Under the Supervision of : Prof. Samahi King Abdulaziz University Faculty of Dentistry Removable Prosthodontics Division
1 - 15 Evidence-Based Dentistry (EBD), a brief definition: Finding information Wisely Critically applying it evaluating it in our practiceEmpowers practitioners a strong scientific basis rather than common practice or expert’s opinion.
2 - 15 1. Wood MR, Vermilyea SG. AAFP Report: Review of Selected Dental Literature on Evidence-Based Treatment Planning for Dental Implants. J Prosthet Dent 2004; 92:447-62.Aim: Provide dentists with evidence-based guidelines to apply when planning treatment with osseointegrated implantsMethod: Peer-reviewed literature published in the English language between 1969 and 2003 was reviewed
3 - 15 Cont. 1. Wood MR, Vermilyea SG. AAFP Report: Review of Selected Dental Literature on Evidence-Based Treatment Planning for Dental Implants. J Prosthet Dent 2004; 92:447-62Evidence-Based Guidelines for Implant Treatment Planning: Factors Systemic Host Factors "The Cluster Phenomenon” Habits Smoking, Bruxing Local Host Factors bone quality/quantity Prosthesis Design Factors
4 - 15 Prosthodontic Considerations: 1. Wood MR, Vermilyea SG. AAFP Report: Review of Selected Dental Literature on Evidence-Based Treatment Planning for Dental Implants. J Prosthet Dent 2004; 92:447-62. 2. Taylor TD, Belser U, Mericske-Stern R. Prosthodontic Considerations. Clin Oral Impl Res 2000: 11 (Suppl.): 101-107. Aim: Come up with a general agreement on issues related to the prosthodontic phase of implant therapy. Method:Examined issues related to the prosthodontic phase of implant therapy from 1952 to1997 in a Consensus Conference held in Switzerland in 1997.Agreement on all points was reached by voting within the prosthodontic section.
5 - 15 Cont. Prosthodontic Considerations: 1. Number, Size and Position of Implants: * Greater number and size stress distribution, retention  * Length 7mm  * Width 4mm  * Ideal mesiodistal distance 3mm (implant-implant) 1.5mm (implant-tooth)  * Narrow-body vs. wide-body implants  2. Cantilever: * Anterior-posterior spread 11.1 mm  * Maximum cantilever length 15 mm – mandible 3. Passivity to Fit: 10-12 mm – maxilla  Accuracy in impression making ,, Wood et al (2004) , Taylor et al (2000), Carl Mish (2005)  Kim Y. et al (2005)
4. Cemented Vs. Screw -Retained Restorations: 6 - 15Cemented Restorations:Indications: single unit restorations, short span restorations. Advantages: screw-loosening is not a complication, passive-fit. Screw-Retained Restorations:Indications: long span and full arch restorations  deep mucosal implant shoulder placement ( > 3mm ) extended cantilever, Taylor et al (2000) Wood et al (2004)
7 - 15 3. Kim Y, Tae-Ju Oh, Misch CE, Wang H. Occlusal Considerations in Implant Therapy: clinical guidelines with biomechanical rationale. Clin. Oral Impl. Res 2005; 16:26-35.Aim: Discuss the importance of implant occlusion for implant longevity. Provide clinical guidelines of optimal implant occlusion. Possible solutions managing complications related to implant occlusion.Method: Literature published between 1958 and 2002 was reviewed
8 - 15 Cont 3. Kim Y, Tae-Ju Oh, Misch CE, Wang H. Occlusal Considerations in Implant Therapy: clinical guidelines with biomechanical rationale. Clin. Oral Impl. Res 2005; 16:26-35. Occlusal Considerations in Implant Therapy Occlusal considerations for implants do not differ from those for natural teeth However lack of the periodontal ligament causes osseointegrated implants to react biomechanically in a different fashion to occlusal force. Occlusal Overloading Implant FailureKim Y. et al (2005)
9 - 15 Overloading Factors of Implant Occlusion: 1. Overextended cactilever > 15mm in the mandible > 10-12mm in the maxilla 2. Parafunctional habits / Heavy bite force 3. Excessive premature contacts 4. Steep cuspal inclination 5. Large occlusal table 6. Poor bone density/quality 7. Inadequate number of implantsKim Y. et al (2005)
10-15 Principles of Implant Occlusion:1. Bilateral stability in centric occlusion.2. Evenly distributed occlusal contacts and force.3. Wide freedom in centric occlusion.4. Anterior or canine guidance whenever possible.5. Smooth lateral excursive movements without working/non-workinginterferences.Kim Y. et al (2005)
11-15 Clinical Applications: Full-arch Fixed Prosthesis Group functionBilateral Balanced occlusion or No working and Infraocclusion Freedom in occlusion with mutually protected balancing in cantilever centric opposing occlusion when contact oncomplete denture opposing natural segment (1-1.5mm) cantilever teethKim Y. et al (2005)
12-15 Clinical Applications…Continued Overdenture Bilateral balanced Monoplane occlusion occlusion using on a severely resorbed lingualized occlusion ridgeKim Y. et al (2005)
13-15 Conclusion:1st Review:With any prosthodontic restoration, meticulous attention must be given to treatmentplanning.In the current “evidence-based” enviroment, it is no longer acceptable to apply theprinciples and concepts for the treatment of natural teeth to the treatment of dentalimplants.Clinicians need the results of randomized, controlled clinical trials for evidence-based decision making.Limitations:The article has not discussed the issue of esthetic restoration with implants.There is lack of quantifiable evidence-supported guidelines regarding esthetics.Future research is required to establish such guidlines.
14-15 Cont. Conclusion:2nd Review:Limitation:Many of the consensus statements were reached unanimously, while some werereached with compromise and split vote.3rd Review:It emphasized that currently there is no evidence-based, implant-specific conceptof occlusion. Future studies in this area are needed to clarify the relationshipbetween occlusion and implant success.
15-151. Wood MR, Vermilyea SG. AAFP Report: Review of SelectedDental Literature on Evidence-Based Treatment Planning forDental Implants. J Prosthet Dent 2004; 92:447-62.2. Taylor TD, Belser U, Mericske-Stern R. ProsthodonticConsiderations. Clin Oral Impl Res 2000: 11 (Suppl.): 101-107.3. Kim Y, Tae-Ju Oh, Misch CE, Wang H. OcclusalConsiderations in Implant Therapy: clinical guidelines withbiomechanical rationale. Clin. Oral Impl. Res 2005; 16:26-35.4. Carl E. Misch: Dental Implant Prosthetics, 2005, ElsevierMosby, chapter 14, 206-227.