Welcome
to
the     2009
Pacific
Northwest
Dental
Conference!PNDC
is
green!

Please
visit:
www.wsda.org/speakers/defaultpd...
2
What
Will
You
Do?   3
4
Contemporary
ProsthodonticTreatment
of
the
Edentulous        Mandible        Dr
Robert
Stover,
DDS
MSDiplomate,
American
B...
Overview• Treatment
options  • Conventional
Prosthesis  • Implant
overdentures    • Tissue
supported    • Implant
supporte...
Complete
denture  Tissue
supported                           Implant
supportedimplant
overdenture
   Treatment
Options    ...
Prognostic
Guidelines•
Prosthetic
considerations:    •
Stability   •
Preservation   •
Support   •
Esthetics   •
Phonetics ...
Prognostic
Guidelines•
Prosthetic
considerations:    •
Patient
confidence   •
Hygiene   •
Chewing
efficiency   •
Surgical
...
Treatment
SequenceFabricate
Complete
Dentures                              10
Complete
Dentures
in
Atrophic              PatientsConsiderations:•
Guide
for
further
treatment•
Establish
rapport•
Potent...
Complete
Dentures
in
Atrophic              PatientsConsiderations:•
Guide
for
further
treatment•
Establish
rapport•
Potent...
Space
Analysis                 13
Conventional
Radiographic
Guides                                   14
Space
Analysis                                       15




putty
matrix
for
space
analysis
Conventional
Surgical
Guides                               16
17
Complete
Dentures                    18
Complete
Dentures
in
Atrophic                      Patients     Limitations:     •
Continued
resorption        •
Individua...
Complete
denture  Tissue
supported                           Implant
supportedimplant
overdenture
   Treatment
Options    ...
OverdenturesBenefits:  •
Stability  •
Retention  •
Patient
confidence  •
Chewing
efficiency  •
Hygiene
access  •
Preservat...
OverdenturesLimitations:•
Support
similar
to
completedentures•
Surgical
intervention
required•
Potential
for
implant
failu...
OverdenturesImplant
supported•
Support
similar
to
hybrid•
Surgical
intervention
required•
Potential
for
implant
failure•
B...
Common
AttachmentsAttachments1.Form  A. Bar
and
clip    -
Dolder,
Ackerman,
Hader  B.

Stud
attachments    1.   Magnetic  ...
Bar
AttachmentsBar
/
clip-
Dolder
bar


a.
Pear
shaped
(resilient)
-
allows
movement


b.
Parallel
bar
(solid)
-
no

movem...
Bar
AttachmentsBar/clip-
Ackermann
bar







a.
Round







b.
Egg
shaped                                26
Bar
AttachmentsBar/clip-
Hader




a.  Standard
1.8mm
diameter
or
13
gauge




b.
 Compatible
with
other
bar
patterns




...
Bar
Attachments
Stud
AttachmentsAdvantages







a.
Easier
hygiene
than
bars







b.
Crown/root
ratio
enhanced







c.
Low
profile   ...
Stud
Attachments                   30
Mini
Implants  Small
diameter
implants  • Victor
Sendax  • Titanium
alloy
(Ti6Al4V)  • 1.8-3.25mm
diameter  • 10,
13,
15,
...
Mini
Implants     Small
diameter
implants     • Interim
overdenture
retentionShatkin
TE,
et

al.

Mini
dental
implants
for...
OverdenturesSmall
diameter
implants• Definitive
overdenture
stabilization                                         33
OverdenturesSmall
diameter
implants• Definitive
overdenture
stabilization                                         34
Mini
Implants      Contemporary
indications:      • Mandibular
overdenture      • Cost
effective      • Poor
surgical
cand...
Complete
denture  Tissue
supported                           Implant
supportedimplant
overdenture
   Treatment
Options    ...
Fixed-Detachable
DentureBenefits:•
Extremely
stable•
Preservation•
Support•
Retention•
Patient
confidence•
Chewing
efficie...
Fixed-Detachable
DentureLimitations:•
Access
for
hygiene•
Esthetic
compromises•
Phonetic
compromises•
Costs•
Appropriate
l...
Fixed-Detachable
DentureLimitations:•
Access
for
hygiene•
Esthetic
compromises•
Phonetic
compromises•
Costs•
Appropriate
l...
Biomechanics
–
Force
AnalysisIntraforaminal
placement  •   Historically
indicated  •   Simple
anatomy  •   Induces
posteri...
Biomechanics
–
Force
Analysis    A-P
spread
based    •      1½
x
(A-P
spread)    •      15-20mm
/
minimum           10mm
A...
Biomechanics
–
Force
Analysis   Guidelines
for
Cantilever     Length                                                      ...
Biomechanics
–
Force
AnalysisOcclusion•    Increased
force
/
area
on
implantsRichter
E
(1989).
Basic
biomechanics
of
denta...
Treatment
Sequence•   Diagnostic
workup
&
complete
dentures•   Radiographic
/
surgical
guides•   Conventional
radiology•  ...
Treatment
Sequence•
42
yo
AD
Navy
PO1•
Edentulous
21
years•
Unsuccessful
denture
wearer•
Loss
of
OVD•
Functionally
atrophi...
Treatment
Sequence   •CC:   “I
have
a
lack
of
bone
on
the   bottom
and
I
can’t
get
my   denture
to
fit.”   •Expectations: ...
Complete
denture  Tissue
supported                           Implant
supportedimplant
overdenture
   Treatment
Options    ...
Decision
Process
–
Case
PresentationRe-evaluation   –   Stability   –   Preservation   –   Support   –   Esthetics   –   P...
Radiographic
/
Surgical
Guides                                 49
Radiographic
/
Surgical
Guides                                 50
Conventional
Radiology                         51
Conventional
Radiographic      Assessment                            52
Conventional
Radiographic             Assessment                                    16.2mm   7.5mm                        ...
CT-based
Assessment              1
1/2
x
(A-P)            (A-P)                              54
Diagnostic
Planning                      55
Diagnostic
Planning                 2
x
(A-P)             (A-P)                             56
Surgical
Guide                 57
Surgical
Guide                 58
CT
/
CAD
Treatment
PlanningCT
/
CAD
design
systems• NobelGuide

(NobelBiocare)• Materialise



(Astra)• StentCAD• Keystone...
NobelGuide ®1. Fabricate
complete
dentures  a. Good
fit
to
anatomy  b. Adequate
extensions  c. Ideal
tooth
set-up2. Radiog...
NobelGuide ®  3.

CT
scan      a. Double
scan
techniqueRadiographic
Index        First
CT
Scan             Second
CT
scan ...
NobelGuide ®4.

Computer
planning                          62
NobelGuide®Surgical
Template           Fabricate
Stone
Model      Design
ProsthesisOrder
sent
electronically   Use
Surgica...
Treatment
Plan•   IAN
lateralization•   Implant-supported
bar
overdenture•   2
posterior
bars•   1
anterior
bar•   Support...
Justification
for
Treatment•   Inability
to
tolerate
complete
denture•   Cost
effective•   Oral
hygiene
access•   Stabilit...
Clinical
Treatment• Implant
workup
/
imaging    – Conventional
radiology    – CT
/
Simplant    – Stereolithography• Surgic...
Nerve
Lateralization•   Deglove
mandible•   Un-roof
nerve•   Lateralization•   Stabilization•   Insulation
(bone    graft)...
Implant
Placement                    68
Implant
Placement                    69
Stage
2
Surgery                  70
Post
Healing• Healing
phase• Re-present
for
restoration                               71
Maxillary
Overdenture   Locator
Attachments                         72
Refabricate
Complete
Dentures                                73
Fabricate
Bars                 74
Refabricate
Complete
Dentures                                75
Attachment
procedure                       76
Laboratory
Processed
Attachments                                   77
Clinical
Pick-up                   78
Final
Prostheses                   79
80
81
Patient
preferences   Acceptance         •     Denture
patients         •     Preference
evenly
split               •     ...
Treatment
planning
the
atrophic
mandible                Complete      OD             OD          Fixed                Dent...
Summary• Treatment
options  • Conventional
Prosthesis    • Space
analysis  • Implant
overdenture    •   Tissue
supported  ...
Questions? Thank
You!OFCD@live.com                85
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Transcript of "Pacific Northwest Dental Conference - Dr. Stover"

  1. 1. Welcome
to
the 2009
Pacific
Northwest
Dental
Conference!PNDC
is
green!

Please
visit:
www.wsda.org/speakers/defaultpdf.view
to
download
lecturehandouts.Please
turn
off
all
cell
phones
and
pagers.
There
is
no
photography
or
recording
of
any
kind
allowed
during
the
presentation.CDE
verification
forms
will
be
available
at
the
END
of
the
course.WSDA
members
may
have
your
ADA
card
scanned
by
our
room
host
at
the
END
of
the
course.AGD
members

fill
out
a
CDE
verification
form
and
take
it
down
to
the
AGD
counter
in
theregistration
area.Please
fill
out
the
yellow
course
evaluation
form
and
leave
it
on
the
back
table
or
with
your
host.Visit
the
Exhibit
Hall
&
Relaxation
Lounge,
get
free
massages
and
other
giveaways.
There
aredrawings
throughout
the
day,
including
2
HD
TVs
and
a
Scooter.

Please
support
our
exhibitorswho
support
the
PNDC!Thank
You.
  2. 2. 2
  3. 3. What
Will
You
Do? 3
  4. 4. 4
  5. 5. Contemporary
ProsthodonticTreatment
of
the
Edentulous Mandible Dr
Robert
Stover,
DDS
MSDiplomate,
American
Board
of
Prosthodontics Olympia
Family
and
Cosmetic
Dentistry 5
  6. 6. Overview• Treatment
options • Conventional
Prosthesis • Implant
overdentures • Tissue
supported • Implant
supported • Common
attachments • Fixed-detachable
denture
(‘hybrid’)• Case
Presentation – Sequencing
treatment
planning – Surgical
guides
&
predictability 6
  7. 7. Complete
denture Tissue
supported Implant
supportedimplant
overdenture
 Treatment
Options implant
overdenture
 Fixed
detachable (‘hybrid’) 7
  8. 8. Prognostic
Guidelines•
Prosthetic
considerations: •
Stability •
Preservation •
Support •
Esthetics •
Phonetics •
Retention 8
  9. 9. Prognostic
Guidelines•
Prosthetic
considerations: •
Patient
confidence •
Hygiene •
Chewing
efficiency •
Surgical
limitations •
Cost •
Esthetics
(again) 9
  10. 10. Treatment
SequenceFabricate
Complete
Dentures 10
  11. 11. Complete
Dentures
in
Atrophic PatientsConsiderations:•
Guide
for
further
treatment•
Establish
rapport•
Potentially
address
chiefcomplaint 11
  12. 12. Complete
Dentures
in
Atrophic PatientsConsiderations:•
Guide
for
further
treatment•
Establish
rapport•
Potential
to
address
chief
complaint 12
  13. 13. Space
Analysis 13
  14. 14. Conventional
Radiographic
Guides 14
  15. 15. Space
Analysis 15




putty
matrix
for
space
analysis
  16. 16. Conventional
Surgical
Guides 16
  17. 17. 17
  18. 18. Complete
Dentures 18
  19. 19. Complete
Dentures
in
Atrophic Patients Limitations: •
Continued
resorption •
Individual
propensity •
Patient
with
marked resorption •
Crestal
IAN
positionAtwood,
D.:
Reduction
of
residual
ridge:
a
major
oral
disease
entitiy.
J
Prosthet
Dent
26:
266-279,
1971.Tallgren
A:
The
continuing
reduction
of
the
residual
alveolar
ridges
in
complete
denture
wearers:
a
mixed-


















longitudinal
study
covering
25
years.
J
Prothet
Dent
27(2):120-132
1972 19
  20. 20. Complete
denture Tissue
supported Implant
supportedimplant
overdenture
 Treatment
Options implant
overdenture
 Fixed
detachable (‘hybrid’) 20
  21. 21. OverdenturesBenefits: •
Stability •
Retention •
Patient
confidence •
Chewing
efficiency •
Hygiene
access •
Preservation •
Esthetics •
Phonetics 21
  22. 22. OverdenturesLimitations:•
Support
similar
to
completedentures•
Surgical
intervention
required•
Potential
for
implant
failure•
Anatomical
limitations•
Higher
maintenance
cost 22
  23. 23. OverdenturesImplant
supported•
Support
similar
to
hybrid•
Surgical
intervention
required•
Potential
for
implant
failure•
Biomechanical
limitations•
Higher
maintenance
cost [implant
od
pic] 23
  24. 24. Common
AttachmentsAttachments1.Form A. Bar
and
clip -
Dolder,
Ackerman,
Hader B.

Stud
attachments 1. Magnetic 2. Matrix
/
Patrix -
Locator,

Ball
and
socket,
ERA2.Function A.

Resilient B.

Non-resilient 24
  25. 25. Bar
AttachmentsBar
/
clip-
Dolder
bar


a.
Pear
shaped
(resilient)
-
allows
movement


b.
Parallel
bar
(solid)
-
no

movement 25
  26. 26. Bar
AttachmentsBar/clip-
Ackermann
bar







a.
Round







b.
Egg
shaped 26
  27. 27. Bar
AttachmentsBar/clip-
Hader




a.  Standard
1.8mm
diameter
or
13
gauge




b.
 Compatible
with
other
bar
patterns




c.  Gold
plated
machined
metal
housing 27
  28. 28. Bar
Attachments
  29. 29. Stud
AttachmentsAdvantages







a.
Easier
hygiene
than
bars







b.
Crown/root
ratio
enhanced







c.
Low
profile 29
  30. 30. Stud
Attachments 30
  31. 31. Mini
Implants Small
diameter
implants • Victor
Sendax • Titanium
alloy
(Ti6Al4V) • 1.8-3.25mm
diameter • 10,
13,
15,
18mm
length • FDA
approval* – Interim
&
on-going
retention • US
intro
1999 • 2008
3M
subsidiaryUlatoqski,
TA.
Nov
1997.

FDA
written
communication,.Office
of
Device
Evaluation,
Center
for
Devices
&Radiological
Health,
FDA. 31
  32. 32. Mini
Implants Small
diameter
implants • Interim
overdenture
retentionShatkin
TE,
et

al.

Mini
dental
implants
for
long-term
fixed
and
removable
prosthetics:
a

retrospective
analysis
of2514
implants
placed
over
a
five-year
period.
 Compend
Contin
Educ
Dent
2007;
28(2):92-99.Griffitts
TM,
et
al.
Mini
dental
implants:
an
adjunct
for
retention,
stability
and
comfort
for
the
edentulous
patient.Oral
Surg,Oral
Med
Oral
Pathol
Oral
Radiol
Endod
2005;100(5):e81-e84. 32
  33. 33. OverdenturesSmall
diameter
implants• Definitive
overdenture
stabilization 33
  34. 34. OverdenturesSmall
diameter
implants• Definitive
overdenture
stabilization 34
  35. 35. Mini
Implants Contemporary
indications: • Mandibular
overdenture • Cost
effective • Poor
surgical
candidates • Compromised
medical
history • Adverse
to
extensive
surgery • Inadequate
bone
for
conventional implantsChristensen,
Gordon
J.
Feb
2001.

Simplified
Implant
Surgery
Techniques.
DentalTown
Magazine,
pg
32.Christensen,
Gordon
J.
June
2009.
The
Increased
Use
of
Small-Diameter
Implants.
JADA,
Vol
140,
pp
709-712.Bulard,
RA.
Dec
2005.
Multi-Clinic
Evaluation
Using
Mini-Dental
Implants
for
Long-Term
Denture
Stabilization:A
Preliminary
Biometric
Evaluation.
Compendium,
26(12):892-897. 35
  36. 36. Complete
denture Tissue
supported Implant
supportedimplant
overdenture
 Treatment
Options implant
overdenture
 Fixed
detachable (‘hybrid’) 36
  37. 37. Fixed-Detachable
DentureBenefits:•
Extremely
stable•
Preservation•
Support•
Retention•
Patient
confidence•
Chewing
efficiency•
Bypass
anatomical
structures 37
  38. 38. Fixed-Detachable
DentureLimitations:•
Access
for
hygiene•
Esthetic
compromises•
Phonetic
compromises•
Costs•
Appropriate
lab
support•
Anatomical
limitations•
Limited
cantilever
length 38
  39. 39. Fixed-Detachable
DentureLimitations:•
Access
for
hygiene•
Esthetic
compromises•
Phonetic
compromises•
Costs•
Appropriate
lab
support•
Anatomical
limitations•
Limited
cantilever
length 39
  40. 40. Biomechanics
–
Force
AnalysisIntraforaminal
placement • Historically
indicated • Simple
anatomy • Induces
posterior cantileverChewing
table • Limited
surface
area • Cantilever
length 40
  41. 41. Biomechanics
–
Force
Analysis A-P
spread
based • 1½
x
(A-P
spread) • 15-20mm
/
minimum 10mm
A-P
spread • maximum
implants maximum
spread McAlarney
et
al
(2000).
Theoretical
cantilever
lengths
versus clinical
variables
in
fifty-five
clinical
cases.
J
Prosthet
Dent; 83:332-43.Rangert,
B,
T
Jent,
L
Jorneus
(1989).
Forces
and
moments
on
Branemark
Implants.
Int
J
Oral
Maxillofac
Implants;
4:241-7.English
CE
(1990).
The
critical
A-P
spread.
Implant
Soc
J;
1:2-3.Taylor
R
and
G
Bergman
(1990).
Laboratory
techniques
for
the
Branemark
System
(ed
1).
Chicago,
IL,
Quintessence.Skalak
R
(1983).
Biomechanical
considerations
in
osseointegrated
prostheses.
J
Prosthet
Dent;
49:843-48. 41
  42. 42. Biomechanics
–
Force
Analysis Guidelines
for
Cantilever Length Compression • 2-3
premolars • <20mm
with
5-6
implants • <15mm
with
4
implants Tension McAlarney
et
al
(2000).
Theoretical
cantilever
lengths
versus clinical
variables
in
fifty-five
clinical
cases.
J
Prosthet
Dent; 83:332-43.Branemark,
PI,
GA
Zarb,
T
Albrektsson
(1985).
Tissue
Integrated
Prostheses.
Chicago
IL,
Quintessence,
pp
51-70,
117-128.Zarb
GA
and
A
Schmitt
(1990).
The
longitudinal
clinical
effectiveness
of
osseointegrated
dental
i9mplants:
the
Toronto
study,part
II,
the
prosthetic
results.
J
Prosthet
Dent;
64:53-61. 42
  43. 43. Biomechanics
–
Force
AnalysisOcclusion• Increased
force
/
area
on
implantsRichter
E
(1989).
Basic
biomechanics
of
dental
implants
in
prosthetic
dentistry.
J
Prosthet
Dent
61:602-9.• More
force
on
rigid
integrated
fixturesBrunski
JB,
JA
Hipp,
M
El-Wakad
(1984).
Dental
implant
design:
Biomechanics
and
interfacial
tissues.
J Oral
Implantol
12:365-77.• Cantilevers
may
increase
loading
1½-2xSkalak
R
(1983).
Biomechanical
considerations
in
osseointegrated
prostheses.
J
Prosthet
Dent;
49:843- 48.• Large
moments
generated
by
cantileversRangert
B,
T
Jent,
L
Jorneus
(1989).
Forces
and
moments
on
Branemark
Implants.
Int
J
Oral
Maxillofac Implants;
4:241-7.Rangert
B,
J
Gunne,
DY
Sullivan
(1991).
Mechanical
aspects
of
a
Branemark
implant
connected
to
a natural
tooth:
an
in
vitro
study.
Int
J
Oral
Maxillof
Implants
6:177-85. 43
  44. 44. Treatment
Sequence• Diagnostic
workup
&
complete
dentures• Radiographic
/
surgical
guides• Conventional
radiology• CT
scan• CAD
analysis• Treatment
plan• Surgery• Definitive
prosthesis 44
  45. 45. Treatment
Sequence•
42
yo
AD
Navy
PO1•
Edentulous
21
years•
Unsuccessful
denture
wearer•
Loss
of
OVD•
Functionally
atrophic
mandible 45
  46. 46. Treatment
Sequence •CC: “I
have
a
lack
of
bone
on
the bottom
and
I
can’t
get
my denture
to
fit.” •Expectations: “I
want
to
be
able
to
wear bottom
dentures
comfortably for
the
rest
of
my
life.” •CD
prognosis: max:
good man:
extremely
guarded/poorEnglemeier,
R.
and
R.
Phoenix
(1996).
Patient
Evaluation
and
Treatment
Planning
for
Complete-Denture
Therapy.
DCNA40:1-18,
1994 46
  47. 47. Complete
denture Tissue
supported Implant
supportedimplant
overdenture
 Treatment
Options implant
overdenture
 Fixed
detachable (‘hybrid’) 47
  48. 48. Decision
Process
–
Case
PresentationRe-evaluation – Stability – Preservation – Support – Esthetics – Phonetics – Retention – Patient
confidence – Hygiene – Chewing
efficiency – Anatomical
/
surgical
limitations – Cost 48
  49. 49. Radiographic
/
Surgical
Guides 49
  50. 50. Radiographic
/
Surgical
Guides 50
  51. 51. Conventional
Radiology 51
  52. 52. Conventional
Radiographic Assessment 52
  53. 53. Conventional
Radiographic Assessment 16.2mm 7.5mm 7.2mm 13.4mm 13.4mm• Useful
in
planning definitive
treatment 53
  54. 54. CT-based
Assessment 1
1/2
x
(A-P) (A-P) 54
  55. 55. Diagnostic
Planning 55
  56. 56. Diagnostic
Planning 2
x
(A-P) (A-P) 56
  57. 57. Surgical
Guide 57
  58. 58. Surgical
Guide 58
  59. 59. CT
/
CAD
Treatment
PlanningCT
/
CAD
design
systems• NobelGuide

(NobelBiocare)• Materialise



(Astra)• StentCAD• Keystone 59
  60. 60. NobelGuide ®1. Fabricate
complete
dentures a. Good
fit
to
anatomy b. Adequate
extensions c. Ideal
tooth
set-up2. Radiographic
guide a. Acrylic b. 6-#4
round
burr 





reference
points c.

Fill
with
GP 60
  61. 61. NobelGuide ® 3.

CT
scan a. Double
scan
techniqueRadiographic
Index First
CT
Scan Second
CT
scan  Secures
correct Radiographic
Guide
only  Patient positioning
and seating
of
the  Radiographic
Guide Radiographic
Guide  Radiographic
Index during
CT
scan 61
  62. 62. NobelGuide ®4.

Computer
planning 62
  63. 63. NobelGuide®Surgical
Template Fabricate
Stone
Model Design
ProsthesisOrder
sent
electronically Use
Surgical
Template
as  Definitive
prosthesisStereolithograpy the
“impression”  Implant
Bridge  Provisional  short
term 63
  64. 64. Treatment
Plan• IAN
lateralization• Implant-supported
bar
overdenture• 2
posterior
bars• 1
anterior
bar• Supported
by
6
implants 64
  65. 65. Justification
for
Treatment• Inability
to
tolerate
complete
denture• Cost
effective• Oral
hygiene
access• Stability• Retention• Support• Esthetics• Preservation• Bilateral
nerve
impingment
in
premolar
area
of edentulous
ridge 65
  66. 66. Clinical
Treatment• Implant
workup
/
imaging – Conventional
radiology – CT
/
Simplant – Stereolithography• Surgical
guide• Nerve
lateralization• Phase
1
Implant
surgery• Complete
Denture Maintenance• Phase
2
Implant
surgery 66
  67. 67. Nerve
Lateralization• Deglove
mandible• Un-roof
nerve• Lateralization• Stabilization• Insulation
(bone graft) 67
  68. 68. Implant
Placement 68
  69. 69. Implant
Placement 69
  70. 70. Stage
2
Surgery 70
  71. 71. Post
Healing• Healing
phase• Re-present
for
restoration 71
  72. 72. Maxillary
Overdenture Locator
Attachments 72
  73. 73. Refabricate
Complete
Dentures 73
  74. 74. Fabricate
Bars 74
  75. 75. Refabricate
Complete
Dentures 75
  76. 76. Attachment
procedure 76
  77. 77. Laboratory
Processed
Attachments 77
  78. 78. Clinical
Pick-up 78
  79. 79. Final
Prostheses 79
  80. 80. 80
  81. 81. 81
  82. 82. Patient
preferences Acceptance • Denture
patients • Preference
evenly
split • Stability 



(fixed
preferred) • Chewing
ability

(fixed
preferred) • Ability
to
clean


(removable
preferred) • Esthetics 



(removable
preferred)Feine,
J
et
al.:
Within-subject
comparisons
of
implant-supported
mandibular
prostheses:
Choice
of
prosthesis. J
Dent
Res
73(5):
1105-11,
1994. 82
  83. 83. Treatment
planning
the
atrophic
mandible Complete OD OD Fixed Denture (soft
tissue) (implant) Detachable Stability 
- +
+ +
++ +
+
+ Preservation 
- +
/
- +
++ +
+
+ Support +
/
- +
/
- ++ +
+
+ Esthetics +
+
+ +
+
+ +
+
+ + Phonetics +
+ +
+
+ +
+
+ - Retention - +
+
+ +
+
+ +
+
+ Confidence - +
+ +
++ +
+
+ Hygiene +
+
+ +
++ +
+ +
/
- Efficiency 
- ++ +
++ +
+
+ Fabrication ++ - -
- -
-
-
- Cost ++ - -
- -
-
-
- 83
  84. 84. Summary• Treatment
options • Conventional
Prosthesis • Space
analysis • Implant
overdenture • Tissue
supported • Implant
supported • Mini
implants • Attachment
types • Fixed-detachable
denture
(‘hybrid’)• Conventional
/
CAD
tx
planning• Case
Presentation 84
  85. 85. Questions? Thank
You!OFCD@live.com 85

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