Treatment planning for
implant restorations
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalac...
ContentsContents
 IntroductionIntroduction
 Available bone and implantAvailable bone and implant
 Classification and tr...
INTRODUCTIONINTRODUCTION
The treatment plan should begin withThe treatment plan should begin with
a clear idea of the end ...
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Available BoneAvailable Bone
 Available bone is that portion of a partiallyAvailable bone is that portion of a partially
...
ATWOODS CLASSIFICATION
 Order I:Order I: pre-extraction.pre-extraction.
 Order II:Order II: post extraction.post extract...
 CLASSIFICATION ACCORDING TO THE AMERICANCLASSIFICATION ACCORDING TO THE AMERICAN
COLLEGE OF PROSTHODONTISTS:COLLEGE OF P...
AVAILABLE BONEAVAILABLE BONE
Available bone describes the amount of bone in the
edentulous area considered for implantatio...
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AVAILABLE BONE HEIGHTAVAILABLE BONE HEIGHT
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The minimum height of the available bone
for endosteal implants is related to the density of
the bone.
The minimum bone he...
 The height of the implant also affects its totalThe height of the implant also affects its total
surface areasurface are...
 The root form implants ofThe root form implants of
4.0 mm4.0 mm crestal diametercrestal diameter
usually require more th...
 Each 1mm increase in diameter corresponds to aEach 1mm increase in diameter corresponds to a
surface area increase of ap...
1 mm1 mm – Bone remaining after implant– Bone remaining after implant
placement to anatomical structuresplacement to anato...
AVAILABLE BONE LENGTHAVAILABLE BONE LENGTH
The mesio-distal length of available bone in
an edentulous area is often limite...
AVAILABLE BONE ANGULATIONAVAILABLE BONE ANGULATION
Ideally the bone angulation is aligned with
the forces of occlusion and...
 TheThe limiting factor of angulationlimiting factor of angulation of force betweenof force between
the body and the abut...
CROWN-IMPLANT BODY RATIOCROWN-IMPLANT BODY RATIO
The crown height is measured from the
occlusal or incisal plane to the cr...
 The greater the crown height, the greater theThe greater the crown height, the greater the
lever arm with any lateral fo...
DIVISIONSDIVISIONS
OFOF
AVAILABLE BONEAVAILABLE BONE
 Division A (Abundant Bone)
 Division B (Barely Sufficient Bone)
 ...
Division ADivision A
(Abundant Bone)(Abundant Bone)
 >5mm width>5mm width
 >12 mm height>12 mm height
 >7mm mesio-dista...
 Division A is mostDivision A is most
often restored withoften restored with
Division A root formDivision A root form
imp...
DIVISION A ROOT FORM IMPLANTDIVISION A ROOT FORM IMPLANT
ADVANTAGESADVANTAGES
 Greatest surface areaGreatest surface area...
Division B (Barely sufficientDivision B (Barely sufficient
bone)bone)
 As the bone resorbs, the width of available boneAs...
Division BDivision B
(Barely Sufficient Bone)(Barely Sufficient Bone)
2.5-5mm width2.5-5mm width
>12 mm height>12 mm heigh...
Treatment options available for theTreatment options available for the
Division B edentulous ridgeDivision B edentulous ri...
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DISADVANTAGES OF DIVISION B ROOTDISADVANTAGES OF DIVISION B ROOT
FORMSFORMS
 Almost twice the stress is concentrated at t...
Division CDivision C
(Compromised Bone)(Compromised Bone)
Unfavorable in: WidthUnfavorable in: Width
(C-w)(C-w)
Height (C-...
 The resorption of the available bone occurs first inThe resorption of the available bone occurs first in
bone width, and...
Treatment options available for theTreatment options available for the
Division C edentulous ridgeDivision C edentulous ri...
Division DDivision D
(Deficient Bone)(Deficient Bone)
Severe atrophySevere atrophy
Basal bone lossBasal bone loss
Flat max...
Treatment options available for theTreatment options available for the
Division D edentulous ridgeDivision D edentulous ri...
 If implant failure occurs, the patient may become aIf implant failure occurs, the patient may become a
dental cripple, u...
Treatment planning forTreatment planning for
implant restorations inimplant restorations in
partially edentulouspartially ...
 The implant dentistry bone volumeThe implant dentistry bone volume
classification developed byclassification developed b...
Class IClass I
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Class IIClass II
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CLASS IIICLASS III
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CLASS IVCLASS IV
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Class I - Division AClass I - Division A
Bone height > 10 mm
Length > 7 mm
Angulation < 30 degrees
Crown height < 15 m...
Class I division BClass I division B
Bone width 2.5-5
mm
Bone height > 10
mm
Angulation < 20
degrees
Crown height < 15...
CLASS I – Division CCLASS I – Division C
Inadequate
available bone
height, Length
,Angulation.
Crown height > 15
mm
 Au...
CLASS I Division DCLASS I Division D
Inadequate available bone
due to Severly resorbed
ridge involving basal bone
Crown he...
CLASS II Division A, BCLASS II Division A, B
Endostel implants with min
osteoplasty are common
modality.
Extrusion of oppo...
CLASS II Division CCLASS II Division C
Conventional prosthesis
and small diameter
implants after ridge
augmentation with o...
CLASS IIICLASS III
DIVISION A DIVISION C
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 Single tooth implants are treatment ofSingle tooth implants are treatment of
choice when the soft and hard tissues arech...
CLASS IVCLASS IV
•Traditional fpd is treatment of
choice when canines are
present
•Bone grafts should be placed
before pla...
TREATMENT PLANSTREATMENT PLANS
FOR COMPLETELYFOR COMPLETELY
EDENTULOUS ARCHESEDENTULOUS ARCHES
www.indiandentalacademy.com...
Classification of completelyClassification of completely
edentulous arches is also basededentulous arches is also based
on...
TYPE ITYPE I
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TYPE IITYPE II
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TYPE IIITYPE III
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IMPLANTIMPLANT
OVERDENTURESOVERDENTURES
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Many edentulous patients experience problems withMany edentulous patients experience problems with
their dentures, especia...
Implant Overdenture AdvantagesImplant Overdenture Advantages
1.1. Minimum anterior bone loss; prevents boneMinimum anterio...
6. Improved retention6. Improved retention
7. Improved support7. Improved support
8.Improved speech8.Improved speech
9. Re...
Implant overdenture advantages versus fixedImplant overdenture advantages versus fixed
prosthesisprosthesis
 Fewer implan...
 Soft tissue considerationsSoft tissue considerations
Improved periimplant probingImproved periimplant probing
HygieneHyg...
 Less cost and laboratory costLess cost and laboratory cost
Fewer implantsFewer implants
Less bone graftingLess bone graf...
Over denture disadvantagesOver denture disadvantages
1.1.Psychological (need for non removablePsychological (need for non ...
6. New prosthesis every 7 years6. New prosthesis every 7 years
7. Continued posterior bone loss7. Continued posterior bone...
Treatment options for ImplantTreatment options for Implant
retained overdentureretained overdenture
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Categorization of potential implant site in mandible –Categorization of potential implant site in mandible –
By Carl E Mis...
Option OneOption One
6767
Anatomical conditions
Cost is primary factor
Hygiene is improved
Arch form is tapered
Additional...
Option twoOption two
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 AnatomicalAnatomical
conditions good toconditions good to
moderatemoderate
 Posterior ridgePosterior ridge
form is u sh...
Disadvantages of A and E splinted implantsDisadvantages of A and E splinted implants
Difficulty with speechDifficulty wit...
 Increased screw looseningIncreased screw loosening
 Bite force is increased than B and DBite force is increased than B ...
Option threeOption three
1st
option
Pt needs and desires
Improved retention and stability
Cost a moderate factor
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 If posterior ridge formIf posterior ridge form
is good , implants areis good , implants are
placed on A, C, Eplaced on A...
advantagesadvantages
 Six times less bar flexure than A and ESix times less bar flexure than A and E
 Less screw looseni...
Option four (Resilient Hybrid bar design)Option four (Resilient Hybrid bar design)
Four implants areFour implants are
plac...
 Typically fourTypically four
attachments areattachments are
placed evenly. Twoplaced evenly. Two
anterior and twoanterio...
advantagesadvantages
 Greater occlusal load distributionGreater occlusal load distribution
 Lateral prosthesis stability...
ALL ON FOUR CONCEPTALL ON FOUR CONCEPT
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Option five (Rigid Hybrid bar design)Option five (Rigid Hybrid bar design)
Five implants are placed in (A, B, C, D, E).Fiv...
IndicationsIndications
Inability to wear conventional denturesInability to wear conventional dentures
Very high expectatio...
Mandibular full arch implantMandibular full arch implant
fixed prosthetic optionsfixed prosthetic options
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Prosthodontic classificationProsthodontic classification
 Fp 1Fp 1 fixed prosthesis; replaces only crown; looks like afix...
Rp-4Rp-4 Removable prosthesis ; over dentureRemovable prosthesis ; over denture
supported completely by implantsupported c...
Mandibular full arch implant fixed prostheticMandibular full arch implant fixed prosthetic
optionsoptions
Advantages:Advan...
Medial movementMedial movement
800 micro m
1500 micro m
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TorsionTorsion
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Consequences of cross arch connectionConsequences of cross arch connection
includes:includes:
1.1.Bone loss around implant...
Implant treatment optionsImplant treatment options
Treatment option 1: the branemarkTreatment option 1: the branemark
appr...
Antero posterior distanceAntero posterior distance
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Treatment option 2Treatment option 2
12 mm
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Treatment option 3Treatment option 3
A-P spread is 1.5 – 2 times
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Treatment option 4Treatment option 4
Division C-H , subperiosteal or disc implantswww.indiandentalacademy.comwww.indianden...
Treatment option 5Treatment option 5
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CONCLUSIONCONCLUSION
Treatment planning for implant restorationsTreatment planning for implant restorations
may at first a...
REFERENCESREFERENCES
1.1. Atlas of oral implantology – A.Norman CraninAtlas of oral implantology – A.Norman Cranin
2.2. Co...
5.5. Atlas of tooth and implant supportedAtlas of tooth and implant supported
prosthodontics – Lawrence.A.Weinbergprosthod...
8. “All-on-four” immediate function concept and clinlical
report of treatment of an edentulous mandible with a
fixed compl...
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Treatment planning for implants/fixed orthodontics courses

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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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Transcript of "Treatment planning for implants/fixed orthodontics courses"

  1. 1. Treatment planning for implant restorations INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.comwww.indiandentalacademy.com
  2. 2. ContentsContents  IntroductionIntroduction  Available bone and implantAvailable bone and implant  Classification and treatment plans forClassification and treatment plans for partially and completely edentulouspartially and completely edentulous  Treatment options for mandibular implantTreatment options for mandibular implant over denturesover dentures  ConclusionConclusion  ReferencesReferences www.indiandentalacademy.comwww.indiandentalacademy.com
  3. 3. INTRODUCTIONINTRODUCTION The treatment plan should begin withThe treatment plan should begin with a clear idea of the end result which shoulda clear idea of the end result which should fulfill the functional and aesthetic needs offulfill the functional and aesthetic needs of the patient. It is important that these goalsthe patient. It is important that these goals are realistic, predictable and readilyare realistic, predictable and readily maintainable.maintainable. www.indiandentalacademy.comwww.indiandentalacademy.com
  4. 4. www.indiandentalacademy.comwww.indiandentalacademy.com
  5. 5. Available BoneAvailable Bone  Available bone is that portion of a partiallyAvailable bone is that portion of a partially or totally edentulous alveolar ridge thator totally edentulous alveolar ridge that can be used to insert an endostealcan be used to insert an endosteal implant, or basal bone that can be used toimplant, or basal bone that can be used to support a subperiosteal implant.support a subperiosteal implant. (Charles(Charles M.M. Weiss)Weiss) www.indiandentalacademy.comwww.indiandentalacademy.com
  6. 6. ATWOODS CLASSIFICATION  Order I:Order I: pre-extraction.pre-extraction.  Order II:Order II: post extraction.post extraction.  Order III:Order III: high, wellhigh, well rounded.rounded.  Order IV:Order IV: knife edge.knife edge.  Order V:Order V: low, well rounded.low, well rounded.  Order VI:Order VI: depressed.depressed. www.indiandentalacademy.comwww.indiandentalacademy.com
  7. 7.  CLASSIFICATION ACCORDING TO THE AMERICANCLASSIFICATION ACCORDING TO THE AMERICAN COLLEGE OF PROSTHODONTISTS:COLLEGE OF PROSTHODONTISTS:  Based on bone height (mandible only) that isBased on bone height (mandible only) that is measured at least vertical height of the mandiblemeasured at least vertical height of the mandible  Type I:Type I: Residual bone height of 21mm or greater.Residual bone height of 21mm or greater.  Type II:Type II: Residual bone height of 16-20mm.Residual bone height of 16-20mm.  Type III:Type III: Residual alveolar bone height of 11-15mm.Residual alveolar bone height of 11-15mm.  Type IV:Type IV: Residual alveolar bone height of 10mm or less.Residual alveolar bone height of 10mm or less. www.indiandentalacademy.comwww.indiandentalacademy.com
  8. 8. AVAILABLE BONEAVAILABLE BONE Available bone describes the amount of bone in the edentulous area considered for implantation and is measured in: Height. Width. Length Angulation. Crown-Implant body ratio. www.indiandentalacademy.comwww.indiandentalacademy.com
  9. 9. www.indiandentalacademy.comwww.indiandentalacademy.com
  10. 10. AVAILABLE BONE HEIGHTAVAILABLE BONE HEIGHT www.indiandentalacademy.comwww.indiandentalacademy.com
  11. 11. The minimum height of the available bone for endosteal implants is related to the density of the bone. The minimum bone height for a predictable long- term endosteal implant survival is 10mm. www.indiandentalacademy.comwww.indiandentalacademy.com
  12. 12.  The height of the implant also affects its totalThe height of the implant also affects its total surface areasurface area..  An implant 3 mm longer provides more than 10%An implant 3 mm longer provides more than 10% increase in surface area.increase in surface area.  The advantage of increased height helps inThe advantage of increased height helps in initialinitial stability, the overall amount of bone-implantstability, the overall amount of bone-implant interface, and long term resistance to momentinterface, and long term resistance to moment forcesforces.. www.indiandentalacademy.comwww.indiandentalacademy.com
  13. 13.  The root form implants ofThe root form implants of 4.0 mm4.0 mm crestal diametercrestal diameter usually require more thanusually require more than 5.0 mm5.0 mm of bone width toof bone width to ensure sufficient boneensure sufficient bone thickness and blood supplythickness and blood supply around the implant foraround the implant for predictable survival. Thesepredictable survival. These dimensions provide moredimensions provide more thanthan 0.5 mm0.5 mm bone on eachbone on each side of the implant.side of the implant. AVAILABLE BONE WIDTHAVAILABLE BONE WIDTH www.indiandentalacademy.comwww.indiandentalacademy.com
  14. 14.  Each 1mm increase in diameter corresponds to aEach 1mm increase in diameter corresponds to a surface area increase of approximately 20% tosurface area increase of approximately 20% to 30%.30%.  StressStress equals force / functional area over which it isequals force / functional area over which it is applied, theapplied, the greater diameter decreases thegreater diameter decreases the amount of stress at the crestal bone-implantamount of stress at the crestal bone-implant interface.interface. www.indiandentalacademy.comwww.indiandentalacademy.com
  15. 15. 1 mm1 mm – Bone remaining after implant– Bone remaining after implant placement to anatomical structuresplacement to anatomical structures 2 mm2 mm – Tooth to implant– Tooth to implant 3 mm3 mm – Implant to implant– Implant to implant 7 mm7 mm - Implant to implant in over denture- Implant to implant in over denture www.indiandentalacademy.comwww.indiandentalacademy.com
  16. 16. AVAILABLE BONE LENGTHAVAILABLE BONE LENGTH The mesio-distal length of available bone in an edentulous area is often limited by adjacent teeth or implants. The length of available bone necessary for endosteal implant survival depends on the width of the bone. www.indiandentalacademy.comwww.indiandentalacademy.com
  17. 17. AVAILABLE BONE ANGULATIONAVAILABLE BONE ANGULATION Ideally the bone angulation is aligned with the forces of occlusion and is parallel to the long axis of the Prosthodontic restoration. www.indiandentalacademy.comwww.indiandentalacademy.com
  18. 18.  TheThe limiting factor of angulationlimiting factor of angulation of force betweenof force between the body and the abutment of an implant isthe body and the abutment of an implant is correlated to the width of bone.correlated to the width of bone.  In edentulous areas with aIn edentulous areas with a wide ridgewide ridge, wider root, wider root form implants may be used. Such implants allowform implants may be used. Such implants allow modifications up tomodifications up to 30 degrees divergence30 degrees divergence  Narrow yet adequate width ridgeNarrow yet adequate width ridge often requires aoften requires a narrower design root form implant. This limits thenarrower design root form implant. This limits the acceptable angulation of bone toacceptable angulation of bone to 2020 degreesdegrees www.indiandentalacademy.comwww.indiandentalacademy.com
  19. 19. CROWN-IMPLANT BODY RATIOCROWN-IMPLANT BODY RATIO The crown height is measured from the occlusal or incisal plane to the crest of the ridge and the endosteal implant height from the crest of the ridge to its apex. www.indiandentalacademy.comwww.indiandentalacademy.com
  20. 20.  The greater the crown height, the greater theThe greater the crown height, the greater the lever arm with any lateral force.lever arm with any lateral force.  As theAs the crown-implant ratio increasescrown-implant ratio increases, the, the number of implants and/or wider implantsnumber of implants and/or wider implants shouldshould be inserted to counteract the increase in stressbe inserted to counteract the increase in stress www.indiandentalacademy.comwww.indiandentalacademy.com
  21. 21. DIVISIONSDIVISIONS OFOF AVAILABLE BONEAVAILABLE BONE  Division A (Abundant Bone)  Division B (Barely Sufficient Bone)  Division C (Compromised Bone)  Division D (Deficient Bone) www.indiandentalacademy.comwww.indiandentalacademy.com
  22. 22. Division ADivision A (Abundant Bone)(Abundant Bone)  >5mm width>5mm width  >12 mm height>12 mm height  >7mm mesio-distal>7mm mesio-distal lengthlength  <30 degrees<30 degrees angulationangulation  <15 mm crown height<15 mm crown height  C/I ratio <1C/I ratio <1 www.indiandentalacademy.comwww.indiandentalacademy.com
  23. 23.  Division A is mostDivision A is most often restored withoften restored with Division A root formDivision A root form implant.implant.  Root form implantsRoot form implants presents severalpresents several advantages to otheradvantages to other endosteal designs asendosteal designs as the plate form orthe plate form or transosteal implants.transosteal implants. www.indiandentalacademy.comwww.indiandentalacademy.com
  24. 24. DIVISION A ROOT FORM IMPLANTDIVISION A ROOT FORM IMPLANT ADVANTAGESADVANTAGES  Greatest surface areaGreatest surface area  Improved stress distributionImproved stress distribution  Less fracture of implant and componentsLess fracture of implant and components  Designed for variable bone densityDesigned for variable bone density  More esthetic conditionsMore esthetic conditions www.indiandentalacademy.comwww.indiandentalacademy.com
  25. 25. Division B (Barely sufficientDivision B (Barely sufficient bone)bone)  As the bone resorbs, the width of available boneAs the bone resorbs, the width of available bone first decreases at the expense of the facialfirst decreases at the expense of the facial cortical plate.cortical plate.  There is 25% decrease in bone width the firstThere is 25% decrease in bone width the first year, and 40% decrease in bone width within theyear, and 40% decrease in bone width within the first 1 to 3 years after tooth extraction.first 1 to 3 years after tooth extraction.  Once this Division B bone volume is reached, itOnce this Division B bone volume is reached, it may remain for more than 20 years.may remain for more than 20 years. www.indiandentalacademy.comwww.indiandentalacademy.com
  26. 26. Division BDivision B (Barely Sufficient Bone)(Barely Sufficient Bone) 2.5-5mm width2.5-5mm width >12 mm height>12 mm height >6 mm mesio-distal>6 mm mesio-distal lengthlength <20 degree angulation<20 degree angulation between implant bodybetween implant body and occlusal planeand occlusal plane Crown/Implant ratio <1Crown/Implant ratio <1 www.indiandentalacademy.comwww.indiandentalacademy.com
  27. 27. Treatment options available for theTreatment options available for the Division B edentulous ridgeDivision B edentulous ridge  Insert division B implantsInsert division B implants  OSTEOPLASTYOSTEOPLASTY Converts to division A when greater than 12Converts to division A when greater than 12 mm bone height resultsmm bone height results Converts to division C-H when less than 12 mmConverts to division C-H when less than 12 mm bone height resultsbone height results www.indiandentalacademy.comwww.indiandentalacademy.com
  28. 28. www.indiandentalacademy.comwww.indiandentalacademy.com
  29. 29. DISADVANTAGES OF DIVISION B ROOTDISADVANTAGES OF DIVISION B ROOT FORMSFORMS  Almost twice the stress is concentrated at the top crestalAlmost twice the stress is concentrated at the top crestal region around the implantregion around the implant  Lateral loads on the implant result in almost 3 timesLateral loads on the implant result in almost 3 times greater stress than division A root formsgreater stress than division A root forms  Fatigue fractures of the abutment post are increased.Fatigue fractures of the abutment post are increased.  The crown emergence profile is less estheticThe crown emergence profile is less esthetic  Implant costs are not related to diameter, so an increaseImplant costs are not related to diameter, so an increase in implant number results in greater cost to the doctorin implant number results in greater cost to the doctor and patientand patient www.indiandentalacademy.comwww.indiandentalacademy.com
  30. 30. Division CDivision C (Compromised Bone)(Compromised Bone) Unfavorable in: WidthUnfavorable in: Width (C-w)(C-w) Height (C-h)Height (C-h) Angulation (C-a)Angulation (C-a) C/I ratio >1C/I ratio >1 www.indiandentalacademy.comwww.indiandentalacademy.com
  31. 31.  The resorption of the available bone occurs first inThe resorption of the available bone occurs first in bone width, and then in height.bone width, and then in height.  As a result, Division B ridge continues to resorb inAs a result, Division B ridge continues to resorb in width although height of bone is still present, untilwidth although height of bone is still present, until it becomes inadequate for any design ofit becomes inadequate for any design of endosteal implants. This bone category is calledendosteal implants. This bone category is called Division C-wDivision C-w..  This resorption process continues, and theThis resorption process continues, and the available bone is then reduced in height andavailable bone is then reduced in height and calledcalled Division C-hDivision C-h www.indiandentalacademy.comwww.indiandentalacademy.com
  32. 32. Treatment options available for theTreatment options available for the Division C edentulous ridgeDivision C edentulous ridge (1) Osteoplasty(1) Osteoplasty (2) Augmentation procedures(2) Augmentation procedures (3) Root form implants(3) Root form implants (4) Subperiosteal implants(4) Subperiosteal implants (5) Ramus frame implants(5) Ramus frame implants (6) Transosteal implants(6) Transosteal implants www.indiandentalacademy.comwww.indiandentalacademy.com
  33. 33. Division DDivision D (Deficient Bone)(Deficient Bone) Severe atrophySevere atrophy Basal bone lossBasal bone loss Flat maxillaFlat maxilla pencil thin mandiblepencil thin mandible www.indiandentalacademy.comwww.indiandentalacademy.com
  34. 34. Treatment options available for theTreatment options available for the Division D edentulous ridgeDivision D edentulous ridge  The completely edentulous Division D patient is mostThe completely edentulous Division D patient is most difficult to treat in implant dentistry.difficult to treat in implant dentistry.  The choice to render treatment is the doctor’s, notThe choice to render treatment is the doctor’s, not the patient’sthe patient’s  Benefits must carefully be weighed against the risksBenefits must carefully be weighed against the risks www.indiandentalacademy.comwww.indiandentalacademy.com
  35. 35.  If implant failure occurs, the patient may become aIf implant failure occurs, the patient may become a dental cripple, unable to wear any prosthesis.dental cripple, unable to wear any prosthesis.  Therefore autogenous bone grafts to upgrade theTherefore autogenous bone grafts to upgrade the division are strongly recommended before anydivision are strongly recommended before any implant treatment is attemptedimplant treatment is attempted  Once autogenous grafts are in place and allowedOnce autogenous grafts are in place and allowed to heal for 5 or more months, endosteal orto heal for 5 or more months, endosteal or subperiosteal implants may be inserted,subperiosteal implants may be inserted, depending on the division of bone obtaineddepending on the division of bone obtained.. www.indiandentalacademy.comwww.indiandentalacademy.com
  36. 36. Treatment planning forTreatment planning for implant restorations inimplant restorations in partially edentulouspartially edentulous archesarches www.indiandentalacademy.comwww.indiandentalacademy.com
  37. 37.  The implant dentistry bone volumeThe implant dentistry bone volume classification developed byclassification developed by Misch and JudyMisch and Judy builds on the four classes of partialbuilds on the four classes of partial edentulism described in the Kennedy-edentulism described in the Kennedy- Applegate system.Applegate system. www.indiandentalacademy.comwww.indiandentalacademy.com
  38. 38. Class IClass I www.indiandentalacademy.comwww.indiandentalacademy.com
  39. 39. Class IIClass II www.indiandentalacademy.comwww.indiandentalacademy.com
  40. 40. CLASS IIICLASS III www.indiandentalacademy.comwww.indiandentalacademy.com
  41. 41. CLASS IVCLASS IV www.indiandentalacademy.comwww.indiandentalacademy.com
  42. 42. Class I - Division AClass I - Division A Bone height > 10 mm Length > 7 mm Angulation < 30 degrees Crown height < 15 mm Removable prosthesis Root form implants www.indiandentalacademy.comwww.indiandentalacademy.com
  43. 43. Class I division BClass I division B Bone width 2.5-5 mm Bone height > 10 mm Angulation < 20 degrees Crown height < 15 mm Osteoplasty Small implants augmentation www.indiandentalacademy.comwww.indiandentalacademy.com
  44. 44. CLASS I – Division CCLASS I – Division C Inadequate available bone height, Length ,Angulation. Crown height > 15 mm  Augmentation and Sub periosteal implants Nerve repositioning www.indiandentalacademy.comwww.indiandentalacademy.com
  45. 45. CLASS I Division DCLASS I Division D Inadequate available bone due to Severly resorbed ridge involving basal bone Crown height more than 20 mm Augmentation www.indiandentalacademy.comwww.indiandentalacademy.com
  46. 46. CLASS II Division A, BCLASS II Division A, B Endostel implants with min osteoplasty are common modality. Extrusion of opposing and tipping of adjacent teeth will cause excessive forces www.indiandentalacademy.comwww.indiandentalacademy.com
  47. 47. CLASS II Division CCLASS II Division C Conventional prosthesis and small diameter implants after ridge augmentation with onlay grafts www.indiandentalacademy.comwww.indiandentalacademy.com
  48. 48. CLASS IIICLASS III DIVISION A DIVISION C www.indiandentalacademy.comwww.indiandentalacademy.com
  49. 49.  Single tooth implants are treatment ofSingle tooth implants are treatment of choice when the soft and hard tissues arechoice when the soft and hard tissues are in normal range.in normal range. www.indiandentalacademy.comwww.indiandentalacademy.com
  50. 50. CLASS IVCLASS IV •Traditional fpd is treatment of choice when canines are present •Bone grafts should be placed before placement of implants www.indiandentalacademy.comwww.indiandentalacademy.com
  51. 51. TREATMENT PLANSTREATMENT PLANS FOR COMPLETELYFOR COMPLETELY EDENTULOUS ARCHESEDENTULOUS ARCHES www.indiandentalacademy.comwww.indiandentalacademy.com
  52. 52. Classification of completelyClassification of completely edentulous arches is also basededentulous arches is also based on bone volume and locationon bone volume and location present given bypresent given by Kent andKent and Lousiana Dental schoolLousiana Dental school  Edentulous jaw is divided into 3Edentulous jaw is divided into 3 regions:regions: www.indiandentalacademy.comwww.indiandentalacademy.com
  53. 53. TYPE ITYPE I www.indiandentalacademy.comwww.indiandentalacademy.com
  54. 54. TYPE IITYPE II www.indiandentalacademy.comwww.indiandentalacademy.com
  55. 55. TYPE IIITYPE III www.indiandentalacademy.comwww.indiandentalacademy.com
  56. 56. IMPLANTIMPLANT OVERDENTURESOVERDENTURES www.indiandentalacademy.comwww.indiandentalacademy.com
  57. 57. Many edentulous patients experience problems withMany edentulous patients experience problems with their dentures, especially lack of stability andtheir dentures, especially lack of stability and retention, together with a decrease of chewing ability.retention, together with a decrease of chewing ability. one possibilty of solving this problem is the use ofone possibilty of solving this problem is the use of endosseous implants to which an overdenture can beendosseous implants to which an overdenture can be attached.attached. www.indiandentalacademy.comwww.indiandentalacademy.com
  58. 58. Implant Overdenture AdvantagesImplant Overdenture Advantages 1.1. Minimum anterior bone loss; prevents boneMinimum anterior bone loss; prevents bone lossloss 2.2. Improved estheticsImproved esthetics 3.3. Improved stability (reduces or eliminatesImproved stability (reduces or eliminates prosthesis movement)prosthesis movement) 4.4. Decrease in soft tissue abrasionsDecrease in soft tissue abrasions 5.5. Improved chewing efficiency - 20 %Improved chewing efficiency - 20 % www.indiandentalacademy.comwww.indiandentalacademy.com
  59. 59. 6. Improved retention6. Improved retention 7. Improved support7. Improved support 8.Improved speech8.Improved speech 9. Reduced prosthesis size (eliminates palate9. Reduced prosthesis size (eliminates palate flanges)flanges) 10. improved10. improved maxillofacial prosthesesmaxillofacial prostheses www.indiandentalacademy.comwww.indiandentalacademy.com
  60. 60. Implant overdenture advantages versus fixedImplant overdenture advantages versus fixed prosthesisprosthesis  Fewer implantsFewer implants less bone graftless bone graft less specific placementless specific placement  Improved estheticsImproved esthetics Labial flangeLabial flange Denture teethDenture teeth www.indiandentalacademy.comwww.indiandentalacademy.com
  61. 61.  Soft tissue considerationsSoft tissue considerations Improved periimplant probingImproved periimplant probing HygieneHygiene  Reduced stressReduced stress Nocturnal parafunctionNocturnal parafunction Stress-relief attachmentStress-relief attachment www.indiandentalacademy.comwww.indiandentalacademy.com
  62. 62.  Less cost and laboratory costLess cost and laboratory cost Fewer implantsFewer implants Less bone graftingLess bone grafting Easy repairEasy repair Laboratory cost decreaseLaboratory cost decrease www.indiandentalacademy.comwww.indiandentalacademy.com
  63. 63. Over denture disadvantagesOver denture disadvantages 1.1.Psychological (need for non removablePsychological (need for non removable teeth)teeth) 2.2.Abutment crown height space requiredAbutment crown height space required 3.3.Long-term maintenanceLong-term maintenance 4.4.Attachments (change)Attachments (change) 5.5.RelinesRelines www.indiandentalacademy.comwww.indiandentalacademy.com
  64. 64. 6. New prosthesis every 7 years6. New prosthesis every 7 years 7. Continued posterior bone loss7. Continued posterior bone loss 8. Food impaction8. Food impaction 9. Movement9. Movement www.indiandentalacademy.comwww.indiandentalacademy.com
  65. 65. Treatment options for ImplantTreatment options for Implant retained overdentureretained overdenture www.indiandentalacademy.comwww.indiandentalacademy.com
  66. 66. Categorization of potential implant site in mandible –Categorization of potential implant site in mandible – By Carl E MischBy Carl E Misch www.indiandentalacademy.comwww.indiandentalacademy.com
  67. 67. Option OneOption One 6767 Anatomical conditions Cost is primary factor Hygiene is improved Arch form is tapered Additional implants can be placed Dis advantages: www.indiandentalacademy.comwww.indiandentalacademy.com
  68. 68. Option twoOption two www.indiandentalacademy.comwww.indiandentalacademy.com
  69. 69.  AnatomicalAnatomical conditions good toconditions good to moderatemoderate  Posterior ridgePosterior ridge form is u shapedform is u shaped www.indiandentalacademy.comwww.indiandentalacademy.com
  70. 70. Disadvantages of A and E splinted implantsDisadvantages of A and E splinted implants Difficulty with speechDifficulty with speech  Anterior tipping of over dentureAnterior tipping of over denture  5 times greater flexure than B and D5 times greater flexure than B and D positionspositions Greater flexibility of bar when a curved bar splintGreater flexibility of bar when a curved bar splint is used ( 9 times than B and D position)is used ( 9 times than B and D position) BAB D A E www.indiandentalacademy.comwww.indiandentalacademy.com
  71. 71.  Increased screw looseningIncreased screw loosening  Bite force is increased than B and DBite force is increased than B and D positionspositions  Greater lateral load than B and DGreater lateral load than B and D positionspositions  Greater bite force in posterior region thanGreater bite force in posterior region than B and D positionB and D position www.indiandentalacademy.comwww.indiandentalacademy.com
  72. 72. Option threeOption three 1st option Pt needs and desires Improved retention and stability Cost a moderate factor www.indiandentalacademy.comwww.indiandentalacademy.com
  73. 73.  If posterior ridge formIf posterior ridge form is good , implants areis good , implants are placed on A, C, Eplaced on A, C, E  if posterior ridge isif posterior ridge is poor, implants placedpoor, implants placed in B, C, D regions.in B, C, D regions. www.indiandentalacademy.comwww.indiandentalacademy.com
  74. 74. advantagesadvantages  Six times less bar flexure than A and ESix times less bar flexure than A and E  Less screw looseningLess screw loosening  Less flexure than A and E curve splintingLess flexure than A and E curve splinting  Less stress to each abutment than A and ELess stress to each abutment than A and E  Greater surface areaGreater surface area  more implantsmore implants  Greater a-p spreadGreater a-p spread  Less prosthesis movementLess prosthesis movement  One implant failure still gives good supportOne implant failure still gives good support www.indiandentalacademy.comwww.indiandentalacademy.com
  75. 75. Option four (Resilient Hybrid bar design)Option four (Resilient Hybrid bar design) Four implants areFour implants are placed inplaced in A, B, D and E position.A, B, D and E position. IndicationsIndications  Poor posteriorPoor posterior anatomyanatomy  Lack of retention andLack of retention and stabilitystability  Soft tissue abrasionSoft tissue abrasion  Speech difficultiesSpeech difficulties  Very high patientVery high patient expectationsexpectations www.indiandentalacademy.comwww.indiandentalacademy.com
  76. 76.  Typically fourTypically four attachments areattachments are placed evenly. Twoplaced evenly. Two anterior and twoanterior and two posterior.posterior. www.indiandentalacademy.comwww.indiandentalacademy.com
  77. 77. advantagesadvantages  Greater occlusal load distributionGreater occlusal load distribution  Lateral prosthesis stabilityLateral prosthesis stability  Cantilever not extended till molars soCantilever not extended till molars so excessive stress on cantileverexcessive stress on cantilever www.indiandentalacademy.comwww.indiandentalacademy.com
  78. 78. ALL ON FOUR CONCEPTALL ON FOUR CONCEPT www.indiandentalacademy.comwww.indiandentalacademy.com
  79. 79. Option five (Rigid Hybrid bar design)Option five (Rigid Hybrid bar design) Five implants are placed in (A, B, C, D, E).Five implants are placed in (A, B, C, D, E). www.indiandentalacademy.comwww.indiandentalacademy.com
  80. 80. IndicationsIndications Inability to wear conventional denturesInability to wear conventional dentures Very high expectationsVery high expectations Unfavourable anatomyUnfavourable anatomy Problems with function and stabilityProblems with function and stability Posterior sore spotsPosterior sore spots 8080www.indiandentalacademy.comwww.indiandentalacademy.com
  81. 81. Mandibular full arch implantMandibular full arch implant fixed prosthetic optionsfixed prosthetic options www.indiandentalacademy.comwww.indiandentalacademy.com
  82. 82. Prosthodontic classificationProsthodontic classification  Fp 1Fp 1 fixed prosthesis; replaces only crown; looks like afixed prosthesis; replaces only crown; looks like a natural tooth.natural tooth.  Fp 2Fp 2 fixed prosthesis; replaces crown and portion of root.fixed prosthesis; replaces crown and portion of root.  Fp 3Fp 3 fixed prosthesis; replaces missing crowns andfixed prosthesis; replaces missing crowns and gingival color and portion of the edentulous site.gingival color and portion of the edentulous site. www.indiandentalacademy.comwww.indiandentalacademy.com
  83. 83. Rp-4Rp-4 Removable prosthesis ; over dentureRemovable prosthesis ; over denture supported completely by implantsupported completely by implant Rp-5Rp-5 Removable prosthesis ; over dentureRemovable prosthesis ; over denture supported by soft tissue and implantsupported by soft tissue and implant www.indiandentalacademy.comwww.indiandentalacademy.com
  84. 84. Mandibular full arch implant fixed prostheticMandibular full arch implant fixed prosthetic optionsoptions Advantages:Advantages: 1.1. Psychological: feels like teethPsychological: feels like teeth 2.2. Less prosthetic maintainenceLess prosthetic maintainence AttachmentsAttachments RelinesRelines New over dentureNew over denture 3. Less food entrapment3. Less food entrapment www.indiandentalacademy.comwww.indiandentalacademy.com
  85. 85. Medial movementMedial movement 800 micro m 1500 micro m www.indiandentalacademy.comwww.indiandentalacademy.com
  86. 86. TorsionTorsion www.indiandentalacademy.comwww.indiandentalacademy.com
  87. 87. Consequences of cross arch connectionConsequences of cross arch connection includes:includes: 1.1.Bone loss around implantsBone loss around implants 2.2.Loss of implant fixationLoss of implant fixation 3.3.Components fractureComponents fracture 4.4.Unretained restorationsUnretained restorations 5.5.Discomfort on openingDiscomfort on opening www.indiandentalacademy.comwww.indiandentalacademy.com
  88. 88. Implant treatment optionsImplant treatment options Treatment option 1: the branemarkTreatment option 1: the branemark approachapproach Force factors Number Size design www.indiandentalacademy.comwww.indiandentalacademy.com
  89. 89. Antero posterior distanceAntero posterior distance www.indiandentalacademy.comwww.indiandentalacademy.com
  90. 90. Treatment option 2Treatment option 2 12 mm www.indiandentalacademy.comwww.indiandentalacademy.com
  91. 91. Treatment option 3Treatment option 3 A-P spread is 1.5 – 2 times www.indiandentalacademy.comwww.indiandentalacademy.com
  92. 92. Treatment option 4Treatment option 4 Division C-H , subperiosteal or disc implantswww.indiandentalacademy.comwww.indiandentalacademy.com
  93. 93. Treatment option 5Treatment option 5 www.indiandentalacademy.comwww.indiandentalacademy.com
  94. 94. CONCLUSIONCONCLUSION Treatment planning for implant restorationsTreatment planning for implant restorations may at first appear complicated. It is imperative tomay at first appear complicated. It is imperative to consider all treatment options with the patient, andconsider all treatment options with the patient, and during detailed planning it may become apparent that anduring detailed planning it may become apparent that an alternative solution is preferred. In all cases the implantalternative solution is preferred. In all cases the implant treatment should be part of an overall plan to ensuretreatment should be part of an overall plan to ensure health of any remaining teeth. The cost of the proposedhealth of any remaining teeth. The cost of the proposed treatment plan is also of great relevance.treatment plan is also of great relevance. www.indiandentalacademy.comwww.indiandentalacademy.com
  95. 95. REFERENCESREFERENCES 1.1. Atlas of oral implantology – A.Norman CraninAtlas of oral implantology – A.Norman Cranin 2.2. Contemporary implant dentistry – Carl.E.mischContemporary implant dentistry – Carl.E.misch 3.3. Implants in clinical dentistry –Implants in clinical dentistry – Richard.M.PalmerRichard.M.Palmer 4.4. Implant prosthodontics – Stevens FriedricksonImplant prosthodontics – Stevens Friedrickson www.indiandentalacademy.comwww.indiandentalacademy.com
  96. 96. 5.5. Atlas of tooth and implant supportedAtlas of tooth and implant supported prosthodontics – Lawrence.A.Weinbergprosthodontics – Lawrence.A.Weinberg 6.6. color atlas of implantology – hubertuscolor atlas of implantology – hubertus spiekermanspiekerman 7. Treatment planning for implant restorations.7. Treatment planning for implant restorations. British dental journal, volume 187, no. 6,British dental journal, volume 187, no. 6, september 25 1999september 25 1999 www.indiandentalacademy.comwww.indiandentalacademy.com
  97. 97. 8. “All-on-four” immediate function concept and clinlical report of treatment of an edentulous mandible with a fixed complete denture. J Prosthodont 2008;17:47-51. 9. Classification system for complete edentulism. J Prosthodont 1999;8:27-39. 10. implants in the esthetic zone. Dent Clin N Am10. implants in the esthetic zone. Dent Clin N Am 2006:50:391-407.2006:50:391-407. www.indiandentalacademy.comwww.indiandentalacademy.com
  98. 98. www.indiandentalacademy.comwww.indiandentalacademy.com

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