DIAGNOSIS AND
TREATMENT
PLANNING
PRE PROSTHETIC
EVALUATION

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INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

www.indiandentalacademy.com
Pre Prosthetic Evaluation
Intraoral examination
 Analysis of mounted study casts
 Bone mapping
 Radiographic analysis
...
Intraoral Examination
 Existing

occlusion
 Existing occlusal plane, orientation
 Interarch space
 Existing vertical d...
Intraoral Examination
 Arch

form
 Ideal implant permucosal position
 Missing teeth location
 Missing teeth number
 L...
Arch form

www.indiandentalacademy.com
Diagnostic Casts
Mounted diagnostic cast are invaluable
for Occlusal centric relation position
including premature occlusi...
Position of the replacement in
relation to the residual ridge

www.indiandentalacademy.com
Diagnostic Casts
Direction of forces in future implant
sites
 Present occlusal scheme including the
presence of balancing...
Study Model Analysis –
Edentulous Patient
 Pattern

of resorption - can
exhibit as cross bite in posterior
region and as ...
Mounted study models indicating
minimum Interocclusal distance

www.indiandentalacademy.com
Mounted Study models showing
large interarch space

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Prognathic relationship

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Angle class II

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Study Model Analysis –
Partially Edentulous Patients

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Interarch
Distances

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Evaluation Of Available Bone
 Evaluation

of bone quantity
 Evaluation of bone quality

www.indiandentalacademy.com
Available bone is evaluated by
Digital Palpation
 Radiographs
 Study models
 Bone sounding


www.indiandentalacademy.c...
Bone sounding

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OSTEOMETER

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MAINZ MEASURING GAUGE

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EVALUATION OF BONE QUANTITY

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ALVEOLAR PROCESS

FUNCTIONAL ADAPTATION

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ATWOODS CLASSES OF RESORPTION
FOR MAXILLA

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ATWOODS CLASSES OF RESORPTION
FOR MANDIBLE

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Classification Of Degree Of Resorption Of
Edentulous Jaws By
Lekholm And Zarb(1985)

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Pattern of resorption (Harle)
 Maxillary

arch buccal to lingual
 Mandibular arch lingual to buccal

www.indiandentalaca...
Available bone is studied under
Height of bone
 Width of bone
 Length of bone
 Bone contour
 Crown implant
ratio


ww...
Height of bone
 Vertical

extent bone available for
implantation
 Distance between the crest of
alveolar bone to the opp...
Width of bone
 Distance

between oral and vestibular
cortical plates
 1mm diameter increase = 20-30%
increase in the tot...
Length of bone
 Minimum

distance between axis to
axis between two implants is 7mm
 R1+R2+2mm=distance between two
impla...
Bone contour (Angulation)
 Favorable

bone contour is one in
which the functional and esthetic
demands of the prosthesis ...
Divisions of
Available bone quantity
 Division

A (abundant)
 Division B (barely sufficient)
 Division C (Compromised)
...
Division A
 Width

> 5mm
 Height >10-13mm
 Length >7mm
 C/I < 1

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Division B
 Width

2.5-5mm
 Height >10-13mm
 Length >12mm
 C/I < 1

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Options for Division B Bone
 Modify

the existing Div B ridge to
another division by Osteoplasty
 Insert a narrow Div B ...
www.indiandentalacademy.com
Disadvantages Division B
 Stress

at the crestal region around
the implant is twice
 Lateral loads on the implant result...
Disadvantages Division B
 Conditions

around the cervical aspect
of the crown for daily care is poor
 Angle of load must...
Division C
 Unfavorable
 Unfavorable
 Unfavorable
 Unfavorable

Width (C-w)
Height (C-h)
Angulation (C-a)
C/I = 1

www...
Treatment options for Division C
 Ostoeplasty
 Root

form implants
 Subperiosteal implants
 Augmentation procedures
 ...
EVALUATION OF BONE QUALITY

www.indiandentalacademy.com
Bone Quality Is Evaluated By
 Tactile
 Radiographic
 Biochemical

www.indiandentalacademy.com
Bone density and success rates
 Adell

et al reported 10% greater
sucesss rate in the anterior mandible
compared to anter...
CT determination of bone density
 D1:
 D2:
 D3:
 D4:
 D5:

> 1250 Hounsfield units
850 - 1250 Hounsfield units
350 - ...
Mechanostat theory of Frost
 The

structure of bone is maintained
by the micro strain environment
 Bone reaction to diff...
Bone Classification Related To Implant
Dentistry By Linkow (1970)
 Class

I Bone structure:

ideal type of bone with even...
BONE DENSITY
CLASSIFICATION BY MISCH
D1

Dense
cortical

D2

Porous
cortical

D3

Coarse
Trabecular

www.indiandentalacade...
Bone density location
 D1

– 6% in anterior mandible
3% in posterior mandible
 D2 – most common in mandible
 D3 – most ...
Influence Of Bone Density On Treatment
Planning
 Surgical

– Soft bone protocol
– Selection of fixture size
– Selection o...
Evaluation of force
 Parafunction
 Position

of abutment in the arch
 Masticatory dynamics
 Nature of the opposing arc...
Thank you
www.indiandentalacademy.com
Leader in continuing dental education

www.indiandentalacademy.com
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Implant diagnosis n planning /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.


Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078

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Implant diagnosis n planning /certified fixed orthodontic courses by Indian dental academy

  1. 1. DIAGNOSIS AND TREATMENT PLANNING PRE PROSTHETIC EVALUATION www.indiandentalacademy.com
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 3. Pre Prosthetic Evaluation Intraoral examination  Analysis of mounted study casts  Bone mapping  Radiographic analysis  Force evaluation  www.indiandentalacademy.com
  4. 4. Intraoral Examination  Existing occlusion  Existing occlusal plane, orientation  Interarch space  Existing vertical dimension of occlusion  Maxillomandibular arch relations  Temporomandibular joint status  Existing prosthesis www.indiandentalacademy.com
  5. 5. Intraoral Examination  Arch form  Ideal implant permucosal position  Missing teeth location  Missing teeth number  Lip line at rest and during speech  Mandibular flexure  Soft tissue support www.indiandentalacademy.com
  6. 6. Arch form www.indiandentalacademy.com
  7. 7. Diagnostic Casts Mounted diagnostic cast are invaluable for Occlusal centric relation position including premature occlusion  Edentulous ridge relations to adjacent teeth and opposing arches  Position of potential natural abutments including inclination rotation extrusion spacing parallelism and esthetic considerations  www.indiandentalacademy.com
  8. 8. Position of the replacement in relation to the residual ridge www.indiandentalacademy.com
  9. 9. Diagnostic Casts Direction of forces in future implant sites  Present occlusal scheme including the presence of balancing or working contacts  Edentulous soft tissue angulation, length, width, locations, permucosal esthetic position, muscle attachments and tuberosities  www.indiandentalacademy.com
  10. 10. Study Model Analysis – Edentulous Patient  Pattern of resorption - can exhibit as cross bite in posterior region and as prognathism in anterior region.  Mounted study models will help ascertain vertical and sagittal relationships www.indiandentalacademy.com
  11. 11. Mounted study models indicating minimum Interocclusal distance www.indiandentalacademy.com
  12. 12. Mounted Study models showing large interarch space www.indiandentalacademy.com
  13. 13. Prognathic relationship www.indiandentalacademy.com
  14. 14. Angle class II www.indiandentalacademy.com
  15. 15. Study Model Analysis – Partially Edentulous Patients www.indiandentalacademy.com
  16. 16. Interarch Distances www.indiandentalacademy.com
  17. 17. Evaluation Of Available Bone  Evaluation of bone quantity  Evaluation of bone quality www.indiandentalacademy.com
  18. 18. Available bone is evaluated by Digital Palpation  Radiographs  Study models  Bone sounding  www.indiandentalacademy.com
  19. 19. Bone sounding www.indiandentalacademy.com
  20. 20. OSTEOMETER www.indiandentalacademy.com
  21. 21. MAINZ MEASURING GAUGE www.indiandentalacademy.com
  22. 22. EVALUATION OF BONE QUANTITY www.indiandentalacademy.com
  23. 23. ALVEOLAR PROCESS FUNCTIONAL ADAPTATION www.indiandentalacademy.com
  24. 24. ATWOODS CLASSES OF RESORPTION FOR MAXILLA www.indiandentalacademy.com
  25. 25. ATWOODS CLASSES OF RESORPTION FOR MANDIBLE www.indiandentalacademy.com
  26. 26. Classification Of Degree Of Resorption Of Edentulous Jaws By Lekholm And Zarb(1985) www.indiandentalacademy.com
  27. 27. Pattern of resorption (Harle)  Maxillary arch buccal to lingual  Mandibular arch lingual to buccal www.indiandentalacademy.com
  28. 28. Available bone is studied under Height of bone  Width of bone  Length of bone  Bone contour  Crown implant ratio  www.indiandentalacademy.com
  29. 29. Height of bone  Vertical extent bone available for implantation  Distance between the crest of alveolar bone to the opposing anatomic structures www.indiandentalacademy.com
  30. 30. Width of bone  Distance between oral and vestibular cortical plates  1mm diameter increase = 20-30% increase in the total surface area  3mm increase in length provides more than 10% increase in surface area www.indiandentalacademy.com
  31. 31. Length of bone  Minimum distance between axis to axis between two implants is 7mm  R1+R2+2mm=distance between two implants www.indiandentalacademy.com
  32. 32. Bone contour (Angulation)  Favorable bone contour is one in which the functional and esthetic demands of the prosthesis to be borne by the implant can be fulfilled with axial loading of the prosthesis www.indiandentalacademy.com
  33. 33. Divisions of Available bone quantity  Division A (abundant)  Division B (barely sufficient)  Division C (Compromised)  Division D (Deficient) www.indiandentalacademy.com
  34. 34. Division A  Width > 5mm  Height >10-13mm  Length >7mm  C/I < 1 www.indiandentalacademy.com
  35. 35. Division B  Width 2.5-5mm  Height >10-13mm  Length >12mm  C/I < 1 www.indiandentalacademy.com
  36. 36. Options for Division B Bone  Modify the existing Div B ridge to another division by Osteoplasty  Insert a narrow Div B root form implant  Modify existing Div B bone into Div A by augmentation www.indiandentalacademy.com
  37. 37. www.indiandentalacademy.com
  38. 38. Disadvantages Division B  Stress at the crestal region around the implant is twice  Lateral loads on the implant result in almost 3 times greater stress than Division A  Fatigue fractures in the abutment are increased  Crown emergence profile is less esthetic www.indiandentalacademy.com
  39. 39. Disadvantages Division B  Conditions around the cervical aspect of the crown for daily care is poor  Angle of load must be reduced to less than 20 degrees to compensate for the small diameter  Two implants are required for proper prosthetic support www.indiandentalacademy.com
  40. 40. Division C  Unfavorable  Unfavorable  Unfavorable  Unfavorable Width (C-w) Height (C-h) Angulation (C-a) C/I = 1 www.indiandentalacademy.com
  41. 41. Treatment options for Division C  Ostoeplasty  Root form implants  Subperiosteal implants  Augmentation procedures  Ramus frame implants  Transosteal implants www.indiandentalacademy.com
  42. 42. EVALUATION OF BONE QUALITY www.indiandentalacademy.com
  43. 43. Bone Quality Is Evaluated By  Tactile  Radiographic  Biochemical www.indiandentalacademy.com
  44. 44. Bone density and success rates  Adell et al reported 10% greater sucesss rate in the anterior mandible compared to anterior maxilla  Schnitman et al reported highest success rate of 75% in the posterior maxilla  Friberg et al reported 66% of the implant failures occurred in soft bone www.indiandentalacademy.com
  45. 45. CT determination of bone density  D1:  D2:  D3:  D4:  D5: > 1250 Hounsfield units 850 - 1250 Hounsfield units 350 - 850 Hounsfield units 150 - 350 Hounsfield units < 150 Hounsfield units www.indiandentalacademy.com
  46. 46. Mechanostat theory of Frost  The structure of bone is maintained by the micro strain environment  Bone reaction to different degrees of micro strains 0-50 : acute disuse window 50-1500 : adapted window 1500-3000 : mild overload Above 3000 : pathologic overload www.indiandentalacademy.com
  47. 47. Bone Classification Related To Implant Dentistry By Linkow (1970)  Class I Bone structure: ideal type of bone with evenly spaced trabeculae with small cancellated spaces  Class II Bone structure: bone has larger cancellated spaces with less uniformity of the cancellous spaces  Class III Bone structure: large marrow spaces between trabeculae www.indiandentalacademy.com
  48. 48. BONE DENSITY CLASSIFICATION BY MISCH D1 Dense cortical D2 Porous cortical D3 Coarse Trabecular www.indiandentalacademy.com D4 Fine trabecular
  49. 49. Bone density location  D1 – 6% in anterior mandible 3% in posterior mandible  D2 – most common in mandible  D3 – most common in maxilla 65% in anterior maxilla 50% in posterior maxilla  D4 – most common in posterior maxilla www.indiandentalacademy.com
  50. 50. Influence Of Bone Density On Treatment Planning  Surgical – Soft bone protocol – Selection of fixture size – Selection of the drilling sequence – Selection of the material of the implant – Auxiliary procedures  Prosthetic – Progressive loading www.indiandentalacademy.com
  51. 51. Evaluation of force  Parafunction  Position of abutment in the arch  Masticatory dynamics  Nature of the opposing arch  Direction of load forces  Crown-Implant ratio www.indiandentalacademy.com
  52. 52. Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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