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occlusion in implantology.pptx

for the long run of implant, occlusion is most important factor.

1 of 99
PRESENTED BY- DR VAISHALI SHRIVASTAVA
POST GRADUATE STUDENT
DEPARTMENT OF PROSTHODONTICS,
CROWN & BRIDGE AND IMPLANTOLOGY
OCCLUSION IN Implantology
1
2
CONTENT
• INTRODUCTION
• NATURAL TOOTH VERSUS IMPLANT SUPPORT SYSTEM
• SIGNIFICANCE OF OCCLUSION ON OSSEOINTEGRATED
IMPLANTS
• IMPLANT PROTECTIVE OCCLUSION
• OCCLUSAL CONSIDERATIONS FOR FIXED IMPLANT
PROSTHESIS
• CONCLUSION
• REFERENCES
3
• Determining an occlusal scheme for the restoration of implants requires careful
consideration.
• This stems from the fact that after osseointegration, mechanical stresses beyond the
physical limits of hard tissues have been suggested as the primary cause of initial and
long-term bone loss around implants.
INTRODUCTION
4
• Occlusal overload is often regarded as one of the main causes of peri-implant bone loss
and implant prosthesis failure because it can cause crestal bone loss, thus increasing the
anaerobic sulcus depth and peri-implant disease states.
• It can be rightly said that occlusion is a determining factor for implant success in the
long run
5
NATURAL TOOTH VERSUS IMPLANT SUPPORT SYSTEM
Periodontal
membrane
Shock
absorber
Longer force
duration(decre
ased impulse
of force)
Distribution
of force
around
tooth
Tooth
mobility can
be related to
force
Mobility
dissipates
lateral force
Fremitus
related to
force
Radiographic
changes
related to
force
reversible
TOOTH
6
Direct bone
Higher
impact force
Short force
duration(incre
ased impulse
of force)
Force
primarily to
crest
Implant is
rigid
Lateral
force
increases
strain to
bone
no
Fremitus
Radiographic
changes at
crest (bone
loss)
IMPLANT

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occlusion in implantology.pptx

  • 1. PRESENTED BY- DR VAISHALI SHRIVASTAVA POST GRADUATE STUDENT DEPARTMENT OF PROSTHODONTICS, CROWN & BRIDGE AND IMPLANTOLOGY OCCLUSION IN Implantology 1
  • 2. 2 CONTENT • INTRODUCTION • NATURAL TOOTH VERSUS IMPLANT SUPPORT SYSTEM • SIGNIFICANCE OF OCCLUSION ON OSSEOINTEGRATED IMPLANTS • IMPLANT PROTECTIVE OCCLUSION • OCCLUSAL CONSIDERATIONS FOR FIXED IMPLANT PROSTHESIS • CONCLUSION • REFERENCES
  • 3. 3 • Determining an occlusal scheme for the restoration of implants requires careful consideration. • This stems from the fact that after osseointegration, mechanical stresses beyond the physical limits of hard tissues have been suggested as the primary cause of initial and long-term bone loss around implants. INTRODUCTION
  • 4. 4 • Occlusal overload is often regarded as one of the main causes of peri-implant bone loss and implant prosthesis failure because it can cause crestal bone loss, thus increasing the anaerobic sulcus depth and peri-implant disease states. • It can be rightly said that occlusion is a determining factor for implant success in the long run
  • 5. 5 NATURAL TOOTH VERSUS IMPLANT SUPPORT SYSTEM Periodontal membrane Shock absorber Longer force duration(decre ased impulse of force) Distribution of force around tooth Tooth mobility can be related to force Mobility dissipates lateral force Fremitus related to force Radiographic changes related to force reversible TOOTH
  • 6. 6 Direct bone Higher impact force Short force duration(incre ased impulse of force) Force primarily to crest Implant is rigid Lateral force increases strain to bone no Fremitus Radiographic changes at crest (bone loss) IMPLANT
  • 7. 7 Biomechanical design Cross section related to direction and amount of stress Elastic modulus similar to bone Diameter related to force magnitude Implant design Round cross section Elastic modulus 5 to 10 times that of cortical bone Diameter related to existing bone TOOTH IMPLANT
  • 8. 8 Sensory nerve complex Occlusal material (enamel) Surrounding bone cortical No Sensory nerve complex Occlusal material(ceramic) Surrounding bone trabecular TOOTH IMPLANT
  • 9. 9 NATURAL TOOTH VERSUS IMPLANT CHARACTERISTICS UNDER LOAD Jacob SA, Nandini VV, Nayar S, Gopalakrishnan A. Occlusal principles and considerations for the osseointegrated prosthesis. J Dent Med Sci. 2013 Jan;3(5):47-54.
  • 10. 10
  • 11. 11
  • 12. 12 SIGNIFICANCE OF OCCLUSION ON OSSEOINTEGRATED IMPLANTS • No specific defense mechanisms against occlusal forces in implants • Prosthesis must be fabricated as accurately as possible in order to achieve longstanding success • Occlusion should be key factor in overall success rate. • An impact force can have destructive effects on prosthesis and implants and supporting bone • Teeth should contact simultaneously when mandible closes into maximum intercuspal position.
  • 13. 13 OCCLUSAL GOALS FOR IMPLANT PROSTHODONTICS • No prematurities in retrude contact position. • Smooth,even,lateral,excursive movement with no nonworking interferences. • Equal distribution of occlusal forces
  • 14. 14 CAUSES OF OCCLUSAL STRESS • Inadequate number of implants • Heavy occlusal contacts • Working side and non working side interferences • Excessive buccal or lingual cantilever
  • 15. 15 Porcelain fracture Prosthesis fracture Screw loosening (abutment) Early crestal bone loss Intermediate to late implant bone loss Peri implant disease (from bone loss) Poor esthetic result (from tissue shrinkage after bone loss) Intermediate to late implant failure Component fracture CONSEQUENCES OF BIOMECHANICAL OVERLOAD
  • 16. 16 HOW TO MINIMIZE OVERLOAD? • Proper diagnosis and treatment plan • A passive prosthesis of adequate retention and form • Progressive loading to improve amount and density of adjacent bone • An occlusal scheme that minimizes risk factors and functions in harmony with stomatognathic system Goal- implant protective occlusion with prosthetically driven implant treatment plan
  • 17. 17 • OCCLUSION- the static relationship between the incising or masticating surfaces of the maxillary or mandibular teeth or tooth analogues.(GPT10) • BALANCED ARTICULATION : the bilateral, simultaneous occlusal contact of the anterior and posterior teeth in excursive movements.(GPT10) Terms (GPT10)
  • 18. • 18 • LINGUALIZED OCCLUSION -this concept was first described by S. Howard Payne, prosthodontist, U.S.A., 1941; this form of denture occlusion articulates the maxillary lingual cusps with the mandibular occlusal surfaces in centric occlusion, working and nonworking mandibular positions .(GPT10) • MUTUALLY PROTECTED ARTICULATION- an occlusal scheme in which the posterior teeth prevent excessive contact of the anterior teeth in maximal intercuspal position, and the anterior teeth disengage the posterior teeth in all mandibular excursive movements.(GPT10)
  • 20. 20 • A proper occlusal scheme is primary requisite for long term implant prosthetic survival, especially when parafunction habits are present. • Concept refers to an occlusal plan specifically designed for restoration of implants, providing an environment for reduced biomechanical complications and improved clinical longevity of both the implant and prosthesis. • The biomechanical rationale for this concept was published by Dr Carl Misch and Dr. MW Bidez • And was originally called medial positioned lingualized occlusion.
  • 21. 21 CONSIDERATIONS FOR FOLLOWING THE IPO SCHEME THAT SHOULD BE JUDICIOUSLY IMPLEMENTED BEFORE RESTORATION • No premature occlusal contacts or interferences • Mutually protected articulation • Implant body angle to occlusal load • Cusp angle of crowns (cuspal inclination) • Cantilever or offset loads • Crown height (vertical offset) • Implant crown contour • Occlusal contact positions • Protect the weakest component
  • 22. 22 Existing Occlusion Maximal intercuspation (MI) is defined as the complete intercuspation of the opposing teeth independent of condylar position, sometimes described as the best fit of teeth regardless of the condylar position.(Carl E Misch) Correction of the deflective contacts before treatment presents many advantages and may follow a variety of approaches depending on the severity of the incorrect tooth position: • selective odontoplasty (a subtractive technique), • restoration with a crown (with or without endodontic therapy), • extraction of the offending tooth. The existing occlusion is best evaluated with facebow-mounted diagnostic casts on an articulator mounted with an bite registration in CR
  • 23. 23 PREMATURE OCCLUSAL CONTACTS • A fundamental biomechanical formula is stress equals force divided by the area over which the force is applied (S = F/A). • premature occlusal contacts often result in localized lateral loading of the opposing contacting crowns. • Because the surface area of a premature contact is small, the magnitude of stress in the bone increases proportionately
  • 24. 24 Myata et al. evaluated premature contacts on implant crowns in monkeys (Macaca fascicularis). • The crestal bone was histologically evaluated on implant crowns with 100 microns, 180 microns, and 250 microns of premature contacts for 4 weeks. • The crowns with 100-micron premature contacts had little bone changes. • The 180-micron group demonstrated a V-shaped pattern of bone loss for several millimeters. • The 250-micron implant crowns for 4 weeks had a large V-shaped defect around the implants that extended for more than two thirds of the implant body
  • 25. 25
  • 26. 26 • an initial premature occlusal contact on a tooth often affects the closure of the mandible to result in an MI position different from CO. • A premature contact on an implant crown does not benefit from such protective features; as a result, the implant system is at increased risk. • Therefore, occlusal evaluation in CO and MI and adjustment as necessary in partially edentulous implant patients are more critical than in natural dentition because the premature contacts can result in more damaging consequences on implants compared with teeth
  • 27. 27 IMPLANT BODY ORIENTATION • Forces acting on teeth and dental implants are referred to as vectors (defined in magnitude and direction). • Occlusal forces are typically three dimensional, with components directed along one or more of the clinical coordinate axes. • Implants are also designed for long-axis loads.
  • 28. 28
  • 29. 29 • Two dimensional finite element analysis by Binderman in 1970 evaluated 50 endosteal implant designs and found that all designs sustained stress contours concentrated primarily at the transosteal (crestal) region. • In addition, less stress was observed under a long-axis load compared with angled loads. Since then, two- and three-dimensional finite element analyses by several authors have yielded similar results
  • 30. 30 • Most anatomical variations of the bone (e.g., bony concavities) are located on the facial aspect and influence implant body inclination. • An implant body may be positioned with a 15-degree angle to avoid the facial concavity and therefore is positioned at 15 degrees to the occlusal load. • This angled implant may be restored during prosthetic reconstruction with a 15-degree angle abutment.
  • 31. 31 From the level of the crest of the ridge to the occlusal plane, the implant abutment looks similar to one in an axial implant body. Hence, the laboratory technician and restoring dentist often treat the angled implant and axial implant in similar fashion. However, in the 15-degree angled implant body, the load to the facial bone increases by 25.9% compared with an axial load
  • 32. 32 FORCE DIRECTION AND BONE MECHANICS The noxious effect of offset or angled loads to bone is exacerbated further because of the anisotropy of bone. Anisotropy refers to the character of bone whereby its mechanical properties, including ultimate strength, depend on the direction in which the bone is loaded and the type of force applied.
  • 33. 33 IPO attempts to eliminate or reduce all shear loads to the implant system because the bone, porcelain, titanium components, and cement are weakest to shear load. Angular occlusal load resolve into normal and shear forces. As the angle of load to an implant body increases, the amount of compressive and tensile forces is modified by the cosine of the angle
  • 34. 34 The greater the angle of load to the implant long axis, the greater the compressive, tensile, and shear stresses
  • 35. 35 when the direction of the force changes to a more angled or horizontal load, the magnitude of the stress is increased by three times or more. The axial-loaded implants have less strain in the system (left side and lower right of figure). The angled implant has more strain lines indicating greater loads (right upper implant)
  • 36. 36 the crestal bone load increase around the implant with angled forces, but also the amount of stress the bone may withstand (i.e., the ultimate strength) decreases in shear, tension, and compression. The greater the angle of load, the lower the ultimate strength of bone. Therefore, IPO attempts to eliminate lateral or angled loads to an implant-supported prosthesis because the magnitude of the force increases and the strength of the bone decreases.
  • 37. 37 PROSTHETIC ANGLED LOADS Greater crestal bone strains with angled forces have been confirmed with photoelastic and three-dimensional finite element analysis methods. Whether the occlusal load is applied to an angled implant body or an angled load (e.g., premature contact on an angled cusp) is applied to an implant body perpendicular to the occlusal plane, the results are similar . A biomechanical risk increases to the implant system
  • 38. 38 In a study by Ha et al., the angled abutment was compared with a straight abutment for screw loosening in the anterior maxilla. The angled abutments showed more screw loosening with cyclic loading than the straight abutments
  • 39. 39 SOLUTIONS TO ANGLED LOADS When lateral or angled loads cannot be eliminated, a reduction in the force magnitude or additional surface area of implant support is indicated to reduce the risk of biomechanical complications to the implant system
  • 40. 40 if three adjacent implants are inserted with the first in the long axis to the load, the second at 15 degrees, and the third implant at 30 degrees, the surgeon may decrease the overall risk by (1) adding an additional implant in the edentulous space next to the most angled implant (2) increasing the diameter of the angled implants (3) selecting an implant design with greater surface area.
  • 41. 41 reduce the overload risk by (1) splinting the implants together, (2) reducing the occlusal load on the second implant and further reducing the load on the third implant (3) eliminating all lateral or horizontal loads from the most angled implant and completely eliminating them in all posterior regions.
  • 42. 42 Ridge augmentation may be necessary before implant placement to improve implant position or facilitate the use of a wider-diameter implant. IPO aims at reducing the force of occlusal contacts, increasing the implant number, or increasing the implant diameter for implants subjected to angled loads.
  • 43. 43 Posterior Crown Cusp Angle The angle of force to the implant body may be influenced by the cusp inclination of the implant crown in similar fashion as an angled load to an implant body. The posterior natural dentition often has steep cuspal inclines, and 30-degree cusp angles have been designed in denture teeth and natural tooth prosthetic crowns
  • 44. 44 The greater cusp angles are often considered more esthetic and may even incise food more easily and efficiently. To negate the negative effect of an angle cusp contact, the opposing teeth need to occlude at the same time in two or more exact positions on the ipsilateral cusp angles of the crowns .
  • 45. 45 • The occlusal contact along only one of the angled cusps result in an angled load to the implant system even when it is not premature to other occlusal contacts. • The magnitude of the force is minimized when the angled occlusal contact is not a premature contact but instead is a uniform load over several teeth or implants. • the angled cusp load does increase the resultant tensile and shear stress with no observable benefit. • Hence, no advantage is gained, but the biomechanical risk is increased (e.g., increased abutment screw loosening, porcelain fracture, and unretained restoration)
  • 46. 46
  • 47. 47 MUTUALLY PROTECTED ARTICULATION This occlusal design is based on the concept of using the maxillary canine as the key of this occlusion scheme to avoid lateral forces on the posterior teeth. In CO, the anterior teeth contacts are shared and protected by the occlusal contacts of the posterior teeth. When the canine separates the posterior teeth in right or left lateral excursions, the term canine or cuspid protected occlusion may be used.
  • 48. 48 • The mutually protected articulation concept is used in IPO. In protrusive mandibular movements, the central and lateral incisors disocclude the posterior teeth. • In lateral excursions, the canine (and lateral incisor when possible) disocclude the posterior teeth. • In CO, the posterior and canine teeth occlude. When the centrals and lateral incisors are natural, they may also occlude in CO (or MI). • When the anterior teeth are implants, they may not occlude in centric, especially when the opposing dentition is also implant supported.
  • 49. 49 • According to Weinberg and Kruger, for every 10-degree change on the angle of disclusion, there is a 30% difference in load. • the incisal guidance should be less than 20 degrees. • However because the condylar disc assembly is usually 20 to 22 degrees, the incisal guidance should be greater than this amount to separate the posterior teeth. • Hence, in most patients, an incisal guidance of at least 23 to 25 degrees is suggested in IPO
  • 50. 50 • The increase in load that occurs from the incisal guidance angle is further multiplied by the crown height above the initial occlusal contact (the vertical overbite) because it acts as a lever while the mandible slides down the incline plane. • An ideal vertical overbite in prosthetics has been reported to be 5 mm • However, especially in parafunctional patients, incisal guidance should be as shallow as possible in implant prostheses (23–25 degrees) and the vertical overbite reduced to less than 4 mm, yet the posterior teeth should disocclude in the excursion
  • 51. 51
  • 52. 52 CANTILEVERS AND IMPLANT-PROTECTIVE OCCLUSION • Cantilevers are class-1 levers, which increase the amount of stress on implants. • Twice the load applied at the cantilever will act on the abutment farthest from the cantilever, and the load on the abutment closest to cantilever is the sum of the other two components. • The goal of IPO relative to cantilevers is to reduce the force on the pontics of the lever region compared with that over and between the implant abutments. • To reduce the amount of force that is magnified by the cantilever, the occlusal contact force may be reduced on the cantilevered portion of the prosthesis
  • 53. 53 • cement and screws are weaker to tensile loads, the implant abutment farthest from the cantilever often becomes unretained, resulting in the fulcrum abutment’s bearing the entire load. • Because the implant is more rigid than a tooth, it acts as a fulcrum with higher force transfer. • It is a higher risk to cantilever from an implant than a tooth
  • 54. 54 CROWN HEIGHT AND IMPLANT- PROTECTIVE OCCLUSION • An increased crown height acts as a vertical cantilever, magnifying the stress at the implant-bone interface. • It also leads to angled load with a greater lateral component of force. • It is important to note that crown height is determined at the time of diagnosis and that all methods of either reducing the load or reducing the crown-implant ratio should be applied before restoration.
  • 55. 55 POSTERIOR IMPLANT CROWN CONTOUR A buccal or lingual cantilever in the posterior regions is called an offset load, and the same principles of force magnification from class 1 levers apply. the greater the offset, the greater the load to the implant system. Offset loads may also result from buccal or lingual occlusal contacts and create moment forces, which increase compressive, tensile, and shear forces to the entire implant system
  • 56. 56 Narrower implant bodies are more vulnerable to occlusal table width and offset loads. Therefore, in IPO, the width of the occlusal table is related directly to the width of the implant body. As a result, in the nonaesthetic regions the width of the occlusal table must be reduced in comparison to a natural tooth
  • 57. 57 MANDIBULAR POSTERIOR CROWNS The mandibular implant crown should be reduced from the buccal and the maxillary crown reduced from the lingual. Thus, the “stamp cusp” offset load is reduced. The reduced buccal contour in the posterior mandible is of no consequence to cheek biting because the buccal horizontal overjet is maintained (and increased).
  • 58. 58
  • 59. 59 In the posterior mandible, as the implant diameter decreases, the buccal cusp contour is reduced. This decreases the offset length of cantilever load. The lingual contour of the crown remains similar regardless of the diameter of the implant. The lingual contour permits a horizontal overlap with the maxillary lingual cusp, so the tongue is pushed away from the occlusal table during function.
  • 60. 60 MAXILLARY POSTERIOR CROWNS When maxillary posterior implants are in the esthetic zone, they are positioned more facial than the center of the ridge. The lingual contour of a maxillary implant crown should be reduced because it is out of the esthetic zone and is a stamp cusp for occlusion (which is an offset load)
  • 61. 61
  • 62. 62 Occlusal contact position • The ideal occlusal contact is over the implant body. This contact leads to the axial loading of implants. • A posterior implant is hence placed under the central fossa of the implant crown. • A buccal cusp contact is an offset or cantilever load. • A marginal ridge contact is also a cantilever load, as the marginal ridge may also be several millimeters away from the implant body.
  • 63. 63 • ideal primary occlusal contact should reside within the diameter of the implant within the central fossa. • The secondary occlusal contact should remain within 1 mm of the periphery of the implants to decrease the moment loads. • The marginal ridge contact is not an offset load when located between implants splinted to one another and is acceptable only under such circumstances. • Moreover, adjacent crowns should preferably be splinted in order to decrease occlusal stresses to crestal bone and to reduce screw loosening.
  • 64. 64 peter K. Thomas’ occlusal theories suggest that there should be a tripod contact on each occluding cusp (stamp cusp), on each marginal ridge, and in the central fossa with 18 and 15 individual occlusal contacts on a mandibular and maxillary molar, respectively. Other occlusal contact schemes indicate the number of occlusal contacts for molars may be reduced to five or six contacts, including the dominant cusp (stamp cusp) the marginal ridges, and the central fossa
  • 65. 65 Vertical Movement The sudden, initial (primary) tooth movement ranges from 8 to 28 microns in a vertical direction under a 3- to 5-lb load, depending on the size, number, and geometry of the roots and the time elapsed since the last load application. This tooth movement has been called “primary” tooth movement and is a result of the movement within the periodontal complex.
  • 66. 66 Implant with a heavy bite force may move apically up to 5 microns. When the initial tooth movement occurs, secondary tooth movement is present during a greater load and reflects the viscoelastic property of the surrounding bone. The vertical secondary tooth movement is minimal and may approach 3 to 5 microns for a natural tooth
  • 67. 67 HORIZONTAL MOVEMENT The initial lateral movement of healthy anterior teeth ranges from 68 to 108 microns before secondary tooth movement, or two to four times more movement than their apical movement Horizontal (lateral) implant movements are not immediate and with heavier forces range from 10 to 50 microns
  • 68. 68 Design to the Weakest Arch All treatment planning decisions for ipo should be based on careful consideration of (1) identifying the weakest link in the overall restoration and (2) establishing occlusal and prosthetic schemes to protect that component of the structure. The amount of force distributed to a system can be reduced by stress-relieving components that may dramatically reduce impact loads to the implant support.
  • 69. 69 Reduced occlusal forces with an absence of lateral contacts during excursions are recommended on posterior cantilevers or anterior offset pontics whenever possible. This minimizes the moment forces on the abutments and decreases the loads on terminal implant abutments
  • 70. 70
  • 71. 71 • Usually the maxilla is the weaker of the two arches, predominantly due to less dense bone. • From a biomechanical perspective, an implant-restored premaxilla is often the weakest section compared with the other regions of the mouth.
  • 72. 72 • Compromised anatomical conditions include narrow ridges and the need for narrow implants, • the use of facial cantilevers, • oblique centric contacts, • lateral forces in excursion, • reduced bone density, • the absence of a thick cortical plate at the crest, • and accelerated bone loss in the incisor region often resulting in instability when placing central and lateral incisor implants without substantial augmentation procedures
  • 73. 73 OCCLUSAL MATERIAL The selection of occlusal materials depends on the opposing dentition, the remaining dentition, and the quadrant to be restored. The selection is usually made from among porcelain, zirconia, metal etc
  • 74. 74 Shakir DQ, Pailw ND. implant placement: A clinical case report”. International Journal o.
  • 75. 75 Division B Bone In division B bone, maxillary and mandibular implants are positioned more toward the lingual cusp of the original natural tooth position. As a result, the buccal aspect of the mandibular crowns is further reduced to avoid offset occlusal contacts. The primary occlusal contact on an opposing natural posterior maxillary tooth is the lingual cusp, which is reshaped to load the implant axially
  • 76. 76 Division C and D Maxillae On occasion, the maxillary ridge atrophy from division A to C or D bone results with the maxillary ridge under the position of the maxillary lingual cusp tip. A sinus graft restores the available bone height but does not reposition the resorbed residual ridge.
  • 77. 77 Occlusal considerations for the various osseointegrated prosthesis
  • 78. 78 General Occlusal Scheme In centric, all of the posterior teeth should have contacts, and anterior teeth should have a clearance of about 30µm If the entire arches are restored with osseointegrated prostheses such as a fully bone anchored bridge, it will be easier to establish such an occlusion. In the mixed dentition, which is composed of natural teeth and osseointegrated bridgework, the natural tooth sinks approximately 30µm during its function. During eccentric movement, the concept of disclusion is generally recommended Anterior segments of the osseointegrated prosthesis should guide the mandible to produce the posterior disclusion. Canineguided occlusion is not recommended for the osseointegrated prosthesis as it generates excessive occlusal forces into the single implant fixture, which is placed in the canine area. In order to distribute the stress over the entire fixture, anterior group function is recommended
  • 79. 79 Classification Free standing bridge Kennedy class1 Kennedy class II Kennedy classIII Kennedy class IV Bridge connected to the natural teeth Fully bone anchored bridge Overdenture . Single tooth replacement Jacob SA, Nandini VV, Nayar S, Gopalakrishnan A. Occlusal principles and considerations for the osseointegrated prosthesis. J Dent Med Sci. 2013 Jan;3(5):47-54.
  • 80. 80 Occlusion For Overdentures The occlusion recommended for the overdenture is the fully balanced occlusion with lingualized occlusion. The concepts that apply to the regular denture are accepted for the osseointegrated overdenture. However, in the case of an edentulous maxillary overdenture and a mandibular fully bone anchored bridge, in centric a small clearance is recommended in the anterior teeth, while the posterior teeth contact simultaneously. The amount of disclusion in protrusive and lateral movement non working side and working side is 0 mm.
  • 81. 81 Occlusion For Free Standing Bridge( Kennedy Class I) – In this, both sides of the arch are restored by osseointegrated bridges, and they maintain the vertical height. The amount of disclusion required for this case is the same as in the natural dentition because anterior guidance is provided by the natural dentition: Protrusive 1.1 mm, non- working side 1.0 mm; working side 0.5 mm
  • 82. 82 • Kennedy Class II – • This situation is ideal for the osseointegrated free-standing bridge because the contralateral side of the arch will maintain the vertical height, while the other side is restored by the osseointegrated bridge. • It induces less stress to the implant while it holds centric. In centric, the posterior osseointegrated bridge should have 30µm open contacts, while anterior teeth also have 30µm openings, and it begins to contact under strong bite pressure. • In the Kennedy Class II situation, because the anterior teeth are natural teeth, they can bear the occlusal load safely. • The amount of disclusion suggested for this case is the same as for a natural dentition: Protrusive 1.1 mm; Non-working side 1.0 mm, Working side 0.5 mm
  • 83. 83 • Kennedy Class III – This situation is also ideal for osseointegrated implants because the vertical height is maintained by natural teeth. • In centric, the osseointegrated bridge only contacts under strong bite pressure. • Eccentric movement is guided by the natural dentition. The amount of disclusion suggested for this case is the same as for a natural dentition: Protrusive 1.1 mm; Non- working side 1.0 mm, Working side 0.5 mm
  • 84. 84 • Kennedy Class IV - In this case, posterior disclusion is guided by the osseointegrated bridge. In order to minimize the horizontal load introduced to the implant site, group-function occlusion is preferred. • During lateral movement, posterior teeth on the working side can help bear the horizontal load, while the non-working side is discluded. • During protrusive movement, an osseointegrated bridge will guide the mandible and produce posterior disclusion.
  • 85. 85 In order to minimize the load induced to the fixtures during protrusive movement, anterior guidance should be flatter than the natural dentition. The amount of disclusion suggested for this case is as follows: Protrusive 0.8mm; Non- working side 0.4mm; Working side 0.0mm. Because an anterior fixed bridge does not sink like natural teeth, the clearance of natural teeth must be greater than the one given to natural anterior teeth (> 30µm)
  • 86. 86 Occlusion For Single Tooth Replacement Occlusion required for this restoration is equal to the natural dentition. In centric for anterior teeth, it must have a clearance of 30µm During eccentric movement, the anterior restoration should contact with opposing teeth in order to create anterior group function. This eccentric contact is essential to prevent the extrusion of opposing teeth. Because the restoration does not contact in centric, contact during eccentric movement is required. For premolars, the restoration must disclude during eccentric movement and avoid lateral stress
  • 87. 87
  • 88. 88 Rilo B, da Silva JL, Mora MJ, Santana U. Guidelines for occlusion strategy in implant-borne prostheses. A review. International dental journal. 2008 Jun 1;58(3):139-45
  • 89. 89 Wismeijer D, van Waas MA, Kalk W. Factors to consider in selecting an occlusal concept for patients with implants in the edentulous mandible. The Journal of prosthetic dentistry. 1995 Oct 1;74(4):380-4.
  • 90. 90 OCCLUSAL CONSIDERATIONS FOR FULL-ARCH IMPLANT-SUPPORTED PROSTHESES Full-arch fixed implant-supported prostheses can be a treatment option for patients presenting with failing dentition or complete edentulism. Full-arch implant-supported prostheses (immediately or conventionally loaded) have shown very high (90% or greater) survival rates in short-term retrospective studies and high patient satisfaction in surveys Yoon D, Pannu D, Hunt M, Londono J. Occlusal considerations for full-arch implant-supported prostheses: A guideline. Dentistry Review. 2022 Jun 1;2(2):100042.
  • 91. 91 the authors have developed an occlusal guideline for five possible scenarios of full-arch implant supported prostheses: Metal-acrylic vs Metal- acrylic Metalacrylic vs Natural dentition All-ceramic vs All- ceramic All-ceramic vs Natural dentition All-ceramic vs Metal- acrylic the goal of the guideline is to maximize patient comfort and function while minimizing prosthetic complications
  • 95. 95 All-ceramic opposing metal acrylic. A. All-ceramic (zirconia) opposing metal-acrylic. Centric. B. B. Protrusive. C. C. Right lateral. D. D. Left lateral.
  • 97. 97 A poor selection of occlusal scheme can lead to biological and mechanical complications. The various consequences that can be encountered are implant failure, early crestal bone loss, screw loosening, uncemented restorations, component failure, porcelain fracture, prosthesis fracture, and peri-implant disease. An IPO scheme addresses several conditions to minimize overload on bone/implant interfaces and implant prostheses, thus restricting implant loads within physiological limits. CONCLUSION
  • 98. 98 REFERENCES Dental implant prosthetics by Carl E Misch Jacob SA, Nandini VV, Nayar S, Gopalakrishnan A. Occlusal principles and considerations for the osseointegrated prosthesis. J Dent Med Sci. 2013 Jan;3(5):47-54. Yoon D, Pannu D, Hunt M, Londono J. Occlusal considerations for full-arch implant-supported prostheses: A guideline. Dentistry Review. 2022 Jun 1;2(2):100042. Prakash O. Occlusal considerations and principles in Dental Implant: A Review of Literature. National Medicos Organisation Journal (ISSN-2348-3806). 2022 Feb 25;16(1):40-5. Verma M, Nanda A, Sood A. Principles of occlusion in implant dentistry. Journal of the International Clinical Dental Research Organization. 2015 Dec 1;7(Suppl 1):S27-33. Rilo B, da Silva JL, Mora MJ, Santana U. Guidelines for occlusion strategy in implant-borne prostheses. A review. International dental journal. 2008 Jun 1;58(3):139-45. Wismeijer D, van Waas MA, Kalk W. Factors to consider in selecting an occlusal concept for patients with implants in the edentulous mandible. The Journal of prosthetic dentistry. 1995 Oct 1;74(4):380-4.