This document provides an overview of implant planning and treatment options for different clinical scenarios. It begins with discussing patient profiling and customizing treatment plans based on a patient's wishes, budget, and medical factors. Single tooth replacements, bridges for multiple missing teeth, free end situations, and fully edentulous jaws are then reviewed. For each scenario, conventional treatment options are outlined along with survival rates. Implant-supported restorations are presented as alternatives, noting numbers of implants and types of prostheses. Key factors in treatment planning like bone augmentation and financial considerations are also addressed. The document concludes with applying this framework to a clinical case of a fully edentulous lower jaw.

1. Recapitulation of the basics of the anatomy

2. Prof. Dr. med. dent. Christian Mehl
• Studied dentistry at the Christian-Albrechts University
(CAU) at Kiel, Germany
• Asisstant professor CAU Kiel
• Dentist in London
• Specialist for Prosthodontics (DGPro/GDC)
• Certified by the German Society for Implantology
(DGI)
• Extraordinary professor at CAU

3. Team Wimpole Street Dental Clinic

4. Wimpole Street Dental Clinic
• Founded in 2019
• Specialist centre for prosthodontics and
implantology in the heart of the medical district
in London, United Kingdom

5. Block I
Part I - Anatomy
Part II - Aesthetic rules
Part III – Implant planning

6. Part I - Anatomy

9. ( N e r v u s s u p r a o r b i t a l i s )
N e r v u s i n f r a o r a b i t a l i s
N e r v u s m e n t a l i s
N e r v i

10. ( N e r v u s f a c i a l i s )
N e r v i

11. A r t e r i a p a l a t i n a
A r t e r i a b u c c a l i s
A r t e r i a l i n g u a l i s
A r t e r i a e ( e t v e n a e )

12. S i n u s m a x i l l a r i s
A p e r t u r a p i r i f o r m i s ( l a t e r a l )
L i n e a m y l o h y o i d e a
O s s a , c a v i t a t e s , s i n u s
O s p t e r y g o i d e u m
S p i n a n a s a l i s a n t e r i o r

13. Bindewegebstransplantate

14. Bindewegebstransplantate
Q u e l l e : S u b o t t a

15. Bindewegebstransplantate
Q u e l l e : G i r a r o t e l l e 2 0 1 3

16. Bindewegebstransplantate
Q u e l l e : h t t p s : / / w w w . g a l a x y m e d . d e

17. enamel
dentine
pulp
Sharpey
fibers
bone
Free gingiva
Attached gingiva
connective tissue
From: http://histohal.uni-halle.de/histopatho/index.php?loc=all&page=za&system=histo&nav=org

21. Mehl et al. 2018 - Effect of ultraviolet photofunctionalization of dental titanium implants on
osseointegration. Journal of Zhejiang University Science B

22. Mehl et al. 2018 - Effect of ultraviolet photofunctionalization of dental titanium implants on
osseointegration. Journal of Zhejiang University Science B

23. Part II – Aesthetic golden rules

25. the aesthetic zone!

26. Davis LG, Ashworth PD, Spriggs LS: Psychological effects of aesthetic dental treatment. J Dent. 1998; 26:
547-554.
Mehl C et al.: Does the Oral Health Impact Profile questionnaire measure dental appearance? Int J
Prosthodont. 2009; 22: 87-93.
Mehl et al.: Patients' and dentists' perception of dental appearance. Clin Oral Investig. 2011; 15: 193-199.
Wolfart S, Braasch K, Brunzel S, et al.: The central single implant in the edentulous mandible:
improvement of function and quality of life. A report of 2 cases. Quintessence Int. 2008; 39: 541-548.

27. Mehl et al.: Patients' and dentists'
perception of dental appearance. Clin Oral Investig. 2011; 15: 193-199.
Mehl C et al.: Does the Oral Health Impact
Profile questionnaire measure dental appearance? Int J Prosthodont. 2009; 22: 87-93.
Mehl C et al.: Perception of dental esthetics influence of restoration type, symmetry and color in four
different countries. Int J Prosthodont. 2015; 28: 2-6.
Mehl C et al.: Perception of dental esthetics in different cultures .
Int J Prosthodont. 2015; 28: 60-4.

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Deutschland
Schweiz
China
UK
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Mehl C et al.: Perception of dental esthetics in different cultures . International Journal of Prosthodontics.

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Mehl, C., Harder, S., Lin, J., Vollrath, O. & Kern, M. (2015) Perception of dental esthetics in different cultures. Int J Prosthodont 27:
523-529.
Mehl, C., Harder, S., Lin, J., Vollrath, O. & Kern, M. (2015) Perception of dental esthetics: Influence of restoration type, symmetry
and color in four different countries. Int J Prosthodont 28: 60-64.

34. How do we see each other?

35. 70%
30%
How do we see each other?

36. 30% à 90%
How do we see each other?

37. Midline splits smile in two equal halves
How do we see each other?

38. Midline splits smile in two equal halves
Angulus oris level
Incisal edge of canines touch the lower
lip

39. Midline splits smile in two equal halves
Angulus oris level
Incisal edge of canines touch the lower
lip
Equal buccal corridor
How do we see each other?

40. Midline splits smile in two equal halves
Angulus oris level
Incisal edge of canines touch the lower
lip
Equal buccal corridor
Incisal edges follow the upper rim of the
lower lip
How do we see each other?

41. Midline splits smile in two equal halves
Angulus oris level
Incisal edge of canines touch the lower
lip
Equal buccal corridor
Incisal edges follow the upper rim of the
lower lip

42. 1. Chiche GJ, Pinault A. Esthetics of Anterior Fixed Prosthodontics. 1st ed1994, Chicago: Quintessence.
2. Goldstein R. Change your smile. 3rd ed 1997, Chicago: Quintessence.
3. Fradiani M et al., Esthetic Rehabilitation in Fixed Prosthodontics. 2004, London: Quintessence.
4. Magne P, Belser U. Natural oral esthetics. In: Bonded porcelain restorations in the anterior dentition: a biomimetic approach. 1st ed 2002, Chicago:
Quintessence.
5. Donitza A et al. 2008 Creating the perfect smile: prosthetic considerations and procedures for optimal dentofacial esthetics. J Calif Dent Assoc 36:335-340,
342.
6. Wolfart S et al., 2006 Subjective and objective perception of upper incisors. J Oral Rehabil 33:489-495.
75%
1,62
1 :
0,23 : 0,62 :

43. 1. Chiche GJ, Pinault A. Esthetics of Anterior Fixed Prosthodontics. 1st ed1994, Chicago: Quintessence.
2. Fradeani M et al. Esthetic Rehabilitation in Fixed Prosthodontics. 2004, London: Quintessence.
3. Magne P, Belser U. Natural oral esthetics. In: Bonded porcelain restorations in the anterior dentition: a biomimetic approach. 1st ed 2002, Chicago:
Quintessence.

45. 1. Reither W. 1959 Die Bedeutung der Relation zwischen Lippen und Zahnreihen für die
ästhetische Wirkung der Mundregion. Dsch Zahnärztebl 13:764-778
Sichtbarkeit der Zähne
Incisal effect Cervical effect „Gummy Smile“

46. Facial harmony
Dental harmony Gingival harmony
ü

47. our job is to restore nature or to leave it intact

48. Part I – Implant planning

49. 7 Ground rules of implant planning and patient guidance
1. Patient profile
• What does the patient want?
• How invasive can we be?
• Money?
• Cognitive and manual abilities
2. Leave teeth intact as much as possible, but weigh long term options and exit strategy
3. Fixed restorations preferable, if possible small units
4. Restore until the first molar in all quadrants
5. If fixed restorations, then:
• Do not incorporate uncertain teeth in long span fixed restorations (> more than three teeth)
6. If removable restoration, then:
• Incorporate uncertain teeth in long span fixed restorations, but have an exit strategy ready
7. Life long individual recall

50. Always plan together with the patient
• What is most important for the patient?
• Limit this to three points
(remember, who asks leads the conversation, not who talks)

51. • Mention all treatment options
• Not doing anything
• Conventional treatment options
• Implant supported restorations
• Experimental treatment options
• Advise about costs
• Ask for a budget
• Adjust planning to budget without compromising medical integrity
Always plan together with the patient

52. • Does the treatment chosen by the patient match the thre wishes?
• Does something have to be omitted?
• Due to financial reasons?
• Due to health reasons?
• Due to any other reasons?
• Customise treatment plan („wishful thinking vs reality“)
Always plan together with the patient

53. Treatment options
• Single gap
• Free end situation
• Many missing teeth
• Edentulous jaw

54. Single gap

55. Single gaps conventional treatments
• No treatment (Cretsi, 2006)
• Bridges (conventional/adhesive)
• 85-90% 10-year-survival rate (metal-ceramic)
• 50% survival ca. 20 years
• Removal of clinical tooth substance 63-73%
• Risk of nerve damage
• 3-5% periapical infection (after 10 years)
• 10-15% loss of sensibility (after 10 Jahren)
• Removable denture
• „Denture for a drawer“

56. Single gap Konventionelle Versorgungsformen
Single crowns on implants:
5-year survival rate 96 %
10-year survival rate 89 %
Implant survival:
5 years 97 %
10 years 95 %
Clin Oral Implants Res, 2012. 23 Suppl 6: p. 2-21.

57. Single gap – two teeth

58. Two teeth missing
≥ 3mm ≥ 1,5mm
≥ 1,5mm

59. ≥ 1,5mm
Hybrid bridge
10-year survival rate ca. 78 %
Two teeth missing

60. ≥ 1,5mm
Implant supported cantilever bridge
10-year survival rate ca. 97%
Two teeth missing

61. ≥ 1,5mm
Two teeth missing
Implant supported cantilever bridge
10-year survival rate ca. 97%

62. ≥ 1,5mm
≥ 1,5mm
Implant supported bridge
10-year survival rate ca. 90%
Three teeth missing

63. ≥ 1,5mm
≥ 1,5mm
≥ 3mm ≥ 3mm
Three teeth missing

64. ≥ 1,5mm
≥ 1,5mm
≥ 3mm ≥ 3mm
Three teeth missing

65. Free end situations

68. ≥ 3 mm
≥ 1,5 mm

69. ≥ 1,5 mm

71. ≥ 3 mm
≥ 3 mm
≥ 1,5
mm

72. ≥ 3 mm
≥ 1,5
mm

73. ≥ 3 mm

75. ≥ 1,5
mm

76. ≥ 3 mm
≥ 1,5
mm

77. Many missing teeth

78. Many missing teeth (conventional treatments)
• No treatment
• Removable options
• Dentures with clasps or other temporary options
• Telescopic crowns
• Geschiebe or adhesive prosthodontics
• Hybrid prosthodontics

79. • Removable
• Double crowns
• E.g. galvanotelescopic crowns
• Retentive elements
• E.g. Dalbo or Locator anchor
• Fixed restorations
• Crowns
• Bridges
Many missing teeth (conventional treatments)

80. • Removable concepts
• Only replace until first molar
• Additional implants under old but functioning dentures
• Double crowns
• Dalbo or locator as a low budget option
• Fixed concepts
• Crowns
• Bridges
Many missing teeth (conventional treatments)

82. Stark reduziertes Restgebiss (Implantatversorgung)

83. Stark reduziertes Restgebiss (Implantatversorgung)

84. Edentulous jaw

85. • Unterlassung
• Herausnehmbarer Zahnersatz
Edentulous jaw

86. Edentulous jaw conventional treatments
• No treatment
• Removable dentures

87. Edentulous jaw conventional treatments

88. Edentulous jaw conventional treatments

89. Edentulous jaw conventional treatments

90. Edentulous jaw conventional treatments

91. • Fixed restorations
• Upper jaw
• 8 implants, small units of crowns and bridges
• 4-6 implants and screw-retained suprastructure (full-arch)
• Lower jaw
• 6 implants small units of crowns and bridges
• 4-6 implants screw-retained suprastructure (full-arch)
Edentulous jaw conventional treatments

92. • Unterlassung
• Herausnehmbarer Zahnersatz
Versorgungsoptionen: Einzellücke, Schaltlücke, Freiendsituation, stark reduziertes Restgebiss, zahnloser Kiefer

93. • Unterlassung
• Herausnehmbarer Zahnersatz
Versorgungsoptionen: Einzellücke, Schaltlücke, Freiendsituation, stark reduziertes Restgebiss, zahnloser Kiefer

94. Zahnloser Kiefer

95. Zahnloser Kiefer
Bone augmentation needed?

96. Financial or anatomic or any other reason for reducing implant number?

97. Clinical case

104. 6 implants, full arch, screw-retained

105. Clinical case

123. No augmention?

124. Fixed or removable?

125. Edentulous jaw implant supported restorations
• Removable
• Upper jaw
• 6 implants and double crowns (galvanic)
• 4 implants and Dalbo or Locator
• Unterkiefer
• 4 implants and double crowns (galvanic)
• 2-4 implants and Dalbo or Locator

126. removable

127. removable

128. removable
? ?

129. Full arch screw-retained

130. Clinical case
Fixed teeth in a day

131. Diagnostics

132. Safe
Uncertain
Hopeless

134. OP-Planning

143. Implantation and immediate restoration

162. Break