Welcome why i wanted to give this lecture Use the benefit of my experience and others take care of some of the more common questions that come up help avoid pitfalls in tx planning and execution(how many, how to temporize, what do i tell the lab occ scheme, advance your learning curve so you will be more comfortable and exude more confidence before the patient gets to me
First big question Two things kill implants in the early going surgical error, idiopathic Long term usually occlusal overload and lack of adequate bone quality
Make sure you have a good reason to entertain cantilevers and it is just not for the sake of cutting down on the number of implants far better to place an implant in the distal position here Lateral forces concentrate the force at the crest Incidentally, the allowance of shorter implants much unlike the days when we wanted to place 15 and 18 mm implants because we know the stress/force is concentrated mostly at the crest. That is why even Branemark says we only need 5 mm. center of rotation is different for a tooth then it is for an implant. Go to blackboard ankylosed implant vs tooth with PDL Cantilevers are “allowed” up to certain point. Good rule of thumb after one tooth cantilever in either direction start to get real nervous Able to go around the arch then two teeth can start to think about. In general, if you are entertaining cantilevers you may not be treatment planning enough implants.
Force of natural tooth Ideal force transmitted to implant is through the long axis
Mostly surgical positioning challenge/error will see this.
Did everything right 1996, sinus lift, harvested bone from chin, place 15 and 18 mm implants Combo of things wrong = bone quality, smoking. Implants placed to lingual and pt would not consent to setting the case up in cross bite to avoid a buccal cantilever. This failure took about a year. Bad experience stuck with me
In case you want to know what you are looking at this person took impressions of the screw hole and casted up some post and cores. This was my old boss who was doing this, so I had to find an easy implant to restore because I did not want him doing this to my 3i implants.
Need photo of
Fighting for every mm I can get.
Lucky because of the wide interradicular bone If you are faced with extraction just respect the buccal plate try not to luxate towards the buccal too much
I haven’t had to lay flaps and grind buccal and lingual bone for a very long while now.
Over the foramen, pap, molar sites difficult No pathology, premolars, canines, max incisor
Lose a good opportunity to grow bone and tissue
You see the sinus and say it can’t be done, I see it and say let me just get that tooth out of there and I have access to graft