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The ABCs of Implant Prosthodontics 1

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The ABCs of Implant Prosthodontics: …

The ABCs of Implant Prosthodontics:
A Step by Step Idiot’s Guide For A Successful Restorative Outcome.

If you are interested about taking the most comprehensive localized implant training course with hands-on & live surgeries then please give us call at 530.715.0050.

This course will fulfill a doctor's desire to learn implant dentistry with practical clinical information and techniques. Emphasis is placed on anatomic considerations, treatment planning, and prosthetic technique.

Published in: Health & Medicine

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  • There is no such thing as a perfect implant for every situation
  • Some systems have the driver and or abutment and impression coping included with the implant.4 drive “standards”: Square, Nobel compatible, Straumann compatible.
  • Use in posterior non-esthetic sites, not recommended in anterior sitesNo Trephines on soft tissue, bone only
  • Preserve tissue and push it around more likely to preserve vrs. Cut and hope it grows back
  • Platform shift lower coronal bone stress, but implants like to be placed slightly sub crestal of the boneThe advantage of the platform switching works only if the bone grows over… so it is necessary to place imlant sub-crestal.
  • Preserve tissue and push it around more likely to preserve vrs. Cut and hope it grows back
  • Use surgical 557 to expose the cover screw, being careful not to ditch the edge of the implant, or hex socket of the cover screw
  • Hiossen bone trimmer
  • Screw in the guide post for the trephine bur
  • True morse taper하이오센 11 디그리…메가젠 5앵클로스 5.8
  • The size selection of a healing abutment will be determined by the height of the tissue, the width of the ridge, and the location
  • Some implant systems are more prone to bone loss around the neck of the implant, probably due to leakage
  • HiOssen has stock round and custom (using temporary abutment)
  • Web site “What implant is this” Discus advantages of Hiossen connection HiOssen 11, Megagen 6, Bicon 1.5, Ankalos 5.8, Sacrifice strength at implant neck as the degree angle decreases for the same given diameter: if narrow the abutment mating diameter to compensate, then weaken the abutment…a balance
  • The old Sterioss were all non engaging, positional jig necessary
  • Descriptions, advantages/disadvantages, where to use, selection criteria, etc.
  • Buy longer lengths and cut if needed for less inventory: 4, 5.5, 7mm. Impression cap comes with the set, vrs impression coping has to be separately ordered
  • Buy longer lengths and cut if needed for less inventory: 4, 5.5, 7mm. Impression cap comes with the set, vrs impression coping has to be separately ordered
  • Disadvantages more of a factor of the implant angle/occlusal plane
  • No sandblasting of the mating surfaces!Up to 22 degrees divergence with non-engaging (non-hex)
  • Do not use non-precious with gold abutments
  • Transcript

    • 1. The ABCs of Implant Prosthodontics: A Step by Step Idiot’s Guide For A Successful Restorative Outcome
    • 2. Choices Choices ChoicesHiossen. Klockner. Swissdent. BTI. Zimmer. Nobel Biocare. Neoss. Blue Sky Bio. AIDA. Megagen. Atlas. DIO. Alphatech. Basic. Friadent. Camlog. Global Implant Solutions. Anthogyl. Dyna Dental. Astratech. Euroteknika. Dentegris. Champions. Bio Horizons. Cumdente. Medentika. Leone. M&K Dental. Intra- Lock. Dentaurum. Keystone. Biomet 3i. Kentec. Bicon. BEGO. Clinical House Europe. Biotech. Champions. Cumdente. Dentalpoint. JdentalCare. Z-systems. Southern Implants. AOCO Biomedical. MIS. TBR Group. Straumann. Metoxit. Tekka. OT Medical. Riemser. Serf. OMT. Wieland Dental Implants. Titaniumfix. Sweden&Martina. Tommen Medical. SIC invent. Shinhung. Neodent. Medical Instinct. Medentis Medical. Hitech Implants. Implant Direct. Ace Surgical. Glidwell Labs. 3M Imtec ESPE. CeraRoot. C5 Medicalwerks. Zsystems.Ziterion. Bioimplant. Bicon. Ankalos. Alpha Bio Dental Devices. ADIN Dental. Tatum Surgical. Sterngold. Tramonte. Innova. Leader Italia. Zest anchor LODI. Etc, etc. etc.
    • 3. Implant Basic Components
    • 4. Uncovering the Implant
    • 5. Uncovering the Implant, Things to Consider“X” cut, “Star” cut, and “C” cut using a scalpelTissue punchLASERCT GraftBone Tone/Tissue Issue (Scott Gantz)Coronal bone loss around the implantPhase 2 in 2 stages or one
    • 6. Uncovering the Implant, ComplicationsStuck cover screw or healing abutment Use of torque wrench Correct driverCross threading of the cover screw or healing abutment Thread repairBone growth over cover screw or healing abutment Tissue sparing Incision techniques Surgical bur HiOssen bone trimmersTissue punch sacrificing too much tissueLASER Possible sacrifice of tissue if “punched” NeatDo not use electrosurge!
    • 7. Healing Abutments
    • 8. Healing AbutmentsPurpose-do we need a healing abutment? Tissue-forming Emergence profile aid for lab and Dentist Prevention of tissue growth over implantDrainage of fluids Complications of non-drainage Bone loss Tissue inflammation Pain Change in tissue morphology Implant exposure
    • 9. Healing AbutmentsFormation of tissue-abutment interface PEEK Ti Ceramic Vitalium Acrylic
    • 10. Types of Healing AbutmentsStock roundStock anatomicalCustom
    • 11. Stock Round Healing AbutmentsMaterials Titanium PEEK and other plastics Stainless SteelAdvantages Easy, quick Lower costDisadvantages Customizability limitation Emergence profile compromises Uneven gingival, margin location Apical impingement may cause tissue necrosis and pain
    • 12. Stock Round Healing AbutmentsPhotos of stock round healing abutments put into previous slide #24 PEEK,Nobel, etc pictures
    • 13. Stock Anatomical Healing AbutmentsPhotos of anatomical healing abutments put into next slide
    • 14. Stock Anatomical Healing AbutmentsMaterials Ti PEEK and other plastics The actual abutment Fit and finishAdvantages Use conventional C&B impression techniques Easy, quick Customizability, esp. plasticDisadvantages-same as stock round, but less so
    • 15. Custom Healing AbutmentsMaterials Ti temporary abutment modified for use as a custom healing abutment Acrylics Lab can burn-out in oven Composites Use of stock healing abutments for custom fabrication, plastic works bestAdvantages Custom shaping of the emergence profile of the soft tissue Can determine future problems such as the potential for interproximal food trapping, etc Lab doesn’t have to guess emergence profile, Dentist is in control Can custom shape to allow for provisional non-interference Can be the provisional itself
    • 16. Custom Healing AbutmentsDisadvantages Healing time is increased, as compared to not placing a healing abutment. More trouble to fabricate, longer chair time Pt. may need an extra appointment if the abutment is lab fabricated Absence of soft tissue attachment to plastic or acrylic a factor?Things to keep in mind Rapid tissue collapse after custom abutment removal necessitates quick impression techniques (see hands-on) or the use of a preformed impression coping to be used within the impression Can be harder to manipulate, abutment goes in one way only
    • 17. Custom Healing Abutment Fabrication TechniquesIndirect-lab fabricated Advantages Time is not as much as an issue, fabrication at leisure Can be lab fabricated Disadvantages Impression needed 2nd appointment Additional lab materials and total fabrication time neededDirect-in mouth Advantages 1 appointment fabrication Can see the direct effects of the custom abutment upon the tissue Disadvantages Longer chair time May be more difficult to fabricate if blood, limited mouth opening, etc. and other factors are present
    • 18. Custom Healing Abutment Fabrication TechniquesUse of a modified stock abutment into a customized abutment Plastic abutments work best; some are designed for this Advantages Can be a time saver Disadvantages The stock shape may make it more difficult to custom fabricate: very short custom abutments May delaminate if acrylic or composite is used to modify shapeUse of an existing provisional for fabricating accustom abutment
    • 19. Abuttments
    • 20. Abutment Connection MorphologyExternal connectionInternal connection Hex Tapered Hex Octagon Tri Lobe Spline Morse Taper Flat Conical Other Proprietary
    • 21. Abutment Connection MorphologySmooth SurfaceTextured surface (Laser Lock, etc.) Soft tissue attachment or not?Abutment-Implant stability interface relationships Ease of prosthetic practical use and machining tolerances Micro leakage, micro gap, and bone loss relationshipRotational timing of abutment Implant positioning jig with non engaging abutments
    • 22. HiOssen AbutmentsRigid Abutments (integral abutment screw)Transfer AbutmentsFree Form Abutments Ti, ZioCera (Zirconium)Angled Abutments Ti, ZioCera (Zirconium)Gold Cast (UCLA) AbutmentsTemporary AbutmentsStud Abutments (“O” ring)Locator Abutments (Zest Anchor)
    • 23. Rigid AbutmentsIndications Best for single units, but can be used for multiple units if implants are parallel Cement-retained onlyAdvantages Simple as you can get, no impression coping (need an impression cap instead) or abutment screw necessary Tissue-abutment adhesion not disturbed
    • 24. Rigid AbutmentsDisadvantages Implants must be relatively parallel Limited abutment bulk before impingement on hex socket, no margin customizability Tissue impingement may make “snapping” the impression cap on difficult Difficult to be sure impression cap is fully seated with deep tissue Less accurate if used for FPDs Cannot splint together the impression copings reliability at time of impression Impression caps may flex Timing of the abutment may not be consistent Must use special lab analogs, burn out cylinder, and finishing reamer
    • 25. Transfer AbutmentsIndications Single unit or FPDs Primarily cement-retained, but can be screw-retained with modificationAdvantages Abutment level or implant level impressions Easer to repair compared to Rigid Abutments Customization may not be as necessary as compared to Free Form Abutments Abutment screw means that abutment can be torqued down to seat with deep tissueDisadvantages Implants must be relatively parallel for FPDs Thinner axial walls, limited customizability, no margin customizability
    • 26. Angled AbutmentsIndications Single units or FPDs, however, the lack of non-engaging ZioCera angled abutments may limit its FPD use Use when implants are at a severe angle Usually cement-retained, but can be screw retained in certain circumstancesAdvantages Multiple abutment angles available means less abutment adjustment needed with off- angled implants as compared to straight abutments: less abutment ground away means a greater retention form 2 timing forms available Ti or ZioCera (zirconium) availableDisadvantages Customization must be done carefully: wall thickness Greater stress on the abutment and implant connection
    • 27. Free Form AbutmentsIndications Single units or FPDs Screw and/or cement-retainedAdvantages Customizability enhanced due to thicker abutment walls Easier to repair as compared to Rigid Abutments Abutment screw means that the abutment can be torqued down to seat with deep tissueDisadvantages More work-intensive, since abutment must usually be prepared
    • 28. Gold Cast (UCLA) AbutmentsIndications Single units or FPDs Cement and/or screw-retained When ultimate customizability is neededAdvantages Total control of abutment shape, angle, and form Plaque and tarter adhesion less than with titanium abutmentsDisadvantages More lab intensive: must wax-up and cast the gold abutment More expensive Tissue adhesion less than with Ti abutments
    • 29. Custom AbutmentsUCLA Gold Machined cast Plastic pattern cast Non precious Plastic pattern castCEREC, etcAtlantis, Custom Fit, and othersTemporary abutments Used for fabrication of provisionals

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