SlideShare a Scribd company logo
1 of 50
Download to read offline
Prosthetic options in implant dentistry Bibinbhaskaran
Index  Introduction. Treatment options. Treatment planning for implant supported prosthesis. Classification of prosthesis movts. Completely edentulous prosthesis design.
Index  Advantages of removable implant supported prosthesis in completely edentulous patient. Partially edentulous design. Advantages of implant supported FPD. Guidelines for joining tooth with implant. Prosthetic options. Summary.
Introduction  Goals of implant dentistry-replace pts missing teeth to normal contour, comfort,function,esthetics,speech and health. Final restoration – not implants. In stress Rx theorem final restoration first planned-after abutments designed.
Traditional Treatment Options Removable partial dentures. Fixed partial dentures. Complete dentures.
Treatment planning for implant supported prosthesis Designing the prosthesis [to satisfy patients needs and desire]. Individual areas of abutment support are determined. Bone in that area is evaluated for type of implant
Classification of prosthesis movement Classification of prosthesis movement :- PM-O PM-2 PM-3 PM-4 PM-6
Classification of prosthesis movement PM-0 – prosthesis rigid – no movt (implant support similar to FPD). 0-ring attachments  (6 directions). 4 0-rings placed on complete arch and prosthesis rests on the bar- PM-0.
PM-2 – prosthesis with hinge motion (2 planes). Hinge attachment (Dolder bar without a spacer or Hader bar and clip).
Classification of prosthesis movement PM-3 – prosthesis with an apical and hinge motion. Dolder bar with spacer and clip.
PM-4 – movts in 4 directions. Rarely used in O.D. Magnets are used.(no lateral force).
PM-6 – all ranges of prosthesis movt. O-ring attachment or extra coronal resilient attachment (ERA). Implants independent of each other.(no bar)
Completely edentulous prosthesis design Pts desires-fixed or removable. To assess ideal final prosthetic design-existing anatomy evaluated. An axiom of implant Rx is to provide ,most cost effective Rx that will satisfy pts anatomical needs and personal desires. In completely edentulous pt a removable implant supported prosthesis offers several advantages over a fixed implant restoration.
Completely edentulous prosthesis design However some completely edentulous patients require a fixed restoration because of their desire or because their oral condition makes fabrication of teeth difficult if a super structure and removable prostheses are planned.  For eg when pt has abundant bone-implants already placed-lack of crown height space-removable prosthesis. Too often Rx plans for completely edentulous pts-max denture and mand over denture with 2 implants.
Completely edentulous prosthesis design Long term-disservice to pt-parasthesia, facial changes and reduced posterior occlusion on max prosthesis are to be expected. Important to visualize the final restoration at the onset with a fixed implant restoration. Individual areas of ideal or key abutment determined.
Completely edentulous prosthesis design Pts force factors and bone density in region of implant support are evaluated. Only then available bone is evaluated to assess whether it is possible to place implants to support the intended prosthesis. In inadequate natural or implant abutment  situations-oral conditions altered-augmentation.
Completely edentulous prosthesis design A fixed implant restoration-partially or completely edentulous pt.  Fixed lasts longer.(acrylic teeth wear,attachments replacement-removable prosthesis). No food entrapment.
Advantages of removable implant-supported prostheses in completely edentulous patient Facial esthetics enhanced with labial flanges. Prosthesis – removed at night - nocturnal parafunction. Fewer implants.
Advantages of removable implant-supported prostheses in completely edentulous patient Less bone augmentation-before implant insertion. Shorter RX-no bone augmentation. Less expensive. Daily home care is easier.
Partially edentulous design A common axiom-FPD. Fewer natural teeth missing-better indication for FPD. Ideally FPD-completely implant supported. Added implants-fewer pontics-less stress.
Advantages of implant supported FPD When Compared conventional tooth supported FPD Im FPD has – No caries. No endodontic problems.  No retention failure. No periodontal breakdown. Easier to clean.
Guidelines for joining implant with tooth No clinically observed mobility of the natural tooth. Use of rigid connectors. Less lateral forces to the prosthesis [occlusion]. Rarely connect to anterior tooth.
Prosthetic options Misch-1989. FP-1 FP-2 FP-3 RP-4 RP-5
FP-1 Anatomical crowns. Minimal loss. Root of natural tooth.
FP-1 Max anterior region. FP-1 restoration-crown –natural tooth. Width or height – augmentation. Soft tissue augmentation – black     .
FP-1 Restorative material-porcelain to noble metal. A single tooth FP crown-Al2O3 or ceramic. Fracture in latter.
FP-2 Anatomical crown and portion of root. Bone more apical (1-2mm). Incisal edge correct-gingival 3rd overextended.
FP-2 Prosthetic teeth – longer. Multiple FP-2 – no specific implant position. Implant position – width, angulation, hygiene.
FP-2 Embrassure b/w teeth – mand ant teeth. Material of choice – precious metal to porcelain.
FP-2 Contour of metal different – FP-1. Unsupported porcelain in final prosthesis.
FP-3 Missing crowns and gingival color and portion of edentulous site. Dec bone height – resorption. Unnatural long teeth – esthetics,function,support.
FP-3 Pt – high max lip line – smiling. Low lip line – speech.
FP-3 Ideal high smile line-interdental papilla of max ant teeth-not soft tissue-mid cervical regions. Complain-display of longer teeth. Gingival color of FP-3-esthetic. Gingival acrylic-multiple abutments-bone loss.
FP-3 2 basic approaches-FP-3. Hybrid restoration-denture teeth & metal. Porcelain metal restoration.
FP-3 Restorative material-amt of crown height space. An FP-3 porcelain to metal-difficult-FP-2. Pink porcelain-more baking-risk of porosity.
FP-3 Alternative-PFM-hybrid restoration. Highly esthetic-denture teeth & acrylic soft tissue.
FP-3 Crown height space for hybrid prosthesis versus PFM – 15mm from bone to occlusal plane. FP-2 or FP-3 prosthesis-high lip lines-implant abutments.
FP-3 Greater crown height-force-implant cervical regions. Additional implant abutments or shorter cantilever lengths. In max arch open embrassures-food impaction. Mand restoration-above tissue-sanitary pontic.
Cement Vs Screw retained Cement retained Passive castings. Enhanced esthetics. Improved direction of loading. Reduced crestal bone loss. Improved access. Reduced complications,cost, time.  Screw retained Retrievability. No cement in the sulcus. Low profile retention. Possible with limited inter-arch space .
RP-4 Removable prosthesis-implants. Restoration rigid when inserted. Overdenture attachments-tissue bar or super structure that splints the abutments.
RP-4 5 -6 implants-mand & 6-8-max – implant supported. Implant criteria-RP-4-different-Fixed prosthesis. Denture teeth & more acrylic-removable restoration.
RP-4 Super structure and O.D attachments-abutments. Lingual and apical implant placement-FP. Implants for RP-4 and an FP-2 or FP-3 – mesiodistal.  Occasionally attachment-6mm spacing b/w implants.
RP-4 Reduce No of implants-mental foramina. RP-4 same – FP-1,FP-2 or FP-3 restoration. PFM prosthesis Cattachments-abutments-esthetics. O.D attachments-oral hygiene-nocturnal bruxism. Hader bar with PM-0.
RP-5 Removable prosthesis-implant & soft tissue.
Completely edentulous mand O.D may have :- 2 ant implants independent. Splinted implants in canine. 3 splinted implants in P.M and central incissor. Implants splinted with a cantilevered bar. Advantage :-  reduced cost.
RP-5 Preimplant denture :- esthetics. Guide. Healing stage. Converted - RP-4 or RP-5. Bone resorption – soft tissue borne areas. Relines and occlusal adjustments. Bone resorption – 2 – 3times faster – RP-5.
Fp-3 Fp-3
Summary  Benefits of implant dentistry realized-prosthesis. 5-prosthetic options available. Amt of support required initially designed. Once prosthesis designed-implant Rx established.
Prosthetic options in implant dentistry

More Related Content

What's hot

Implant prosthetic dentistry
Implant prosthetic dentistryImplant prosthetic dentistry
Implant prosthetic dentistryRuhi Kashmiri
 
TOOTH SUPPORTED OVERDENTURE
TOOTH SUPPORTED OVERDENTURETOOTH SUPPORTED OVERDENTURE
TOOTH SUPPORTED OVERDENTUREshari kurup
 
Impression techniques in implants
Impression techniques in implantsImpression techniques in implants
Impression techniques in implantsMohammad Algraisi
 
dental implant impression technique
dental implant impression technique dental implant impression technique
dental implant impression technique Sara Zaky
 
Implant supported overdenture
Implant supported overdentureImplant supported overdenture
Implant supported overdentureJISSA SUNNY
 
prosthetic options in implant
prosthetic options in implantprosthetic options in implant
prosthetic options in implantNishu Priya
 
support for distal extension partial denture
support for distal extension partial denture support for distal extension partial denture
support for distal extension partial denture Anil Goud
 
Immediate dentures
Immediate denturesImmediate dentures
Immediate denturesKelly Norton
 
Provisional restoration
Provisional restorationProvisional restoration
Provisional restorationSk Aziz Ikbal
 
Impression techniques
Impression techniquesImpression techniques
Impression techniquesAamir Godil
 
Precision attachments
Precision attachmentsPrecision attachments
Precision attachmentsAmit Bhargav
 
FULL MOUTH REHABILITATION
FULL MOUTH REHABILITATIONFULL MOUTH REHABILITATION
FULL MOUTH REHABILITATIONILA YADAV
 
Immediate denture
Immediate dentureImmediate denture
Immediate denturesundas alam
 
Full Mouth Rehabilitation
Full Mouth RehabilitationFull Mouth Rehabilitation
Full Mouth RehabilitationSelf employed
 
Preventive prosthodontics
Preventive prosthodonticsPreventive prosthodontics
Preventive prosthodontics04842698028
 
Implants the future of prosthodontics
Implants the future of prosthodonticsImplants the future of prosthodontics
Implants the future of prosthodonticsPriyank Pareek
 

What's hot (20)

Implant prosthetic dentistry
Implant prosthetic dentistryImplant prosthetic dentistry
Implant prosthetic dentistry
 
TOOTH SUPPORTED OVERDENTURE
TOOTH SUPPORTED OVERDENTURETOOTH SUPPORTED OVERDENTURE
TOOTH SUPPORTED OVERDENTURE
 
Impression techniques in implants
Impression techniques in implantsImpression techniques in implants
Impression techniques in implants
 
dental implant impression technique
dental implant impression technique dental implant impression technique
dental implant impression technique
 
Implant supported overdenture
Implant supported overdentureImplant supported overdenture
Implant supported overdenture
 
Implant loading
Implant loading  Implant loading
Implant loading
 
prosthetic options in implant
prosthetic options in implantprosthetic options in implant
prosthetic options in implant
 
12.surveyed crowns and combined fixed rpd cases
12.surveyed crowns and combined fixed rpd cases12.surveyed crowns and combined fixed rpd cases
12.surveyed crowns and combined fixed rpd cases
 
support for distal extension partial denture
support for distal extension partial denture support for distal extension partial denture
support for distal extension partial denture
 
Immediate dentures
Immediate denturesImmediate dentures
Immediate dentures
 
Provisional restoration
Provisional restorationProvisional restoration
Provisional restoration
 
Impression techniques
Impression techniquesImpression techniques
Impression techniques
 
Precision attachments
Precision attachmentsPrecision attachments
Precision attachments
 
FULL MOUTH REHABILITATION
FULL MOUTH REHABILITATIONFULL MOUTH REHABILITATION
FULL MOUTH REHABILITATION
 
Immediate denture
Immediate dentureImmediate denture
Immediate denture
 
Full Mouth Rehabilitation
Full Mouth RehabilitationFull Mouth Rehabilitation
Full Mouth Rehabilitation
 
stress breakers in prosthodontics
stress breakers in prosthodonticsstress breakers in prosthodontics
stress breakers in prosthodontics
 
Implant failure
Implant failureImplant failure
Implant failure
 
Preventive prosthodontics
Preventive prosthodonticsPreventive prosthodontics
Preventive prosthodontics
 
Implants the future of prosthodontics
Implants the future of prosthodonticsImplants the future of prosthodontics
Implants the future of prosthodontics
 

Viewers also liked

Implant prosthetic considerations
Implant   prosthetic considerationsImplant   prosthetic considerations
Implant prosthetic considerationsNitika Jain
 
types and classification of dental implants
types and classification of dental implantstypes and classification of dental implants
types and classification of dental implantsDesa Ghanavi
 
Dental implant
Dental implantDental implant
Dental implantdukeheart
 
Dental Implants surgical considerations / implant dentistry course/ implant d...
Dental Implants surgical considerations / implant dentistry course/ implant d...Dental Implants surgical considerations / implant dentistry course/ implant d...
Dental Implants surgical considerations / implant dentistry course/ implant d...Indian dental academy
 
Dental implant biomechanics, treatment planing, and prosthetic considerations
 Dental implant biomechanics, treatment planing, and prosthetic considerations Dental implant biomechanics, treatment planing, and prosthetic considerations
Dental implant biomechanics, treatment planing, and prosthetic considerationsPalm Immsombatti
 

Viewers also liked (8)

Implant prosthetic considerations
Implant   prosthetic considerationsImplant   prosthetic considerations
Implant prosthetic considerations
 
Dental implants
Dental implantsDental implants
Dental implants
 
types and classification of dental implants
types and classification of dental implantstypes and classification of dental implants
types and classification of dental implants
 
Dental implant
Dental implantDental implant
Dental implant
 
Dental Implants surgical considerations / implant dentistry course/ implant d...
Dental Implants surgical considerations / implant dentistry course/ implant d...Dental Implants surgical considerations / implant dentistry course/ implant d...
Dental Implants surgical considerations / implant dentistry course/ implant d...
 
Implant
ImplantImplant
Implant
 
Dental implants
Dental implants Dental implants
Dental implants
 
Dental implant biomechanics, treatment planing, and prosthetic considerations
 Dental implant biomechanics, treatment planing, and prosthetic considerations Dental implant biomechanics, treatment planing, and prosthetic considerations
Dental implant biomechanics, treatment planing, and prosthetic considerations
 

Similar to Prosthetic options in implant dentistry

PROSTHETIC OPTIONS IN IMPLANTS (2).ppt
PROSTHETIC OPTIONS IN IMPLANTS (2).pptPROSTHETIC OPTIONS IN IMPLANTS (2).ppt
PROSTHETIC OPTIONS IN IMPLANTS (2).pptnehasrivastava643617
 
Treatment planning and diagnosis for fpd / oral surgery courses
Treatment planning and diagnosis for fpd / oral surgery courses  Treatment planning and diagnosis for fpd / oral surgery courses
Treatment planning and diagnosis for fpd / oral surgery courses Indian dental academy
 
Missing Central Incisor Treatment Options
Missing Central Incisor Treatment OptionsMissing Central Incisor Treatment Options
Missing Central Incisor Treatment OptionsDr. Nikita Aggarwal
 
TREATMENT PLANNING IN FIXED PROSTHODONTICS-Dr MEENU MERRY C PAUL
TREATMENT PLANNING IN FIXED PROSTHODONTICS-Dr MEENU MERRY C PAULTREATMENT PLANNING IN FIXED PROSTHODONTICS-Dr MEENU MERRY C PAUL
TREATMENT PLANNING IN FIXED PROSTHODONTICS-Dr MEENU MERRY C PAULMeenuMerryCPaul
 
Removable partial denture theory and practice 2011
Removable partial denture  theory and practice 2011Removable partial denture  theory and practice 2011
Removable partial denture theory and practice 2011Mostafa Fayad
 
abutment selection in fixed partial denture.pptx
abutment selection in fixed partial denture.pptxabutment selection in fixed partial denture.pptx
abutment selection in fixed partial denture.pptxRajSalvi5
 
Indications contraindications and classification of bridges/endodontic courses
Indications contraindications and classification of bridges/endodontic coursesIndications contraindications and classification of bridges/endodontic courses
Indications contraindications and classification of bridges/endodontic coursesIndian dental academy
 
Implants in oral and maxillo facial surgery /certified fixed orthodontic cou...
Implants in oral and maxillo facial surgery  /certified fixed orthodontic cou...Implants in oral and maxillo facial surgery  /certified fixed orthodontic cou...
Implants in oral and maxillo facial surgery /certified fixed orthodontic cou...Indian dental academy
 
Treatment plan and biological consideration of implants
Treatment plan and biological consideration of implantsTreatment plan and biological consideration of implants
Treatment plan and biological consideration of implantsDiana Abo el Ola
 
Abutment evaluation /Fixed orthodontics teaching
Abutment evaluation /Fixed orthodontics teachingAbutment evaluation /Fixed orthodontics teaching
Abutment evaluation /Fixed orthodontics teachingIndian dental academy
 
Fpdarun M K
Fpdarun M KFpdarun M K
Fpdarun M KTADANO
 
FIXED PARTIAL DENTURE -DESIGN CONSIDERATION
FIXED PARTIAL DENTURE -DESIGN CONSIDERATIONFIXED PARTIAL DENTURE -DESIGN CONSIDERATION
FIXED PARTIAL DENTURE -DESIGN CONSIDERATIONBHU VARANASI
 
Abutment selection in FPD
Abutment selection in FPDAbutment selection in FPD
Abutment selection in FPDDr. Anshul Sahu
 
Abutment evaluation / cosmetic dentistry training
Abutment evaluation  / cosmetic dentistry trainingAbutment evaluation  / cosmetic dentistry training
Abutment evaluation / cosmetic dentistry trainingIndian dental academy
 
5- OVERDENTURE.pptx
5- OVERDENTURE.pptx5- OVERDENTURE.pptx
5- OVERDENTURE.pptxAmalKaddah1
 
5- OVERDENTURE.pptx
5- OVERDENTURE.pptx5- OVERDENTURE.pptx
5- OVERDENTURE.pptxAmalKaddah1
 

Similar to Prosthetic options in implant dentistry (20)

Tooth tissue junction, major and minor connectors
Tooth tissue junction, major and minor connectorsTooth tissue junction, major and minor connectors
Tooth tissue junction, major and minor connectors
 
PROSTHETIC OPTIONS IN IMPLANTS (2).ppt
PROSTHETIC OPTIONS IN IMPLANTS (2).pptPROSTHETIC OPTIONS IN IMPLANTS (2).ppt
PROSTHETIC OPTIONS IN IMPLANTS (2).ppt
 
Treatment planning and diagnosis for fpd / oral surgery courses
Treatment planning and diagnosis for fpd / oral surgery courses  Treatment planning and diagnosis for fpd / oral surgery courses
Treatment planning and diagnosis for fpd / oral surgery courses
 
4.the tooth tissue junction, major and minor connectors
4.the tooth tissue junction, major and minor connectors4.the tooth tissue junction, major and minor connectors
4.the tooth tissue junction, major and minor connectors
 
Missing Central Incisor Treatment Options
Missing Central Incisor Treatment OptionsMissing Central Incisor Treatment Options
Missing Central Incisor Treatment Options
 
TREATMENT PLANNING IN FIXED PROSTHODONTICS-Dr MEENU MERRY C PAUL
TREATMENT PLANNING IN FIXED PROSTHODONTICS-Dr MEENU MERRY C PAULTREATMENT PLANNING IN FIXED PROSTHODONTICS-Dr MEENU MERRY C PAUL
TREATMENT PLANNING IN FIXED PROSTHODONTICS-Dr MEENU MERRY C PAUL
 
Removable partial denture theory and practice 2011
Removable partial denture  theory and practice 2011Removable partial denture  theory and practice 2011
Removable partial denture theory and practice 2011
 
abutment selection in fixed partial denture.pptx
abutment selection in fixed partial denture.pptxabutment selection in fixed partial denture.pptx
abutment selection in fixed partial denture.pptx
 
Indications contraindications and classification of bridges/endodontic courses
Indications contraindications and classification of bridges/endodontic coursesIndications contraindications and classification of bridges/endodontic courses
Indications contraindications and classification of bridges/endodontic courses
 
Implants in oral and maxillo facial surgery /certified fixed orthodontic cou...
Implants in oral and maxillo facial surgery  /certified fixed orthodontic cou...Implants in oral and maxillo facial surgery  /certified fixed orthodontic cou...
Implants in oral and maxillo facial surgery /certified fixed orthodontic cou...
 
Treatment plan and biological consideration of implants
Treatment plan and biological consideration of implantsTreatment plan and biological consideration of implants
Treatment plan and biological consideration of implants
 
Abutment evaluation /Fixed orthodontics teaching
Abutment evaluation /Fixed orthodontics teachingAbutment evaluation /Fixed orthodontics teaching
Abutment evaluation /Fixed orthodontics teaching
 
Fpdarun M K
Fpdarun M KFpdarun M K
Fpdarun M K
 
FIXED PARTIAL DENTURE -DESIGN CONSIDERATION
FIXED PARTIAL DENTURE -DESIGN CONSIDERATIONFIXED PARTIAL DENTURE -DESIGN CONSIDERATION
FIXED PARTIAL DENTURE -DESIGN CONSIDERATION
 
Abutment selection in fpd
Abutment selection in fpdAbutment selection in fpd
Abutment selection in fpd
 
Abutment selection in FPD
Abutment selection in FPDAbutment selection in FPD
Abutment selection in FPD
 
Abutment evaluation / cosmetic dentistry training
Abutment evaluation  / cosmetic dentistry trainingAbutment evaluation  / cosmetic dentistry training
Abutment evaluation / cosmetic dentistry training
 
IOD
IODIOD
IOD
 
5- OVERDENTURE.pptx
5- OVERDENTURE.pptx5- OVERDENTURE.pptx
5- OVERDENTURE.pptx
 
5- OVERDENTURE.pptx
5- OVERDENTURE.pptx5- OVERDENTURE.pptx
5- OVERDENTURE.pptx
 

More from Bibin Bhaskaran

Solidification and microstructure of metals
Solidification and microstructure of metals Solidification and microstructure of metals
Solidification and microstructure of metals Bibin Bhaskaran
 
Removal partial denture considerations in maxillofacial prosthetics
Removal partial denture considerations in maxillofacial prostheticsRemoval partial denture considerations in maxillofacial prosthetics
Removal partial denture considerations in maxillofacial prostheticsBibin Bhaskaran
 
Occlusal relationship in_rpd__prostho_
Occlusal relationship in_rpd__prostho_Occlusal relationship in_rpd__prostho_
Occlusal relationship in_rpd__prostho_Bibin Bhaskaran
 
Diagnosis and rx planning
Diagnosis and rx planning Diagnosis and rx planning
Diagnosis and rx planning Bibin Bhaskaran
 
denture base considerations
denture base considerationsdenture base considerations
denture base considerationsBibin Bhaskaran
 

More from Bibin Bhaskaran (10)

Solidification and microstructure of metals
Solidification and microstructure of metals Solidification and microstructure of metals
Solidification and microstructure of metals
 
Restorative resins
Restorative resinsRestorative resins
Restorative resins
 
Removal partial denture considerations in maxillofacial prosthetics
Removal partial denture considerations in maxillofacial prostheticsRemoval partial denture considerations in maxillofacial prosthetics
Removal partial denture considerations in maxillofacial prosthetics
 
Occlusal relationship in_rpd__prostho_
Occlusal relationship in_rpd__prostho_Occlusal relationship in_rpd__prostho_
Occlusal relationship in_rpd__prostho_
 
Minor connectors
Minor connectorsMinor connectors
Minor connectors
 
Implant materials
Implant materialsImplant materials
Implant materials
 
Diagnosis and rx planning
Diagnosis and rx planning Diagnosis and rx planning
Diagnosis and rx planning
 
Classification of rpd
Classification of rpd Classification of rpd
Classification of rpd
 
denture base considerations
denture base considerationsdenture base considerations
denture base considerations
 
Impression materials
Impression  materialsImpression  materials
Impression materials
 

Prosthetic options in implant dentistry

  • 1. Prosthetic options in implant dentistry Bibinbhaskaran
  • 2. Index Introduction. Treatment options. Treatment planning for implant supported prosthesis. Classification of prosthesis movts. Completely edentulous prosthesis design.
  • 3. Index Advantages of removable implant supported prosthesis in completely edentulous patient. Partially edentulous design. Advantages of implant supported FPD. Guidelines for joining tooth with implant. Prosthetic options. Summary.
  • 4. Introduction Goals of implant dentistry-replace pts missing teeth to normal contour, comfort,function,esthetics,speech and health. Final restoration – not implants. In stress Rx theorem final restoration first planned-after abutments designed.
  • 5. Traditional Treatment Options Removable partial dentures. Fixed partial dentures. Complete dentures.
  • 6. Treatment planning for implant supported prosthesis Designing the prosthesis [to satisfy patients needs and desire]. Individual areas of abutment support are determined. Bone in that area is evaluated for type of implant
  • 7. Classification of prosthesis movement Classification of prosthesis movement :- PM-O PM-2 PM-3 PM-4 PM-6
  • 8. Classification of prosthesis movement PM-0 – prosthesis rigid – no movt (implant support similar to FPD). 0-ring attachments (6 directions). 4 0-rings placed on complete arch and prosthesis rests on the bar- PM-0.
  • 9. PM-2 – prosthesis with hinge motion (2 planes). Hinge attachment (Dolder bar without a spacer or Hader bar and clip).
  • 10. Classification of prosthesis movement PM-3 – prosthesis with an apical and hinge motion. Dolder bar with spacer and clip.
  • 11. PM-4 – movts in 4 directions. Rarely used in O.D. Magnets are used.(no lateral force).
  • 12. PM-6 – all ranges of prosthesis movt. O-ring attachment or extra coronal resilient attachment (ERA). Implants independent of each other.(no bar)
  • 13. Completely edentulous prosthesis design Pts desires-fixed or removable. To assess ideal final prosthetic design-existing anatomy evaluated. An axiom of implant Rx is to provide ,most cost effective Rx that will satisfy pts anatomical needs and personal desires. In completely edentulous pt a removable implant supported prosthesis offers several advantages over a fixed implant restoration.
  • 14. Completely edentulous prosthesis design However some completely edentulous patients require a fixed restoration because of their desire or because their oral condition makes fabrication of teeth difficult if a super structure and removable prostheses are planned. For eg when pt has abundant bone-implants already placed-lack of crown height space-removable prosthesis. Too often Rx plans for completely edentulous pts-max denture and mand over denture with 2 implants.
  • 15. Completely edentulous prosthesis design Long term-disservice to pt-parasthesia, facial changes and reduced posterior occlusion on max prosthesis are to be expected. Important to visualize the final restoration at the onset with a fixed implant restoration. Individual areas of ideal or key abutment determined.
  • 16. Completely edentulous prosthesis design Pts force factors and bone density in region of implant support are evaluated. Only then available bone is evaluated to assess whether it is possible to place implants to support the intended prosthesis. In inadequate natural or implant abutment situations-oral conditions altered-augmentation.
  • 17. Completely edentulous prosthesis design A fixed implant restoration-partially or completely edentulous pt. Fixed lasts longer.(acrylic teeth wear,attachments replacement-removable prosthesis). No food entrapment.
  • 18. Advantages of removable implant-supported prostheses in completely edentulous patient Facial esthetics enhanced with labial flanges. Prosthesis – removed at night - nocturnal parafunction. Fewer implants.
  • 19. Advantages of removable implant-supported prostheses in completely edentulous patient Less bone augmentation-before implant insertion. Shorter RX-no bone augmentation. Less expensive. Daily home care is easier.
  • 20. Partially edentulous design A common axiom-FPD. Fewer natural teeth missing-better indication for FPD. Ideally FPD-completely implant supported. Added implants-fewer pontics-less stress.
  • 21. Advantages of implant supported FPD When Compared conventional tooth supported FPD Im FPD has – No caries. No endodontic problems. No retention failure. No periodontal breakdown. Easier to clean.
  • 22. Guidelines for joining implant with tooth No clinically observed mobility of the natural tooth. Use of rigid connectors. Less lateral forces to the prosthesis [occlusion]. Rarely connect to anterior tooth.
  • 23. Prosthetic options Misch-1989. FP-1 FP-2 FP-3 RP-4 RP-5
  • 24. FP-1 Anatomical crowns. Minimal loss. Root of natural tooth.
  • 25. FP-1 Max anterior region. FP-1 restoration-crown –natural tooth. Width or height – augmentation. Soft tissue augmentation – black .
  • 26. FP-1 Restorative material-porcelain to noble metal. A single tooth FP crown-Al2O3 or ceramic. Fracture in latter.
  • 27. FP-2 Anatomical crown and portion of root. Bone more apical (1-2mm). Incisal edge correct-gingival 3rd overextended.
  • 28. FP-2 Prosthetic teeth – longer. Multiple FP-2 – no specific implant position. Implant position – width, angulation, hygiene.
  • 29. FP-2 Embrassure b/w teeth – mand ant teeth. Material of choice – precious metal to porcelain.
  • 30. FP-2 Contour of metal different – FP-1. Unsupported porcelain in final prosthesis.
  • 31. FP-3 Missing crowns and gingival color and portion of edentulous site. Dec bone height – resorption. Unnatural long teeth – esthetics,function,support.
  • 32. FP-3 Pt – high max lip line – smiling. Low lip line – speech.
  • 33. FP-3 Ideal high smile line-interdental papilla of max ant teeth-not soft tissue-mid cervical regions. Complain-display of longer teeth. Gingival color of FP-3-esthetic. Gingival acrylic-multiple abutments-bone loss.
  • 34. FP-3 2 basic approaches-FP-3. Hybrid restoration-denture teeth & metal. Porcelain metal restoration.
  • 35. FP-3 Restorative material-amt of crown height space. An FP-3 porcelain to metal-difficult-FP-2. Pink porcelain-more baking-risk of porosity.
  • 36. FP-3 Alternative-PFM-hybrid restoration. Highly esthetic-denture teeth & acrylic soft tissue.
  • 37. FP-3 Crown height space for hybrid prosthesis versus PFM – 15mm from bone to occlusal plane. FP-2 or FP-3 prosthesis-high lip lines-implant abutments.
  • 38. FP-3 Greater crown height-force-implant cervical regions. Additional implant abutments or shorter cantilever lengths. In max arch open embrassures-food impaction. Mand restoration-above tissue-sanitary pontic.
  • 39. Cement Vs Screw retained Cement retained Passive castings. Enhanced esthetics. Improved direction of loading. Reduced crestal bone loss. Improved access. Reduced complications,cost, time. Screw retained Retrievability. No cement in the sulcus. Low profile retention. Possible with limited inter-arch space .
  • 40. RP-4 Removable prosthesis-implants. Restoration rigid when inserted. Overdenture attachments-tissue bar or super structure that splints the abutments.
  • 41. RP-4 5 -6 implants-mand & 6-8-max – implant supported. Implant criteria-RP-4-different-Fixed prosthesis. Denture teeth & more acrylic-removable restoration.
  • 42. RP-4 Super structure and O.D attachments-abutments. Lingual and apical implant placement-FP. Implants for RP-4 and an FP-2 or FP-3 – mesiodistal. Occasionally attachment-6mm spacing b/w implants.
  • 43. RP-4 Reduce No of implants-mental foramina. RP-4 same – FP-1,FP-2 or FP-3 restoration. PFM prosthesis Cattachments-abutments-esthetics. O.D attachments-oral hygiene-nocturnal bruxism. Hader bar with PM-0.
  • 45. Completely edentulous mand O.D may have :- 2 ant implants independent. Splinted implants in canine. 3 splinted implants in P.M and central incissor. Implants splinted with a cantilevered bar. Advantage :- reduced cost.
  • 46. RP-5 Preimplant denture :- esthetics. Guide. Healing stage. Converted - RP-4 or RP-5. Bone resorption – soft tissue borne areas. Relines and occlusal adjustments. Bone resorption – 2 – 3times faster – RP-5.
  • 48.
  • 49. Summary Benefits of implant dentistry realized-prosthesis. 5-prosthetic options available. Amt of support required initially designed. Once prosthesis designed-implant Rx established.