Treatment Planning pt.1-2

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Treatment Planning pt.1-2

  1. 1. Implant Dentistry Course goals Students will improve their clinical decision making skills when treatment planning patients requiring prosthodontic care. Students will understand how dental implants can be used to improve masticatory function and quality of life issues.
  2. 2. Instructional Objectives <ul><li>Students will be familiar with implant component identification and the steps involved in completing an implant crown for a patient requiring a single tooth implant. </li></ul><ul><li>Students will understand how to treatment plan using implants being aware of patient assessment, biomechanical issues, and risk factors with implants. </li></ul><ul><li>In the partially and completely edentulous patient, students will understand the options for treatment using dental implants as opposed to traditional prosthodontic treatment. </li></ul>
  3. 3. My vision of the UCSF graduate– a good decision maker: an example Decision making
  4. 4. Decision Making <ul><li>Gather appropriate information for assessment of what went wrong and why. Next, determine the treatment options. </li></ul><ul><li> If Implants: </li></ul><ul><li>The type, position, diameter and length of implants </li></ul><ul><li>The number of implants </li></ul><ul><li>Internal or external connection </li></ul><ul><li>Splinting? </li></ul><ul><li>Treatment sequence </li></ul>
  5. 5. <ul><li>Caries process/ RCT </li></ul><ul><li>Weakened tooth perio, structurally </li></ul><ul><li>Root proximity </li></ul><ul><li>Difficult maintenance </li></ul><ul><li>Crown lengthening </li></ul>
  6. 6. FPD Success Rates <ul><li>87% 10 yr success rate,69% at 15 years </li></ul><ul><li>Failure by recurrent caries (18%),loose retainer (7%), porcelain fracture 6.1%, Endo 5%, Perio 4%. </li></ul><ul><li>Please read Goodacre et al. </li></ul>
  7. 7. Removable partial denture <ul><li>RPD is often a good option; especially if there is support from teeth </li></ul><ul><li>Less expensive than FPD, Implants </li></ul><ul><li>Increased plaque accumulation 25%. </li></ul><ul><li>Psychological </li></ul>
  8. 8. Shortened Dental Arch <ul><li>Article by Armellini et. al. </li></ul><ul><li>Function and stability of bicuspid occlusion </li></ul><ul><li>Evaluated over time </li></ul>
  9. 11. What would you do here?
  10. 12. To restore: <ul><li>Root canal, post build-up, crown </li></ul><ul><li>Would you do crown lengthening; no , why not? Crown lengthening would compromise soft tissue esthetics and compromise a future implant site because you are removing bone. </li></ul><ul><li>How would you develop sufficient ferrule if you were to try to save this tooth? This could be done by orthodontic extrusion. </li></ul>
  11. 13. Issues with an implant?
  12. 14. What would you do here?
  13. 15. What would you do here? Please read: Curtis et al. Treatment planning in the 21 st century.
  14. 17. Implants are not always the best treatment
  15. 20. Treatment planning <ul><li>Treatment plan based on functional need rather than anatomic loss </li></ul><ul><ul><li>Some patients may have a substantial anatomic loss but QOL may be satisfactory </li></ul></ul>
  16. 21. <ul><li>Today’s lecture: 1/7/09 </li></ul><ul><li>What do the implant components look like and how do the parts work together. Nomenclature </li></ul><ul><li>Reasons dental implants should be considered when providing prosthodontic care. </li></ul><ul><li>What are the success rates of dental implants and what factors influence success? </li></ul><ul><li>Treatment planning dental implants using efficacy and benefit/risk as outcome assessments. </li></ul>
  17. 22. Articles for this week and next week <ul><li>Curtis et al. Occlusal considerations for Implant restorations… Please read entire article carefully. </li></ul><ul><li>Curtis et al. Treatment planning in the 21 st Centruy; What’s new. Please read introduction and section on prosthodontics on page 505. </li></ul><ul><li>Curtis et al. The use of dental implants to improve quality of life…. Please read entire article carefully. </li></ul><ul><li>Goodacre et al. Clinical complications with implants and implant prostheses </li></ul>
  18. 23. Supplements for this week <ul><li>Implant DVD; please look over the treatment planning section and single tooth implant section </li></ul><ul><li>Course goals for 2009 handout; outlines goals for this course </li></ul><ul><li>Short answer essay questions; outlines most of the major concepts I hope you will learn </li></ul>
  19. 24. Optional essay <ul><li>Any topic related to implants </li></ul><ul><li>Previous national awards </li></ul>
  20. 25. Assessments <ul><li>Some MC, some essay, some slide identification </li></ul><ul><li>The only make up and/or remedial exams will be essay exams </li></ul>
  21. 26. What are dental implants?? Materials: (Ti-99) or (ti-6Al-4V) Threaded or not threaded Ti or HA Smooth or acid etched Diameter Tapered or parallel Length Distribution
  22. 27. Nomenclature: please also see DVD <ul><li>Healing abutment </li></ul><ul><li>Fits into implant </li></ul><ul><li>Maintains access through tissue </li></ul>
  23. 28. Nomenclature <ul><li>Transfer assembly </li></ul>
  24. 29. Nomenclature <ul><li>Transfer assembly that is used to transfer the position of the implant in the patient to the cast </li></ul>
  25. 30. Nomenclature <ul><li>Transfer assembly with implant analogue attached so the impression can be poured up in stone </li></ul>
  26. 31. Nomenclature <ul><li>Implant analogue; this has the same geometry as the top of the implant </li></ul><ul><li>The implant analogue is in the same position on the cast as the implant is in the mouth. </li></ul>
  27. 32. Traditional protocol
  28. 33. 4 to 6 implants added between foramen Traditional protocol for implant prosthesis
  29. 35. A 15 year study of osseointegrated implants in the edentulous jaws ADELL, R. et al. 1981 Surgery prosthesis maxilla mandible
  30. 36. Overdenture option 45% increase in chewing efficiency. Adaptations to the traditional protocol
  31. 37. Adapted for single tooth implants
  32. 39. Steps for a single tooth implant
  33. 41. 3
  34. 42. Nomenclature <ul><li>Implant (sometimes called a fixture) </li></ul>
  35. 43. Nomenclature <ul><li>Implant abutment (solid) </li></ul><ul><li>Implant abutment (to be waxed up </li></ul>
  36. 44. Nomenclature <ul><li>Healing abutment </li></ul><ul><li>Transfer assembly </li></ul>
  37. 45. Nomenclature <ul><li>Implant analogue </li></ul>
  38. 46. Nomenclature <ul><li>Implant screws </li></ul>
  39. 47. <ul><li>Today’s lecture: 1/7/09 </li></ul><ul><li>What do the implant components look like and how do the parts work together. Nomenclature </li></ul><ul><li>Reasons dental implants should be considered when providing prosthodontic care. </li></ul><ul><li>What are the success rates of dental implants and what factors influence success? </li></ul><ul><li>Treatment planning dental implants using efficacy and benefit/risk as outcome assessments. </li></ul>
  40. 48. Why implants should be considered <ul><li>Over 40 million </li></ul><ul><li>65% affects quality of life- Curtis article </li></ul><ul><li>50% of patients are limited in food choices </li></ul><ul><li>150 million on denture adhesives </li></ul><ul><li>Psychosocial implications </li></ul>
  41. 49. Why consider implants? <ul><li>About 60%, or over 21 million Americans that use a prosthesis report at least one major problem with their prosthesis that limits their ability to masticate the foods they would like to eat. </li></ul><ul><li>29% of edentulous patients are able to eat only soft or mashed foods. </li></ul><ul><li>50% of edentulous patients state they avoid many foods. </li></ul>
  42. 50. <ul><li>Today’s lecture: 1/7/09 </li></ul><ul><li>What do the implant components look like and how do the parts work together. Nomenclature </li></ul><ul><li>Reasons dental implants should be considered when providing prosthodontic care. </li></ul><ul><li>What are the success rates of dental implants and what factors influence success? </li></ul><ul><li>Treatment planning dental implants using efficacy and benefit/risk as outcome assessments. </li></ul>
  43. 51. Success rates <ul><li>Integration above 95% </li></ul><ul><li>Some compromises (esthetics, function, timing) when treatment is not coordinated </li></ul><ul><li>Success is if the patients expectations are met; be careful to outline limitations of functional improvement and/or esthetic issues. </li></ul>
  44. 53. <ul><li>Space </li></ul>
  45. 54. Treatment Planning with dental implants: what is possible and what is best? 5 patient examples

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