Single tooth defects in the posterior quadrants

1. Single tooth defects in the posterior
quadrants
John Beumer III DDS, MS
Robert Faulkner DDS
Division of Advanced Prosthodontics, UCLA
This program of instruction is protected by copyright ©. No portion of
this program of instruction may be reproduced, recorded or transferred
by any means electronic, digital, photographic, mechanical etc., or by
any information storage or retrieval system, without prior permission.

2. Single tooth defects – Posterior quadrants
Fixed dental prostheses
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been
corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then
insert it again.
Delivery 15 year follow-up

3. Fixed vs Implant
Implant is preferred when:
l Adjacent natural teeth are virgin or nearly virgin
l The long term prognosis of the abutments is
questionable due to previous endondotic treatment or
periodontal compromise
Fixed is preferred
l Maxillary 1st molar defects -
l Pneumatization of the maxillary sinus
l Higher failure rates

4. Restoration of endodonticallly treated teeth
vs Implant crown
Endo is preferred (given a successful endodontic
treatment outcome)
l Reasonable volume of tooth structure remains
l Occlusion is ideal
l Parafunctional activity is minimal
Courtesy Dr. C. Goodacre

5. Mandible
Anatomic issues
l Buccal-lingual dimension.
l Thickness of the buccal plate
(immediate load)
l The lingual concavity
l Inferior alveolar nerve
l Mental nerve
The image cannot be displayed. Your computer may not have enough
memory to open the image, or the image may have been corrupted. Restart
your computer, and then open the file again. If the red x still appears, you
may have to delete the image and then insert it again.
Courtesy Dr. N. Barakat

6. Mandible
Anatomic issues
l Buccal-lingual dimension.
l Thickness of the buccal
plate (immediate load)
l The lingual concavity
l Inferior alveolar nerve
l Mental nerve
These structures are best appreciated with CT scans
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted.
Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
Courtesy Dr. N. Barakat

7. The image cannot be displayed. Your computer may not have enough memory to open the
image, or the image may have been corrupted. Restart your computer, and then open the file
again. If the red x still appears, you may have to delete the image and then insert it again.
COURTESY DR N. GEHA
Anterior loop of the mental nerve
Courtesy Dr. N. Barakat

8. Anatomic issues
• Buccal-lingual
dimension.
• Thickness of the buccal
plate (immediate load)
• Maxillary sinus
Maxilla
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the
file again. If the red x still appears, you may have to delete the image and then insert it again.

9. Site enhancement
l Most commonly necessary in the
maxillary premolar region
The image cannot be displayed. Your computer may not have enough memory to open the image, or the
image may have been corrupted. Restart your computer, and then open the file again. If the red x still
appears, you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If
the red x still appears, you may have to delete the image and then insert it again.

10. Timing for implant placement
Immediate vs delayed vs staged
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image
may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may
have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image
may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may
have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may
have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to
delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have
been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the
image and then insert it again.
The image cannot be displayed. Your computer may not have enough
memory to open the image, or the image may have been corrupted.
Restart your computer, and then open the file again. If the red x still
appears, you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have
enough memory to open the image, or the image may have been
corrupted. Restart your computer, and then open the file again. If
the red x still appears, you may have to delete the image and then
insert it again.
Immediate placement - placing the implant at the same time as extraction of the tooth
ª Delayed placement - placement of the implant 2-3 months following extraction.
ª Staged placement - placement of the implant 4-6 months after tooth extraction in
order to allow for bone healing of the extraction site.

11. The intent of these strategies is to minimize bone resorption,
particularly on the facial surfaces of the implant.
ª However, following tooth removal, resorption of labial and lingual
bone occurs regardless of whether an implant is placed into the
extraction site, whether placement of the implant is delayed for 2-3
months, or whether the socket is augmented with bone substitutes.
ª Two hypotheses for resorption
ª Bone resorption is secondary to the contraction of the mucosal tissues
secondary to expression of the WIT genes (Suwanwela, et al, 2011)
ª Compromise of the blood supply to the facial bone following extraction
(DeRouk et al, 2008)
Timing for implant placement
Immediate vs delayed vs staged implant placement

12. Immediate implant placement
ª Tooth fracture, defects with no infection and
intact labial plates
ª Sufficient bone apical to the tooth socket to
insure adequate primary stabilization
The image cannot be displayed. Your computer may not have enough memory to open the image, or the
image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears,
you may have to delete the image and then insert it again.
ª Patients with significant bone loss are poor candidates. Those presenting with
loss of labial bone with extended biologic width requiring bone augmentation are
best treated with a staged technique
ª Patients presenting with periodontal or peri-apical infections are poor candidates
for immediate placement primarily because of the compromised blood supply
associated with the potential implant site. They are best treated with “staged
implant placement.”
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have
been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the
image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or
the image may have been corrupted. Restart your computer, and then open the file again. If the red x
still appears, you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the
image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears,
you may have to delete the image and then insert it again.

13. Immediate placement
ª Tooth fracture, defects with no infection and
intact labial plates
ª Sufficient bone apical to the tooth socket to
insure adequate primary stabilization
The image cannot be displayed. Your computer may not have enough memory to open the image, or the
image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears,
you may have to delete the image and then insert it again.
ª Immediate placement helps retain the levels of the interdental papilla, but will not
preserve the bone on the labial side of the implant (Araugo et al, 2005; Botticelli et
al, 2006; Araujo and Lindhe, 2009).
ª If immediate placement is considered, there should be sufficient bone apical to
the tooth socket order to insure adequate primary stabilization of the implant.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have
been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the
image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or
the image may have been corrupted. Restart your computer, and then open the file again. If the red x
still appears, you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the
image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears,
you may have to delete the image and then insert it again.

14. Delayed implant placement
l Delayed placement - placement of the implant 2-3
months following extraction.

15. Site enhancement
ª Socket augmentation
ª Treatment of fresh extraction sockets with intact
buccal and lingual bone walls.
ª Ridge preservation
ª Augmenting edentulous sites that are insufficient
for implant placement.
ª Ridge reconstruction

16. Ridge preservation
Defined as treatment of fresh extraction sockets with deficient
bone walls in order to maintain ridge contours.
The image cannot be displayed. Your computer may not have enough memory to open the image, or
the image may have been corrupted. Restart your computer, and then open the file again. If the red
x still appears, you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the
image, or the image may have been corrupted. Restart your computer, and then open the file
again. If the red x still appears, you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the
image, or the image may have been corrupted. Restart your computer, and then open the file
again. If the red x still appears, you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory
to open the image, or the image may have been corrupted. Restart your
computer, and then open the file again. If the red x still appears, you may have
to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to
open the image, or the image may have been corrupted. Restart your computer,
and then open the file again. If the red x still appears, you may have to delete the
image and then insert it again.
When successful, these procedures
permit placement of implants in ideal
position and angulation. There is no
evidence to indicate which particular
approach might be the most
efficacious (Chen and Buser, 2009).
Courtesy Dr. Krill

17. Site requirements and implant selection
Premolars
Bone volumes necessary
l Implant diameters 4.0-4.5 mm
l There should be sufficient volume of buccal-lingually
and mesial-distally to encompass the implant with at
least 2 mm of bone on each side
l 7 mm of mesial-distal space required
l Implant lengths
l Mandible – 8-10mm
l Maxilla – 10-12 mm
The image cannot be displayed. Your computer may not have enough memory to open the
image, or the image may have been corrupted. Restart your computer, and then open the
file again. If the red x still appears, you may have to delete the image and then insert it
again.
Beware of the use of excessively wide implants in the premolar region.
When the bone is excessively thin on the buccal side of the implant there is
risk of loss of gthe facial plate and apical migration of bone and soft tissue.
10 year follow-up

18. Site requirements and implant selection
Molars
Bone volumes necessary
l Implant diameters 5-6 mm
l Two implants, 4 mm in
diameter are preferred
when the mesial – distal
space permits
l Preferred in extension areas
l Implant lengths
l Mandible – 8-10mm
l Maxilla – 10-12 mm
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been
corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and
then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or
the image may have been corrupted. Restart your computer, and then open the file again. If the red x
still appears, you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open
the image, or the image may have been corrupted. Restart your computer, and then
open the file again. If the red x still appears, you may have to delete the image and
then insert it again.

19. The image cannot be displayed. Your computer may not have enough memory to open the
image, or the image may have been corrupted. Restart your computer, and then open the
file again. If the red x still appears, you may have to delete the image and then insert it
again.
Solitary implants restoring single molars
Avoid the use of 4mm implants - Cantilever effect
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image
may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may
have to delete the image and then insert it again.
When the food bolus is applied to the marginal ridge (B), the restoration
is easily tipped because the crown is supported by such a narrow
platform.
Result: Cantilever forces lead to screw loosening, implant fracture
and overload the bone anchoring the implant.

20. Immediate loading
Generally discouraged in the posterior
quadrants
Immediate placement into
extraction sites
Generally discouraged in the molaer sites
Possible in premolar sites

21. Selection of implants
External hex vs internal interlocking
l Internal interlocking is preferred but
both have been used successfully
Tapered implants
l In extraction sites
The image cannot be displayed. Your
computer may not have enough memory
to open the image, or the image may
have been corrupted. Restart your
computer, and then open the file again. If
the red x still appears, you may have to
delete the image and then insert it again.
The image cannot be
displayed. Your computer may
not have enough memory to
open the image, or the image
may have been corrupted.
Restart your computer, and
then open the file again. If the
red x still appears, you may
have to delete the image and
then insert it again.
The image cannot be
displayed. Your computer
may not have enough
memory to open the image,
or the image may have been
corrupted. Restart your
computer, and then open the
file again. If the red x still
appears, you may have to
delete the image and then
insert it again.

22. l Semi-guided or fully guided site preparation
using surgical drill guides is preferred
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart
your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and
then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
Surgical placement

23. Prosthodontic Issues - Single tooth defects
Posterior quadrants
ª Internal connections are favored as opposed the
external hex
ª Custom abutments must be designed with
appropriate resistance and retention form if cement
retention is planned
ª Avoid ridge laps
ª Occlusal surfaces
ª Metal vs ceramic
ª Screw retention preferred over cement retention
ª Occlusion is centric only contact
ª Lingualized or buccalized

24. l Internal connections
are favored as opposed
the external hex
although external hex
designs have been
used effectively,
especially in premolar
sites
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted.
Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted.
Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
External hex vs internal connections

25. Custom abutments
CAD-CAM vs Hand Milled
l Hand milled when retention is with cross
linking scews
l CAD-CAM when cement retention is used
The image cannot be displayed. Your computer may not have enough memory to open the image, or the
image may have been corrupted. Restart your computer, and then open the file again. If the red x still
appears, you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the
image may have been corrupted. Restart your computer, and then open the file again. If the red x still
appears, you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the
image, or the image may have been corrupted. Restart your computer, and then open the file
again. If the red x still appears, you may have to delete the image and then insert it again.

26. Abutment materials
l Titanium
l Metal ceramic
l Zirconia
l Not recommended
because of the risk of
fracture
The image cannot be displayed. Your
computer may not have enough
memory to open the image, or the
image may have been corrupted.
Restart your computer, and then open
the file again. If the red x still appears,
you may have to delete the image and
then insert it again.
The image cannot be displayed. Your computer may not have enough
memory to open the image, or the image may have been corrupted.
Restart your computer, and then open the file again. If the red x still
appears, you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the
image, or the image may have been corrupted. Restart your computer, and then open the
file again. If the red x still appears, you may have to delete the image and then insert it
again.

27. Custom abutments
Retention and resistance form
l 3 degree taper
l Add grooves for additional resistance form
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and
then open the file again. If the red x still appears, you may have to delete the image and then insert it again. The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and
then open the file again. If the red x still appears, you may have to delete the image and then insert it again.

28. Custom abutments
Retention and resistance form
l Note the groove
l Important even for crowns
retained with cross linking screws
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have
been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the
image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been
corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and
then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the
image may have been corrupted. Restart your computer, and then open the file again. If the red x still
appears, you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have
been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the
image and then insert it again.

29. The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have
been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete
the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been
corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and
then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your
computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been
corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and
then insert it again.
l Hygiene becomes problematic
Avoid ridge laps

30. Maxillary premolars
l Ridge lapping
is discouraged
except in the
esthetic zone
The image cannot be displayed. Your computer may not have
enough memory to open the image, or the image may have been
corrupted. Restart your computer, and then open the file again. If
the red x still appears, you may have to delete the image and then
insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may
have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to
delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been
corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and
then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been
corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and
then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the
image may have been corrupted. Restart your computer, and then open the file again. If the red x still
appears, you may have to delete the image and then insert it again.

31. Smooth emergence profiles preferred
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have
been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the
image and then insert it again.
The image cannot be displayed. Your computer may not have enough
memory to open the image, or the image may have been corrupted. Restart
your computer, and then open the file again. If the red x still appears, you
may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or
the image may have been corrupted. Restart your computer, and then open the file again. If the red x
still appears, you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to
open the image, or the image may have been corrupted. Restart your computer,
and then open the file again. If the red x still appears, you may have to delete the
image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the
image, or the image may have been corrupted. Restart your computer, and then open the
file again. If the red x still appears, you may have to delete the image and then insert it
again.
The image cannot be displayed. Your computer may not have enough memory
to open the image, or the image may have been corrupted. Restart your
computer, and then open the file again. If the red x still appears, you may have
to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the
image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears,
you may have to delete the image and then insert it again.

32. Occlusal materials
Metal vs ceramic
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and
then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been
corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then
insert it again.
Laminated porcelain occlusal surfaces
are at risk for chipping and fracture

33. Avoid buccal and lingual cantilevers
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears,
you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted.
Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
The occlusal table must be narrowed to
avoid buccal and lingual cantilevers. Molars
should be no wider than premolars as
shown in these two examples.

34. Occlusion
Centric only contact
(during clenching)
The image cannot be
the red x still appears
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart
your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the
image, or the image may have been corrupted. Restart your computer, and then open the file
again. If the red x still appears, you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have
enough memory to open the image, or the image may have been
corrupted. Restart your computer, and then open the file again. If
the red x still appears, you may have to delete the image and then
insert it again.

35. Occlusion contacts
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then
open the file again. If the red x still appears, you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted.
Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
l Occlusal adjustment
l Two thicknesses of mylar should pass through the implant contact
when the natural teeth hold one thickness

36. Proximal contacts
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x
still appears, you may have to delete the image and then insert it again.
Proximal adjustments
Two thicknesses of mylar

37. Premolar Sites
The image cannot be displayed. Your computer may not have enough memory to open the image, or the
image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears,
you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or
the image may have been corrupted. Restart your computer, and then open the file again. If the red x
still appears, you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart
your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been
corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then
insert it again.
4 mm diameter
implants are ideal
for premolar sites
Occlusion should
be centric only
contact
This 1st premolar
site was restored
with a 4 mm implant
fixture and a UCLA
abutment
T
h
e
i

38. Premolar Sites
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open
the file again. If the red x still appears, you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then
open the file again. If the red x still appears, you may have to delete the image and then insert it again.
This mandibular 1st premolar site was restored
with a 4 mm implant fixture and a conical abutment

39. Single Tooth Restorations Distal
Extension DefectsThe image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been
corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and
then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been
corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and
then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your
computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your
computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.

40. Distal Extension Defects
The image cannot be displayed. Your computer may not have enough memory to open
the image, or the image may have been corrupted. Restart your computer, and then
open the file again. If the red x still appears, you may have to delete the image and
then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then
open the file again. If the red x still appears, you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image
may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may
have to delete the image and then insert it again.
ª Two implants are recommended
when restoring a single molar in an
edentulous extension area.
ª Note the access for a proxy brush

41. Restoration of single molar sites
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears,
you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may
have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have
to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image
may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may
have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image
may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may
have to delete the image and then insert it again.
Custom abutment Lingual set screw
In this patient, two 4 mm diameter implant were used to
restore the first molar. The width of the occlusal table was
limited to the width of the
natural premolar,
thereby eliminating any
possible buccal or
lingual cantilevers.

42. The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted.
Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to
delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted.
Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
Restoration of single molar sites
Note:
Hygiene access for proxy brush
Note width of occlusal table

43. Restoration of single molar sites - Solutions
The image cannot be displayed. Your computer may not have enough
memory to open the image, or the image may have been corrupted. Restart
your computer, and then open the file again. If the red x still appears, you
may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or
the image may have been corrupted. Restart your computer, and then open the file again. If the red x
still appears, you may have to delete the image and then insert it again.
In this patient a wide diameter implant was used to
restore the first molar.
The image cannot be displayed. Your computer
may not have enough memory to open the
image, or the image may have been corrupted.
Restart your computer, and then open the file
again. If the red x still appears, you may have to
delete the image and then insert it again.
When there is insufficient space for two
implants, a wide diameter implant is preferred
The image cannot be displayed. Your computer may not have enough memory to open the image,
or the image may have been corrupted. Restart your computer, and then open the file again. If the
red x still appears, you may have to delete the image and then insert it again.

44. Cement vs screw retention
l Screw retention preferred
l Cement retention

45. Problem - Insufficient interocclusal space to design
an abutment with appropriate resistance and retention
form.
Solution – Screw retention
l Another advantage is with screw retention the
emergence profile of the crown is improved
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have
been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the
image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or
the image may have been corrupted. Restart your computer, and then open the file again. If the red
x still appears, you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image
may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may
have to delete the image and then insert it again.
Courtesy G. Perri
Lack of interocclusal space

46. Challenges of cementation
Platform reduction (platform switching)
l If the cement becomes impacted below the margin, its
removal is problematic
l Access is extremely difficult if not impossible without
laying a soft tissue flap
The image cannot be displayed. Your computer may not have enough memory to
open the image, or the image may have been corrupted. Restart your computer, and
then open the file again. If the red x still appears, you may have to delete the image
and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may
have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to
delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been
corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then
insert it again.
Courtesy Dr. G. Perri

47. Challenges of cementation
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image
may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may
have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image
may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may
have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not
have enough memory to open the image, or the image may
have been corrupted. Restart your computer, and then
open the file again. If the red x still appears, you may have
to delete the image and then insert it again.
l How will you remove the cement if it becomes
impacted beneath the margins of this implant
crown?
l More than likely, you will not given the severity
of the undercut associated with the custom
abutment.
l Therefore, under these circumstances it is
advisable to place the margins supra-gingival.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been
corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and
then insert it again.
The image cannot be displayed.
Your computer may not have
enough memory to open the
image, or the image may have
been corrupted. Restart your
computer, and then open the file
again. If the red x still appears,
you may have to delete the image
and then insert it again.

48. Avoid the use of preformed non-
preparable abutments
Issues of concern
v Position of the cement margin
in relation to the gingival
margin
v Particularly significant in the
anterior region
v Impaction of cement into the
gingival sulcus is highly likely
v Difficulty in seating the crown
because of hydraulic pressure
The image cannot be displayed. Your computer may not
have enough memory to open the image, or the image may
have been corrupted. Restart your computer, and then open
the file again. If the red x still appears, you may have to
delete the image and then insert it again.
The image cannot be displayed. Your computer may not have
enough memory to open the image, or the image may have
been corrupted. Restart your computer, and then open the
file again. If the red x still appears, you may have to delete
the image and then insert it again.

49. The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer,
and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and
then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
Avoid the use of preformed non-
preparable abutments

50. l Cementing crowns
with platform
reduction
l Cement the crown
extra-orally
The image cannot be displayed. Your computer may not have enough memory to open
the image, or the image may have been corrupted. Restart your computer, and then
open the file again. If the red x still appears, you may have to delete the image and then
insert it again.
The image cannot be displayed. Your computer may not have enough memory
to open the image, or the image may have been corrupted. Restart your
computer, and then open the file again. If the red x still appears, you may have
to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have
enough memory to open the image, or the image may have been
corrupted. Restart your computer, and then open the file again. If
the red x still appears, you may have to delete the image and then
insert it again.
The image cannot be displayed. Your computer may not have enough memory
to open the image, or the image may have been corrupted. Restart your
computer, and then open the file again. If the red x still appears, you may have
to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the
image may have been corrupted. Restart your computer, and then open the file again. If the red x still
appears, you may have to delete the image and then insert it again.
Cement retention with platform reduction
The image cannot be displayed. Your computer may not have enough memory to open the image, or the
image may have been corrupted. Restart your computer, and then open the file again. If the red x still
appears, you may have to delete the image and then insert it again.

51. Complications
l Implant fracture
l Implant overload
l Recurrent screw loosening
l Subgingival cement accumulation leading
to peri-implantitis and loss of the implant

52. The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been
corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then
insert it again.
The image cannot be displayed. Your computer may not have enough memory to
open the image, or the image may have been corrupted. Restart your computer,
and then open the file again. If the red x still appears, you may have to delete the
image and then insert it again.
The combination of a small diameter implant,
restoring a large mesial – distal space leads
to either screw loosening, implant fracture or
resorption of bone anchoring the implant.

53. Fracture
Implant fractured after 30 months of function
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted.
Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
Solitary implants restoring single molars
Cantilever effect
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been
corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and
then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the
image, or the image may have been corrupted. Restart your computer, and then open the
file again. If the red x still appears, you may have to delete the image and then insert it
again.

54. The image cannot be displayed. Your computer m
memory to open the image, or the image may ha
your computer, and then open the file again. If th
may have to delete the image and then insert it a
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image
may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may
have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough
memory to open the image, or the image may have been corrupted.
Restart your computer, and then open the file again. If the red x still
appears, you may have to delete the image and then insert it again.
Solitary implants restoring single molars
Cantilever effect
Fracture
l Implant fractured after 18 months of function

55. Single tooth restorations in the molar
region – Cantilever effect
This implant was too short and too narrow to
withstand occlusal loads and bone loss caused by
the resorptive remodeling response led to its loss.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been
corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and
then insert it again.
4 mm
diameter
implant
Mesial cantilever

56. The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been
corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and
then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may
have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have
to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to
open the image, or the image may have been corrupted. Restart your computer,
and then open the file again. If the red x still appears, you may have to delete the
image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to
open the image, or the image may have been corrupted. Restart your computer, and
then open the file again. If the red x still appears, you may have to delete the image
and then insert it again.
The image cannot be displayed. Your computer may not
have enough memory to open the image, or the image
may have been corrupted. Restart your computer, and
then open the file again. If the red x still appears, you
may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough
memory to open the image, or the image may have been corrupted.
Restart your computer, and then open the file again. If the red x still
appears, you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not
have enough memory to open the image, or the image
may have been corrupted. Restart your computer, and
then open the file again. If the red x still appears, you may
have to delete the image and then insert it again.
Subgingival cement accumulation and implant loss

57. v Visit ffofr.org for hundreds of
additional lectures on Complete
Dentures, Fixed Prosthodontics
Implant Dentistry, Removable
Partial Dentures, Fixed
Prosthodontics and
Maxillofacial Prosthetics.
v The lectures are free.
v Our objective is to create the
best and most comprehensive
online programs of instruction in
Prosthodontics
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart
your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.
The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your
computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.