Treatment planning

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Treatment planning

  1. 1. Member A.O.I.AFellow I.C.O.IScientific consultant of sybron implant solutionsManager of implant direct company Dr. Amr Saad
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  6. 6. 1) Proper diagnosis2) Proper History taking3) Proper treatment planning4) Proper investigations5)Proper biomechanical considerations6) Proper knowledge of your system requirement Dr. Amr Saad
  7. 7. Patient’s Oral HygienePatient’s medical conditionPatient’s Dental conditionPatient’s occlusionPatient’s ageSoft tissue assessmentPatient’s financial status Dr. Amr Saad
  8. 8. A) Medical history : Diabetes Osteoporosis Heavy smoker H.I.V.B) Dental History Dr. Amr Saad
  9. 9. It’s not always animplant therapy Dr. Amr Saad
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  11. 11. Clinical investigationsRadiographic investigationsLaboratory investigations Dr. Amr Saad
  12. 12. PeriapicalsO.P.G.Lateral cephalometricComputed tomography (c.t.)Cone beam c.t. (c.b.c.t.) 3D cat scans Dr. Amr Saad
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  20. 20. Key Implant positioning :1. Canine 1st Molar rule2. No cantlivers3. No 3 adjacent pontics.4. Arch segments Dr. Amr Saad
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  26. 26. How Far Can I Cantilever From Implants?Cantilevers can be your best friend or your worstenemy. ! Dr. Amr Saad
  27. 27. When used intelligently, a cantilever can allowyou to replace a missing tooth without anadditional implant.But when physics are ignored, a cantilever can bethe cause of fractured porcelain, screwloosening, bone destruction, and other nastysurprises. Dr. Amr Saad
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  29. 29. Multiply by 1.5 to 2.5 Dr. Amr Saad
  30. 30. Luigi Baggi, DDS,a Ilaria Cappelloni, MS,b Michele Di Girolamo, DDS,c Franco Maceri, MS,d and Giuseppe Vairo, MS, PhDe (J Prosthet Dent 2008;100:422-431) Dr. Amr Saad
  31. 31. Load transfer mechanisms and possible failure ofosseointegrated implants are affected byimplant shape, geometrical and mechanicalproperties of the site of placement, as well ascrestal bone resorption.Suitable estimation of such effects allows forcorrect design of implant features. Dr. Amr Saad
  32. 32. The purpose of this study was to analyze theinfluence of implant diameter and length onstress distributionand to analyze overload risk of clinicallyevidenced crestal bone loss at the implant neck inmandibular and maxillarymolar periimplant regions. Dr. Amr Saad
  33. 33. Stress-based performances of 5 commercially available implants(2 ITI, 2 Nobel Biocare,and 1 Ankylos implant; diameters of 3.3 mm to 4.5 mm, bone-implant interface lengths of 7.5 mm to 12 mm) wereanalyzed by linearly elastic 3-dimensional finite elementsimulations, under a static load (lateral component: 100 N;vertical intrusive component: 250 N). Numerical models ofmaxillary and mandibular molar bone segments were generatedfrom computed tomography images, and local stress measureswere introduced to allow for the assessment ofbone overload risk. Different crestal bone geometries were alsomodelled. Type II bone quality was approximated, andcomplete osseous integration was assumed. Dr. Amr Saad
  34. 34. Maximum stress areas were numerically located at the implantneck, and possible overloading could occurin compression in compact bone (due to lateral components ofthe occlusal load) and in tension at the interfacebetween cortical and trabecular bone (due to vertical intrusiveloading components). Stress values and concentrationareas decreased for cortical bone when implant diameterincreased, whereas more effective stress distributions forcancellous bone were experienced with increasing implantlength.Finally, dissimilar stress-based performances were exhibited formandibular and maxillary placements, resulting in highercompressive stress in maxillary situations. Dr. Amr Saad
  35. 35. Implant designs, crestal bone geometry, and site ofplacement affect load transmission mechanisms.Due to the low crestal bone resorption documented byclinical evidence, the Ankylos implant based on theplatform switching concept and subcrestal positioningdemonstrated better stress-based performance and lowerrisk of bone overload than the other implant systemsevaluated. Dr. Amr Saad
  36. 36. Numerical results suggest that implant diametermay be more effective than implant length as adesign parameter to control the risk of boneoverload. For a given implant in the molarregion, the worst load transmission mechanismsarise with maxillary placement, and implantbiomechanical behavior greatly improves if boneis efficiently preserved at the crest. Dr. Amr Saad
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  43. 43. ALL ON 4 Dr. Amr Saad
  44. 44. Evaluation of the structural behavior of three and fourimplant-supported fixed prosthetic restorations byfinite element analysisSantiago Correa PhDa,*, Juliana Ivancik MScb, Juan Felipe IsazaMSca, Mauricio Naranjo DDScReceived 7 October 2010; received in revised form 16 June 2011; accepted 19 July2011 Dr. Amr Saad
  45. 45. Finite elements analysis of three and fourimplant-supported prostheses wasperformed to determine the stresses in thesuperstructure, implants and cortical boneand, therefore, the failure prediction foreach restoration. Dr. Amr Saad
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  47. 47. failure in the three implant-supportedprosthesis for all cases analyzed. The sameapplies for the four-implant prosthesis of 15mm cantilever length. However, fourimplants and a cantilever length of 10 mmpassed the failure criteria and wereconsidered safe. Dr. Amr Saad
  48. 48. The results from the patient analyzed showed thatfixed support prostheses on three implants are notrecommended from a structural point of viewbecause they do not adequately support occlusalloads. Excessive stress in the superstructure andthe cortical bone can be expected, which wouldanticipate the failure of the restoration. Fixedsupport prostheses on four implants with acantilever length of 10 mm properly resist occlusalloading. Dr. Amr Saad
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  55. 55. YES OR NODr. Amr Saad
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