Prosthodontic evidence-based treatment planning for dental implants

1. Under the Supervision of : Prof. Samahi
King Abdulaziz University
Faculty of Dentistry
Removable Prosthodontics Division

2. 1 - 15
Evidence-Based Dentistry (EBD), a brief definition:
Finding
information
Wisely
Critically applying it
evaluating it in our
practice
Empowers practitioners a strong scientific basis rather than common
practice or expert’s opinion.

3. 2 - 15
1. Wood MR, Vermilyea SG. AAFP Report: Review of Selected Dental
Literature on Evidence-Based Treatment Planning for Dental Implants.
J Prosthet Dent 2004; 92:447-62.
Aim:
Provide dentists with evidence-based guidelines to apply when
planning treatment with osseointegrated implants
Method:
Peer-reviewed literature published in the English language
between 1969 and 2003 was reviewed

4. 3 - 15
Cont. 1. Wood MR, Vermilyea SG. AAFP Report: Review of Selected
Dental Literature on Evidence-Based Treatment Planning for Dental
Implants. J Prosthet Dent 2004; 92:447-62
Evidence-Based Guidelines for Implant Treatment Planning:
Factors
Systemic Host Factors
"The Cluster Phenomenon”
Habits
Smoking, Bruxing
Local Host Factors
bone quality/quantity
Prosthesis Design Factors

5. 3 - 15

6. 4 - 15
Prosthodontic Considerations:
1. Wood MR, Vermilyea SG. AAFP Report: Review of Selected
Dental Literature on Evidence-Based Treatment Planning for
Dental Implants.
J Prosthet Dent 2004; 92:447-62.
2. Taylor TD, Belser U, Mericske-Stern R. Prosthodontic
Considerations. Clin Oral Impl Res 2000: 11 (Suppl.): 101-107.
Aim:
Come up with a general agreement on issues related to the prosthodontic
phase of implant therapy.
Method:
Examined issues related to the prosthodontic phase of implant therapy from 1952 to
1997 in a Consensus Conference held in Switzerland in 1997.
Agreement on all points was reached by voting within the prosthodontic section.

7. 5 - 15
Cont. Prosthodontic Considerations:
1. Number, Size and Position of Implants:
* Greater number and size stress distribution, retention [1]
* Length 7mm [2]
* Width 4mm [3]
* Ideal mesiodistal distance 3mm (implant-implant)
1.5mm (implant-tooth) [4]
* Narrow-body vs. wide-body implants [5]
2. Cantilever:
* Anterior-posterior spread 11.1 mm [6]
* Maximum cantilever length 15 mm – mandible
3. Passivity to Fit: 10-12 mm – maxilla [7]
Accuracy in impression making [8]
[1],[2],[3] Wood et al (2004) [5],[8] Taylor et al (2000)
[4],[6] Carl Mish (2005) [7] Kim Y. et al (2005)

8. 5 - 15

11. 4. Cemented Vs. Screw -Retained Restorations: 6 - 15
Cemented Restorations:
Indications: single unit restorations, short span restorations. [1]
Advantages: screw-loosening is not a complication, passive-fit. [2]
Screw-Retained Restorations:
Indications:
long span and full arch restorations
[3]
deep mucosal implant shoulder placement ( > 3mm )
extended cantilever
[1],[3] Taylor et al (2000)
[2] Wood et al (2004)

13. 7 - 15
3. Kim Y, Tae-Ju Oh, Misch CE, Wang H. Occlusal
Considerations in Implant Therapy: clinical guidelines with
biomechanical rationale. Clin. Oral Impl. Res 2005; 16:26-35.
Aim:
Discuss the importance of implant occlusion for implant longevity.
Provide clinical guidelines of optimal implant occlusion.
Possible solutions managing complications related to implant occlusion.
Method:
Literature published between 1958 and 2002 was reviewed

14. 8 - 15
Cont 3. Kim Y, Tae-Ju Oh, Misch CE, Wang H. Occlusal
Considerations in Implant Therapy: clinical guidelines with
biomechanical rationale. Clin. Oral Impl. Res 2005; 16:26-35.
Occlusal Considerations in Implant Therapy
Occlusal considerations for implants do not differ from those for natural teeth
However
lack of the periodontal ligament causes osseointegrated implants to react
biomechanically in a different fashion to occlusal force.
Occlusal Overloading
Implant Failure
Kim Y. et al (2005)

15. 9 - 15
Overloading Factors of Implant Occlusion:
1. Overextended cactilever
> 15mm in the mandible
> 10-12mm in the maxilla
2. Parafunctional habits / Heavy bite force
3. Excessive premature contacts
4. Steep cuspal inclination
5. Large occlusal table
6. Poor bone density/quality
7. Inadequate number of implants
Kim Y. et al (2005)

18. 10-15
Principles of Implant Occlusion:
1. Bilateral stability in centric occlusion.
2. Evenly distributed occlusal contacts and force.
3. Wide freedom in centric occlusion.
4. Anterior or canine guidance whenever possible.
5. Smooth lateral excursive movements without working/non-working
interferences.
Kim Y. et al (2005)

20. 11-15
Clinical Applications:
Full-arch
Fixed
Prosthesis
Group function
Bilateral Balanced occlusion or No working and Infraocclusion Freedom in
occlusion with mutually protected balancing
in cantilever centric
opposing occlusion when contact on
complete denture opposing natural segment (1-1.5mm)
cantilever
teeth
Kim Y. et al (2005)

22. 12-15
Clinical Applications…Continued
Overdenture
Bilateral balanced Monoplane occlusion
occlusion using on a severely resorbed
lingualized occlusion ridge
Kim Y. et al (2005)

24. 13-15
Conclusion:
1st Review:
With any prosthodontic restoration, meticulous attention must be given to treatment
planning.
In the current “evidence-based” enviroment, it is no longer acceptable to apply the
principles and concepts for the treatment of natural teeth to the treatment of dental
implants.
Clinicians need the results of randomized, controlled clinical trials for evidence-
based decision making.
Limitations:
The article has not discussed the issue of esthetic restoration with implants.
There is lack of quantifiable evidence-supported guidelines regarding esthetics.
Future research is required to establish such guidlines.

25. 14-15
Cont. Conclusion:
2nd Review:
Limitation:
Many of the consensus statements were reached unanimously, while some were
reached with compromise and split vote.
3rd Review:
It emphasized that currently there is no evidence-based, implant-specific concept
of occlusion. Future studies in this area are needed to clarify the relationship
between occlusion and implant success.

26. 15-15
1. Wood MR, Vermilyea SG. AAFP Report: Review of Selected
Dental Literature on Evidence-Based Treatment Planning for
Dental Implants. J Prosthet Dent 2004; 92:447-62.
2. Taylor TD, Belser U, Mericske-Stern R. Prosthodontic
Considerations. Clin Oral Impl Res 2000: 11 (Suppl.): 101-107.
3. Kim Y, Tae-Ju Oh, Misch CE, Wang H. Occlusal
Considerations in Implant Therapy: clinical guidelines with
biomechanical rationale. Clin. Oral Impl. Res 2005; 16:26-35.
4. Carl E. Misch: Dental Implant Prosthetics, 2005, Elsevier
Mosby, chapter 14, 206-227.