Treatment planning for dental 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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  • 1. Treatment planning for implant restorations INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.comwww.indiandentalacademy.com
  • 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. 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. 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
  • 5. 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
  • 6.  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
  • 7. 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
  • 8. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 9. AVAILABLE BONE HEIGHTAVAILABLE BONE HEIGHT www.indiandentalacademy.comwww.indiandentalacademy.com
  • 10. 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. Failure rates higher - < 9 MM www.indiandentalacademy.comwww.indiandentalacademy.com
  • 11.  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
  • 12.  ANTERIOR OF THE MANDIBLEANTERIOR OF THE MANDIBLE www.indiandentalacademy.comwww.indiandentalacademy.com
  • 13. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 14. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 15.  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
  • 16.  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
  • 17. 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
  • 18. 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
  • 19.  For bone more than 5 mm wide, a minimumFor bone more than 5 mm wide, a minimum mesiodistal length of 7 mm is usually sufficientmesiodistal length of 7 mm is usually sufficient for each implant.for each implant.  A width of bone less than 5 mm requires a 3.2A width of bone less than 5 mm requires a 3.2 mm implant with compromises such as lessmm implant with compromises such as less surface area and greater crestal concentration ofsurface area and greater crestal concentration of stressstress.. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 20. 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
  • 21.  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
  • 22. 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
  • 23.  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
  • 24. 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
  • 25. 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
  • 26.  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
  • 27. 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
  • 28. 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
  • 29. 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
  • 30. 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
  • 31. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 32. 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
  • 33. 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
  • 34.  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
  • 35. 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
  • 36. 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
  • 37. 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
  • 38.  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
  • 39.  Autogenous grafts are not intended forAutogenous grafts are not intended for soft tissue born prosthesissoft tissue born prosthesis  Repeated relinesRepeated relines  Highly mobile tissueHighly mobile tissue  Sore spotsSore spots  Patient frustrationPatient frustration www.indiandentalacademy.comwww.indiandentalacademy.com
  • 40. Treatment planning forTreatment planning for implant restorations inimplant restorations in partially edentulouspartially edentulous archesarches www.indiandentalacademy.comwww.indiandentalacademy.com
  • 41.  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
  • 42. Class IClass I www.indiandentalacademy.comwww.indiandentalacademy.com
  • 43. Class IIClass II www.indiandentalacademy.comwww.indiandentalacademy.com
  • 44. CLASS IIICLASS III www.indiandentalacademy.comwww.indiandentalacademy.com
  • 45. CLASS IVCLASS IV www.indiandentalacademy.comwww.indiandentalacademy.com
  • 46. 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
  • 47. 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
  • 48. 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
  • 49. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 50. 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
  • 51. CLASS II Division ACLASS II Division A www.indiandentalacademy.comwww.indiandentalacademy.com
  • 52. CLASS II Division CCLASS II Division C www.indiandentalacademy.comwww.indiandentalacademy.com
  • 53. CLASS IIICLASS III DIVISION A DIVISION C www.indiandentalacademy.comwww.indiandentalacademy.com
  • 54. CLASS IVCLASS IV www.indiandentalacademy.comwww.indiandentalacademy.com
  • 55. TREATMENT PLANSTREATMENT PLANS FOR COMPLETELYFOR COMPLETELY EDENTULOUS ARCHESEDENTULOUS ARCHES www.indiandentalacademy.comwww.indiandentalacademy.com
  • 56. 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
  • 57. TYPE ITYPE I www.indiandentalacademy.comwww.indiandentalacademy.com
  • 58. TYPE IITYPE II www.indiandentalacademy.comwww.indiandentalacademy.com
  • 59. TYPE IIITYPE III www.indiandentalacademy.comwww.indiandentalacademy.com
  • 60. TYPE I DIVISION ATYPE I DIVISION A www.indiandentalacademy.comwww.indiandentalacademy.com
  • 61. TYPE I DIVISION C-HTYPE I DIVISION C-H www.indiandentalacademy.comwww.indiandentalacademy.com
  • 62. TYPE I DIVISION DTYPE I DIVISION D www.indiandentalacademy.comwww.indiandentalacademy.com
  • 63. TYPE II DIVISION A,BTYPE II DIVISION A,B www.indiandentalacademy.comwww.indiandentalacademy.com
  • 64. TYPE II DIVISION B,CTYPE II DIVISION B,C www.indiandentalacademy.comwww.indiandentalacademy.com
  • 65. TYPE III DIVISION A,B,DTYPE III DIVISION A,B,D www.indiandentalacademy.comwww.indiandentalacademy.com
  • 66. TYPE III DIVISION C,D,CTYPE III DIVISION C,D,C www.indiandentalacademy.comwww.indiandentalacademy.com
  • 67. IMPLANTIMPLANT OVERDENTURESOVERDENTURES www.indiandentalacademy.comwww.indiandentalacademy.com
  • 68. 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
  • 69. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 70. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 71. 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
  • 72. 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
  • 73. 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
  • 74.  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
  • 75.  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  Transitional device until fixedTransitional device until fixed restoration guidelines are complete.restoration guidelines are complete. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 76. 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
  • 77. 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
  • 78. Treatment planning for implant restorations DR.K.V. KRISHNAM RAJU www.indiandentalacademy.comwww.indiandentalacademy.com
  • 79. MAXILLARY ANTERIOR SINGLE TOOTHMAXILLARY ANTERIOR SINGLE TOOTH REPLACEMENT:REPLACEMENT: Factors influencing treatment:Factors influencing treatment:  Patients agePatients age  Patient desiresPatient desires  Patient compliance/ patient fearPatient compliance/ patient fear  Treatment timeTreatment time  Consequence of failure: potential damage toConsequence of failure: potential damage to adjacent teethadjacent teeth www.indiandentalacademy.comwww.indiandentalacademy.com
  • 80.  costcost  Transitional prosthesisTransitional prosthesis  Adjacent tooth mobilityAdjacent tooth mobility  EstheticsEsthetics www.indiandentalacademy.comwww.indiandentalacademy.com
  • 81. Smile lineSmile line www.indiandentalacademy.comwww.indiandentalacademy.com
  • 82. GINGIVAL BIOTYPE THIN SCALLOPEDTHIN SCALLOPED PERIODONTIUMPERIODONTIUM THICK PERIODONTIUM. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 83. 2-3 MM www.indiandentalacademy.comwww.indiandentalacademy.com
  • 84. INTERDENTAL PAPILLAINTERDENTAL PAPILLA www.indiandentalacademy.comwww.indiandentalacademy.com
  • 85. BUCCOLINGUAL POSITIONBUCCOLINGUAL POSITION www.indiandentalacademy.comwww.indiandentalacademy.com
  • 86. BUCCOLINGUAL POSITIONBUCCOLINGUAL POSITION www.indiandentalacademy.comwww.indiandentalacademy.com
  • 87. MESIODISTAL POSITIONMESIODISTAL POSITION www.indiandentalacademy.comwww.indiandentalacademy.com
  • 88. APICOCORONAL POSITIONAPICOCORONAL POSITION www.indiandentalacademy.comwww.indiandentalacademy.com
  • 89. Timing of implant placement following toothTiming of implant placement following tooth removal:removal: According to Garber:According to Garber:  Immediate placementImmediate placement  Atraumatic extractionAtraumatic extraction  Delayed placement after 3 months.Delayed placement after 3 months. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 90. Implant placement in edentulous sites:Implant placement in edentulous sites: Garber classification:Garber classification:  Garber class 1Garber class 1  Garber class 2Garber class 2  Garber class 3Garber class 3  Garber class 4Garber class 4  Garber class 5Garber class 5 www.indiandentalacademy.comwww.indiandentalacademy.com
  • 91. Posterior single tooth replacementPosterior single tooth replacement Alternative options of single toothAlternative options of single tooth replacement :replacement : 1.1.Removable partial dentureRemovable partial denture 2.2.Resin retained prosthesisResin retained prosthesis 3.3.Space maintainerSpace maintainer 4.4.Fixed partial dentureFixed partial denture 5.5.Implant prosthesisImplant prosthesis www.indiandentalacademy.comwww.indiandentalacademy.com
  • 92. ADVANTAGES OF POSTERIOR SINGLEADVANTAGES OF POSTERIOR SINGLE TOOTH IMPLANTSTOOTH IMPLANTS 1.1. longevitylongevity 2.2. Improved estheticsImproved esthetics 3.3. Maintainence of bone in edentulous regionMaintainence of bone in edentulous region 4.4. Psychological advantagePsychological advantage 5.5. Decreased risk of abutment tooth lossDecreased risk of abutment tooth loss www.indiandentalacademy.comwww.indiandentalacademy.com
  • 93. DISADVANTAGES OF POSTERIORDISADVANTAGES OF POSTERIOR SINGLE TOOTH IMPLANTSSINGLE TOOTH IMPLANTS 1.1. Consequence of implant failureConsequence of implant failure 2.2. CostCost 3.3. Extended treatment timeExtended treatment time www.indiandentalacademy.comwww.indiandentalacademy.com
  • 94. CONTRAINDICATION TO POSTERIORCONTRAINDICATION TO POSTERIOR SINGLE TOOTH IMPLANTSSINGLE TOOTH IMPLANTS 1.1. Inadequate bone volumeInadequate bone volume a.a. faciopalatal bone <5 mmfaciopalatal bone <5 mm b.b. mesiodistal bone <7 mmmesiodistal bone <7 mm c.c. Height >9 mmHeight >9 mm 2. Moderate to advanced mobility of two to four adjacent2. Moderate to advanced mobility of two to four adjacent teeth greater than +1teeth greater than +1 3. Limited time for patient treatment3. Limited time for patient treatment 4. cost4. cost www.indiandentalacademy.comwww.indiandentalacademy.com
  • 95. First premolar implant replacementFirst premolar implant replacement www.indiandentalacademy.comwww.indiandentalacademy.com
  • 96. First Molar implant replacementFirst Molar implant replacement www.indiandentalacademy.comwww.indiandentalacademy.com
  • 97. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 98. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 99. Replacing mandibular II molarReplacing mandibular II molar 1.1. Not in esthetic zoneNot in esthetic zone 2.2. Less than 5 % of chewing efficiencyLess than 5 % of chewing efficiency 3.3. Bite force 10 % higherBite force 10 % higher 4.4. Mandibular canal is located higher in that siteMandibular canal is located higher in that site 5.5. Less dense boneLess dense bone www.indiandentalacademy.comwww.indiandentalacademy.com
  • 100.  Limited access for correct implant bodyLimited access for correct implant body placementplacement  Hygiene access more difficultHygiene access more difficult  Greater mandibular flexureGreater mandibular flexure www.indiandentalacademy.comwww.indiandentalacademy.com
  • 101. Implant requirements:Implant requirements: Fixed restorations:Fixed restorations: Anterior teeth Suggested number of implantsAnterior teeth Suggested number of implants requiredrequired  One missing toothOne missing tooth 11  Two missing teethTwo missing teeth 22  Three missing teethThree missing teeth 2 or 32 or 3  Four missing teethFour missing teeth 2, 3 or 42, 3 or 4  Molar teethMolar teeth  One missing toothOne missing tooth 1 or 21 or 2  Two missing teethTwo missing teeth 2 or 32 or 3 www.indiandentalacademy.comwww.indiandentalacademy.com
  • 102. Full arch bridgesFull arch bridges  Edentulous maxilla at leastEdentulous maxilla at least 66  Edentulous mandible at leastEdentulous mandible at least 4 or 54 or 5 OverdenturesOverdentures  Edentulous maxilla at leastEdentulous maxilla at least 44 joinedjoined  Edentulous mandibleEdentulous mandible 22 joined or separatejoined or separate www.indiandentalacademy.comwww.indiandentalacademy.com
  • 103. Treatment options for ImplantTreatment options for Implant retained overdentureretained overdenture www.indiandentalacademy.comwww.indiandentalacademy.com
  • 104. 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
  • 105. Option OneOption One 105105www.indiandentalacademy.comwww.indiandentalacademy.com
  • 106. Option twoOption two www.indiandentalacademy.comwww.indiandentalacademy.com
  • 107. 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 BAB D A E www.indiandentalacademy.comwww.indiandentalacademy.com
  • 108. Option threeOption three www.indiandentalacademy.comwww.indiandentalacademy.com
  • 109.  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
  • 110. 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
  • 111.  Typically fourTypically four attachments areattachments are placed evenly. Twoplaced evenly. Two anterior and twoanterior and two posterior.posterior. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 112. ALL ON FOUR CONCEPTALL ON FOUR CONCEPT www.indiandentalacademy.comwww.indiandentalacademy.com
  • 113. 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
  • 114. 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 114114www.indiandentalacademy.comwww.indiandentalacademy.com
  • 115. Mandibular full arch implantMandibular full arch implant fixed prosthetic optionsfixed prosthetic options www.indiandentalacademy.comwww.indiandentalacademy.com
  • 116. 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
  • 117. 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
  • 118. 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
  • 119. Medial movementMedial movement 800 micro m 1500 micro m www.indiandentalacademy.comwww.indiandentalacademy.com
  • 120. TorsionTorsion www.indiandentalacademy.comwww.indiandentalacademy.com
  • 121. 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
  • 122. 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
  • 123. Antero posterior distanceAntero posterior distance www.indiandentalacademy.comwww.indiandentalacademy.com
  • 124. Treatment option 2Treatment option 2 12 mm www.indiandentalacademy.comwww.indiandentalacademy.com
  • 125. Treatment option 3Treatment option 3 A-P spread is 1.5 – 2 times www.indiandentalacademy.comwww.indiandentalacademy.com
  • 126. Treatment option 4Treatment option 4 Division C-H , subperiosteal or disc implantswww.indiandentalacademy.comwww.indiandentalacademy.com
  • 127. Treatment option 5Treatment option 5 www.indiandentalacademy.comwww.indiandentalacademy.com
  • 128. 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
  • 129. 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
  • 130. 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
  • 131. 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
  • 132. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.comwww.indiandentalacademy.com