Dental Club, an advanced continuing
education organization with over 100 active members. Dr. Sonick is also the founder and director of
Sonick Seminars, LLC, a multidisciplinary teaching institute located in his clinical office and teaching
center. Unique to this program is the three part continuum: dentists get to observe live surgery,
participate during the Hand’s on portion and attend lectures. Interested participants wishing to
participate can contact Carole Brown at 203 254-2006 or visit us on our website,
www.sonickdmd.com.
Dr. Sonick is a frequent contributor to dental literature having published articles on periodontal surgical
technique, esthetics, dental implants, bone grafting, gingival grafting, and radiographic protocol for
predictable implant placement. Dr. Sonick is the recipient of an Honorary Membership in the Indian
Society of Periodontists, Fellowship in the American College of Dentists, Fellowship in the Pierre
Fauchard Society and a member of Who's Who in Dentistry as well as a Diplomate of the International
College of Oral Implantology.
Dr. Sonick completed his undergraduate college education at Colgate University in 1975. He received his
DMD from University of Connecticut School of Dental Medicine in 1979. He completed his residency in
periodontics at Emory University in Atlanta in 1983. He received implant training at the Branemark
Clinic at the University of Gothenburg in Sweden in 1986 and at Harvard.