Dental implants require different biomechanical considerations from natural teeth. Also, with one of the criteria for long-term implant success being “occlusion,” it becomes imperative for the clinician to be well
versed with the different concepts when rehabilitating with an implant prosthesis.
Screw vs cement retained implant prosthesisApurva Thampi
This is a journal club presentation featuring a recent article regarding a screw and cement retained implant prosthesis.
the presentation and all its related material is available on request. Mail me at apurvathampi@gmail.com
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
Screw vs cement retained implant prosthesisApurva Thampi
This is a journal club presentation featuring a recent article regarding a screw and cement retained implant prosthesis.
the presentation and all its related material is available on request. Mail me at apurvathampi@gmail.com
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
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.
Implant impressions- journal club - Accuracy of implant impressions using var...Partha Sarathi Adhya
This journal club deals with different impression techniques for implant restorations. These include two different impression techniques using different impression materials.
This seminar deals with implant-related complications that lead to implant failure.this also discus diagnostic criteria and preventive methods for an implant failure.
Esthetic considerations in implant placement Esthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placement
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.
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.
Implant impressions- journal club - Accuracy of implant impressions using var...Partha Sarathi Adhya
This journal club deals with different impression techniques for implant restorations. These include two different impression techniques using different impression materials.
This seminar deals with implant-related complications that lead to implant failure.this also discus diagnostic criteria and preventive methods for an implant failure.
Esthetic considerations in implant placement Esthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placement
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.
INTRODUCTION
DEFINITION
TYPES OF TRAUMA FROM OCCLUSION
GLICKMAN CONCEPT
WAERHAUG CONCEPT
STAGES OF TISSUE RESPONSE TO INJURY
CLINICAL AND RADIOGRAPHIC FEATURES OF TFO
CLINICAL DIAGNOSIS OF TFO
TFO AND IMPLANTS
TREATMENT OF TFO
CONCLUSION
REFRENCES
INTRODUCTION
DEFINITION
TYPES OF TRAUMA FROM OCCLUSION
GLICKMAN CONCEPT
WAERHAUG CONCEPT
STAGES OF TISSUE RESPONSE TO INJURY
CLINICAL AND RADIOGRAPHIC FEATURES OF TFO
CLINICAL DIAGNOSIS OF TFO
TFO AND IMPLANTS
TREATMENT OF TFO
CONCLUSION
REFRENCES
Design consideration in reducing stress in rpd/ oral surgery courses 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.for more details please visit
www.indiandentalacademy.com
Biomechanics of dental implants/certified fixed orthodontic courses by Indian...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
0091-9248678078
Cancer cell metabolism: special Reference to Lactate PathwayAADYARAJPANDEY1
Normal Cell Metabolism:
Cellular respiration describes the series of steps that cells use to break down sugar and other chemicals to get the energy we need to function.
Energy is stored in the bonds of glucose and when glucose is broken down, much of that energy is released.
Cell utilize energy in the form of ATP.
The first step of respiration is called glycolysis. In a series of steps, glycolysis breaks glucose into two smaller molecules - a chemical called pyruvate. A small amount of ATP is formed during this process.
Most healthy cells continue the breakdown in a second process, called the Kreb's cycle. The Kreb's cycle allows cells to “burn” the pyruvates made in glycolysis to get more ATP.
The last step in the breakdown of glucose is called oxidative phosphorylation (Ox-Phos).
It takes place in specialized cell structures called mitochondria. This process produces a large amount of ATP. Importantly, cells need oxygen to complete oxidative phosphorylation.
If a cell completes only glycolysis, only 2 molecules of ATP are made per glucose. However, if the cell completes the entire respiration process (glycolysis - Kreb's - oxidative phosphorylation), about 36 molecules of ATP are created, giving it much more energy to use.
IN CANCER CELL:
Unlike healthy cells that "burn" the entire molecule of sugar to capture a large amount of energy as ATP, cancer cells are wasteful.
Cancer cells only partially break down sugar molecules. They overuse the first step of respiration, glycolysis. They frequently do not complete the second step, oxidative phosphorylation.
This results in only 2 molecules of ATP per each glucose molecule instead of the 36 or so ATPs healthy cells gain. As a result, cancer cells need to use a lot more sugar molecules to get enough energy to survive.
Unlike healthy cells that "burn" the entire molecule of sugar to capture a large amount of energy as ATP, cancer cells are wasteful.
Cancer cells only partially break down sugar molecules. They overuse the first step of respiration, glycolysis. They frequently do not complete the second step, oxidative phosphorylation.
This results in only 2 molecules of ATP per each glucose molecule instead of the 36 or so ATPs healthy cells gain. As a result, cancer cells need to use a lot more sugar molecules to get enough energy to survive.
introduction to WARBERG PHENOMENA:
WARBURG EFFECT Usually, cancer cells are highly glycolytic (glucose addiction) and take up more glucose than do normal cells from outside.
Otto Heinrich Warburg (; 8 October 1883 – 1 August 1970) In 1931 was awarded the Nobel Prize in Physiology for his "discovery of the nature and mode of action of the respiratory enzyme.
WARNBURG EFFECT : cancer cells under aerobic (well-oxygenated) conditions to metabolize glucose to lactate (aerobic glycolysis) is known as the Warburg effect. Warburg made the observation that tumor slices consume glucose and secrete lactate at a higher rate than normal tissues.
Multi-source connectivity as the driver of solar wind variability in the heli...Sérgio Sacani
The ambient solar wind that flls the heliosphere originates from multiple
sources in the solar corona and is highly structured. It is often described
as high-speed, relatively homogeneous, plasma streams from coronal
holes and slow-speed, highly variable, streams whose source regions are
under debate. A key goal of ESA/NASA’s Solar Orbiter mission is to identify
solar wind sources and understand what drives the complexity seen in the
heliosphere. By combining magnetic feld modelling and spectroscopic
techniques with high-resolution observations and measurements, we show
that the solar wind variability detected in situ by Solar Orbiter in March
2022 is driven by spatio-temporal changes in the magnetic connectivity to
multiple sources in the solar atmosphere. The magnetic feld footpoints
connected to the spacecraft moved from the boundaries of a coronal hole
to one active region (12961) and then across to another region (12957). This
is refected in the in situ measurements, which show the transition from fast
to highly Alfvénic then to slow solar wind that is disrupted by the arrival of
a coronal mass ejection. Our results describe solar wind variability at 0.5 au
but are applicable to near-Earth observatories.
Nutraceutical market, scope and growth: Herbal drug technologyLokesh Patil
As consumer awareness of health and wellness rises, the nutraceutical market—which includes goods like functional meals, drinks, and dietary supplements that provide health advantages beyond basic nutrition—is growing significantly. As healthcare expenses rise, the population ages, and people want natural and preventative health solutions more and more, this industry is increasing quickly. Further driving market expansion are product formulation innovations and the use of cutting-edge technology for customized nutrition. With its worldwide reach, the nutraceutical industry is expected to keep growing and provide significant chances for research and investment in a number of categories, including vitamins, minerals, probiotics, and herbal supplements.
The increased availability of biomedical data, particularly in the public domain, offers the opportunity to better understand human health and to develop effective therapeutics for a wide range of unmet medical needs. However, data scientists remain stymied by the fact that data remain hard to find and to productively reuse because data and their metadata i) are wholly inaccessible, ii) are in non-standard or incompatible representations, iii) do not conform to community standards, and iv) have unclear or highly restricted terms and conditions that preclude legitimate reuse. These limitations require a rethink on data can be made machine and AI-ready - the key motivation behind the FAIR Guiding Principles. Concurrently, while recent efforts have explored the use of deep learning to fuse disparate data into predictive models for a wide range of biomedical applications, these models often fail even when the correct answer is already known, and fail to explain individual predictions in terms that data scientists can appreciate. These limitations suggest that new methods to produce practical artificial intelligence are still needed.
In this talk, I will discuss our work in (1) building an integrative knowledge infrastructure to prepare FAIR and "AI-ready" data and services along with (2) neurosymbolic AI methods to improve the quality of predictions and to generate plausible explanations. Attention is given to standards, platforms, and methods to wrangle knowledge into simple, but effective semantic and latent representations, and to make these available into standards-compliant and discoverable interfaces that can be used in model building, validation, and explanation. Our work, and those of others in the field, creates a baseline for building trustworthy and easy to deploy AI models in biomedicine.
Bio
Dr. Michel Dumontier is the Distinguished Professor of Data Science at Maastricht University, founder and executive director of the Institute of Data Science, and co-founder of the FAIR (Findable, Accessible, Interoperable and Reusable) data principles. His research explores socio-technological approaches for responsible discovery science, which includes collaborative multi-modal knowledge graphs, privacy-preserving distributed data mining, and AI methods for drug discovery and personalized medicine. His work is supported through the Dutch National Research Agenda, the Netherlands Organisation for Scientific Research, Horizon Europe, the European Open Science Cloud, the US National Institutes of Health, and a Marie-Curie Innovative Training Network. He is the editor-in-chief for the journal Data Science and is internationally recognized for his contributions in bioinformatics, biomedical informatics, and semantic technologies including ontologies and linked data.
THE IMPORTANCE OF MARTIAN ATMOSPHERE SAMPLE RETURN.Sérgio Sacani
The return of a sample of near-surface atmosphere from Mars would facilitate answers to several first-order science questions surrounding the formation and evolution of the planet. One of the important aspects of terrestrial planet formation in general is the role that primary atmospheres played in influencing the chemistry and structure of the planets and their antecedents. Studies of the martian atmosphere can be used to investigate the role of a primary atmosphere in its history. Atmosphere samples would also inform our understanding of the near-surface chemistry of the planet, and ultimately the prospects for life. High-precision isotopic analyses of constituent gases are needed to address these questions, requiring that the analyses are made on returned samples rather than in situ.
A brief information about the SCOP protein database used in bioinformatics.
The Structural Classification of Proteins (SCOP) database is a comprehensive and authoritative resource for the structural and evolutionary relationships of proteins. It provides a detailed and curated classification of protein structures, grouping them into families, superfamilies, and folds based on their structural and sequence similarities.
Seminar of U.V. Spectroscopy by SAMIR PANDASAMIR PANDA
Spectroscopy is a branch of science dealing the study of interaction of electromagnetic radiation with matter.
Ultraviolet-visible spectroscopy refers to absorption spectroscopy or reflect spectroscopy in the UV-VIS spectral region.
Ultraviolet-visible spectroscopy is an analytical method that can measure the amount of light received by the analyte.
4. INTRODUCTION
MISCH ; 2nd edition
Dental implants require different biomechanical considerations from
natural teeth. Also, with one of the criteria for long-term implant success
being “occlusion,” it becomes imperative for the clinician to be well
versed with the different concepts when rehabilitating with an implant
prosthesis.
5. SIGNIFICANCE OF IMPLANT OCCLUSION
• Occlusal overload is one of the main causes of peri-implant
bone loss and implant prosthesis failure because it can cause
crestal bone loss, thus increasing the anaerobic sulcus depth
and peri-implant disease states.
MISCH ; 2nd edition
LOAD
6. OVERLOADING FACTORS
Overextended cantilever
>15mm in the mandible(Shackleton et al. 1994)
>10–12mm in the maxilla(Rangert et al. 1989; Taylor 1991)
Parafunctional habits/Heavy bite force
Excessive premature contacts
>100 mm in human(Falk et al. 1990)
Large occlusal table
Steep cusp inclination
Poor bone density/quality
Inadequate number of implants
Kim Y, Oh TJ, Misch CE, Wang HL. Occlusal considerations in implant therapy: clinical guidelines with biomechanical rationale.
Clinical oral implants research. 2005 Feb;16(1):26-35.
7. GOALS OF IMPLANT OCLUSION
Direct forces along long axis of implant.
Minimize lateral forces on implant
Distribute force over as many teeth and implants as possible.
Place lateral forces as far anterior as possible
MISCH ; 2nd edition
9. TOOTH IMPLANT
1. CONNECTION PDL Fibres Osseointegration
2.PROPRIOCEPTION Periodontal
mechanoreceptors
Osseoperception
3. TACTILE
SENSITIVITY
High Low
4. MOVEMENT
a)APICAL
b)LATERAL
25-100µm
56-108µm
3-5µm
10-50µm
6.MOVEMENT
PATTERN
Primary-immediate
Secondary-gradual
Gradual
7.FULCRUM TO
LATERAL FORCE
Apical third of root Crestal bone 9
MISCH ; 2nd edition
10. Evaluated occlusal awareness by perception of an interference and
reported –
when teeth oppose each other , interference is perceived at
approximately 20µm.
An implant opposing a natural tooth - 48µm
Opposing implant - 64µm
Tooth opposes implant overdenture - 108µm
Because of decreased occlusal awareness of dental implants , adaptive
responses like closure in a position other than centric occlusion is not
perceived.
Jacobs R, comparative evaluation of oral tactile function. Clin oral implant res 1991;2:75-80
11. R. Jacobs and D. van Steenberghe, Comparative evaluation of oral tactile function by means of teeth or implant
supported prostheses, Clin. Oral Impl. Res. 2 (1991), 75–80.
Average
100 micron
less than
50 micron for implants
BONE ACTUALLY
GOES ON THE
IMPLANTSURFACE
Periodontal ligament
12. FORCE
• A force applied to a dental implant is rarely directed absolutely
longitudinally along a single axis.
• A single occlusal contact most commonly result in a three-dimensional
occlusal force.
VECTOR RESOLUTION
12MISCH ; 2nd edition
14. The manner in which forces are applied to implant restorations
dictates the likelihood of system failure.
If a force is applied some distance away from an implant or
prosthesis, bending or torsional failure may result from
moment loads.
MOMENT LOAD
MISCH ; 2nd edition
15. The moment of a force about a
point tends to produce rotation or
bending about that point.
This imposed moment
load is also referred to as
a torque or torsional load
MISCH ; 2nd edition
16. 100 N
Moment Loads = force magnitude X moment arm
(perpendicular distance from the point of interest to
the line of action of the force)
16MISCH ; 2nd edition
23. Moment load
resulting in crestal
bone loss
Bone loss further
increases the
occlusal height
Increased occlusal
height increases
moment arm
Increased
mesiodistal and
faciolingual rotations
MISCH ; 2nd edition
25. IMPLANT PROTECTED OCCLUSION
By Dr Carl Misch and Dr . MW Bidez
Medially positioned lingualized occlusion
14 considerations for following IPO scheme.
MISCH ; 2nd edition
26. Occlusal considerations
No premature
occlusal contacts
or interferences
and Parafunction
Occlusal
table width
Influence of
surface area
Mutually
protected
articulation
Implant
body
0rientation
Crown cusp
angulation
Cantilevers
MISCH ; 2nd edition
28. PREMATURE
OCCLUSAL
CONTACT
Occlusal contacts that displaces a tooth, diverts the mandible from its
intended movement or displaces a removable denture from its basal seat
(GPT 9)
The surface area of a premature contact is small , the magnitude of
stress in the bone increases proportionately
MISCH ; 2nd edition
29. 100N
12 DEGRESS
AXIAL FORCE
100N X COS 12 = 97.81 N
LATERAL FORCES
100N X SIN 12 = 20.79N
TOTAL FORCE 118.60N
A 12 DEGREE ANGLED FORCE INCREASES THE FORCE TO THE IMPLANT SYSTEM BY 18.6%
30. Implant prosthesis should barely make contact and surrounding arch
should have initial contact.
occlusal contacts axial and of similar intensity on implant crown and
adjacent teeth under heavy force.
Regular evaluation of occlusal contacts to prevent stress related
complications
MISCH ; 2nd edition
31. SURFACE AREA
Adequate surface area sustain load transmitted to the
prosthesis
Wider implants
Increase the number of implant
Splinting of implants
MISCH ; 2nd edition
32. 32
LIMIT SHEAR
STRESSES ON BONE
ESPECIALLY IN
REGIONS OF
DECREASED BONE
DENSITY
USE OF WIDER
IMPLANTS
INCREASE THE AMOUNT OF
THE IMPLANT-BONE
INTERFACE PLACED UNDER
COMPRESSIVE LOADS
MISCH ; 2nd edition
33. Implant restorations splinting lead to the better distribution of stress causing lower
stress in implant body and bone in comparison with non splinted restorations,
especially when the load is applied on the off center of the implant body.
Angulations of the implant can reduce cantilever forces when the applied load is in
the same direction of implant angulation.
34. OCCLUSAL TABLE WIDTH
The width of occlusal table is directly related to width of implant
body.
Offset load
Increased risk of porcelain fracture
MISCH ; 2nd edition
35. 35MISCH ; 2nd edition
Wide occlusal tables increase the
moment arm for any offset occlusal
loads
Faciolingual tipping (rotation) can be
significantly reduced by narrowing the
occlusal tables and/or adjusting the
occlusion to provide more centric
contact.
36. MUTUALLY
PROTECTED
OCCLUSION
An occlusal scheme in which the
posterior teeth prevent excessive
contact of the anterior teeth in
maximum intercuspation and the
anterior teeth disengage the
posterior-teeth in all mandibular
excursive movements (GPT 9)
37. oAnterior guidance of implant prosthesis with anterior implant should
be shallow.
oForces are distributed to segments of jaws with an overall decrease in
force magnitude.
MISCH ; 2nd edition
38. IMPLANT BODY ORIENTATION
Implants are designed for long axis load.
Anisotropy is a character of bone where mechanical properties
depend on the direction in which bone is loaded.
Separation of the load to compressive, tension and shear
stresses.
MISCH ; 2nd edition
40. Strength of cortical load decreases with increasing angle of applied load
MISCH ; 2nd edition
41. Whenever lateral/angled cannot be eliminated:
increasing diameter of angled abutments
selecting implant design with greater surface area
additional implant next to most angled implants
splinting of implants
MISCH ; 2nd edition
42. CROWN CUSP ANGLE
Angle force influenced by cusp inclination
Central groove width increased 2-3mm in
posterior implant.
Opposing cusp recontoured
MISCH ; 2nd edition
43. CANTILEVERS
A cantilever considered a Class 1
lever
Force and length of cantilever are
directly proportional to force on
implant.
MISCH ; 2nd edition
44. 44
Force twice as great will be
applied to the farthest
abutment from the
cantilever.
The force on the cantilever
is a compressive force,
whereas the force to the
distal abutment is a tensile
force.
The load on the abutment
closest to the cantilever
(which acts as a fulcrum) is
the sum of the other two
components and is
compressive.
MISCH ; 2nd edition
48. Occlusal Contact Position
No buccal cusp contact or marginal ridge contact
Primary occlusal contact within diameter of implant within
central fossa.
Secondary occlusal contact within 1mm of periphery of implants
MISCH ; 2nd edition
49. IMPLANT CROWN CONTOUR
Due to ridge resorption,
the direction of the
remaining ridge shifts
lingually and implant body
is most often not under
buccal cusp tip position of
natural teeth.
MISCH ; 2nd edition
50.
51. Primary occlusal contacts should be
the central fossa
Maxillary implant opposing
mandibular natural teeth, the
mandibular buccal cusp acts as the
primary tooth contact.
Division A Bone
MISCH ; 2nd edition
52. maxillary natural tooth and mandibular
implant in division A bone , maxillary
lingual cusp primary contact
MISCH ; 2nd edition
53. Maxillary implant supported
prosthesis vs mandibular
implant supported prosthesis in
divison A bone, mandibular
buccal cusp maintains primary
occlusal contacts.
MISCH ; 2nd edition
54. Division B Bone
Implant position is lingual to natural tooth
Submandibular fossa
Angulated abutments
Crossbite
MISCH ; 2nd edition
55. Mandibular implants positioned under the lingual
cusp when compared with the original natural tooth
position.
Mandibular reduced buccal contours to avoid offset
occlusal contacts.
The primary contact of occlusion on an opposing
natural posterior maxillary tooth is the lingual cusp
MISCH ; 2nd edition
56. DIVISION C AND D BONE
Bone augmentation performed Division B
MISCH ; 2nd edition
57. DESIGN TO THE WEAKEST ARCH
Identifying the weakest link in the overall restoration
Establishing occlusal scheme to protect that component of
the structure I
MISCH ; 2nd edition
58. Most common implant treatment is maxillary denture opposing a
mandibular implant supported restoration.
Weakest area, premaxilla.
Elimination of anterior contact
MISCH ; 2nd edition
59. If the implants for both arches cannot be loaded in an axial position ,bone
density , implant surface area and the prosthesis type determine the area
to be protected
MISCH ; 2nd edition
60. The material selected affect the transmission of forces and the maintenance of
occlusal contacts.
Occlusal material fracture is the most common complications for restorations
on natural teeth or implants.
The three most common groups of occlusal materials are porcelain, acrylic and
metal.
OCCLUSAL MATERIALS
MISCH ; 2nd edition
61.
62. A stiff prosthesis is preferable over a flexible one in
the superstructure which is supported by
osseointegrated implants and will distribute loads
more effectively to the supporting abutments.
SKALAL
MISCH ; 2nd edition
63. TIMING OF OCCLUSAL CONTACTS
The initial difference in vertical
movement of teeth and implants in the
same arch – 28µm.
Initial occlusal contacts should
account for this difference or implants
will sustain greater loads
MISCH ; 2nd edition
64. Thin articulating paper used for the initial implant occlusal
adjustment in centric relation occlusion under a LIGHT
TAPPING FORCE.
Initial contact : axial contact on implants , adjacent teeth exihibit
greater contacts.
Heavy bite forces: equal forces on implant and adjacent teeth
MISCH ; 2nd edition
65. BASIC PRINCIPLES OF IMPLANT OCCLUSION
Bilateral stability in centric occlusion
No interferences between centric position and retruded position
Wide freedom in centric occlusion
Anterior guidance
Smooth lateral excursive movements without working/ non-working
interferences.
Kim Y, Oh TJ, Misch CE, Wang HL. Occlusal considerations in implant therapy: clinical guidelines with biomechanical rationale.
Clinical oral implants research. 2005 Feb;16(1):26-35.
68. Bilateral balanced occlusion with opposing complete
denture
Group function occlusion or mutually protected occlusion
with shallow anterior guidance when opposing natural
dentition
No working and balancing contact on cantilever
Infraocclusion in cantilever segment
Freedom in centric (1–1.5mm)
74. Anterior or lateral guidance with natural dentition
Light contact at heavy bite and no contact at light bite
Centered contacts (1–1.5mm flat area)
No offset contacts
Increased proximal contact
75. CONCLUSION
The objectives of implant protected occlusion are minimizing
overload on the bone–implant interface and implant prosthesis to
maintain implant load within the physiological limits of
individualized occlusion, and, finally, to provide long-term stability
of implants and implant prostheses
76. REFERENCES
1. Carl.E.Misch : Implant Dentistry, 2nd ed.,pp 609-629,1999
2. Hobo, Ichida, Garcia: Osseointegration and Occlusal Rehabilitation,1st ed.
pp.239-47,1988
3. Shantanu Jambhekar - Occlusion And Occlusal Considerations; IJDA, 2(1),
2010
4. Dhanasekar B-OCCLUSION IN IMPLANT DENTISTRY-ISSUES AND
CONSIDERATIONS; JOHCD May 2012;6(2)
5. MD Gross-Occlusion in implant dentistry. A review of the literature of
prosthetic determinants and current concepts; Australian Dental Journal
2008; 53:(1 Suppl): S60–S68
6. AKPINAR-A natural tooth’s stress distribution in occlusion with a dental
implant; Journal of Oral Rehabilitation 2000 27; 538–545
76
77. 7. Rosse Mary Falco Influence of Cusp Inclination on Stress Distribution in Implant-Supported
Prostheses. A Three-Dimensional Finite Element Analysis :J of prosth19 (2010) 381–386.
8. Lakshya Kumar -Osseoperception in Implants Supported Prosthesis - A Review ‘: Online J. Med.
Med. Sci. Res.
9. Judy Chia - Occlusion for implant-supported fixed dental prostheses in partially edentulous
patients: a literature review and current concepts:J Periodontal Implant Sci 2013;43:51-57
10. Carl E. Misch ,Hom-Lay - Occlusal considerations in implant therapy: clinical guidelines with
biomechanical rationale: Clin. Oral Impl. Res. 16, 2005; 26–35
77
SO SHORTER CANTILEVER LENGTH IS MORE FAVOURABLE . THIS I SHALL BE EXPLAINING IN DETAIL IN LATER PART OF MY SEMINAR.
th.ese all ARE probable cause of implant loss and marginal bone loss after loading.
So our main goal of implant occlusion are;
Almost all concepts of occlusion are based on those developed with natural dentition. The probable reason for this practise is the similarity (during mandibular movement) in the velocity , the pattern of movement and the operating muscles that are used by patients with implants and those with natural dentitions.
However, there are a few innate differences between natural teeth and implants,
Natural teeth are associated with high occlusal awareness (proprioception) of about 20 μm. However Occlusal proprioception is low in implants
The lack of proprioception and the absence of periodontal shock absorption are often associated with increased impact force with an implant-supported prosthesis than with a tooth-supported prosthesis.
The presence of periodontal ligament as a shock absorber in a natural tooth brings about an apical intrusion by about 28 μm and lateral movement by around 50-108 μm. In the case of a similar load acting on an implant, no initial movement is seen and the delayed apical movement observed is around 10-50 μm. The same can be attributed to the viscoelastic properties of bone
Another disadvantage of not having pdl is poor perception of interference as compared to tooth.
Which means there is a decresed occlusal awareness with implants and
meaning as a result of premature occlusal contact on teeth , mandible may close in a different position to avoid premature contact and result in an occlusion different from centric occlusion.
Normal tooth can absorb a force upto 100 micron as compared to less than 50 microns for implants becoz of the absence of pdl
Therefore implants are more “rigid” than teeth and consequently are more prone to failure ..
have mechanoreceptors to tune occlusal forces via the central nervous system . Feedback leads to a reduction of the occlusal forces (i.e., ending the chewing action),which prevents tooth failure. Such a safety mechanism is lacking with implants and occlusal forces can accumulate to the point of failure
NOW the force or load applied on the dental implant can be studied according to the direction of force. It may be directed absolutely along single axis of implant which is very rare. Or the force could be angulated which is the case with occulusal contact where it results into three dimensional occlusal force or vector resolution
The force can be applied along three axises that is Mesiodistal ,,, apicocoronal ,,,linguofacial
A total of six moments develop about the three clinical coordinate axis
From here to here is the moment arm and here is the force applied. Moment equals force into moment arm so the prosthesis has the tendency to rotate in this direction.
MOMENT LOADS TEND TO INDUCE ROTATIONS IN THREE PLANES . CLOCKWISE AND COUNTERCLOCKWISE ROTATIONS IN THESE PLANES RESULT IN SIX MOMENTS
Such moment loads induce microrotations and stress concentrations at the crest of the alveolar ridge of the implant-to-tissue interface, which leads to crestal bone loss.
Occlusal height serves as moment arm for force components directed along faciolingual axis .
and along mesiodistal axis.
Moment of a force along the vertical axis is not affected by the occlusal height because there is no effective moment arm.
These are THE CONSEQUENSES OF OVERLOAD ON IMPLANT WHICH ULTIMATELY LEADS TO IMPLANT FAILURE. SO THAT’S Y , EVEN AFTER A PROPER DIAGNOSIS, TREATMENT PLANNING AND SURGERY, THE PROSTHETIC CONSIDERATION /OCCLUSAL CONSIDERATION IS IMPORTANT.
THE DIFFERENCES BETWEEN NATURAL TEETH AND IMPLANTS LEAD TO ESTABLISHMENT OF IMPLANT PROTECTED OCCLUSIONN
As it stems from the change in relation of edentulous maxillary ridge to mandibular ridge due to resorption in a medial direction.
Mandible always searches for path having no interferences so premature contacts diverts the mandible from its normal path. As we know that pressure or stress = force by area so as the surface area of premature contact is small, so stress increases proportionately. Premature contact occurs on cuspal inclines so these stress divide into a horizontal component and increasing compressive and tensile stress.
Premature contact occurs on cuspal inclines so these stress divide into a horizontal component and increases compressive and tensile stress. So A 12 DEGREE ANGLED FORCE INCREASES THE FORCE TO THE IMPLANT SYSTEM BY 18.6%
to correct premature contacts. Using articulating paper. First we will go with initial light contact where the implant prosthesis barely makes contact then we go for heavy occlusal forces in which both the implant and crown share similar intensity because Natural tooth exhibits greater vertical movement than implants. Heavy occlusal loads position the natural teeth closer to depressed position of implant, permitting equal sharing of loads between implants and natural teeth.
As we know Stress= force/area, when we increase the area the stress is decreased.
So adequate surface area sustain load transmitted to the prosthesis
How can we increase the surface area ?? By placing wider implants, increasing the number of implants.
as we increase the number of implants the stress is distributed and less force is trasmited to the transosteal region as seen in this picture.
Splinting the implants further add to the retention and resistance by reducing the horizontal force transmitted to the bone and prevention of screw loosening in abutment.
A restoration mimicking the occlusal anatomy of natural teeth often results in offset load, increased stress and Increased risk of porcelain fracture. So in nonesthetic region width of occlusal table must be reduced in comparison to natural tooth.
Next is mutually protected occlusion
Because steeper anterior guidance result in greater are forces on anterior implants. Rationale of mutually protected occlusion is that the forces are distributed to segments of jaws with an overall decrease in force magnitude. In cases where we have to increase the anterior guidance to disclude the posteriors then we use two or more implants splinted together.
Whether occlusal load is applied to angled implant body or an angled load is applied to an implant body perpendicular to occlusal plane, the biomechanical risk increases.
This is attributed to anisotropic nature of bone, resulting in separation of load to compressive, shear and tensile stresses. Anisotropy refers to character of bone whereby mechanical properties depend on the direction in which bone is loaded. the greater the angle of load, greater is shear component of the load.
Cortical bone is strongest and most able to withstand compressive forces. Its ability to withstand tensile and shear forces is 30% and 65% less, respectively, than its ability to withstand compressive forces as seem in this bar diagram.
Strength of cortical load decreases with increasing angle of applied load. According to this table when a force at a 30 degree angle decreases the bone strength limit by 10% under compression and by 25% under tention and same goes for 60 degree angle. So increase in shear stresses causes increased crestal bone losses and impairs successful bone growth.
Whenever lateral/angled loads cannot be eliminated, a reduction in force magnitude or additional surface area of implant surface is indicated to reduce the risk of bone loss or of implant component fracture. So these measure include…
force angulation to implant is body influenced by cusp inclination which inturn will increase crestal bone stress. So to decrease effect of these forces, the occlusal contact on implant crown should be on flat surface perpendicular to implant body. Increasing width of central groove to 2-3 mm in posterior crown which are positioned over center of implant abutment. Opposing cusp recontoured to occlude in central fossa over implant body.
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When a force is applied to the cantilever, a force twice as great will be applied to the farthest abutment from the cantilever. That is this one.The force on the cantilever is a compressive force, whereas the force to the distal abutment is a tensile force. that is this one. The load on the abutment closest to the cantilever (which acts as a fulcrum) is the sum of the other two components and is compressive. That is this one.
LINGUAL FORCE COMPONENT ALSO INDUCE TWISTING MOMENT ABOUT IMPLANT NECK IF APPLIED THROUGH THE CANTILEVER LENGTH
For a system with 4-6 implants, the following cantilever lengtha are recommended.
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An increased crown height acts as a vertical cantilever, magnifying stress at implant bone interface. It also leads to angled load with a greater lateral component of force.
How it does that I have explained ealier.
Ideal occlusal contact should be over implant body. This contacts should lead to axial loading of implants. A posterior implant hence is placed under central fossa of implant. A buccal cusp contact or marginal ridge contact is an offset or cantilever load as these are several milimeter away from implant body. Also the marginal ridge contacts are more damaging than buccal contact as mesiodistal dimension of crowns is more than buccolingual dimention. Thus ideally primary occlusal contact should reside within diameter of implant within central fossa. The secondary contact should be within 1mm of periphery of implants to decrease moments load.
In fact it is under or near central fossa or more lingual under lingual cusp of natural tooth depending on resulting position of remaining ridge due to resorption.
So what are the types of resorbed ridges.
Bone height, length, direction of load,
divison a : posterior mandible and anterior maxilla
Lingual cusp of maxillary crown placed out of occlusal contact to eliminate offset loads.
Maxillary buccal cusps maintain esthetics where required and prevent cheek bite.
Mandibular lingual cusps out of occlusal contacts and width of lingual cusps prevents tongue entrapment between occlusal surfaces. Mandibular buccal cusps reduced in height ( to reduce offset load ) and width ( to prevent cheek entrapement)
When axial loading of both arches is not possible it is recommended to favour weaker arches that is maxilla. Widened central fossa of maxillary implant to receive primary contact. Maxillary buccal cusp maintain esthetics and prevent cheek bite and lingual cusp is out of contact and reduced width.
Lingual cusp of mandibular implant crown placed out of occlusal contact to eliminate offset loads.
In division b bone, implant position is often lingual to natural tooth. In cases of mandibular posterior implants limitation is imposed by submandibular fossae. In case of excessive medial positioning of the implant, it may be necessary to use angulated abutment and a straight lingual profile. Maxillary posterior implants in division b bone may require restoration in crossbites, primary occlusal contact over implant, maxillary lingual ovejet prevents tongue bite and mandibular buccal overjet prevents cheek bite.
IN Case of division c and d bone , all attempts must be made to perform a bone augmentation procedure and create a condition as close as possible to division b bone.
All treatment planning decisions for ipo should be based on carefull consideration of
The amount of force distributed to a system can be reduced by stress relieving components that may dramatically reduce the impact loads to implant support.
In this cases the weakest area is the premaxilla. So we eliminate the anterior contact.
1.MOST ESTHETIC IS PORCELAIN BUT PORCELAINE FRACTURE IS SECOND MOST COMMON CAUSE OF PROSTHETIC FAILURE
2.IMPACT LOAD IS INCREASED FORCE PRIMARILY DUE TO SPEED OF CLOSURE AND DAMPENING EFFECT OF OCCLUSAL forces.
IMPACT LOAD IS LOWEST FOR ACRYLIC, INCREASES WITH COMPOSITE AND METAL OCCLUSALS INCREASE EVEN MORE WITH ENAMELAND INCREASE EVEN MORE WITH PORCELAIN.
3.CHEWING EFFICIENCY OF ACRYLIC IS LOWER THAN PORCELAIN OR METAL BUT THERE IS NO DIFFERENCE IN GOLD AND PORCELAIN.
4.ACRYLIC WEARS 7-30 TIMES FASTER WHEN OPPOSING GOLD, RESIN, ENAMEL OR PORCELAIN, GOLD OCCLUSAL SURFACE WEAR LESS WITH ANY OTHER COMBINATION OF MATERIALS.. PORCELAIN OPPOSING PORCELAIN WEAR MORE THAN PORCELAIN OPPOSING GOLD OR METAL.COMPOSITE RESIN IS THREE TIMES STRONGER THAN ACRYLIC.
5.Material fracture is one of the most common factors that leads to refabrication of a prosthesis.Composite resin is 3 times stronger than acrylic. Metal occlusals do not easily fracture, provide good wear porcelain. Porcelaine fracture is most common condition and ideal thickness of porcelain to prevent breakage is approximately 2mm.
6.Metal shrinkage is 10 times less than porcelain or acrylic and therefore permits fabrication of more passive casting. Accuracy of casting is paramount in screw retained prosthesis , occlusal material make a significant difference.
7.Acrylic restorations receive their strength from bulk and so require greater interarch space. Metal occlusals require the least amount of space.
So overall metal is an excellent occlusal material with improved properties in accuracy,wear, fracture resistance, abutment retention, and good qualities for impact or static force. and Esthetic is best satisfied with porcelain.
The implant prosthesis should barely contact, and the adjacent teeth should exhibit greater initial contacts. Only axial occlusal contacts should be present on the implant crown
, a heavy bite force depresses the natural teeth, positioning them closer to the depressed implant position and equally sharing the load.
So ingeneral these are the basic principles that should be taken care to maintain implant occlusion.Stabilize masticatory system,Proper force distribution., Reduce possibilities of premature contact.
Wide freedom in centric accomplish more favourable vertical lines of force and thus minimize the premature contact during function.
Anterior or canine guidance to potentially decrease the destructive forces in posterior implants.
Smooth and even lateral working contacts without cantilever contacts in posterior region preferred to provide proper force distribution.
The inflraocclusion on cantilever unit was suggested to reduce fatigue and technical failure of prosthesis.
Anterior guidance in excursions and initial occlusal contacts on natural dentition will reduce lateral force on implants.
Group function occlusion utilized when anterior teeth are periodontally compromised.
Reduced inclination of cusps, centrally oriented contacts with a 1-1.5mm flat area, a narrowed occlusal table and elimination of cantilvers controls the bend overload in posterior restoration.
THE OCCLUSION IN SINGLE IMPLANT SHOULD BE DESIGNED TO MINIMIZE OCCLUSAL FORCE ONTO THE IMPLANT AND TO MAXIMIZE FORCE DISTRIBUTION TO ADJACENT NATURAL TEETH.
TO DISTRIBUTE OCCLUSAL FORCES ON TEETH AND IMPLANTS.
LIKE THE POSTERIOR FIXED PROSTHESIS Reduced inclination of cusps, centrally oriented contacts with a 1-1.5mm flat area, a narrowed occlusal table IS UTILIZED FOR POSTERIOR SINGLE TOOTH IMPLANT RESTORATION.
INCREASED PROXIMAL CONTACTS IN THE POSTERIOR REGION MAY PROVIDE ADDITIONAL STABILITY OF RESTORATIONS.