implant supported complete denture/ cosmetic dentistry training


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Indian Dental Academy: will be one of the most relevant and exciting

training center with best faculty and flexible training programs

for dental professionals who wish to advance in their dental

practice,Offers certified courses in Dental

implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic

Dentistry, Periodontics and General Dentistry.

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implant supported complete denture/ cosmetic dentistry training

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education
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  11. 11. The use of osseointegrated implants in edentulous patients was first developed Dr. Per- Ingvar Brànemark and the type of restorative treatment studied was by using the fully jawbone anchored prosthesis. The term used by Branemark and others is “Tissue-Integrated Prostheses” (Brànemark et al.,1985).
  12. 12. “CONCEPT OF OSSEOINTEGRATION” Dr. Per-Ingvar Branemark Orthopaedic surgeon Professor University of Goteburg, Sweden. Threaded implant design made up of pure titanium.
  13. 13. After fixture placement, healing, and subsequent prosthesis insertion, the bone level reaches a “steady state” (Brànemark et al., 1985). This is a balance between forces transmitted through the prosthesis and fixtures, and bone remodeling capabilities. The resorptive process can be controlled with proper fixture placement to prevent rampant resorption while offering the patient a high quality, functional prosthesis.
  14. 14. Many fabrication methods for fully bone anchored prostheses are introduced (Loos, 1986; Lundqvist, Carlsson, 1983; Parel et al., 1986; Rasmussen, 1987; Siirila et al., 1988; Zarb et al., 1987; Zarb, Jansson, 1985; Zarb, Symington, 1983). Treatment planning is essential for successful results and is an integral part of good communication between the surgeon and the prosthodontist or restorative dentist.
  15. 15. In particular, treatment planning for the maxillary arch is critical and requires good communication. Since the fully bone anchored prosthesis may not obturate the space between the prosthesis and residual tissues, air flow pattern produced during speech is unimpeded. This might present problems for the patient if their occupation requires good speaking abilities.
  16. 16. Also if there has been severe resorption in the maxilla, esthetic results are difficult due to the added amount of material needed to replace missing anatomical structure. Lip support may be insufficient in the area of space between the prosthesis and tissues. When discussing treatment alternatives with a patient, be certain to discuss advantages and disadvantages of each option.
  17. 17. For the patient with high esthetic demands, consider overdenture treatment for the maxilla (Parel, 1986). However, many patients prefer bone anchored prostheses to satisfy functional demands.
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  20. 20. Any object or material, such as an alloplastic substance or other tissue, which is partially or completely inserted or grafted into the body for therapeutic, diagnostic, prosthetic, or experimental purposes GPT 8
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  22. 22. A prosthetic device made of alloplastic material(s) implanted into the oral tissues beneath the mucosal or/and/ periosteal layer, and on/or within the bone to provide retention and support for an fixed or removable dental prosthesis. A substance that is placed into or /and upon the jaw bone to support a fixed or removable dental prosthesis. GPT 8
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  26. 26. HISTORY AND EVOLUTION OF ORAL IMPLANTOLOGY Dental implant history dates back thousands of years and includes civilizations such as the ancient Chinese, who 4000 years ago inserted bamboo into the jaw bone for fixed tooth replacements.
  27. 27. The Eygptians and, later, physicians from Europe used ferrous and precious metals for implants over 2000 years ago, and the Incas used pieces of sea shell, inserted into the jaw bones to replace missing teeth. 600A.D: First evidence of use of implants; in mayan population, Pieces of shell to replicate 3 lower incisors.
  28. 28. In the 1700’s: John Hunter; Transplantation of incompletely Developed tooth into the comb of a Rooster. In the 1800’s: Transplantation fell into dispute because of disease transmission & rejection. 1809: Maggiolo: Gold root into extraction socket to support teeth.
  29. 29. 1911: Greenfield; Iridioplatinum basket implant soldered with 24 karat gold solder. 1939: Strock; Vitallium screw implant. Mid 1940’s: Foramiggini; Stainless steel spiral implant.
  30. 30. SUBPERIOSTEAL IMPLANT Mid 1943: Dahl used first Superiosteal Implant; Bulky, flat, abutment and screw. Mid 1948: Goldberg and Gerskkoff; Extension of the framework to the external oblique region. Mid 1952: Lew: Direct impression technique; Fewer struts on crest of ridge. In 1950’s: Bodine; More secondary struts. 1959: Lew; Minimum bulk, simple tapered abutment as transmucosal abutment.
  31. 31. Mid 1950’s: Lee; Endosseous implant with central post and circumferential extension Early 1960’s: Chercheve; Double-helical spiral implant (Co-Cr) Early 1960’s: Scialom; Tripodial endosseous pin arrangement. Early 1960’s: Orlay; Vitallium post-endodontic implants.
  32. 32. Early 1960’s: Linkow; Ventplant implants self-tapping endosseous screw implants. Early 1960’s: Linkow; Blade vent implants. Mid 1960’s: Sandhaus; Crystalline bone screw (Aluminum oxide) In 1970’s: Roberts and Roberts; Ramus frame implants. 1973: Grenoble; Vitreous carbon Implants 1978: Small; Mandibular Staple implant
  33. 33. 1986: Tatum; Omni R-implant (Titanium alloy root from implant) 1973: Weiss and Judy; Intramucosal inserts Early 1980’s: Nichnick: Core Vent Implants; a) Hollow Basket Implant b) Screw Vent Implant c) Hydroxyapatite Coated Implant In 1980’s: Driskell; Stryker root form implants (Titanium alloy & Hydroxyapatite coated).
  34. 34. Late 1970’s: Krisch: IMZ implant; Titanium plasma spray & intramobile element. Early 1980’s: Calcitek corporation; Synthetic poly crystalline ceramic hydroxyapatite calcite implants. 1985: Straumann Company: ITI Implants; Plasma sprayed cylinder & screw “one-stage operation”.
  35. 35. 1700 – John hunter → “Transplantation” Transmission of various diseases
  36. 36. 1809-Maggiolo Gold roots 1939-Strock Vitallium screw
  37. 37. 1943 - Dahl 1948 - Goldberg and Gershkoff Subperiosteal implant
  38. 38. 1960 – Linkow Blade vent implant
  39. 39. • Inflammatory reaction • Gradual bone loss • Fibrous encapsulation
  40. 40. Classification of Implants : 1) Sub - periosteal implant 2) Transosteal implant 3) Endosseous implant 4) Endodontic or Diodontic implant 5) Intramucosal implant
  41. 41. Classification : Based on placement within the tissues Sub - Periosteal Implants Transosteal Implants Endosteal Implants
  42. 42. Sub Periosteal Implant : an implant that is placed beneath the periosteum of the bone. It receives it’s primary bone support by resting on it. This implant does not osseointegrate.
  43. 43. They may be fabricated by making a direct bone impression. They may be used in any part of either jaw, and will serve as abutments for a variety of prosthetic configurations, although the overdenture is the most widely used to complement the complete subperiosteal implant.
  44. 44. Prosthetic options: overdentures, fixed bridges. Suitable arch: Maxillary or mandibular, completely or partially edentulous Required bone: 5mm or mandibular augmentation is required.
  45. 45. Extremely thin (pencil-like) mandibular and maxillae may permit subperiosteal implants to settle through them. Therefore, seek a moderate amount of vertical bone height (at least 5mm), or make plans to augment the inferior mandibular border or elevate the antral floor on a preventive basis.
  46. 46. Use of subperiosteal implants, which generally are quite reliable, when sufficient bone is unavailable for the use of endosteal varieties. However, when extreme mandibular atrophy exists, mandibular augmentation further improves the prognosis. Subperiosteal implants are always custom made.
  47. 47. Transosteal Implants : an dental implant that penetrates both cortical plates and passes through the entire thickness of the alveolar bone.
  48. 48. Transosteal implants are one-piece, transmandibular complex implants or are available as individual abutments. One advantage of using the transosteal implant is predictable longevity. Several designs are available:
  49. 49. Single component: Multiple component, staple designs (several varieties) Prosthetic options: the usual application for these implants is to support an overdenture. Fixed bridges are rarely made as alternative. Suitable arch: Mandible, anterior region, completely or partially edentulous (single component may be used in the presence of adjacent teeth).
  50. 50. Required bone: 6-mm vertical bone height 5-mm bone width (labial to lingual)
  51. 51. Endosseous Implant : an implant that is present within the bone , extends into basal bone for support. Types : Screw form Cylinder form (Hollow,Solid) Blade form
  52. 52. Endosseous implant 1) Blade form or Plate form 2) Root form implants Screw ( V-thread, Buttress thread, Power or square thread) Cylinder ( Hollow or Solid ) Endosseous, root form, screw type, power thread Endosseous, root form, tapered, hollow, cylindrical,
  53. 53. Root Form Implants: Given sufficient width and height of the bone available, root forms (submergible, two-stage and single-stage, one-piece) are the first choice in selecting an implant. The following types are available: Press-fit (unthreaded but covered with a roughened hydroxyapatite [HA] or titanium plasma spray coating [TPS]) Self-tapping (threaded) Pre-tapping (threaded)
  54. 54. Prosthetic options: Prostheses may be supported by fixed, fixed-detachable, overdenture, and single tooth purposes (antirotational design required). Required bone: 8-mm vertical bone height 5.25-mm bone width (buccal to lingual)
  55. 55. Blade Implants: Blade implants are available as submergible. two-stage and single-stage, one-piece devices as follows:
  56. 56. Ramus Blade and Ramus Frame: The ramus implant is a one-piece blade made for use in the posterior mandible when insufficient bone exists in the body of this jaw. The ramus frame is a three- blade, one-piece device designed for relatively atrophied mandibles for which the subperiosteal implant, because of cost or operator preference, is not desirable.
  57. 57. Prosthetic option: overdentures Suitable arch: mandibular. completely edentulous Required bone: 6-mm vertical bone height (symphysis, rami) 3-mm bone width (buccal to lingual)
  58. 58. Other Implants: Endodontic Stabilizers: Endodontic stabilizers are highly successful, tooth root-lengthening implants. One reason for their success is that they have no site of permucosal penetration because they are placed into bone through the apices of natural teeth.
  59. 59. This implant offers a one-stage treatment for the stabilization of teeth that suffer from inadequate crown-root ratios. Their percentage of success when periodontal problems have been treated approaches that of conventional endodontic therapy. Prosthetic options: Crowns and fixed bridge abutments
  60. 60. Suitable arch: Maxillary or mandibular; any tooth may be treated. Required bone: 8mm of lesion-free bone in direct proximity to apex-within the long axis of the recipient root canal.
  61. 61. Intramucosal Inserts: Intramucosal inserts are buttonlike, nonimplanted retention devices that can be used to stabilize full and partial maxillary and mandibular removable denture prostheses. Because of the simple and relatively noninvasive nature of the procedure placement, they are of particular value for patients who are poor medical risks.
  62. 62. Prosthetic options: Removal denture, full or partial Suitable arch: maxillary, completely or partially edentulous; mandibular partial only. Required bone: none; required mucosa, 2.2mm thick (bone beneath thinner mucosa may be deepened in nonantral area)
  63. 63. Bone Augmentation Materials, including Guide Tissue Regeneration Membranes: Use bone augmentation materials for ridge maintenance after dental extractions, for ridge augmentation, for periodontal and periimplant repair and support, and for maxillofacial surgical onlay and inlay purposes when bone replacement is required.
  64. 64. None but autogenous bone and possibly bone morphogenic protein (BMP) is osteogenic. Demineralized freeze-dried bone (DFDB) is said to be osteoinductive.
  65. 65. Doped surfaces that contain various types of bone growth factors or other bone-stimulating agents may prove advantageous in compromised bone beds. However, at present clinical documentation of the efficacy of such surfaces is lacking : BMP = Bone morphogenetic protein. Doped surfaces
  66. 66. Ceramic: Resorbable, tricalcium phosphate (TCP) Nonresorbable: hydroxyapatite Porous particulate and block forms Nonporous particulate and block forms Block are available as particles held together in resorbable collagen media, strung like beads with polyglycolic acid suture or supported in a matrix of calcium sulfate (plaster of Paris-Hapset)
  67. 67. Polymeric: Hard tissue replacement (HTR) particulate and porous block forms Biologic: Autogenous bone Irradiated bone DFDB (Decalcified Freeze Dried Bone) Bovine (i.e., BioOss) Membranes: Resorbable and Nonresorbable
  68. 68. MAXILLARY - COMPLETELY EDENTULOUS: Goal: Identify patient’s need for a removable or fixed prosthesis. This is critical because a patient’s need will dictate the design of the prosthesis and may affect the number of implants placed. For instance if the patient's chief complaint is dislike of the removable aspect of the existing denture, then a fixed prosthesis must be planned. This often includes more implants and careful planning.
  69. 69. Restorative Options: A) Maxilla fixed-detachable prosthesis:
  70. 70. Definition: “An implant-supported prosthesis that is fixed and not removable by the patient. This prosthesis is retrievable by the dentist by unscrewing the retaining screws”
  71. 71. Advantages: 1. Predictability based on research 2. Fixedness 3. Retrievability 4. No palatal coverage 5. Usefulness for patients with significant maxillary resorption. 6. The metallic components will not be as likely to show with severe resorption, v hen combined with a low smile line.
  72. 72. Disadvantages: 1. Maintenance is difficult owing to contours Created to hide metal components. 2. Phonetic problems can result from air escape. 3. Esthetic problems are possible with short lip or high smile line: the metal components may show.
  73. 73. 4. Limitation on cantilever extension often make it impossible to match occlusal planes and provide adequate centric contacts with some skeletal relations. 5. Profile cannot be altered with flange. 6. The potential site for implants is often only in the anterior maxilla. If the implant end up in a straight line, the cantilever is limited.
  74. 74. Design Considerations: 1. Number of implants: At least four Ideally six or more
  75. 75. MANDIBULAR - COMPLETELY EDENTULOUS: Goal: Determine whether the patient requires fixed or removable prosthesis.
  76. 76. Presurgical needs: 1. Mounted diagnostic casts 2. Wax trial denture set-up 3. Surgical guide 4. Plan for prosthesis type and design, which will determine implant placement. 5. Examination of smile line
  77. 77. If teeth are removed and implant placed soon, there is little resorption of the vertical height of the mandible. There is a potential for metal to show due to this lack of resorption because the restoration and its components will be more superior.
  78. 78. 6. Radiographic needs a. Panoramic radiograph: essential All other radiographic aids utilized if additional information necessary: b. Occlusal c. Periapical d. Tomograms e. Lateral cephalometric f. Computerized axial tomograms
  79. 79. OCCLUSAL CONSIDERATIONS: I. Completely Edentulous: Maxilla: Complete denture, no implants Mandible: complete denture, no implants 1. Nonbalanced occlusion 2. Balanced occlusion a. Bilateral balanced-anatomic tooth b. Lingualized occlusion c. Monoplane-balanced
  80. 80. Maxilla: Complete denture, no implants Mandible: overdenture, implants 1. Nonbalanced occlusion a. Potential problem with unstable maxillary complete denture 2. Balanced occlusion b. Bilateral balanced c. Lingualized occlusion d. Monoplane-balanced
  81. 81. Maxilla: Overdenture, implants Mandible: overdenture, implants 1. Nonbalanced occlusion 2. Balanced occlusion a. Bilateral balanced b. Lingualized occlusion c. Monoplane-balanced
  82. 82. Maxilla: Complete denture, no implants Mandible: Fixed detachable prosthesis, 4 to 6 implants 1. Nonbalanced occlusion a. Potential problem with unstable maxillary complete denture b. Potential painful tissue under maxillary complete denture 2. Balanced occlusion a. Bilateral balanced b. Lingualized
  83. 83. Maxilla: fixed detachable prosthesis, 4 to 6 implants Mandible: fixed detachable prosthesis, 4 to 6 implants 1. Anterior group function a. Simultaneous contact on anterior and posterior teeth in centric - goal is force over the implants. This is often difficult to achieve with a class II malocclusion patient due to lack of anterior occlusion contact. b. Contact on multiple teeth and over multiple implants in laterotrusion and protrusion. c. No force or contact on cantilever laterotrusion and protrusion. d. Avoid all contact on one tooth or one implant.
  84. 84. II. Completely and Partially Edentulous: Maxilla: complete denture, no implants Mandible: dentulous with implant-supported partial denture (teeth + implants) 1. The goal is balanced occlusion (in order to stabilize the maxillary complete denture
  85. 85. a. Bilateral balanced b. Lingualized occlusion 2.This is difficult to accomplish with natural teeth.
  86. 86. Maxilla: overdenture, implants Mandible: dentulous with implant-supported fixed partial denture (teeth + implants,)
  87. 87. 1. If the overdenture is totally implant supported, avoid contact in laterotrusion on teeth distal to last implant. It is a cantilever and may place excessive load on the implants. 2. If the overdenture is joint implant and mucosal supported, the goal is bilateral balanced or Lingualized occlusion. This is difficult with natural teeth.
  88. 88. Maxilla: fixed detachable prosthesis, implants Mandible: dentulous with implant-supported fixed partial denture (teeth + implants) 1. In laterotrusion and protrusion, avoid contact on cantilever. 2. In laterotrusion and protrusion, contact is on multiple teeth over multiple implants. Avoid placing all contact on one implant.
  89. 89.
  90. 90. For many years, traditional complete denture designs have been modified to gain additional support and stability from a few retained and suitably prepared natural teeth. Brànemark’s original prosthodontic protocol described a screw-retained full-arch fixed prosthesis. This clinical objective produced a prosthesis that was literally attached to the arch, while remaining electively removable.
  91. 91. The argument was made that, if the prosthesis were inseparable from the patient, it would be perceived as part of the patient and would therefore be the best solution to the problem of unsatisfactory adaptation of the complete denture experience. The biotechnological achievement of osseointegration was justifiably heralded as a major therapeutic breakthrough for edentulous people.
  92. 92. Prosthodontists had previously developed an ingenious repertoire of methods and techniques to manage the edentulous condition. Experience and observation had taught them that the vast majority of their patients’ early years of denture wearing were without major problems. With the use of implants more stable and retentive dentures can be given to the patient preserving the underlying alveolar bone and increasing the proprioception.
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  94. 94. 1.Michael Norton: “Dental Implants. A Guide for the General Practitioner”. 33-51. 2. Patrick J. Stevens, Edward J. Fredrickson, M.L. Gress: “Implant Prosthodontics, Clinical Laboratory Procedures” 2 Edn., 2000; 63-75 3. Sumiya Hobo, Eiji Ichida, Lily T. Garcia: “Osseointegration and Occlusal Rehabilitation” 1989; 65-273, 153-161, 169-180, 197-230. 4. Carl E. Misch: “Contemporary Implant Dentistry”, 1999; 420.
  95. 95. 5. Babbush CA: “Dental Implants: The Art and Science “, Philadelphia, Pennsylvania, W.B. Saunders Company, 1997. 7. Cranin AN: “Atlas of Oral Implantology” St Louis, Missouri, Mosby, 1999. 12. Watzek G: “Endosseous Implants: Scientific and Clinical Aspects”, Chicago, Illinois, Quintessence Publishing 1996.
  96. 96. Thank you For more details please visit