2. Introduction
With advances in implant design and implant
components technology, many prosthetic
options are available in implantology
Factors for choosing different prosthetic
options
Age of patient
Bone density & bone avialibility at implant site
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The nature of soft tissue
Force factors
And esthetic and functional demands of the
patient
The socioeconomic status
Finally the time span available to complete the
treatment
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4. Implant prosthetic options for
partially edentulous patients
The partially edentulous patient can be
successfully treated with cement- or screw-
retained fixed implant prosthesis.
The cement retained prosthesis is preferred for
such cases, but the screw retained prosthesis can
be used if there are multiple implants and the
exposed screw hole is detrimental in esthetic view
The screw-retained implant can also be preferred
in cases with limited crown height space
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5. Single tooth replacement
1. Cement-retained ceramic prosthesis.
a metal or ceramic abutment is finally
screwed over the implant and a metal
or ceramic crown is fixed onto it using
appropriate luting cement Fig 4.1A&B
the cement-retained ceramic prosthesis is
preferred in most single-tooth implant
situations, anterior as well as posterior
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2. screw-retained ceramic prosthesis.
A metal or ceramic crown is fabricated in
laboratory using a castable burnout abutment.
The screw-retained crown is directly screwed to
the implant using a connection screw and the
screw hole is screwed, first using gutta parcha
followed by a tooth colored composite material.
Fig 4.2 A-C
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8. Multiple tooth replacement
Depending on bone density and bone volume
available to insert the implant, either an individual
implant is inserted for each unit of a prosthesis or
a joint prosthesis is given in bridge form over a
small number of implants
If adequate amount of bone is available to insert
long and wide implants, if bone density at the site
is sufficient (eg. Anterior and posterior mandible
Or if force factor is minimum (anterior maxilla and
anterior mandible) fewer implants can be inserted
to support a multi unit bridge
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Individual implant for each tooth(cement or screw
retained).
If bone dimensions and bone density are
compromised and force factors are on higher
side(e.g. posterior maxilla) a minimum of one implant
should be inserted to support each prosthesis.Fig
4.4 A & B
Implant bridge (cement or screw-ratained). If bone
density are higher and force factors are low, the
multiple prosthesis can be supported by fewer
implants, Fig 4.5 A & B
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12. Implant prosthesis options for
completely edentulous patients
Implant supported removable prosthesis
(implant overdenture). Depending on the
dentist`s preference and various clinical
parameters, usually two types of implant
overdentures are delivered to patients
Ball-retained overdentures
Bar-retained overdentures
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13. Ball-retained overdentures
Two to four implant are inserted in anterior
mandible while 4-6 implants are inserted in the
anterior maxilla; ball abutments or “locator
abutments” are inserted over the implants
The o ring or metal housing are fitted into the
tissue surface of the denture and they get locked
over the ball abutments or locator abutments,
when the dentures are seated in the mouth
These implants provide adequate retention to the
dentures. Fig 4.6 A-C
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14. Bar-retained overdentures
A metal bar is fabricated in the laboratory and
fixed over the implants
Special header clips are fixed into the tissue
surface of the denture, which gets lock over
the bar, when the denture is seated in the
mouth.
The bar provides adequate retention and
stability to the denture (Fig 4.7 A-C)
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16. Implant supported fixed
prosthesis
These are multiple options for the implant-
supported fixed prosthesis
Usually a number of implants are inserted in
the jaw bone and the multiple unit ceramic or
hybrid prosthesis is fixed over these implants
The following are different options for the full-
arch implant-supported fixed prosthesis
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Screw or cement-retained ceramic prosthesis:
After through diagnosis and treatment planning
several implants(with the best possible dimension for
each implant) are inserted and placed at the best
possible positions in the jaw bone, after
consideration of prosthetic biomechanics and force
factors
The full arch screw or cement retained prosthesis is
fixed over these implants. (Fig 4.8 & 4.9)
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Screw or cement hybrid prosthesis;
Several implants are inserted at the best possible
positions in the jawbone
The impression of these implants is made with the
indirect technique and a metal framework is
fabricated in the dental laboratory, and passively
seated over these implants
The tooth setting is done over these framework
using prefabricated resin teeth and the prosthesis is
acrylized using heat-cured resin
The resulting prosthesis is fixed over the implants
using fixation screws. (Fig 4.10 & 4.11)
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23. Metal-free zirconium prosthesis
The metal-free zirconium prosthesis can be
proffered over the porcelain fused to metal
prosthesis, to achieve desired esthetic result
(Fig 4.12 & 4.13)
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