This document discusses implant biomechanics and treatment planning. It notes that implant overload can lead to bone loss and failure if excessive loads are placed on implants during treatment planning. Linear implant arrangements are less predictable than curvilinear arrangements, especially in posterior areas with heavy biting forces. The number of implants, their arrangement, angulation, length, diameter and the quality of surrounding bone all influence the load bearing capacity of implant restorations. Treatment plans must be designed to minimize non-axial forces and prevent implant overload.
Prosthetic options in implant dentistryNAMITHA ANAND
This document discusses various prosthetic options in implant dentistry. It begins by introducing different treatment options for completely and partially edentulous patients, noting that implant dentistry provides more options compared to traditional dentistry. It then covers Misch's classification system for prosthetic options (FP1-FP3, RP4-RP5), which are determined by the amount of hard and soft tissue replacement needed. The document discusses different prosthesis types for complete and partial edentulism in detail. It also covers considerations for prosthesis design such as crown height space, bone width, implant positioning and restorative materials. In conclusion, the optimal prosthetic option depends on the patient's existing oral condition and treatment goals.
Platform switching involves using a smaller diameter abutment on a larger diameter implant. This shifts the implant-abutment junction inward and away from the crestal bone. According to the document, platform switching reduces crestal bone loss in the following ways: 1) It shifts the inflammatory cell infiltrate inward, decreasing its effect on the crestal bone. 2) It maintains the biological width between the implant and bone. 3) It decreases stress levels in the peri-implant bone by shifting the stress concentration area away from the bone-implant interface. The document discusses the concept, history, advantages, and limitations of platform switching.
This document discusses the biomechanics of dental implants. It explains that osseointegration is the direct bonding of bone to implant surfaces. Studying biomechanics is important because implants must withstand stresses from chewing forces. Implant failures can occur early during healing or later under loading. Failures result from overloading, infection or inadequate bone. Biomechanics applies engineering principles to dental problems. Forces during chewing create both vertical and horizontal stresses on implants. Key biomechanical factors for implants are inclination, preload, material properties, design, and surrounding bone quality and quantity.
The document discusses various factors that can contribute to dental implant failures, including host factors like poor medical health, smoking, bruxism, and poor oral hygiene; surgical factors like trauma during surgery; and implant selection factors like bone quality. It provides definitions for different types of implant failures and lists criteria for determining implant success. The classifications, predictors, warning signs, and ways to enhance outcomes with implants are also examined.
Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document discusses biomechanics as it relates to implantology. It defines key biomechanical concepts such as force, stress, strain and their relationships. Forces on dental implants can come from biting or parafunctional habits and are made up of compressive, tensile and shear components. The magnitude of stress on implants is determined by the applied force and the cross-sectional area over which it is distributed. Maintaining low stress levels is important for long-term implant success and minimizing risk of failure. Biting forces on natural teeth can range from 100-2400 Newtons and impact loads present additional risk. Biomechanical principles guide optimal implant design and placement to ensure forces are properly dissipated.
The document discusses bone density and its importance in implant dentistry. It describes four classifications of bone density (D1-D4) based on macroscopic characteristics, with D1 being the densest. The anterior mandible typically has the densest D1/D2 bone, while the posterior maxilla has the least dense D4 bone. Determining bone density accurately using CT scans is important for developing an appropriate treatment plan and ensuring implant success long-term by avoiding pathological overload conditions.
This document discusses occlusal schemes for implants, known as implant protective occlusion (IPO). IPO aims to reduce stress at the implant-bone interface through 14 considerations including eliminating premature contacts, positioning occlusal contacts over implant bodies, reducing cantilever lengths, and decreasing crown heights. The goals of IPO are to reduce force magnification, improve force direction, and increase the implant support area to promote implant longevity and success.
Prosthetic options in implant dentistryNAMITHA ANAND
This document discusses various prosthetic options in implant dentistry. It begins by introducing different treatment options for completely and partially edentulous patients, noting that implant dentistry provides more options compared to traditional dentistry. It then covers Misch's classification system for prosthetic options (FP1-FP3, RP4-RP5), which are determined by the amount of hard and soft tissue replacement needed. The document discusses different prosthesis types for complete and partial edentulism in detail. It also covers considerations for prosthesis design such as crown height space, bone width, implant positioning and restorative materials. In conclusion, the optimal prosthetic option depends on the patient's existing oral condition and treatment goals.
Platform switching involves using a smaller diameter abutment on a larger diameter implant. This shifts the implant-abutment junction inward and away from the crestal bone. According to the document, platform switching reduces crestal bone loss in the following ways: 1) It shifts the inflammatory cell infiltrate inward, decreasing its effect on the crestal bone. 2) It maintains the biological width between the implant and bone. 3) It decreases stress levels in the peri-implant bone by shifting the stress concentration area away from the bone-implant interface. The document discusses the concept, history, advantages, and limitations of platform switching.
This document discusses the biomechanics of dental implants. It explains that osseointegration is the direct bonding of bone to implant surfaces. Studying biomechanics is important because implants must withstand stresses from chewing forces. Implant failures can occur early during healing or later under loading. Failures result from overloading, infection or inadequate bone. Biomechanics applies engineering principles to dental problems. Forces during chewing create both vertical and horizontal stresses on implants. Key biomechanical factors for implants are inclination, preload, material properties, design, and surrounding bone quality and quantity.
The document discusses various factors that can contribute to dental implant failures, including host factors like poor medical health, smoking, bruxism, and poor oral hygiene; surgical factors like trauma during surgery; and implant selection factors like bone quality. It provides definitions for different types of implant failures and lists criteria for determining implant success. The classifications, predictors, warning signs, and ways to enhance outcomes with implants are also examined.
Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document discusses biomechanics as it relates to implantology. It defines key biomechanical concepts such as force, stress, strain and their relationships. Forces on dental implants can come from biting or parafunctional habits and are made up of compressive, tensile and shear components. The magnitude of stress on implants is determined by the applied force and the cross-sectional area over which it is distributed. Maintaining low stress levels is important for long-term implant success and minimizing risk of failure. Biting forces on natural teeth can range from 100-2400 Newtons and impact loads present additional risk. Biomechanical principles guide optimal implant design and placement to ensure forces are properly dissipated.
The document discusses bone density and its importance in implant dentistry. It describes four classifications of bone density (D1-D4) based on macroscopic characteristics, with D1 being the densest. The anterior mandible typically has the densest D1/D2 bone, while the posterior maxilla has the least dense D4 bone. Determining bone density accurately using CT scans is important for developing an appropriate treatment plan and ensuring implant success long-term by avoiding pathological overload conditions.
This document discusses occlusal schemes for implants, known as implant protective occlusion (IPO). IPO aims to reduce stress at the implant-bone interface through 14 considerations including eliminating premature contacts, positioning occlusal contacts over implant bodies, reducing cantilever lengths, and decreasing crown heights. The goals of IPO are to reduce force magnification, improve force direction, and increase the implant support area to promote implant longevity and success.
Emergence profile in fixed partial denture.Pallawi Sinha
This document discusses emergence profiles in natural tooth contours and their importance in fixed partial denture design. It provides a brief history of emergence profile terminology and concepts. Key points covered include:
- Emergence profiles are generally straight rather than convex or concave to avoid trapping plaque.
- Overcontouring crowns can cause gingival inflammation, while undercontouring does not affect healthy gingiva.
- Crowns should have emergence profiles that facilitate oral hygiene through features like open embrasures and occlusally positioned contact areas.
- Natural tooth emergence profiles were photographed and analyzed to establish anatomic norms for accurate reproduction in dental restorations.
differences between natural tooth periodontium and implant bone connection, biomechanics of implants, implant protected occlusion , occlusal principles for single tooth implant prosthetics and implant supported prosthesis on edentulous arch, shortened arch concept, therapeutic occlusion
The document discusses factors that must be considered for optimal esthetic outcomes when placing implants in the anterior maxilla, or esthetic zone. Specifically, it notes that implant placement and prosthetic planning require strong consideration of bone quality and quantity, soft tissue characteristics, and prosthetic design factors. Multiple techniques for hard and soft tissue augmentation are presented to address various bone deficiency classifications to allow for ideal implant positioning and soft tissue emergence profiles that maximize esthetics.
The benefits of implant dentistry can be realized only when the prosthesis is first discussed and determined. An organized treatment approach based on the prosthesis permits predictable therapy results. Five prosthetic options postulated by Misch are available in implant dentistry. Three restorations are fixed and vary in the amount of hard and soft tissue replaced; two are removable and are based on the amount and type of support for the restoration. The amount of support required for an implant prosthesis should initially be designed similar to traditional tooth-supported restorations. Once the intended prosthesis is designed, the implants and treatment surrounding this specific
result can be established.
This document discusses single tooth dental implants. It provides information on:
- The goals of single tooth implants which is to mimic the function and esthetics of natural teeth.
- Key factors for achieving a sound esthetic result including bone and gingival contours, implant positioning, and ceramist skills.
- Diagnosing implant cases by assessing hard and soft tissues and treatment planning the surgical and restorative aspects.
- Guidelines for restoration design, implant placement, and occlusion to ensure biomechanical success and esthetics.
Biomechanics of dental implants/dental implant courses by Indian dental academyIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
The document outlines standard implant surgical procedures including:
- Patient preparation including health status and informed consent
- Implant site preparation including atraumatic techniques and adequate blood supply
- The differences between one-stage ("non-submerged") and two-stage ("submerged") implant placement surgeries
- Detailed steps for two-stage submerged implant placement including flap design, implant placement, and second stage surgery
- Steps for one-stage non-submerged implant placement including coronal placement and postoperative care
- Emphasis on following guidelines to achieve osseointegration and long term implant success.
There are several protocols for loading dental implants after surgery based on bone density and healing time requirements. Protocols include Brånemark's loading protocol, progressive loading, and immediate/early loading. The density of the bone where the implant is placed determines the appropriate loading protocol, as less dense bone requires more healing time before loading to allow for sufficient bone mineralization and strength. Progressive loading gradually increases stress on the implant over time to allow the bone to adapt, reducing risks of failure. It is particularly important for lower density bone which is weaker.
Indian Dental Academy: will be one of the most relevant and exciting
training center with best faculty and flexible training programs
for dental professionals who wish to advance in their dental
practice,Offers certified courses in Dental
implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic
Dentistry, Periodontics and General Dentistry.
This document discusses various options for connecting dental restorations to implants, including screw retained, cement retained, and screwless systems. It highlights advantages and disadvantages of different abutment selections and placement positions. Custom abutments are described as an option to control porcelain thickness and manage excessive implant inclinations, though excessive angulation can compromise cement retention. Packing retraction cord and lingual access holes are presented as ways to reduce the risk of subgingival cement accumulation.
Indian Dental Academy: will be one of the most relevant and exciting training
center with best faculty and flexible training programs for dental
professionals who wish to advance in their dental practice,Offers certified
courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry,
Prosthetic Dentistry, Periodontics and General Dentistry.
loading protocols in dental implants about indications and contraindications of conventional , immediate,progressive and delayed loading of dental implants
Dental implants can replace missing teeth by surgically placing artificial titanium fixtures into the jawbone. There are typically two surgical phases - the initial implant placement and a later surgery to uncover the implant after healing. The implant then receives an abutment and final prosthetic restoration. While dental implants can provide many benefits over other tooth replacement options, there are also potential complications at various stages that a dentist must take steps to prevent and manage. Proper patient evaluation, surgical planning and technique, as well as post-operative care are important to achieve successful long-term outcomes.
This document discusses prosthetic options for implant dentistry. It outlines 5 prosthetic options (FP-1 to FP-3 and RP-4 to RP-5) and describes the amount of support and number of implants required for each. The key steps are to first plan the desired prosthesis, then determine the ideal abutment positions and amount of support needed before placing implants and designing the final restoration. Removable prostheses offer advantages like fewer implants and reduced costs but have higher risks of bone resorption over time.
This document discusses immediate loading of dental implants. It defines immediate loading as loading an implant with a restoration within 2 weeks of placement. Immediate loading has benefits like eliminating a second surgery and allowing immediate function. However, it risks overloading the implant interface during bone healing. Factors that reduce this risk include increasing the implant surface area, decreasing occlusal forces, and using bone-friendly surfaces like hydroxyapatite. The document describes procedures for immediate loading in fully and partially edentulous patients, including using a provisional restoration made on the day of surgery or at a follow-up appointment. A soft diet is recommended during initial healing from immediate loading.
This document discusses progressive bone loading for dental implants. It begins with an introduction and table of contents. Then it discusses concepts like bone density classifications, rationale for progressive loading based on studies showing bone adapts to stress over time. It outlines elements of progressive loading protocols including extended healing times based on bone density, use of provisional restorations to gradually load bone, and diet restrictions. Studies supporting progressive loading show less crestal bone loss and increased bone density around loaded implants. The conclusion is that progressive loading aims to strengthen bone and reduce risk of implant failure.
This document discusses computer guided treatment planning and implant placement. It describes how computer guided planning allows visualization of potential implant sites in 3D and more precise placement compared to free-hand drilling. Fully guided surgery uses surgical templates to control position, angle, depth and diameter of osteotomies, while semi-guided surgery controls initial position and angle only, allowing more flexibility. Fully guided is used for edentulous patients, while semi-guided is preferred for partially edentulous patients where soft tissue manipulation or bone grafting may be needed.
This document discusses various considerations for treatment planning and prosthodontic rehabilitation of edentulous mandibles with dental implants. It covers factors such as biomechanics, esthetics, oral hygiene access, and amount of keratinized tissue. Minimum implant number, length, and spacing are outlined. Techniques for impressions, soft tissue grafting, and fixed prosthesis options like PFM and hybrid are described.
This document discusses dental implants, specifically angled (tilted) implants used to restore edentulous maxillas. It describes several approaches for using tilted implants, including placing 4-6 implants with angled abutments to offset the implant angles, or using co-axis implants where angulation correction is subgingival. Tilted implants provide advantages like longer distal implants, improved primary stability, and eliminating the need for sinus augmentation. Studies show success rates above 90% for tilted implants.
Emergence profile in fixed partial denture.Pallawi Sinha
This document discusses emergence profiles in natural tooth contours and their importance in fixed partial denture design. It provides a brief history of emergence profile terminology and concepts. Key points covered include:
- Emergence profiles are generally straight rather than convex or concave to avoid trapping plaque.
- Overcontouring crowns can cause gingival inflammation, while undercontouring does not affect healthy gingiva.
- Crowns should have emergence profiles that facilitate oral hygiene through features like open embrasures and occlusally positioned contact areas.
- Natural tooth emergence profiles were photographed and analyzed to establish anatomic norms for accurate reproduction in dental restorations.
differences between natural tooth periodontium and implant bone connection, biomechanics of implants, implant protected occlusion , occlusal principles for single tooth implant prosthetics and implant supported prosthesis on edentulous arch, shortened arch concept, therapeutic occlusion
The document discusses factors that must be considered for optimal esthetic outcomes when placing implants in the anterior maxilla, or esthetic zone. Specifically, it notes that implant placement and prosthetic planning require strong consideration of bone quality and quantity, soft tissue characteristics, and prosthetic design factors. Multiple techniques for hard and soft tissue augmentation are presented to address various bone deficiency classifications to allow for ideal implant positioning and soft tissue emergence profiles that maximize esthetics.
The benefits of implant dentistry can be realized only when the prosthesis is first discussed and determined. An organized treatment approach based on the prosthesis permits predictable therapy results. Five prosthetic options postulated by Misch are available in implant dentistry. Three restorations are fixed and vary in the amount of hard and soft tissue replaced; two are removable and are based on the amount and type of support for the restoration. The amount of support required for an implant prosthesis should initially be designed similar to traditional tooth-supported restorations. Once the intended prosthesis is designed, the implants and treatment surrounding this specific
result can be established.
This document discusses single tooth dental implants. It provides information on:
- The goals of single tooth implants which is to mimic the function and esthetics of natural teeth.
- Key factors for achieving a sound esthetic result including bone and gingival contours, implant positioning, and ceramist skills.
- Diagnosing implant cases by assessing hard and soft tissues and treatment planning the surgical and restorative aspects.
- Guidelines for restoration design, implant placement, and occlusion to ensure biomechanical success and esthetics.
Biomechanics of dental implants/dental implant courses by Indian dental academyIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
The document outlines standard implant surgical procedures including:
- Patient preparation including health status and informed consent
- Implant site preparation including atraumatic techniques and adequate blood supply
- The differences between one-stage ("non-submerged") and two-stage ("submerged") implant placement surgeries
- Detailed steps for two-stage submerged implant placement including flap design, implant placement, and second stage surgery
- Steps for one-stage non-submerged implant placement including coronal placement and postoperative care
- Emphasis on following guidelines to achieve osseointegration and long term implant success.
There are several protocols for loading dental implants after surgery based on bone density and healing time requirements. Protocols include Brånemark's loading protocol, progressive loading, and immediate/early loading. The density of the bone where the implant is placed determines the appropriate loading protocol, as less dense bone requires more healing time before loading to allow for sufficient bone mineralization and strength. Progressive loading gradually increases stress on the implant over time to allow the bone to adapt, reducing risks of failure. It is particularly important for lower density bone which is weaker.
Indian Dental Academy: will be one of the most relevant and exciting
training center with best faculty and flexible training programs
for dental professionals who wish to advance in their dental
practice,Offers certified courses in Dental
implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic
Dentistry, Periodontics and General Dentistry.
This document discusses various options for connecting dental restorations to implants, including screw retained, cement retained, and screwless systems. It highlights advantages and disadvantages of different abutment selections and placement positions. Custom abutments are described as an option to control porcelain thickness and manage excessive implant inclinations, though excessive angulation can compromise cement retention. Packing retraction cord and lingual access holes are presented as ways to reduce the risk of subgingival cement accumulation.
Indian Dental Academy: will be one of the most relevant and exciting training
center with best faculty and flexible training programs for dental
professionals who wish to advance in their dental practice,Offers certified
courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry,
Prosthetic Dentistry, Periodontics and General Dentistry.
loading protocols in dental implants about indications and contraindications of conventional , immediate,progressive and delayed loading of dental implants
Dental implants can replace missing teeth by surgically placing artificial titanium fixtures into the jawbone. There are typically two surgical phases - the initial implant placement and a later surgery to uncover the implant after healing. The implant then receives an abutment and final prosthetic restoration. While dental implants can provide many benefits over other tooth replacement options, there are also potential complications at various stages that a dentist must take steps to prevent and manage. Proper patient evaluation, surgical planning and technique, as well as post-operative care are important to achieve successful long-term outcomes.
This document discusses prosthetic options for implant dentistry. It outlines 5 prosthetic options (FP-1 to FP-3 and RP-4 to RP-5) and describes the amount of support and number of implants required for each. The key steps are to first plan the desired prosthesis, then determine the ideal abutment positions and amount of support needed before placing implants and designing the final restoration. Removable prostheses offer advantages like fewer implants and reduced costs but have higher risks of bone resorption over time.
This document discusses immediate loading of dental implants. It defines immediate loading as loading an implant with a restoration within 2 weeks of placement. Immediate loading has benefits like eliminating a second surgery and allowing immediate function. However, it risks overloading the implant interface during bone healing. Factors that reduce this risk include increasing the implant surface area, decreasing occlusal forces, and using bone-friendly surfaces like hydroxyapatite. The document describes procedures for immediate loading in fully and partially edentulous patients, including using a provisional restoration made on the day of surgery or at a follow-up appointment. A soft diet is recommended during initial healing from immediate loading.
This document discusses progressive bone loading for dental implants. It begins with an introduction and table of contents. Then it discusses concepts like bone density classifications, rationale for progressive loading based on studies showing bone adapts to stress over time. It outlines elements of progressive loading protocols including extended healing times based on bone density, use of provisional restorations to gradually load bone, and diet restrictions. Studies supporting progressive loading show less crestal bone loss and increased bone density around loaded implants. The conclusion is that progressive loading aims to strengthen bone and reduce risk of implant failure.
This document discusses computer guided treatment planning and implant placement. It describes how computer guided planning allows visualization of potential implant sites in 3D and more precise placement compared to free-hand drilling. Fully guided surgery uses surgical templates to control position, angle, depth and diameter of osteotomies, while semi-guided surgery controls initial position and angle only, allowing more flexibility. Fully guided is used for edentulous patients, while semi-guided is preferred for partially edentulous patients where soft tissue manipulation or bone grafting may be needed.
This document discusses various considerations for treatment planning and prosthodontic rehabilitation of edentulous mandibles with dental implants. It covers factors such as biomechanics, esthetics, oral hygiene access, and amount of keratinized tissue. Minimum implant number, length, and spacing are outlined. Techniques for impressions, soft tissue grafting, and fixed prosthesis options like PFM and hybrid are described.
This document discusses dental implants, specifically angled (tilted) implants used to restore edentulous maxillas. It describes several approaches for using tilted implants, including placing 4-6 implants with angled abutments to offset the implant angles, or using co-axis implants where angulation correction is subgingival. Tilted implants provide advantages like longer distal implants, improved primary stability, and eliminating the need for sinus augmentation. Studies show success rates above 90% for tilted implants.
This document discusses biomechanics considerations for implant treatment planning and prosthesis design. It emphasizes controlling occlusal factors like cusp angles and occlusal table width to reduce cantilever effects and implant overload. Custom abutments are highlighted as a way to control these factors. The importance of proper implant positioning and attachment of implants to natural teeth with rigid rather than semi-precision attachments is also stressed.
The document discusses various implant components including fixtures, abutments, gold cylinders, and analogs. It describes the original Brånemark implant design and newer implant systems with enhanced surfaces and internal connections. The document also outlines different types of abutments from healing abutments to custom UCLA abutments and discusses techniques for impression taking and creating prosthetics on implants.
This document discusses different treatment options for edentulous maxillas including fixed prostheses and implant supported/assisted prostheses. It covers patient selection factors like resorption patterns, jaw relations, lip line, sinus anatomy and economics. Minimum implant requirements, biomechanics, complications and different types of fixed prostheses like PFM and hybrid are described. The document also presents a clinical case of an implant supported fixed partial denture.
This document discusses prosthodontic procedures and complications in posterior quadrants. It covers topics such as exam and workup, selection of implants, platform switching, abutment selection, provisional restorations, and new technologies like shape memory sleeve abutments. Key points addressed include that no implant design has been proven superior for marginal bone loss, and custom abutments offer better control of margins and occlusal thickness than prefabricated abutments. New technologies aim to simplify procedures and improve retrievability of restorations.
This document discusses cement retention versus screw retention for dental implants. Both methods can be used if done properly. Cement retention is simpler but risks residual cement being left under gums, which can lead to peri-implantitis. Screw retention allows easy removal but requires access holes. Residual subgingival cement is the major problem, as it is difficult to fully remove and can cause inflammation and bone loss over time.
This document discusses implant biomechanics and treatment planning considerations for restoring posterior quadrants. It notes that implant restorations must be designed to avoid overload, as excessive loads can lead to bone loss and implant failure over time. Key factors discussed include implant number, length, alignment relative to curves of Spee and Wilson, and linear versus curvilinear configurations. Curvilinear arrangements are emphasized as withstanding more load than linear arrangements due to greater cross-arch stabilization. Case examples demonstrate successful long-term outcomes and failures where biomechanics were not adequately considered.
This document discusses the use of implants to supplement removable partial dentures (RPDs) in various clinical situations. Implants can be used to improve support, stability, and retention of RPDs when existing dentition is compromised. Common scenarios include using implants in extension base RPDs, with questionable implant anchorage or unfavorable configurations, to replace lost implants in key locations, replace a lost natural tooth abutment, or supplement insufficient existing dentition. Resilient attachments are often used to retain implant-assisted RPDs while avoiding implant overload. Complications can include peri-implantitis, loose abutments, and wear of attachments. Overlay RPDs are also discussed as an option to
This document discusses various options for connecting dental restorations to abutments and implants, including the biologic and technical issues involved. It compares screw-retained, cement-retained, and screwless systems. It also discusses arguments in favor of cementation, potential problems like cement accumulation, and the limits of cement retention related to factors like abutment angulation and axial wall height. Finally, it covers custom abutments, platform switching, and the next generation of the UCLA abutment using shape memory alloys.
The document discusses factors that influence the load bearing capacity of dental implants, including:
1. Curvilinear implant arrangements have the greatest load bearing capacity compared to linear arrangements.
2. Excessively long cantilevers (>20mm) and wide occlusal surfaces can lead to prosthesis failures and implant overload due to increased forces.
3. The trabecular bone structure in the mandible allows it to withstand forces better than the maxilla, making posterior mandibular implants more successful.
This document discusses implant-assisted overlay dentures for edentulous maxillas. It begins by defining implant-assisted and implant-supported prostheses, noting that implant-assisted prostheses share forces between implants and mucosa while implant-supported bear all forces on implants. It recommends implant-assisted designs for most patients due to factors like bone quality, resorption patterns, sinus architecture, esthetics, and cost. A four-implant assisted design with anterior Hader bars and posterior ERA attachments is described as providing excellent retention and biomechanics. Implant placement, angulation, impressions, and other technical details are covered.
Implants bio mechanics /certified fixed orthodontic courses by Indian denta...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
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This document discusses implant biomechanics and osseointegration. It notes that osseointegration occurs when an implant bonds to living bone, providing long term stability. Biomechanics involves the interaction between forces and tissues in the body. Key factors for implants include force magnitude and direction, as well as moment arms related to implant location and design. Proper implant selection, placement, and occlusion are important to minimize these forces and moments to prevent implant failure.
This document summarizes key aspects of dental implant surgery including osseointegration, surgical considerations, anatomical considerations, implant stability assessment, one-stage versus two-stage surgery, and extraction and immediate implant placement. It discusses the direct bone-implant connection called osseointegration, factors that influence osseous healing like implant surface characteristics, and techniques for ensuring primary stability. Key anatomical structures like nerves and sinuses are reviewed for surgical safety. Methods of evaluating initial implant stability like resonance frequency analysis are presented. The document compares one-stage and two-stage surgical protocols and reviews when immediate placement is appropriate.
This document provides instructions for fabricating custom impression trays using either light cure resin or tray resin. It describes how to mark registration lines on casts, block out undercut areas, adapt the resin materials, and trim the trays. Completed trays should have rounded, smooth edges of proper thickness and extension, with finger rests and handles as needed.
This document discusses edentulous mandibles treated with implant retained overdentures. It begins by comparing conventional dentures to implant retained dentures. It notes that implant retention can overcome problems with stability, retention and support that some patients experience with conventional dentures. However, implants may not be necessary for patients with favorable denture bearing surfaces. It then discusses which patients are most likely to function well with conventional dentures versus those who would benefit from implant retention, focusing on factors like floor of mouth contours and tongue position. It also summarizes clinical outcomes data regarding improvements in function with different treatment options.
This document discusses maxillo-mandibular records and occlusion for removable partial dentures (RPDs). It covers assessing the vertical dimension of occlusion (VDO) and horizontal relationships, as well as determining centric relation. Methods for making jaw relation records including face bow transfers and bite registrations are described. The document also discusses considerations for developing occlusion for complete dentures, RPDs, and mixed dentition cases. Bilateral balanced occlusion is recommended when one arch is edentulous to prevent tipping of the denture and resorption. Anterior guidance is preferred for distal extension RPDs. Maintaining the ideal occlusal plane is also important.
The document discusses setting up teeth for a balanced occlusion in a complete denture. It describes placing an anterior-posterior curve in the maxillary arch and a slight curve from side to side in the mandibular arch. It provides details on positioning each individual tooth, including landmarks to use and desired angulations, overlaps, and relationships between opposing teeth. The goal is to create a balanced occlusion that provides stability and proper function during speech and jaw movements.
The document discusses various implant components and prosthodontic procedures. It describes the history and evolution of implant fixtures from the original Brånemark design to newer internal connection and tapered implants. It also covers abutment types including standard, esthetic, angled, UCLA and custom abutments. Impression techniques and the use of healing caps and gold cylinders are discussed for different clinical scenarios.
The document discusses surgical and prosthodontic considerations for patients who have undergone a radical maxillectomy. It provides details on:
1) Closing the surgical defect with a radial forearm free flap and addressing distortions to palatal contours and secretions in the nasal cavity.
2) Retaining key abutment teeth by making bony cuts between teeth rather than through them.
3) Covering the palatal margin of defects with palatal mucosa when possible.
4) Designing obturators to be lightweight, inexpensive, and perforated to wire to residual dentition.
Trochanteric and subtrochanteric non union dr mahmoud hadhoudMahmoud Hadhoud
This document discusses the evaluation and treatment of trochanteric and subtrochanteric femoral nonunions. It notes that nonunion must be considered for persistent pain after fixation or hardware failure. CT can help differentiate nonunion from malunion when hardware obscures radiographs. Treatment depends on factors like age, hardware status, and femoral head/neck quality. Younger patients may be treated with bone grafting or hardware revision while older patients may be candidates for arthroplasty. Various fixation methods are discussed like intramedullary nails, blade plates, and locking plates. Hardware failure, malreduction, and deformity correction are also addressed.
Implant design and consideration /orthodontic courses by Indian dental academy Indian dental academy
This document discusses various considerations for dental implant design, including surface area, bone volume/quality, force characteristics, and specific design features. It covers macrogeometry, width, thread geometry, length, crest module, apical design, and surface coatings. Different implant designs are categorized as screw/threaded, conical, basket/vented, or fin/plateau. Key aspects of screw, cylindrical basket, and surface coating designs are described. The goal of design is to optimize load transfer and distribution to the surrounding bone.
This document discusses implant-retained obturators for maxillary defects. Early designs led to bone loss around implants due to implant overload. Photoelastic analysis showed that tissue bars with "0" ring attachments and occlusal rests best direct forces axially. Implant sites include the premaxilla, posterior alveolus, tuberosity, and zygoma. Case reports demonstrate that implants can improve retention but designs must minimize lateral forces. Current designs use resilient attachments and rests to direct forces axially and reduce implant overload.
This document discusses design concepts for removable partial dentures for patients with maxillary defects following radical maxillectomy surgery. Key points include: 1) RPD designs must direct forces along the long axis of abutment teeth to prevent overloading, 2) anterior teeth adjacent to defects require cingulum rests for support, 3) arch form, defect size, and remaining dentition impact design and degree of movement, 4) additional retention features may be needed for less favorable defects and arch forms. The goal is to support resection sites while preventing excessive stresses on abutment teeth.
Indian Dental Academy: will be one of the most relevant and exciting
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implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic
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Thank you for the presentation. I found it very informative regarding the principles of designing removable partial dentures for patients with defects of the maxilla and mandible.
This document discusses implant-retained prostheses for maxillary defects. It begins by outlining challenges with stability, retention, and support for edentulous patients with maxillectomy defects. Implants can improve stability and retention of complete dentures with obturators. Early implant designs led to high failure rates due to overload. Newer designs using attachments like ERA and occlusal rests distribute forces better along implant axes, reducing bone loss. Potential implant sites include the premaxilla, posterior ridge with sinus lift, tuberosity, and zygoma. Tissue bar designs must provide retention while minimizing lateral forces on implants.
Biomechanical aspects of monoblock implant bridges for the edentulous maxilla...droliv
1) The document discusses biomechanical concepts of occlusion and articulation for implant-supported bridges in edentulous jaws.
2) It recommends using a bilateral balanced group guidance occlusion pattern rather than canine guidance to distribute forces and minimize stress on implants.
3) Temporary bridges placed immediately after implantation can help establish the new guidance pattern before placing definitive bridges.
The document discusses the use of an extrusion arch to correct an anterior open bite. It describes how an extrusion arch creates a one-couple force system, applying an extrusive force to the anterior teeth and an intrusive force plus tip-forward moment to the posterior anchorage. It notes that seating elastics are needed to control the unwanted tipping, and presents a case report where miniscrew anchorage was used instead to prevent tipping while the arch closed an open bite over multiple months.
This article reports on 5 consecutive cases where unsplinted dental implants were used to successfully retain maxillary overdentures with partial palatal coverage. A total of 25 textured implants were placed with a minimum of 4 implants per patient. After 12-48 months, none of the implants lost osseointegration and marginal bone levels remained stable. Patients were able to maintain soft tissue health around the unsplinted implants and reported being comfortable with the functioning of their maxillary overdentures. The preliminary results suggest that unsplinted implants can successfully retain removable maxillary overdentures with limited palatal coverage.
This document discusses several key points regarding dental implants:
1) Bone density and quality greatly impact implant success, with the highest success seen in the anterior mandible and lowest in the posterior maxilla due to poorer bone density.
2) Treatment planning considerations include implant placement based on available bone, with a minimum of 3 implants to replace missing posterior teeth in the maxilla.
3) Linear implant configurations are less stable than curved arrangements and more prone to overload from non-axial forces, particularly in low-density posterior areas.
The document discusses the design of implants for unstable extracapsular proximal femur fractures. It notes the limitations of current implant designs, which fail to provide adequate stability and allow fracture collapse and implant failure. New implant designs need to control factors like bone quality, fracture geometry, reduction quality, implant choice, and placement. Computer modeling is used to simulate fractures, apply cyclic loading, and test the stability of various implant designs, including a proposed new indigenous nail design. The finite element analysis provides data on implant migration and the number of load cycles implants withstand before failure.
The document discusses various techniques for limb salvage surgery following bone tumors. It describes the principles of limb salvage compared to amputation, including survival, recurrence, function, and complications. Various reconstruction options after tumor resection are summarized, including allografts, vascularized bone grafts, prosthetics, arthrodesis, rotationplasty, and total femur replacement. Specific case examples illustrate different reconstruction techniques for various tumor locations.
Biomechanics implants/certified fixed orthodontic courses by Indian dental ac...Indian dental academy
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Indian Dental Academy: will be one of the most relevant and exciting training
center with best faculty and flexible training programs for dental
professionals who wish to advance in their dental practice,Offers certified
courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry,
Prosthetic Dentistry, Periodontics and General Dentistry.
orthodontic biomechanics andtreatment of skeletal deformitiesMaherFouda1
1) Maxillary advancement can be done with a device attached directly to the maxilla and cranial bones, or with a rigid frame fixed to the cranium from which a screw device advances the maxilla forward and downward.
2) Errors in maxillary or mandibular positioning can occur during surgery and be difficult to correct, such as the maxilla being placed too high or low in the vertical dimension.
3) "Condylar sag" describes problems where the condyle is not properly seated in the glenoid fossa after surgery, which can result in occlusal discrepancies if not addressed. Precise placement of the condyles during surgery is important for postoperative stability.
orthodontic biomechanics of skeleta deformities part 3MaherFouda1
1) Maxillary advancement can be done with a device attached directly to the maxilla and cranial bones, or with a rigid frame fixed to the cranium from which a screw device advances the maxilla forward and downward.
2) Errors in maxillary or mandibular positioning can occur during surgery and be difficult to correct, such as the maxilla being placed too high or low in the vertical dimension.
3) "Condylar sag" describes problems where the condyle is not properly seated in the glenoid fossa after surgery, which can result in occlusal discrepancies if not addressed. Precise placement of the condyles during surgery is important for postoperative stability.
Biomechanics of extra alveolar mini-implantsAshok Kumar
1) Extra-alveolar mini-implants placed in the infrazygomatic crest and mandibular buccal shelf areas provide effective anchorage for orthodontic tooth movement and treatment of complex malocclusions.
2) These mini-implants allow en masse retraction of the entire maxillary or mandibular arch in a single step using statically determinate biomechanics.
3) Retraction forces generated rotate the dental arch, causing intrusion of posterior teeth and extrusion of anterior teeth, which can assist in treating open bites and sagittal discrepancies.
There are three basic phases of the digital workflow when designing and/or fabricating removable partial denture frameworks; data acquisition, designing (computer aided design (CAD)), and computer-aided manufacturing (CAM). The bulk of this presentation is dedicated to the design steps used in this workflow utilizing sample maxillary and mandibular casts
There are three basic phases of the digital workflow when designing and/or fabricating removable partial denture frameworks; data acquisition, designing (computer aided design (CAD)), and computer-aided manufacturing (CAM). The bulk of this presentation is dedicated to the design steps used in this workflow utilizing sample maxillary and mandibular casts
This document discusses single tooth defects in the posterior quadrants and their restoration. It compares fixed dental prostheses to implants, noting that implants are generally preferred when adjacent teeth are healthy or nearly so. For endodontically treated teeth, a fixed restoration is preferred if sufficient tooth structure remains and occlusion and parafunction are minimal. Considerations for implant placement include anatomic factors, timing of placement, and prosthodontic issues like abutment selection and cement versus screw retention. The goal is to restore function while avoiding complications like fracture, overload, and peri-implantitis.
Crowns significantly improve the success of endodontically treated posterior teeth but do not improve the success of anterior teeth. Posterior teeth require crowns more often than anterior teeth due to greater cuspal deflection after root canal treatment. The main purpose of a post is to retain a core, not strengthen teeth. Posts should extend to retain 5mm of gutta percha and not exceed 7mm in molars. The diameter of posts should not exceed one-third of the root diameter and range between 0.6-1.2mm. A ferrule of at least 2mm helps prevent tooth fracture.
Charles J. Goodacre presents on provisional restorations in fixed prosthodontics. He discusses the functions and requirements of provisional restorations including protection, mastication, esthetics, positional stability, and providing diagnostic information. He describes various provisional restoration resins and their properties. Goodacre also outlines different types of provisional restorations including prefabricated, custom-fabricated, direct and indirect techniques. He demonstrates techniques for direct provisional restorations using templates and indirect restorations fabricated by a laboratory.
This document discusses secondary impression materials used in fixed prosthodontics. It defines an impression as a negative reproduction of prepared teeth that provides information to fabricate a crown or fixed prosthesis. Impressions can be physical materials or digital scans. Physical impressions include reversible hydrocolloid, condensation silicone, polysulfide, polyether, and addition silicone. Custom trays are often used and are fabricated from autopolymerizing or light-cured resin. Ideal impressions accurately record all prepared surfaces and maintain dimensional stability until the laboratory casts are made.
This document discusses techniques for fluid control and tissue management during fixed prosthodontic impressions. It describes the need to displace gingiva to record tooth structure below the finish line. Various methods of fluid control are outlined, including retraction cords, suction, and isolite systems. Retraction cords should be moistened with hemostatic agents before gentle placement to displace tissue. The document recommends a two-cord technique using different diameter cords and additional hemostatic agents if needed to control bleeding and produce accurate impressions. Proper fluid management is essential for high quality fixed prosthodontic impressions.
This document provides an overview of ceramics used in fixed prosthodontics. It discusses various types of ceramics including glass ceramics, glass infiltrated mixtures, and polycrystalline ceramics. Examples mentioned include lithium disilicate, zirconia, and alumina. The document reviews clinical indications and uses of different ceramics, as well as case considerations, preparation designs, and causes of failure. An outline is provided of the topics to be covered in the presentation on ceramics in dental practice.
1) There are two main hardening mechanisms for dental cements - acid-base reactions and polymerization reactions. Common cements that use acid-base reactions include zinc phosphate, polycarboxylate, and glass ionomer cements. Resin cements use a polymerization reaction.
2) Zinc phosphate cement has a long history of success but lacks adhesion and fluoride release. Polycarboxylate cement bonds to tooth structure and has short mixing/working times. Glass ionomer cement releases fluoride and bonds to tooth structure.
3) Resin-modified glass ionomer cement combines the benefits of glass ionomer cement with the strength and handling of resin, providing good early strength and reduced moisture sensitivity.
1. Single tooth defects in the posterior quadrants can often be restored with either fixed dental prostheses or dental implants, depending on the clinical situation and anatomical factors.
2. Implant placement can be immediate, delayed, or staged depending on factors like infection, bone quality, and proximity to anatomical structures.
3. Site enhancement procedures may be needed to augment bone in order to place implants in ideal positions and ensure adequate bone volume.
This document summarizes research on the success rates and complications of resin bonded prostheses (RBPs). It finds that on average, 26% of RBPs experience complications within 4 years, increasing to 28% after 5 years, with debonding being the most common at 21%. Debonding rates are higher for posterior teeth, longer spans, and cantilever designs. Tooth preparation techniques like covering lingual and proximal surfaces, adding proximal grooves or pinholes, and occlusal rests can reduce debonding. Maintaining a minimum of 0.5mm occlusal clearance and 1mm metal thickness also impacts success. Proper diagnosis, treatment planning and cementation techniques are keys to optimizing longevity
This document is a lecture on fixed partial denture (FPD) designs by Charles J. Goodacre from Loma Linda University School of Dentistry. The lecture discusses key considerations for FPD treatment planning including tooth stability, occlusal forces, abutment selection, and material choices. It provides examples of different FPD designs for single and multiple tooth replacements in the maxilla and mandible. Challenges with each case such as cantilevers, oral hygiene access, and risk of failure are evaluated. The goal is to create the best online programs of instruction in prosthodontics.
Crowns significantly improve the success of endodontically treated posterior teeth. Posts are primarily used to retain cores and do not strengthen teeth. The appropriate post length is to extend to the radiographic apex with 5mm of gutta percha retained. Post diameter should not exceed 1/3 of the root diameter and range from 0.6-1.2mm. A ferrule of at least 2mm is recommended to prevent root fracture.
This document discusses various dental cements and cementation procedures. It describes the compositions, characteristics, and mixing procedures of different cement types including provisional cements, zinc phosphate cement, polycarboxylate cement, glass ionomer cement, resin-modified glass ionomer cement, resin cement, and calcium aluminate cement. It also outlines various clinical procedures for cementation such as provisional crown removal, tooth preparation, crown placement, adjustment, and cement cleanup.
This document discusses provisional restorations in fixed prosthodontics. It describes the functions and requirements of provisional restorations, including protection, mastication, esthetics, positional stability, and providing diagnostic information. It discusses different materials used for provisional restorations like methyl methacrylate, ethyl methacrylate, and composite resins. It also describes different types of provisional restorations including prefabricated shells, custom-fabricated templates, and cast metal. Both direct and indirect techniques are covered.
This document contains a lecture by Dr. Charles Goodacre on the importance of cervical contour, marginal fit, and surface smoothness of dental restorations for optimal gingival health. Over several decades of practice, Dr. Goodacre observed many cases where poor contours, fit or smoothness led to gingival inflammation and tissue loss. The lecture reviews key principles for contouring provisional and definitive restorations, and highlights cases with favorable as well as unfavorable outcomes related to restoration design. Dr. Goodacre emphasizes the importance of biologic principles and attention to detail for achieving and maintaining healthy peri-implant and periodontal tissues.
This document discusses secondary impression materials used in fixed prosthodontics. It defines an impression as a negative reproduction of prepared teeth that provides information to fabricate a crown or fixed prosthesis. Impressions can be physical materials or digital scans. Physical impressions include reversible hydrocolloid, condensation silicone, polysulfide, polyether, and addition silicone. Digital impressions involve directly scanning teeth or an indirect scan of a dental cast. Custom trays are often used to carry and confine impression materials. Trays should be rigid, dimensionally stable, and provide adequate space for materials. The document outlines techniques for fabricating custom trays using autopolymerizing or light-cured resin. Good impressions accurately record all prepared surfaces
This document discusses techniques for fluid control and tissue management during fixed prosthodontic impressions. It begins by explaining the importance of fluid control to obtain an accurate impression and lists various methods for fluid control like retraction cords, cotton rolls, and suction. Next, it describes different types of retraction cords and instruments used to displace tissues and examines their purposes. It then provides details on the speaker's preferred technique using two different sized cords and hemostatic agents to minimize trauma during impression making. In summary, this document outlines best practices for fluid control and tissue retraction to obtain high quality fixed prosthodontic impressions.
This document provides guidelines for tooth preparation for complete metal crowns. It discusses advantages like maximum retention and resistance form, as well as disadvantages like requiring more tooth reduction. Ideal preparation includes a 0.3-0.5mm chamfer finish line and 10-20 degrees of axial wall convergence. Occlusal reduction should be 1.0-1.5mm. Additional grooves may enhance resistance for teeth with limited dimensions. Line angles should be rounded to prevent casting defects. Examples demonstrate preparation steps and required modifications for fixed partial dentures.
This document discusses guidelines for clinical shade selection, including recommendations for lighting, selection time, patient positioning, tooth condition, selection distance, and use of digital images. It provides details on:
- Using daylight-balanced lighting with a CRI over 90 for optimal color matching
- Allowing sufficient time for multiple shade selections to avoid eye fatigue
- Positioning the patient upright at eye level for natural viewing of teeth
- Ensuring clean, dry tooth surfaces isolated with a rubber dam
- Comparing shades at a distance of 1-2 feet to evaluate value more easily
- Using digital images and diagrams to document shade zones and characteristics for the technician.
More from www.ffofr.org - Foundation for Oral Facial Rehabilitiation (20)
Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
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- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
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Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
2. Implant Biomechanics and
Treatment Planning
Why should we be concerned with
implant biomechanics when we develop
a plan of treatment?
Because if we are not, we risk implant
overload and prosthesis failures such
as fracture and screw loosening.
Implant overload can lead to bone loss around
implants and eventually implant failure.
3. Is it possible to overload the bone anchoring an
osseointegrated implant?
Bone is a dynamic structure. Excessive loads lead to a
resorptive remodeling response
! Hoshaw et al (1994) observed a resorptive remodeling of the
bone around implants subjected to excessive axial loads
(300N). Bone loss was observed at the crest around the
neck of the implant and in the zone of bone adjacent to the
body of the implant
! Brunski et al, 2000 J Oral Maxillofac Implants - Consensus
! Isador’s studies (1996, 1997) using a monkey model
presented data that was consistent with the hypothesis
proposed by Hoshaw and her colleagues.
! Recent studies by Myamoto et al (1998, 2000, 2008) have
reconfirmed Hoshaw and Brunski’s original hypothesis
4. Do the new surfaces reduce the risk Courtesy C Stanford
of Implant Overload?
v Excessive occlusal loads
v Resulting microdamage
(fractures, cracks, and
delaminations)
v Resorption remodeling
response of bone
v Increased porosity of bone in
the interface zone secondary
to remodeling
v Vicious cycle of continued
loading, more microdamage,
more porosity until failure
5. Implant Biomechanics
! What is the load bearing capacity of
osseointegrated implant supported restorations?
! Is the load carrying capacity of implant prostheses
influenced by the quality of the bone sites?
! What factors control the magnitude of the loads
that are delivered through the implant into the
surrounding bone?
! What loads should implant borne restorations be
designed to resist?
6. Implant Biomechanics
Karnak The Great Wall Pont de Gard
You must over engineer your implant restorations, particularly
when restoring posterior quadrants with linear configurations in
order achieve predictable long term results.
7. Implant Biomechanics
LOAD BEARING CAPACITY ANTICIPATED LOAD
1. Quality of bone site (Affected by)
2. Quality of bone ! Occlusal factors
Cusp angles
implant interface
Width of occlusal table
3. Implant microsurfaces Guidance type
! Machined vs Anterior guidance
microrough vs Group function
nano-enhanced ! Cantilever forces
surfaces Connection to natural
4. Implant dentition
! Number and Size of occlusal table
Arrangement Cantilevered prostheses
Linear vs Curvilinear ! Parafunctional habits
! Length and diameter (bruxism)
! Angulation ! Brachycephalics
8. Load bearing capacity
Implant number and arrangement
l Both the number and arrangement
of implants affect the load carrying
capacity of any particular implant
supported restoration.
l Curvilinear arrangements carry
withstand more load than linear
arrangements
9. Load bearing capacity
Linear vs Curvilinear
Curvilinear arrangements have the
greatest load bearing capacity.
10. Load bearing capacity
Linear vs Curvilinear
v Curvilinear arrangements such as seen in this
patient are very predictable
v This PFM fixed prosthesis is 8 years post insertion.
Occlusion: Group function
11. Load bearing capacity
Linear vs Curvilinear
Linear configurations restoring the cuspid region, such as the
patient on the right, are unpredictable, whereas curvilinear implant
arrangements such as shown on the left are very predictable.
Predictable Not predictable
12. Load bearing capacity
Linear vs Curvilinear
v The
central incisor sites were the most favorable
implant sites. Therefore:
! They were extracted and implants placed into these sites
v Result:
! More favorable biomechanics and predictability
Courtesy Dr. R. Faulkner
13. Load bearing capacity
Linear vs Curvilinear
v Centrals extracted
! Note the horizontal
dimension of the central
incisor sites
v Implants inserted
Courtesy Dr. R. Faulkner
15. Load bearing capacity
Linear vs Curvilinear
v Completedprosthesis
v Biomechanics are favorable
Courtesy Dr. R. Faulkner
16. Load bearing capacity
Implant number and arrangement
v Anterior – Posterior Spread
In the edentulous mandible,
curvilinear arrangements such as
this one have the greatest load
bearing capacity. The cantilever
length can be double the A-P
spread but not exceeding 20 mm.
17. Load bearing capacity
Cantilever length relative to A-P spread
Relatively linear arrangements
combined with excessive
cantilever length such as shown
here are able to withstand less
occlusal load.
v Result
• Mechanical failures
• Implant overload
A-P
In this patient the result Spread
was recurrent fractures
of the prosthesis
retaining screws.
18. Excessive Cantilever forces
Implant Overload and Resorptive Remodeling
l If cantilevers are excessive however, they can lead to implant
overload and provoke a resorptive remodeling response of
bone around the distal implants.
In this patient a fixed edentulous bridge similar to the one
shown previously, was fabricated for this patient. However,
the cantilever extensions were in excess of 30 mm. Note the
bone loss around the distal implants particularly on the
patient’s left. Eventually this implant fractured.
19. Maxilla vs Mandible
Courtesy Dr. C. Stanford
The size and shape of the
trabeculae is different in the
mandible as compared to the
mandible and may be one of
the reasons why the load
carrying capacity of implant
supported prostheses restoring
posterior quadrants in the
mandible appears to be
superior to those in the maxilla.
20. Number of Implants per Unit Posterior Maxilla
When restoring posterior quadrants with implants we
are forced to use linear arrangements by anatomic
necessity. Therefore in most instances:
! One implant for
each dental unit.
! At least three
where possible in
extension areas.
*The third implant
dramatically improves the
biomechanics of the
restoration One dental unit = premolar
21. Number of Implants per Unit Posterior Maxilla
Curvilinear arrangements are favored over linear arrangements from a
biomechanical perspective. However, when restoring posterior quadrants
with implants we are forced to use linear arrangements by anatomic
necessity. Therefore in most instances:
! One implant for
each dental unit.
! At least three
where possible in *The third implant dramatically improves
extension areas. the biomechanics of the restoration
22. Number of Implants per Unit Posterior Maxilla
The distal implants failed 30 months after loading in
both these patients because of implant overload.
23. Number of Implants per Unit Posterior Maxilla
These implants failed 66 months after
loading because of implant overload.
Group function was used to restore this patient. Result:
Another problem:excessive lateral forces
! Application of Cusp angles too steep
! Implant failure
and the occlusion was tripodized
24. Number of Implants per Unit
Posterior Maxilla
Space allowed only two implants to be placed in
this patient. However, note anterior guidance.
Design the occlusion to minimize the delivery of nonaxial forces
25. Number of Implants per Unit
Posterior Maxilla
Only two implants were placed.
Note anterior guidance
26. Bone Augmentation – Horizontal Deficiencies
! Grafting bone defects with horizontal deficiencies
has been relatively predictable, particularly in the
anterior region.
! However, these implants are usually exposed to
minimal loads. In most patients the graft serves to
restore bone and soft tissue contours in order to
enhance the final esthetic result and idealize implant
position.
! Fixation of the graft is easy to accomplish
! The blood supply to graft is usually quite good
27. Bone Augmentation – Vertical Defects
Grafting vertical defects by adding bone on
top of the alveolar ridge, as shown here, is
much less predictable particularly in the
posterior quadrants.
Problems:
! Tension on the wound secondary to closure of
tissue flaps
! Poor blood supply
! Difficulty in achieving fixation
Result:
! Relapse (resorption) rate is 75%
28. Sinus Lift and Graft
Sinus
membrane
Bone graft
Bone of the residual
allveolar ridge
Advantages over only grafts
Resorption probably less than 25%
Challenge
Elevate the sinus membrane without perforation
29. Sinus Lift and Graft
! This procedure has been
reasonably predictable
although no good long term
followup studies are
available.
! Sources of graft material
include chin, ramus, and
iliac crest sometimes mixed
with bone substitutes.
! Best results with respect
to implant success rates
appear to obtained when
there is at least 4-5 mm of
residual ridge.
30. Sinus Lift and Graft
This patient was restored following a sinus lift
and graft. Autogenous chin bone was used.
She is 10 years post treatment and doing well.
Note: Best results achieved when there is 4-5 mm
of normal bone over the sinus before the procedure
31. Sinus Lift and Graft
This patient was restored following a
bilateral sinus lift and graft. Freeze
dried bone was used to graft the left
maxillary sinus. The implants placed
in this graft failed 18 months following
delivery of the implant supported
fixed partial denture.
32. Distraction Osteogenesis
This procedure has been used successfully in other sites,
particularly the anterior maxilla and the mandibular body. Its
usefulness in the posterior maxilla is probably limited. The
relapse (resorption) rate is about 25% (Moy et al, 2005)
Osteotomy
Distracted
site
bone
Distraction
Distraction
apparatus apparatus
33. *Removable Partial Dentures*
Removable partial dentures properly designed and fabricated
provide the patient with masticatory function equivalent to that
obtained with an implant supported fixed partial dentures
(Kapur, et al, 1992) and this service should be offered to the
patient before grafting is considered.
34. Number of Implants per Unit
Posterior Mandible
Two is sufficient for most patients
Why? The trabecular bone is more dense
resulting in better bone anchorage
35. Number of Implants per Unit
Posterior Mandible
Three are recommended when:
v There is bone over the nerve for only short implants
v Bone quality is poor
v When restoring four dental units
36. Number of Implants per Unit
Posterior Mandible
Three implants were used to
restore four units in this patient
37. Posterior Mandible – Limiting Factors
v Inferior alveolar nerve(arrow)
v Insufficient bone over the nerve to permit
placement of a 10 mm or longer implant
v Uni-cortical anchorage (arrow)
38. Posterior Mandible – Limiting Factors
Many patients such as this one, present with moderate
to severe resorption precluding placement of implants
unless the inferior alveolar nerve displaced.
39. Displacement of the Inferior Alveolar Nerve
! This procedure enables placement of implants of sufficient length with
bicortical anchorage.
! Although the risk of nerve injury is relatively small the morbidities
associated with injury may be severe.
! Therefore, these issues must be thoroughly discussed with the patient
before proceeding with the procedure.
40. Crestal Augmentation
Augmentation of vertical defects in posterior mandibular quadrants with free
autogenous bone grafts (A) has been unpredictable. Following surgery the
relapse rate is about 75% and further bone loss is also seen after loading (B).
Why?
a) Tension on the wound upon closure
b) Poor blood supply
c) Difficulty is achieving proper fixation of the graft
A B
Presently, distraction osteogenesis is the only reasonably
predictable method for enhancing this site vertically.
41. Use of Short Wide Diameter
Implants in the Posterior Mandible
This practice has not been predictable. The short implants
are particularly prone to occlusal overload and bone loss. This
is a 5 year followup x-ray of two 6 mm diameter implants.
42. If implants of adequate length cannot be
used, consider removable partial dentures
Mastication efficiency of distal extension RPD’s is
equivalent to implant supported fixed partial dentures.
44. Linear configurations
Over engineer your cases
! When in doubt add the 3rd
implant in posterior
quadrant cases.
! Minimize the length and
width of the occlusal table
45. Over-engineer your linear quadrant cases
v When in doubt re: the quality of
the implant site bone, history of
parafunction etc., add the third
implant
v Minimize the width of the
occlusal table
46. Over-engineer your linear quadrant cases
However there is a flaw in he design of this
case. What is it?
Note: The buccal-lingual dimension is excessive
v Minimize the width of the occlusal surfaces. They should
be no wider than a premolar
47. Staggered vs linear configuration in
posterior quadrants
Straight line implant configuration
1.5 mm 1.5 mm
1.5 mm
Staggered implant configuration
This has been studied using a photoelastic model
by Itoh, et al, 2003
48. Staggered vs linear configuration
Is it biomechanically more favorable?
Straight line implant configuration
1.5 mm 1.5 mm
1.5 mm
v Yes, particularly with specific
chewing cycles. Nonlinear
arrangements resist lateral forces Staggered implant configuration
more effectively
v Is the improvement clinically
significant? This is unknown Itoh and Caputo, et al 2003
49. Staggered vs linear configuration
Is it feasible in the posterior quadrants?
Straight line implant configuration
1.5 mm 1.5 mm
1.5 mm
Probably not. Inthe posterior
quadrants you can’t get enough Staggered implant configuration
stagger to make much of a
difference biomechanically. Itoh and Caputo, et al 2003
50. Implants in Compromised Sites
Can we use shorter implants?
! Posterior maxilla
! Posterior mandible over the
inferior alveolar nerve in partially
edentulous patients
! Craniofacial application
Theoretically perhaps.
However we need well
designed clinical
outcome studies to
determine predictability
51. Length and diameter of Implants
Avoid the use of implants less than 10 mm in length and
4mm in diameter when restoring posterior quadrants.
v Short implants, such as this 7 mm
screw shaped implant, demonstrate
unfavorable stress distribution
patterns as seen in this study
performed with finite element
analysis. Longer implants distribute
stresses more favorably.
v Given the bone anchorage
achieved with modern surfaces,
failures are most likely to occur in the
Cho et al, 1993 trabecular bone
52. Length and diameter of Implants
• Two year followup data from Moy and Sze,’93
• Note the high failure rates with the 7 mm and
10 mm implants in the posterior maxilla.
53. Implant length vs diameter
Does increasing the
diameter compensate for
the lack of sufficient
length?
Using a photoelastic model,
Caputo et al, 2002 attempted
to determine whether
increasing the diameter of the
implant or increasing the length
of the implant had a significant
impact on stress distribution.
They concluded that:
54. Implant length vs diameter
! Most equitable load transfer
with axially directed loads.
! Under comparable loading
conditions, the stresses
transferred by the wide
diameter implant were only
slightly lower than the same
length narrow implant.
! For implants tested,
increased length was more
important than diameter in
Axial Buccal
Lingual
load load
stress reduction.
load
Caputo et al,2002
55. Implant length vs width
These data appear to have clinical significance. In our clinical
experience length is more important than width. Short wide
diameter implants appear to be susceptible to overload when used
in linear configurations such as shown here.
2 years
5 years
Cho,In Ho et
al, 1992
56. Ideal Implant Diameter
4-5 mm in diameter
! Less than 4 mm the rate of implant
fracture is unacceptably high
! Implants
3.75 mm in diameter have a 5-7%
fracture rate
! More than 5 mm the higher the
failure rate.
! Implants
6 mm in diameter have a 20%
failure rate
! Implants 4-5 mm in diameter have a less than
5% failure rate
57. Implant Angulation – Posterior vs Anterior
v Implants in the posterior
quadrants should be placed
so that occlusal loads can be
directed axially in the
posterior quadrants.
v In the anterior region, anatomic
necessity precludes implant
placement perpendicular to the
occlusal plane. However, the
forces used to incise the bolus are
only about ¼ of those used
posteriorly to masticate the bolus.
For this and other reasons implant
overload is rarely seen in the
anterior regions.
58. Implant angulation
v Nonaxial loads result in load magnification. Kinni et al
(1987), using photoelastic analysis and Cho et al (1993),
using finite element analysis, demonstrated that nonaxial
loads concentrated potentially clinically significant stresses
around the neck and at the tip of the implant.
Cho,In Ho et al, 1992
59. Biomechanics – Partially Edentulous Patients
Nonaxial loads and implant overload in posterior
quadrants
v Because of the curve of Spee and the distal angulation of the implants, the
occlusal loads (arrow) are nonaxial. Note the bone loss around the implants.
Linear configurations in the posterior region, such as in this patient, are
particularly vulnerable to the effects of nonaxial loading, particularly
brachycephalic individuals.
60. Cantilever forces
Cantilever forces are potentially detrimental particularly when
applied to implants with a linear configuration and single implants
placed in posterior quadrants.
! The longer the
cantilever the greater the
load magnification and
the more stress
concentrated in the bone
anchoring neck of the
distal implant.
! Note the dramatic
increase in stresses
associated with the 20
mm cantilever as
opposed to the 5 mm
one.
61. Cantilever forces
Cantilever
section
They are well tolerated when
implant supported
restorations are used to
restore the edentulous
mandible, so long as:
l The cantilevered section is
within a reasonable limit
l The implants are arranged in a
reasonable arc of curvature.
l Rigid frameworks with cross
arch stabilization are used
62. Excessive Cantilever forces
Implant Overload and Resorptive Remodeling
l If they are excessive however, they can lead to
implant overload and provoke a resorptive remodeling
response of bone around the distal implants.
In this patient a fixed edentulous bridge similar to the one
shown previously, was fabricated for this patient. However,
the cantilever extensions were in excess of 30 mm. Note the
bone loss around the distal implants particularly on the
patient’s left. Eventually this implant fractured.
63. Excessive Cantilever forces
Implant Overload and Resorptive Remodeling
Case Report
This tissue bar uses nonresilient attachments in the distal with a
long cantilever anteriorly and is therefore an implant supported
design. The implants were exposed to tipping forces magnifying
the occlusal loads, in turn leading to a resorptive remodeling
response of the bone around the implants and eventually loss of
the implants.
64. Excessive Cantilever forces
Implant Overload and Resorptive Remodeling
Cantilever
Cantilever
Overlay Dentures in Edentulous Maxilla
! During the eighties, tissue bar designs using four implants, such as the
one above, were commonly used at UCLA to retain overlay dentures. Hader
bar attachments were used anteriorly and in the extension areas.
! Such designs result in most of the posterior occlusal forces borne by the
implants and therefore are implant supported.
! The followup data (collected by the author from his private patients)
indicated significant bone loss and implant failures of the distal implants as
shown in the following table.
65. Excessive Cantilever forces
Implant Overload and Resorptive Remodeling
Cantilever Cantilever
Overlay Dentures in Edentulous Maxilla
Four implanted supported overlay dentures with nonresilient
(Hader) attachments (arrows) and distal cantilevers
Patients # Implants Followup Failures Position Time of
of failed failure
implants
10 40 5-12 yrs. 4 all distal 39-73 mths.
***Failures were attributed to implant overload, with its
resultant loss of bone around the implants
66. Cantilever forces
Implant Overload and Resorptive Remodeling
l Implant Assisted Design – 4 implants
When implant tissue bars with resilient attachments
connected to the distal portion of the bar (ERA type in
this patient) were used in the maxilla the failures after
loading were completely eliminated.
67. Cantilevers and Linear Configurations in
Posterior Quadrants
Mesial and distal cantilevers
l They are particularly detrimental and are therefore
contraindicated when using linear configurations to restore
posterior quadrants. They cause load magnification and
overload the bone around the implant adjacent to the
cantilever.
68. Cantilevers – Implant Overload
l Note the bone loss around the dental implants
adjacent to the cantilever.
Restorations designed in this
fashion have a poor prognosis.
70. Avoid buccal, lingual and cantilevers
The occlusal tables are
excessively wide in this
case. Buccal and lingual
cantilever forces may
lead in selected patients
to:
Prosthesis failures
• Porcelain fractures
• Screw fractures
Implant overload and
bone loss
71. Occlusal Anatomy and Biomechanics
v Narrow occlusal table
Goal: Reduce the buccal - lingual cantilever effect
72. Avoid buccal and lingual cantilevers
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.
73. Solitary implants restoring single molars –
Cantilever effect
A B
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.
74. Solitary implants restoring single molars
Cantilever effect
Fracture
Implant fractured after 30 months of function
75. Single tooth restorations in the molar
region – Cantilever effect
Mesial cantilever
4 mm
diameter
implant
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.
78. Restoration of single molar sites - Solutions
Eliminate the cantilever by using
! Wide diameter
! Multiple implants
In this patient a wide diameter implant was used to
restore the first molar.
79. Restoration of single molar sites
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 elimating any
possible buccal or
lingual cantilevers.
Custom abutment Lingual set screw
80. Restoration of single molar sites
Note:
! Hygiene access for proxy brush
! Note width of occlusal table
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