1. “Tooth & implant Supported Fixed
Dental Prostheses”
Mohammad Eissa
“Ahmadi”
Supervised by : Prof.Dr.Hassina “Shadab”
Occlusal & prosthetic
therapy
2. Content
Clinical symptoms
of Trauma From
Occlusion
Pathologic tooth
mobility
Treatment of
increased tooth
mobility
Cantilever
Occlusal
overload
Presentation Title
“Tooth & implant Supported Fixed 2
"Supported
Fixed Dental Prostheses”
Toot
h
implan
t
&
3. Clinical
symptoms of
Trauma From
Occlusion
Angular bony defects
• angular bony defects and increased tooth mobility
are important symptoms of trauma from occlusion
Increased tooth mobility
Amplitude of displacement of the crown of the tooth.
• Reduction of the height of the alveolar bone with or
without an accompanying angular bony defect
caused by plaque‐associated periodontal disease
• occlusal interferences
Progressive (increasing) tooth mobility
• series of repeated tooth mobility measurements
carried out over a period of several days or
weeks
3
7. CLASSIFICATION OF TOOTH MOBILITY
“Tooth & implant Supported Fixed
0:clinical mobility with norma range
{-}:clinical mobility slightly more
than physiologic but less than 1mm buccolingually
1:clinical mobility 2mm buccolingually but with no mobility in apical
direction
Class 1 : mobility less than 1mm
Class 2 : mobility within 1-2mm
Class 3 : mobility greater than 2mm
3:clinical mobility greater than 2mm buccolingually in addition to mobility
in an apical direction
SCHLUGER :
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8. CLINICAL IMPACTION OF TOOTH
MOBILITY
Various degrees of
gingival
inflammation
Loss of
attachment with
pocketing
Gingival
recession
Tooth with
furcation
involvement
“Tooth & implant Supported Fixed
SIGNS & SYMPTOMS (Patient awareness of mobility + Functional discomfort + Aesthetics) +
RADIOGRAPHIC CHANGES
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9. Treatment of increased tooth mobility
Situation
1
Situation
2
Situation
3
Situation
4
Situation
5
Conclusio
n
Reference
Increased mobility of
tooth with increased width of
periodontal ligament but normal
height of alveolar bone
Increased mobility of tooth with increased width of periodontal ligament
&reduced width of alveolar bone
Increased mobility of a tooth with reduced height of
alveolar bone & normal width of periodontal ligament
Progressive{increasing}mobility of a tooth/teeth as a result of
gradually increasing width of reduced periodontal ligament
Increased bridge mobility despite splinting
CROSS-ARCHSPLINT
FIXED SPLINT
SPLINT
occlusal
adjustment
eliminating excessive forces
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11. Implant protected
occlusion
Implant protected occlusion is achieved
when the occlusion on the implant
restoration provides only a very light drag or
resistance to shim-stock in maximum
intercuspation with a clenching force
applied
“Tooth & implant Supported Fixed
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12. 1. Treatment plan
2. Passive fit
3. Occlusion
“Tooth & implant Supported Fixed
What are the differences between
tooth & implant prosthesis
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13. Occlusal
overload
Influence of occlusal overload in
implant
1. Disturb osseointegration in healing
period
2. Influence the coronal bone loss
surrounding implant
3. De – osseointegration of Osseo
integrated implant
“Tooth & implant Supported Fixed 13
15. Table 1. Comparison between tooth and
implant
Tooth Implant
Connection Periodontal ligament (PDL) Osseointegration (Branemark et al. 1977), functional
ankylosis (Schroeder et al. 1976)
Proprioception Periodontal mechanoreceptors Osseo perception
Tactile sensitivity (Mericske-Stern
et al. 1995)
High Low
Axial mobility
(Sekine et al. 1986; Schulte 1995)
25–100 mm 3–5 mm
Movement phases
(Sekine et al. 1986)
Two phases
Primary: non-linear and complex
Secondary: linear and elastic
One phase
Linear and elastic
Movement patterns
(Schulte 1995)
Primary: immediate movement
Secondary: gradual movement
Gradual movement
Fulcrum to lateral force Apical third of root (Parfitt 1960) Crestal bone (Sekine et al. 1986)
Load-bearing characteristics Shock absorbing function
Stress distribution
Stress concentration at crestal bone (Sekine et al.
1986)
Signs of overloading PDL thickening, mobility,
wear facets, fremitus, pain
Screw loosening or fracture, abutment or prosthesis
fracture, bone loss, implant fracture (Zarb & Schmitt
1990)
17. Occlusal over
load
Reduced the lateral
components of force
Splinting among
implants
Deformation of
retaining screw
“Tooth & implant Supported Fixed
Force distribution with implant concerning with torque.
By Weinberg 1993 IJOMI
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18. Occlusal over
load
Control the force & moment on
implant
1. Axis of implant to the load
2. Cantilever
3. Fixture – restoration ratio
4. Effect of tripodism
By ranger 1989.91.97 JOMI
19. Lateral overload vs vertical overload
S
E
L
E
C
T
E
D
W
O
R
K
V E R T I C A L O V E R L O A D ( = A X I A L L O A D I N G )
L AT E R A L O V E R L O A D ( = N O N A X I A L L O A D I N G )
20.
21. I s i d o r F.
los s of os s eointegr ation c aus ed by oc c lus al load of or al
implant
c l i n i c a l o r a l i m p l a n t R e s e a r c h 1 9 9 6
• S e t o f i m p l a n t s p l a c e d b i l a t e r a l l y i n 4 m o n k e y ( M a c a c a
f a s c i c u l a r i s )
• 6 m o n t h h e a l i n g p e r i o d f o r o s s e o i n t e g r a t i o n
• P r o d u c e t h e o v e r l o a d u s i n g l a t e r a l e x t e n s i o n o f
p r o s t h e s i s
• R a t h e r t h a n v e r t i c a l e x c e s s i v e l o a d
• B o n e l o s s b y r a d i o g r a p h i c e x a m a t t a c h m e n t l o s s b y
p r o b i n g
• 4 . 5 - 1 5 . 5 m o n t h l o a d i n g t i m e
22. Does non axial loading destroy the
osseointegration
Isidor 1996
Monkey ,off set load
“Tooth & implant Supported Fixed
Celleti 1995
Pre angled abutment
Asikainen 1997
Sleep, lateral force
Miyata 1998,2000
Monkey ,excessive controlled vertical force
Gotfredsen 2001,2002
Rabbit ,static overload
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23. Axis of implant to the
load
“Tooth & implant Supported Fixed
1. None axial / off axis loading is harmful .
2. Reduced the area of occlusal table .?
3. Control the horizontal force using cusp
inclination
Same as teeth
Cantilever loading is
harmful
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24. What we can do for implant occlusion
o Provide even bilateral contacts in centric position
o Prepare the mutually protective occlusion ,if possible
o Reduce the occlusal contacts in cantilever area
o Avoid or reduced the occlusal contacts in excursive movements.
“Tooth & implant Supported Fixed
Dawson P . Textbook 2016
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