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[6]role of avialable bone on dental implants [ 6 ] (3).pptx
1. Role of available bone in
dental implants
Dr.Ahmad Jawed “Safi”
Safi dental Academy
2. Introduction
Available bone is a quantitive assessment of the
bone suitable for placement, which is available at
an edentulous site
Bone availability describe external architerxture
and volume of bone in the edentulous area
considered for ideal implant placement
Bone availibility measured three-dimentionally in
buccolingual width, vertical height, mesiodistal
dimension of edentulous space, bone angulation
and crow height space for future prostheis
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3. Continue…
If the bone available is inadequate for
prosthetically ideal implant insertion, the implant
surgeon can perform bone grafting procedure to
regenerate lost bone dimensions.
The design of a root form implant may vary from
one manufacturer to another
The crest module of implant platform of some
implants maybe wider than the body diameter
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4. Continue…
For example, the 3.3 mm diameter Adin
implant has a 3.75mm platform.
The dentist should be aware that in most
clinical situations, the ridge is found to be
faciolingually thinnest at the crestal region,
which may often make it difficult to place even
the narrowest diameter implant without ridge
modification
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5. Misch & Judy classification of
bone availability
In 1985 Misch and Judy presented a
classification of available bone for dental
implant insertion, which is similar in both arches
Fig 6.2 A-D
Bone modification procedures, grafting
methods, and prosthodontic-related treatments
were suggested for each catagory
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9. Division A (abundant bone )
Division A bone is three dimentionally abundant
for the ideal implant insertion (fig 6.3 A & B)
According to Misch , bone in this category should
be
5 mm or more in width
12 mm or more in height
7 mm or more in length
Less than 30o in angulation
15 mm or less in crown height
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10. Prosthetic options for division
A bone
The division A bone
Is the best bone for any prosthetic option (fig
6.4 A-I)
May need osteoplastiy for implant overdenture
to achieve more vertical height space and
accommodate the implant supra structures
ball/bar under the denture
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13. Division B (barely adequate
bone)
Bone in this category should be
2.5-5 mm in width (B+: 4-5mm: B- : 2.5-4mm)
12mm or more in height
6mm or more in length
Less than 20o in angulation
15mm or less in crown height
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14. Prosthetic options for division
B bone
The bone ridge with division B bone maybe
modified to division A bone by osteoplasty to
achieve the wide ridge crest to insert a regular
diameter implant (Fig 6.5 A-C)
Lateral bone augmentation can also be performed
before or with implant placement, specially in
esthetic area where osteoplasty can elongate the
clinical crown height (Fig 6.6 A-C)
This bone maybe adequate for any prosthetic
option in implant therapy
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16. Division C (compromised
bone)
Bone in division C category should be
0.5-2 mm in width (C-w bone)
Less than 12 mm in height (C-h bone)
More than 30o in angulation (C-a bone)
More than 15 mm in crown height
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17. Treatment options
Osteoplasty can be done in C-w bone to achieve a
wider platform to insert the implant, but the
preferred option for C-w bone is lateral bone
augmentation before or at the time of implant
insertion (Fig 6.7 & 6.8)
Either short length root form implants or
subperiosteal implants are used in C-h bone
Vertical bone augmentation (Fig 6.9 A-C) or
inferior alveolar nerve lateralization for posterior
mandible and sinus elevation and grafting for
posterior maxilla are the other options
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21. Prosthetic options for division
c bone
Implant overdenture
Lateral bone augmentation for C-w bone
Vertical bone augmentation for C-h bone
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22. Division D bone (Deficient
bone)
This is the bone with severe atrophy
This represent basal bone loss, flat maxilla
and pencil thin mandible with more than 20
mm crown height
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23. Treatment options for the
deficient ridge
Bone augmentation like vertical bone block
graft or nerve trans positioning (Fig 6.11 A &
B)
Sinus lifting
Nasal floor elevation
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25. Prosthetic options for division
D bone
Implant over denture should be a treatment of
choice (Fig 6.12 A-D), because implant
supported fixed prosthesis may need multiple
invasive bone grafting procedures
Sinus grafting
Block grafting
Nerve tans positioning etc.….
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