The Dilemma of The Missing Anterior Single Tooth - Restorative Parameters
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By : Shankar Iyer DDS, MDS, Asst. Clinical Professor, AEPP, NYU, UMDNJ
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The Dilemma of The Missing Anterior Single Tooth - Restorative Parameters
- 1. The Dilemma of The Missing Anterior Single Tooth - Restorative Parameters Shankar Iyer DDS, MDS Asst. Clinical Professor, AEPP, NYU, UMDNJ
- 2. “ It is what we know that prevents us from learning more” Albert Einstein
- 3. Clinical Scenarios The Missing Single anterior tooth: • Congenitally missing anterior tooth
- 4. Clinical Scenarios The Missing Single anterior tooth: • Past Perio/Endo involved partial edentulism
- 5. Clinical Scenarios The Endodontically involved tooth: • The non-restorable fractured incisor
- 6. Clinical Scenarios The Endodontically involved tooth: • The non-restorable fractured incisor
- 7. The Options Removable Partial Denture
- 11. 10 Evidence For Single Tooth Implants “Although posterior single-tooth replacement is a relatively new treatment alternative, many studies have been published since 1990, and survival rates reported range from a low of 94.6% to a high of 100% for a 1 to 15 years. 35-45” Misch CE, Contemporary Implant Dentistry III Ed. 2008 Mosby pp 7
- 12. Evidence Based Decision • “Systematic Review of The Scientific Literature failed to demonstrate any direct comparative studies assessing clinical performance of single implant-supported crowns and tooth-supported fixed partial dentures” Salinas TJ, Eckert SE. In Patients Requiring Single-Tooth Replacement, What Are the Outcomes of Implant – as Compared to Tooth-Supported Restorations? IJOMI , 22: Suppl, 71-107, 2007
- 13. Survival Rates of Options* FPD Tooth supported FPD Implant Supported Implant Supported Single Crown Five Years 93.8% 95.2% 94.5% Ten Years 89.2% 86.7% 89.4% *No RCTs only observational studies and case cohorts Paetursson BJ. Osseointegration and Dental Implants ed. Jokstad A. 2009, Wiley-Blackwell, pp 14 - 23.
- 14. “While Single Crowns on vital teeth have the best prognosis, those on endodontically treated teeth have a slightly poorer prognosis over 10 years. Crowns on teeth with posts and cores and implant-supported Single Crowns displayed the highest incidence of (biologic and technical) failures and complications” Schmidlin K, et al. Complications and failure rates in patients treated for chronic periodontitis and restored with single crowns on teeth and/or implants, Clinical Oral implants research,21:55-557, 2010
- 15. Paradigms For Decision Making
- 16. Paradigms For Decision Making INDUCTION
- 17. Paradigms For Decision Making INDUCTION
- 18. Paradigms For Decision Making INDUCTION Clinician’s Experience
- 19. Paradigms For Decision Making INDUCTION DEDUCTION Clinician’s Experience
- 20. Paradigms For Decision Making INDUCTION DEDUCTION Clinician’s Experience
- 21. Paradigms For Decision Making INDUCTION DEDUCTION Clinician’s Experience
- 22. Paradigms For Decision Making INDUCTION DEDUCTION Clinician’s Experience Evidence Based
- 23. Paradigms For Decision Making INDUCTION DEDUCTION SEDUCTION Clinician’s Experience Evidence Based
- 24. Paradigms For Decision Making INDUCTION DEDUCTION SEDUCTION Clinician’s Experience Evidence Based Corporate Lure
- 25. Factors Influencing Decisions Scientific Criteria Clinical Criteria
- 26. Factors Influencing Decisions Scientific Criteria • Long-term Data Clinical Criteria
- 27. Factors Influencing Decisions Scientific Criteria • Long-term Data • Structural Durability Clinical Criteria
- 28. Factors Influencing Decisions Scientific Criteria • Long-term Data • Structural Durability • Periodontal Factors Clinical Criteria
- 29. Factors Influencing Decisions Scientific Criteria • Long-term Data • Structural Durability • Periodontal Factors • Endodontic Factors Clinical Criteria
- 30. Factors Influencing Decisions Scientific Criteria • Long-term Data • Structural Durability • Periodontal Factors • Endodontic Factors • Biomaterials and Biomechanics Clinical Criteria
- 31. Factors Influencing Decisions Scientific Criteria • Long-term Data • Structural Durability • Periodontal Factors • Endodontic Factors • Biomaterials and Biomechanics Clinical Criteria • Trauma
- 32. Factors Influencing Decisions Scientific Criteria • Long-term Data • Structural Durability • Periodontal Factors • Endodontic Factors • Biomaterials and Biomechanics Clinical Criteria • Trauma • Esthetics
- 33. Factors Influencing Decisions Scientific Criteria • Long-term Data • Structural Durability • Periodontal Factors • Endodontic Factors • Biomaterials and Biomechanics Clinical Criteria • Trauma • Esthetics • Preservation of Natural Teeth
- 34. Factors Influencing Decisions Scientific Criteria • Long-term Data • Structural Durability • Periodontal Factors • Endodontic Factors • Biomaterials and Biomechanics Clinical Criteria • Trauma • Esthetics • Preservation of Natural Teeth • Time
- 35. Factors Influencing Decisions Scientific Criteria • Long-term Data • Structural Durability • Periodontal Factors • Endodontic Factors • Biomaterials and Biomechanics Clinical Criteria • Trauma • Esthetics • Preservation of Natural Teeth • Time • Cost
- 37. Diagnostic Considerations • Esthetic Involvement – The Low Smile Line
- 38. Diagnostic Considerations • Esthetic Involvement – The High Smile Line
- 39. Vertical Bone Loss Class I Class II Class III P. Palacci , Quint Pub 2001
- 40. Papillary Prediction Tarnow DP et al. The effect of the distance from the contact point to the crest of Bone on the presence or absence of the interproximal dental papilla. J Periodontol 63:995-996, 1992 Choquet V, Tarnow DP et al. Clinical and radiographic evaluation of the papilla level adjacent to single -tooth dental implants. A retrospective study in the maxillary anterior region. J Peridontol 72:1364-1371, 2001
- 41. Diagnostic Considerations • Three Dimensional Diagnosis – Apical/coronal
- 42. Diagnostic Considerations • Three Dimensional Diagnosis – Mesio-distal
- 43. Diagnostic Considerations • Three Dimensional Diagnosis – Bucco-lingual
- 44. Treatment Considerations Risk Assessment Scale: 1 = Excellent 2 = Good 3 = Fair 4 = Poor
- 45. Esthetics FPDs
- 46. Esthetics FPDs
- 50. 11Esthetics Single Tooth Implant3 Unit FPDRisk Assessment
- 55. 44Esthetics Single Tooth Implant3 Unit FPDRisk Assessment
- 56. Teeth Preparation FPD Implant Treatment Considerations 14Tooth Preparation Single Tooth Implant3 Unit FPDRisk Assessment
- 57. Abutment Bone Support FPD Implant Risk Assessment 3 Unit FPD Implant Bone Support 2 2
- 58. Cost FPD Implant 11Cost Single Tooth Implant3 Unit FPDRisk Assessment
- 59. Cost FPD Implant
- 60. Cost FPD Implant 41Cost Single Tooth Implant3 Unit FPDRisk Assessment
- 61. 22Bone Support 14Teeth Preparation 31Esthetics Single Tooth Implant3 Unit FPDRisk Assessment
- 62. 2-31-2Augmentation 22Bone Support 14Teeth Preparation 31Esthetics Single Tooth Implant3 Unit FPDRisk Assessment
- 63. 2-31Provisionalization 2-31-2Augmentation 22Bone Support 14Teeth Preparation 31Esthetics Single Tooth Implant3 Unit FPDRisk Assessment
- 64. 2-31Provisionalization 2-31-2Augmentation 22Bone Support 14Teeth Preparation 31Esthetics Single Tooth Implant3 Unit FPDRisk Assessment 11Long Term Studies
- 65. 2-41-3Time 2-31Provisionalization 2-31-2Augmentation 22Bone Support 14Teeth Preparation 31Esthetics Single Tooth Implant3 Unit FPDRisk Assessment 11Long Term Studies
- 66. 2-42-3Cost 2-41-3Time 2-31Provisionalization 2-31-2Augmentation 22Bone Support 14Teeth Preparation 31Esthetics Single Tooth Implant3 Unit FPDRisk Assessment 11Long Term Studies
- 67. 2-42-3Cost 2-41-3Time 2-31Provisionalization 2-31-2Augmentation 22Bone Support 14Teeth Preparation 31Esthetics Single Tooth Implant3 Unit FPDRisk Assessment 11Long Term Studies 3 - 42Trauma
- 68. 11Overall Predictability 2-42-3Cost 2-41-3Time 2-31Provisionalization 2-31-2Augmentation 22Bone Support 14Teeth Preparation 31Esthetics Single Tooth Implant3 Unit FPDRisk Assessment 11Long Term Studies 3 - 42Trauma
- 69. The Dilemma
- 70. The Dilemma Mesio-Distal Width • Loss of Golden Proportion Loss of Anterior Coupling • Attrition Atrophic Ridge #9 site • Lack of bucco-lingual width • Multiple restorations
- 72. Treatment Considerations 31Predictability 32Cost 31Time 31Provisionalization 31Augmentation 22Bone Support 44Teeth Preparation 31Esthetics Single Tooth Implant3 Unit FPDRisk Assessment 22Long Term Results 32Trauma
- 76. The Tapered Atrophic Ridge
- 77. The Dilemma
- 78. The Dilemma Atrophic Ridge • Inadequate Bucco-lingual width Root Proximity • Inadequate Mesio-distal width Recession • Compromised Emergence profile
- 79. Treatment Considerations 21Predictability 32Cost 31Time 22Provisionalization 31Augmentation 22Bone Support 13Teeth Preparation 31Esthetics Single Tooth Implant3 Unit FPDRisk Assessment 11Long Term Results 31Trauma
- 91. Pre-Op
- 92. Pre-Op
- 93. Pre-Op
- 95. Optimal Vs Ideal Treatment Plan
- 96. Optimal Vs Ideal Treatment Plan
- 97. Optimal Vs Ideal Treatment Plan
- 98. Optimal Vs Ideal Treatment Plan
- 99. Optimal Vs Ideal Treatment Plan
- 108. Close root proximity • Converging roots Esthetics • High smile line Post Orthodontic result • Inadequate space
- 109. Treatment Considerations 31Predictability 32Cost 31Time 31Provisionalization 31Augmentation 22Bone Support 14Teeth Preparation 31Esthetics Single Tooth Implant3 Unit FPDRisk Assessment 22Long Term Results 32Trauma
- 114. 68 Illiac Crest Graft Failure
- 115. 68 Illiac Crest Graft Failure
- 116. 68 Illiac Crest Graft Failure
- 117. 68 Illiac Crest Graft Failure
- 124. A
- 147. 96
- 148. 96
- 149. 96
- 150. 97
- 151. 98
- 152. The Dilemma Non restorable root • Vertical Fracture Healthy abutments • No restorations Distinct Papillae • Esthetic Demands
- 153. Treatment Considerations 11Predictability 22Cost 21Time 11Provisionalization 21Augmentation 22Bone Support 14Teeth Preparation 11Esthetics Single Tooth Implant3 Unit FPDRisk Assessment 11Long Term Results 22Trauma
- 157. The Dilemma Space Availability • Mesio Distal Width Healthy abutments • No restorations Thin biotype • Esthetic Demands
- 158. Treatment Considerations 12Predictability 32Cost 21Time 21Provisionalization 21Augmentation 22Bone Support 14Teeth Preparation 11Esthetics Single Tooth Implant3 Unit FPDRisk Assessment 22Long Term Results 32Trauma
- 179. Non Restorable Central with Failing Retreatments
- 206. The Dilemma Extreme bone loss • Loss of buccal plate 3 – D loss • Loss of Soft Tissue Esthetic Demands • High Smile Line
- 207. Treatment Considerations 23Predictability 32Cost 21Time 21Provisionalization 22Augmentation 22Bone Support 14Teeth Preparation 11Esthetics Single Tooth Implant3 Unit FPDRisk Assessment 22Long Term Results 32Trauma
- 212. The Dilemma Extreme bone loss • Inadequate width 3 – D loss • Loss of Soft Tissue Esthetic Demands • Metallic Hue
- 213. 31Predictability 32Cost 31Time 11Provisionalization 41Augmentation 42Bone Support 13Teeth Preparation 1-21Esthetics Single Tooth Implant3 Unit FPDRisk Assessment 22Long Term Results 32Trauma
- 219. The Dilemma Non restorable root • Horizontal fracture Healthy abutments • No restorations Esthetic Demands • High Smile Line
- 220. Treatment Considerations 11Predictability 22Cost 2-32Time 11Provisionalization 21Augmentation 22Bone Support 14Teeth Preparation 1-21Esthetics Single Tooth Implant3 Unit FPDRisk Assessment 22Long Term Results 22Trauma
- 226. Immediate Placement and Function – Immediate Post-op 4 months post - op
- 227. Immediate Placement and Function – Pre op 6 months post op
- 231. Restoring Category I Treatment Sequence • Fabrication of Removable Occlusal overlay appliance at increased vertical
- 234. Restoring Category I Treatment Sequence • Diagnostic wax up at the desired vertical dimension
- 236. Restoring Category I Treatment Sequence • Fabrication of definitive provisional restoration
- 251. Chang SW, Romberg E, Driscoll CF, Tabaco M. An In Vitro evaluation of the Reliability and validity of an electronic pantograph by testing with five different Articulators, J Prosthet Dent 2004;92:83-9 “The pantograph was determined to be both reliable and valid”
- 258. The Dilemma
- 259. The Dilemma Failing Restoration • Repeated Decementations Healthy abutments • No restorations Patient Factors • Emotional Intolerance
- 260. Treatment Considerations 11Predictability 21Cost 2-31Time 11Provisionalization 21Augmentation 22Bone Support 14Teeth Preparation 1-21Esthetics Single Tooth Implant3 Unit FPDRisk Assessment 22Long Term Results 22Trauma
- 261. 186