Occlusion in Implants a Case Report

1. OCCLUSION IN IMPLANTS-A CASE REPORT
PRESENTED BY
Dr. AJINS CB

2. CONTENTS
Introduction
Significance of occlusion in implants
Occlusal goals
Implant protective occlusion
Consequences of biomechanical overload
Implant occlusion in edentulous patients
Case report 1
Case report 2
Case report 3
Conclusion

3. INTRODUCTION
Static relationship between the masticating or incising surfaces of the
mandibular and maxillary teeth or teeth analogues is called as occlusion.
In case of osseointegrated impalnts ,occlusion is one of the major elements in
determining the prognosis of the implant supported prosthesis.

4. SIGNIFICANCE OF OCCLUSION IN IMPLANTS.
Poorly restored occlusion has deleterious effects on the overall success rate.
Occlusal forces are controlled through neuromuscular mechanisms via
masticatory muscles.

5. OCCLUSAL GOALS
Bilateral simultaneous contact.
Preventing biomechanical overload
Equal distribution of forces
No premature contacts
Smooth,even,lateral excursive movements with no non working interferences.

6. IMPLANT PROTECTIVE OCCLUSION
Interarch space
Cusp fossa relationship
Cusp marginal ridge relationship
Supra eruption
Canine guided occlusion
Group function
Cantilever length.

7. CONSEQUENCES OF BIOMECHANICAL OVERLOAD
Early implant failure
Early crestal bone loss
Intermediate to late implant failure
Screw loosening
Uncemented restoration
Porcelein fracture prostheseis fracture

8. IMPLANT OCCLUSION IN EDENTULOUS PATIENTS
No attempt should be made to obtain full balanced occlusion
Lingualized occlusion is preferred
Totally implant bone prosthesis opposes arch with natural dentition: group
function occlusion.

9. OCCLUSAL MATERIAL CHARACTERISTICS
Metal is an excellent occlusal material with improved properties in
accuracy,wear,fracture resistance,abutment retention,and good quality for
impact or static force.
Esthetics is best statisfied with porcelain which has improved properties
compared to acrylic concerning fractures and retention.

10. CASE REPORT:1
A patient of 45 years of age without any medical complications has placed 5
external hex implants in maxilla.Remaining natural teeth in the maxilla was
15,16,17 .The patient had missing teeth opposing these natural teeth.

11. ETIOLOGY;
The excessive occlusal load on the implant supported prosthesis due to
new lower anterior crowns due to change of the mutually protected
occlusion,caused the mechanical failure of the prosthesis.
MULTIPLE COMPLICATIONS INCLUDE;
solder joints fractured
multiple screws fractured
implant fixtures fractured.

12. PREVENTION;
The occlusal load on the implant supported prosthesis and style of occlusion
should have been carefully planned to avoid biological failures.
TREATEMENT;
Two options were presented to the patient.
Option 1:maxillary left sinus augmentation followed by placement of multiple
implants.
Option 2:placement of one or more implants in the maxillary region followed by
an implant retained RPD with full palatal coverage there by correcting the vertical
dimension and the occlusal plane.The patient selected option 2 due to its
cost,simplicity of treatement.

13. CASE REPORT :2
This case was a 57-year-old female that received three 16mm long implants in the right
quadrant.
These implants were stable and did not present any bone loss other than normal bone
remodeling. However, 9 years later, the left tooth-supported bridge collapsed due to decay.

14. ETIOLOGY:
Occlusal overload leads to traumatic occlusion and peri-implantitis.
SYMPTOMS:
Bone loss around implant.
Bleeding gums
Redness and swelling of the mucosa

15. TREATEMENT:
Dentist removed the left teeth and placed an overdenture.
Six months after wearing the overdenture, the patient presented to the periodontist office wearing
a very unstable overdenture and severe bone loss that extended to the sixth thread of two
implants.
A new well-fitted removable prosthesis was fabricated and delivered.
The bone lesions begin to heal within 3 months after elimination of the traumatic condition.
Four years after delivery of the well-fitted restoration, the bone is near the level of the first thread
on the 2 implants that experienced bone loss.

16. CASE REPORT 3
A 63 year old female patient with a history of bruxism reported for a early
periodontal examination 3 months after the restoration of an implant in
tooth no 46 position.
The patient was radiographically,periodontally and occlusally examined

17. TREATEMENT.
The radiograph suggested periimplant bone loss in the implant site due
to occlusal overload due to discrepancy of occlusion during implant
placement.
Occlusal adjustments were made to correct the discrepancy.
A radiograph obtained five months later indicated repair of the lost alveolar
bone.

18. CONCLUSION
Occlusion has to be rigourously evaluated with implant supported prosthesis because with natural teeth a
certain degree of flexibility compensates for occlusal irregularity.But
IMPLANTS CANNOT BAIL OUT OUR FAULTY OCCLUSION

19. REFERENCES
1.O’Brien WJ. Dental Materials and Their Selection. Hanover Park, IL: Quintessence Publishing;
2008.
2. Stuart CE. The contributions of gnathology to prosthodontics. J Prosthet Dent. 1973;30:607–608.
3. Pokorny PH, Wiens JP, Litvak H. Occlusion for fixed prosthodontics: a historical perspective of
the gnathological influence. J Prosthet Dent. 2008;99:299–313.