This document discusses single tooth dental implants. It provides information on:
- The goals of single tooth implants which is to mimic the function and esthetics of natural teeth.
- Key factors for achieving a sound esthetic result including bone and gingival contours, implant positioning, and ceramist skills.
- Diagnosing implant cases by assessing hard and soft tissues and treatment planning the surgical and restorative aspects.
- Guidelines for restoration design, implant placement, and occlusion to ensure biomechanical success and esthetics.
Prosthetic options in implant dentistryNAMITHA ANAND
This document discusses various prosthetic options in implant dentistry. It begins by introducing different treatment options for completely and partially edentulous patients, noting that implant dentistry provides more options compared to traditional dentistry. It then covers Misch's classification system for prosthetic options (FP1-FP3, RP4-RP5), which are determined by the amount of hard and soft tissue replacement needed. The document discusses different prosthesis types for complete and partial edentulism in detail. It also covers considerations for prosthesis design such as crown height space, bone width, implant positioning and restorative materials. In conclusion, the optimal prosthetic option depends on the patient's existing oral condition and treatment goals.
This document discusses various options for connecting dental restorations to implants, including screw retained, cement retained, and screwless systems. It highlights advantages and disadvantages of different abutment selections and placement positions. Custom abutments are described as an option to control porcelain thickness and manage excessive implant inclinations, though excessive angulation can compromise cement retention. Packing retraction cord and lingual access holes are presented as ways to reduce the risk of subgingival cement accumulation.
This document discusses prosthetic options for implant dentistry. It outlines 5 prosthetic options (FP-1 to FP-3 and RP-4 to RP-5) and describes the amount of support and number of implants required for each. The key steps are to first plan the desired prosthesis, then determine the ideal abutment positions and amount of support needed before placing implants and designing the final restoration. Removable prostheses offer advantages like fewer implants and reduced costs but have higher risks of bone resorption over time.
There are several protocols for loading dental implants after surgery based on bone density and healing time requirements. Protocols include Brånemark's loading protocol, progressive loading, and immediate/early loading. The density of the bone where the implant is placed determines the appropriate loading protocol, as less dense bone requires more healing time before loading to allow for sufficient bone mineralization and strength. Progressive loading gradually increases stress on the implant over time to allow the bone to adapt, reducing risks of failure. It is particularly important for lower density bone which is weaker.
This document discusses functionally generated path occlusion, which is a technique for developing occlusion without using an articulator. It involves having the patient move their jaw through various motions while wax is placed on their teeth, capturing the path of jaw movement. This wax tracing is then used to create a stone cast, called a functional core, which reproduces the jaw motion. This core can be mounted along with the dental casts to fabricate restorations that align with the patient's natural jaw function. The document outlines the specific steps for using this technique to develop occlusion for fixed dental prosthetics.
The benefits of implant dentistry can be realized only when the prosthesis is first discussed and determined. An organized treatment approach based on the prosthesis permits predictable therapy results. Five prosthetic options postulated by Misch are available in implant dentistry. Three restorations are fixed and vary in the amount of hard and soft tissue replaced; two are removable and are based on the amount and type of support for the restoration. The amount of support required for an implant prosthesis should initially be designed similar to traditional tooth-supported restorations. Once the intended prosthesis is designed, the implants and treatment surrounding this specific
result can be established.
This document discusses terminology and techniques for dental implant impressions. It defines terms like cover screws, healing caps, transfer copings, and implant analogues. It explains that impressions are needed to capture the implant position, depth, axis, and soft tissue contour. The document outlines two main impression techniques - open tray (using pick-up copings) and closed tray (using transfer copings). It notes the advantages and disadvantages of each technique. Abutment level impressions are also discussed for customization and laboratory abutment selection. Gingival simulation is described as a technique to simulate the soft tissue around implants.
Fixed partial dentures transmit forces through the abutments to the periodontium. Failures are due to poor engineering, the use of improper materials, inadequate tooth preparation, and faulty fabrication. Of particular concern to prosthodontist is the selection of teeth for abutments. They must recognize the forces developed by the oral mechanism, and resistance.
Successful selection of abutments for fixed partial dentures requires sensitive diagnostic ability. Thorough knowledge of anatomy, ceramics, the chemistry and physics of dental materials, metallurgy, Periodontics, phonetics, physiology, radiology and the mechanics of oral function is fundamental.
Prosthetic options in implant dentistryNAMITHA ANAND
This document discusses various prosthetic options in implant dentistry. It begins by introducing different treatment options for completely and partially edentulous patients, noting that implant dentistry provides more options compared to traditional dentistry. It then covers Misch's classification system for prosthetic options (FP1-FP3, RP4-RP5), which are determined by the amount of hard and soft tissue replacement needed. The document discusses different prosthesis types for complete and partial edentulism in detail. It also covers considerations for prosthesis design such as crown height space, bone width, implant positioning and restorative materials. In conclusion, the optimal prosthetic option depends on the patient's existing oral condition and treatment goals.
This document discusses various options for connecting dental restorations to implants, including screw retained, cement retained, and screwless systems. It highlights advantages and disadvantages of different abutment selections and placement positions. Custom abutments are described as an option to control porcelain thickness and manage excessive implant inclinations, though excessive angulation can compromise cement retention. Packing retraction cord and lingual access holes are presented as ways to reduce the risk of subgingival cement accumulation.
This document discusses prosthetic options for implant dentistry. It outlines 5 prosthetic options (FP-1 to FP-3 and RP-4 to RP-5) and describes the amount of support and number of implants required for each. The key steps are to first plan the desired prosthesis, then determine the ideal abutment positions and amount of support needed before placing implants and designing the final restoration. Removable prostheses offer advantages like fewer implants and reduced costs but have higher risks of bone resorption over time.
There are several protocols for loading dental implants after surgery based on bone density and healing time requirements. Protocols include Brånemark's loading protocol, progressive loading, and immediate/early loading. The density of the bone where the implant is placed determines the appropriate loading protocol, as less dense bone requires more healing time before loading to allow for sufficient bone mineralization and strength. Progressive loading gradually increases stress on the implant over time to allow the bone to adapt, reducing risks of failure. It is particularly important for lower density bone which is weaker.
This document discusses functionally generated path occlusion, which is a technique for developing occlusion without using an articulator. It involves having the patient move their jaw through various motions while wax is placed on their teeth, capturing the path of jaw movement. This wax tracing is then used to create a stone cast, called a functional core, which reproduces the jaw motion. This core can be mounted along with the dental casts to fabricate restorations that align with the patient's natural jaw function. The document outlines the specific steps for using this technique to develop occlusion for fixed dental prosthetics.
The benefits of implant dentistry can be realized only when the prosthesis is first discussed and determined. An organized treatment approach based on the prosthesis permits predictable therapy results. Five prosthetic options postulated by Misch are available in implant dentistry. Three restorations are fixed and vary in the amount of hard and soft tissue replaced; two are removable and are based on the amount and type of support for the restoration. The amount of support required for an implant prosthesis should initially be designed similar to traditional tooth-supported restorations. Once the intended prosthesis is designed, the implants and treatment surrounding this specific
result can be established.
This document discusses terminology and techniques for dental implant impressions. It defines terms like cover screws, healing caps, transfer copings, and implant analogues. It explains that impressions are needed to capture the implant position, depth, axis, and soft tissue contour. The document outlines two main impression techniques - open tray (using pick-up copings) and closed tray (using transfer copings). It notes the advantages and disadvantages of each technique. Abutment level impressions are also discussed for customization and laboratory abutment selection. Gingival simulation is described as a technique to simulate the soft tissue around implants.
Fixed partial dentures transmit forces through the abutments to the periodontium. Failures are due to poor engineering, the use of improper materials, inadequate tooth preparation, and faulty fabrication. Of particular concern to prosthodontist is the selection of teeth for abutments. They must recognize the forces developed by the oral mechanism, and resistance.
Successful selection of abutments for fixed partial dentures requires sensitive diagnostic ability. Thorough knowledge of anatomy, ceramics, the chemistry and physics of dental materials, metallurgy, Periodontics, phonetics, physiology, radiology and the mechanics of oral function is fundamental.
1. The functionally generated pathway technique involves recording the paths of tooth movement during excursive jaw motions using wax or other materials.
2. This recording is used to develop the occlusal morphology for dental restorations like crowns, ensuring optimal occlusion during all jaw motions.
3. Studies have found that the functionally generated pathway technique results in restorations with better functional articulation compared to conventional single casting techniques, with less adjustment needed and higher patient satisfaction.
This document discusses cement retention versus screw retention for dental implants. Both methods can be used if done properly. Cement retention is simpler but risks residual cement being left under gums, which can lead to peri-implantitis. Screw retention allows easy removal but requires access holes. Residual subgingival cement is the major problem, as it is difficult to fully remove and can cause inflammation and bone loss over time.
Failures in Fixed Partial Denture
(Prosthodontics FPD- Dental science)
Various types of failures in the fabrication of fixed partial denture
Dr.Sachin Sunny Otta
St.Gregorios Dental College,Kothamangalam,Ernakulam
This document provides an overview of implant supported overdentures, including definitions, history, indications, contraindications, advantages, disadvantages, treatment options, and procedures. Key points discussed include:
- Overdentures are removable prostheses that cover natural tooth roots, implants, or both for support.
- Implant supported overdentures have better outcomes than conventional dentures or overdentures supported only by natural tooth roots.
- Treatment options depend on factors like jaw, bone quality, number of implants, and can involve bar-retained or independent attachments.
- Procedures involve medical evaluation, treatment planning, transitional dentures, surgical placement, attachment connection, and definitive prosthesis fabrication
This document discusses occlusal schemes for implants, known as implant protective occlusion (IPO). IPO aims to reduce stress at the implant-bone interface through 14 considerations including eliminating premature contacts, positioning occlusal contacts over implant bodies, reducing cantilever lengths, and decreasing crown heights. The goals of IPO are to reduce force magnification, improve force direction, and increase the implant support area to promote implant longevity and success.
This document discusses different types of implant abutments and their connections. It notes that any abutment can be divided into three segments: the prosthesis connection system, implant connection system, and transgingival system. The implant connection part should not be altered, but the other two parts may be modified for optimal treatment outcomes. The document goes on to describe different types of abutments and connections in more detail, including their advantages and disadvantages. It provides explanations of internal connections, platform switching, morse tapers, and friction-fit joints between abutments and implants.
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
Emergence profile in fixed partial denture.Pallawi Sinha
This document discusses emergence profiles in natural tooth contours and their importance in fixed partial denture design. It provides a brief history of emergence profile terminology and concepts. Key points covered include:
- Emergence profiles are generally straight rather than convex or concave to avoid trapping plaque.
- Overcontouring crowns can cause gingival inflammation, while undercontouring does not affect healthy gingiva.
- Crowns should have emergence profiles that facilitate oral hygiene through features like open embrasures and occlusally positioned contact areas.
- Natural tooth emergence profiles were photographed and analyzed to establish anatomic norms for accurate reproduction in dental restorations.
Full mouth rehabilitation (FMR) involves extensive restorative procedures to modify the occlusal plane and accomplish equilibration. The goals of FMR are to establish a static centric occlusion in harmony with centric relation, evenly distribute stresses during function, and restore normal masticatory function. FMR is indicated for impaired occlusion, preserving remaining teeth, maintaining periodontal health, improving esthetics, and resolving pain. Diagnostic tools include study models, radiographs, photographs, and diagnostic wax-ups to develop the treatment plan.
Implant abutment and implant abutment connectionsDR.BHAVESH JHA
this ppt enlightened with different types of implant abutment connection. Detailed classification of abutments. Different types of abutments. Latest trends of abutments. Smart abutments. Platform switching, rationale of platform switching and related articles.
Platform switching involves using a smaller diameter abutment on a larger diameter implant. This shifts the implant-abutment junction inward and away from the crestal bone. According to the document, platform switching reduces crestal bone loss in the following ways: 1) It shifts the inflammatory cell infiltrate inward, decreasing its effect on the crestal bone. 2) It maintains the biological width between the implant and bone. 3) It decreases stress levels in the peri-implant bone by shifting the stress concentration area away from the bone-implant interface. The document discusses the concept, history, advantages, and limitations of platform switching.
The document discusses recent advances in prosthodontics presented by Dr. J. Koshy Joseph. It covers various topics including complete dentures, fixed partial dentures, removable partial dentures, maxillofacial prosthetics, implantology, materials and instrumentation. New techniques and materials discussed include the use of lasers in denture fabrication, CAD/CAM systems for complete dentures, magnets and denture liners in prosthodontics, and all-on implants. The document provides an overview of the latest developments across different areas of prosthodontics.
loading protocols in dental implants about indications and contraindications of conventional , immediate,progressive and delayed loading of dental implants
The document discusses occlusal considerations for implant-supported prostheses. It introduces various occlusal terminology and explores the significance of occlusion on osseointegrated implants. The document outlines the goals of implant protective occlusion (IPO), which aims to distribute occlusal forces appropriately to minimize stress on implants and surrounding bone. IPO principles include using thin articulating paper for initial adjustment, equalizing contacts under heavy bite forces, avoiding non-axial and offset loads, and designing the occlusion around the weakest component. The document also discusses factors like implant angulation, crown height, bone quality and the materials used for occlusal surfaces.
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
This seminar is of postgraduate level, which will be helpful for students. The presenter has added the information from various sources and the references are quoted in the last few slides of the seminar to gather more information about the seminar.
Indian Dental Academy: will be one of the most relevant and exciting training
center with best faculty and flexible training programs for dental
professionals who wish to advance in their dental practice,Offers certified
courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry,
Prosthetic Dentistry, Periodontics and General Dentistry.
This document discusses stress breakers in prosthodontics. It defines stress and stress breakers, and describes their aims in directing occlusal forces and preventing harm to remaining teeth. Various types of stress breakers are presented for different prosthesis applications, including removable partial dentures, fixed partial dentures, and tooth-implant supported prostheses. Philosophies of stress distribution like stress equalization, physiologic basing, and broad stress distribution are covered. Specific stress breaker designs like hinges, non-rigid connectors, split pontics, and key-keyway joints are explained.
This document discusses factors affecting the selection of patients for implant retained prostheses. It outlines that a thorough patient evaluation including medical history, dental evaluation through examination and imaging, and informed consent is required. The dental evaluation assesses bone quality and quantity, occlusion, and adjacent teeth. Indications for implants include missing teeth from congenital defects, trauma, or being edentulous. Contraindications include certain medical conditions, smoking, drugs/alcohol, or inadequate bone. Proper patient selection is key for implant success and satisfying treatment outcomes.
This document discusses factors to consider when selecting patients for implant retained prostheses. It outlines general patient factors like medical history and motivation that should be assessed. A thorough dental evaluation including extraoral and intraoral exams, various radiographs, and bone density assessment is important. Patients should provide informed consent and understand expectations, risks, and commitments. Clinical indications for implants include missing teeth due to congenital defects, trauma, or being edentulous. Contraindications include conditions that could compromise bone healing or the patient's ability to maintain implants. A multidisciplinary approach may be needed for complex cases.
1. The functionally generated pathway technique involves recording the paths of tooth movement during excursive jaw motions using wax or other materials.
2. This recording is used to develop the occlusal morphology for dental restorations like crowns, ensuring optimal occlusion during all jaw motions.
3. Studies have found that the functionally generated pathway technique results in restorations with better functional articulation compared to conventional single casting techniques, with less adjustment needed and higher patient satisfaction.
This document discusses cement retention versus screw retention for dental implants. Both methods can be used if done properly. Cement retention is simpler but risks residual cement being left under gums, which can lead to peri-implantitis. Screw retention allows easy removal but requires access holes. Residual subgingival cement is the major problem, as it is difficult to fully remove and can cause inflammation and bone loss over time.
Failures in Fixed Partial Denture
(Prosthodontics FPD- Dental science)
Various types of failures in the fabrication of fixed partial denture
Dr.Sachin Sunny Otta
St.Gregorios Dental College,Kothamangalam,Ernakulam
This document provides an overview of implant supported overdentures, including definitions, history, indications, contraindications, advantages, disadvantages, treatment options, and procedures. Key points discussed include:
- Overdentures are removable prostheses that cover natural tooth roots, implants, or both for support.
- Implant supported overdentures have better outcomes than conventional dentures or overdentures supported only by natural tooth roots.
- Treatment options depend on factors like jaw, bone quality, number of implants, and can involve bar-retained or independent attachments.
- Procedures involve medical evaluation, treatment planning, transitional dentures, surgical placement, attachment connection, and definitive prosthesis fabrication
This document discusses occlusal schemes for implants, known as implant protective occlusion (IPO). IPO aims to reduce stress at the implant-bone interface through 14 considerations including eliminating premature contacts, positioning occlusal contacts over implant bodies, reducing cantilever lengths, and decreasing crown heights. The goals of IPO are to reduce force magnification, improve force direction, and increase the implant support area to promote implant longevity and success.
This document discusses different types of implant abutments and their connections. It notes that any abutment can be divided into three segments: the prosthesis connection system, implant connection system, and transgingival system. The implant connection part should not be altered, but the other two parts may be modified for optimal treatment outcomes. The document goes on to describe different types of abutments and connections in more detail, including their advantages and disadvantages. It provides explanations of internal connections, platform switching, morse tapers, and friction-fit joints between abutments and implants.
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
Emergence profile in fixed partial denture.Pallawi Sinha
This document discusses emergence profiles in natural tooth contours and their importance in fixed partial denture design. It provides a brief history of emergence profile terminology and concepts. Key points covered include:
- Emergence profiles are generally straight rather than convex or concave to avoid trapping plaque.
- Overcontouring crowns can cause gingival inflammation, while undercontouring does not affect healthy gingiva.
- Crowns should have emergence profiles that facilitate oral hygiene through features like open embrasures and occlusally positioned contact areas.
- Natural tooth emergence profiles were photographed and analyzed to establish anatomic norms for accurate reproduction in dental restorations.
Full mouth rehabilitation (FMR) involves extensive restorative procedures to modify the occlusal plane and accomplish equilibration. The goals of FMR are to establish a static centric occlusion in harmony with centric relation, evenly distribute stresses during function, and restore normal masticatory function. FMR is indicated for impaired occlusion, preserving remaining teeth, maintaining periodontal health, improving esthetics, and resolving pain. Diagnostic tools include study models, radiographs, photographs, and diagnostic wax-ups to develop the treatment plan.
Implant abutment and implant abutment connectionsDR.BHAVESH JHA
this ppt enlightened with different types of implant abutment connection. Detailed classification of abutments. Different types of abutments. Latest trends of abutments. Smart abutments. Platform switching, rationale of platform switching and related articles.
Platform switching involves using a smaller diameter abutment on a larger diameter implant. This shifts the implant-abutment junction inward and away from the crestal bone. According to the document, platform switching reduces crestal bone loss in the following ways: 1) It shifts the inflammatory cell infiltrate inward, decreasing its effect on the crestal bone. 2) It maintains the biological width between the implant and bone. 3) It decreases stress levels in the peri-implant bone by shifting the stress concentration area away from the bone-implant interface. The document discusses the concept, history, advantages, and limitations of platform switching.
The document discusses recent advances in prosthodontics presented by Dr. J. Koshy Joseph. It covers various topics including complete dentures, fixed partial dentures, removable partial dentures, maxillofacial prosthetics, implantology, materials and instrumentation. New techniques and materials discussed include the use of lasers in denture fabrication, CAD/CAM systems for complete dentures, magnets and denture liners in prosthodontics, and all-on implants. The document provides an overview of the latest developments across different areas of prosthodontics.
loading protocols in dental implants about indications and contraindications of conventional , immediate,progressive and delayed loading of dental implants
The document discusses occlusal considerations for implant-supported prostheses. It introduces various occlusal terminology and explores the significance of occlusion on osseointegrated implants. The document outlines the goals of implant protective occlusion (IPO), which aims to distribute occlusal forces appropriately to minimize stress on implants and surrounding bone. IPO principles include using thin articulating paper for initial adjustment, equalizing contacts under heavy bite forces, avoiding non-axial and offset loads, and designing the occlusion around the weakest component. The document also discusses factors like implant angulation, crown height, bone quality and the materials used for occlusal surfaces.
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
This seminar is of postgraduate level, which will be helpful for students. The presenter has added the information from various sources and the references are quoted in the last few slides of the seminar to gather more information about the seminar.
Indian Dental Academy: will be one of the most relevant and exciting training
center with best faculty and flexible training programs for dental
professionals who wish to advance in their dental practice,Offers certified
courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry,
Prosthetic Dentistry, Periodontics and General Dentistry.
This document discusses stress breakers in prosthodontics. It defines stress and stress breakers, and describes their aims in directing occlusal forces and preventing harm to remaining teeth. Various types of stress breakers are presented for different prosthesis applications, including removable partial dentures, fixed partial dentures, and tooth-implant supported prostheses. Philosophies of stress distribution like stress equalization, physiologic basing, and broad stress distribution are covered. Specific stress breaker designs like hinges, non-rigid connectors, split pontics, and key-keyway joints are explained.
This document discusses factors affecting the selection of patients for implant retained prostheses. It outlines that a thorough patient evaluation including medical history, dental evaluation through examination and imaging, and informed consent is required. The dental evaluation assesses bone quality and quantity, occlusion, and adjacent teeth. Indications for implants include missing teeth from congenital defects, trauma, or being edentulous. Contraindications include certain medical conditions, smoking, drugs/alcohol, or inadequate bone. Proper patient selection is key for implant success and satisfying treatment outcomes.
This document discusses factors to consider when selecting patients for implant retained prostheses. It outlines general patient factors like medical history and motivation that should be assessed. A thorough dental evaluation including extraoral and intraoral exams, various radiographs, and bone density assessment is important. Patients should provide informed consent and understand expectations, risks, and commitments. Clinical indications for implants include missing teeth due to congenital defects, trauma, or being edentulous. Contraindications include conditions that could compromise bone healing or the patient's ability to maintain implants. A multidisciplinary approach may be needed for complex cases.
This study analyzed the position and angulation of 300 maxillary central incisors using cone beam imaging to provide data to help clinicians achieve good esthetic results for immediate dental implants. The thickness of buccal and palatal bone and apical bone height were measured. Incisors were classified according to their position (buccal, midline, palatal) and angulation (toward buccal, anterior to A point, parallel to alveolus). Most incisors were positioned buccally. Recommendations for implant placement based on tooth classification aim to maintain adequate buccal bone thickness and prevent complications.
Orthodontic correction prior to autotransplantation of impacted permanent max...Fa Nasir
1) The patient, a 19-year-old Malay male, was missing his upper left lateral incisor and canine which were impacted.
2) Orthodontic treatment using fixed appliances was used to correct crowding, spacing issues, and midline shift to create room for transplantation of the impacted teeth.
3) Autotransplantation of the impacted lateral incisor and canine was selected as the treatment approach and deemed to be a good alternative to prosthodontics given the patient's age.
This document discusses single tooth defects in the posterior quadrants and their restoration. It compares fixed dental prostheses to implants, noting that implants are generally preferred when adjacent teeth are healthy or nearly so. For endodontically treated teeth, a fixed restoration is preferred if sufficient tooth structure remains and occlusion and parafunction are minimal. Considerations for implant placement include anatomic factors, timing of placement, and prosthodontic issues like abutment selection and cement versus screw retention. The goal is to restore function while avoiding complications like fracture, overload, and peri-implantitis.
The document discusses treatment options for untreatable traumatized anterior maxillary teeth in young patients to preserve the alveolar ridge for future dental implants. It notes that dental implants are contraindicated during childhood, requiring a 8-10 year waiting period for growth to cease. For future implants, it is essential to ensure continuous growth of the alveolar process in width and height from time of injury until skeletal maturity. Some treatment options discussed to achieve this include orthodontic extrusion of the root remnant with a temporary crown, autogenous tooth transplantation, and maintaining ankylosed teeth in place to prevent ridge resorption and space closure. The goal is to preserve the alveolar ridge until after skeletal maturity
This document discusses impacted and unerupted maxillary incisors. It provides information on prevalence, causes such as supernumerary teeth or odontomes, and classifications of delayed eruption. For management, it recommends examining patient history, radiographs, and surgical exposure techniques. Surgical exposure can be open, involve an apically repositioned flap, or use a closed eruption procedure. Factors like position, angulation, and amount of attached gingiva determine the best exposure technique. Orthodontic treatment may involve space creation, surgical exposure with orthodontic alignment, or tooth removal and space management. Complications of orthodontic treatment include relapse, non-compliance, root resorption,
This document provides guidelines for diagnosing and treatment planning for removable partial dentures. It discusses the importance of a thorough oral examination including visual, digital and radiographic exams. Diagnostic casts are made to evaluate occlusion, parallelism of tooth surfaces, and develop the treatment plan. Factors like periodontal health, caries activity, tooth morphology and bone quality are assessed to determine the best treatment approach and whether teeth can serve as abutments. Fixed or removable partial dentures are differentiated based on factors like the span of the edentulous area and the ability of teeth to withstand stresses. The overall goal is to restore function, aesthetics and oral health while preserving supporting tissues.
The document discusses surgical and prosthodontic considerations for patients who have undergone a radical maxillectomy. It provides details on:
1) Closing the surgical defect with a radial forearm free flap and addressing distortions to palatal contours and secretions in the nasal cavity.
2) Retaining key abutment teeth by making bony cuts between teeth rather than through them.
3) Covering the palatal margin of defects with palatal mucosa when possible.
4) Designing obturators to be lightweight, inexpensive, and perforated to wire to residual dentition.
The biological width is defined as the dimension of soft tissue attached to the tooth coronal to the alveolar bone crest, including the sulcus depth, epithelial attachment, and connective tissue attachment. It typically measures around 2.04 mm. Violation of the biological width can occur when restorations are placed too far subgingivally and can lead to inflammation and bone loss. Surgical crown lengthening and orthodontic extrusion are techniques used to correct biological width violations. Maintaining the biological width is important for peri-implant health as well.
Diagnosis and treatment planning in implants 2./prosthodontic coursesIndian 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
Congenitally Missing Lateral Incisor with Orthodontics, Bone Grafting and Sin...Abu-Hussein Muhamad
This case report describes the interdisciplinary treatment of a congenitally missing maxillary lateral incisor. The treatment involved orthodontics to create sufficient space, a chair-side bone graft using autograft bone harvested with trephine drills to augment the alveolar ridge width, and placement of a single dental implant. After orthodontic space opening, bone was harvested from the mandibular ramus using trephine drills and grafted to the alveolar ridge. Then a dental implant was placed. The patient underwent supportive periodontal therapy and prosthetic rehabilitation with an implant-supported crown, providing an esthetic replacement for the missing lateral incisor.
THE ART AND SCIENCE OF TREATMENT PLANNING ON ORTHODONTIC EXTRUSIONAbu-Hussein Muhamad
Traumatized anterior teeth with subgingival fractures of crown are a challenge to treat. This paper reports the man¬agement of subgingival fractures of crown of the maxillary central incisor in an 29 year old female. The technique described here involves the use of fixed appliance, post and core with a loop fabricated on it for retention of fixed appliance.
Keywords: Fracture, Tooth, Root Extrusion, Crown Fracture.
Esthetic Evaluation of ImplantsPlaced after Orthodontic Treatment in Patients...Abu-Hussein Muhamad
Congenitally missing teeth are frequently presented to the dentist. Interdisciplinary approach may be needed for the
proper treatment plan. Several treatment options exist for the replacement of congenitally missing lateral incisors.
These options include canine substitution, resin bonded fixed partial dentures, cantilevered fixed partial dentures,
conventional fixed partial dentures and single tooth implants. Depending on which treatment option is chosen, a
specific criterion has to be addressed. Interdisciplinary treatment plays a vital role to achieve an excellent, esthetic
result for a most predictable outcome. This article aims to present a case report of replacement of bilaterally
congenitally missing maxillary lateral incisors with dental implants
Key words: congenitally missing lateral incisor, interdisciplinary treatment, dental impla
The document discusses factors that must be considered for optimal esthetic outcomes when placing implants in the anterior maxilla, or esthetic zone. Specifically, it notes that implant placement and prosthetic planning require strong consideration of bone quality and quantity, soft tissue characteristics, and prosthetic design factors. Multiple techniques for hard and soft tissue augmentation are presented to address various bone deficiency classifications to allow for ideal implant positioning and soft tissue emergence profiles that maximize esthetics.
This document discusses preprosthetic surgery, which involves surgical procedures done prior to the construction of dentures to improve the denture foundation and ensure successful denture therapy. Some reasons for preprosthetic surgery include removing retained teeth/roots, smoothing uneven ridges, reducing tori or exostoses that could interfere with denture placement, and adjusting the mental foramen if resorption has caused sharp edges that could cause pain. Both non-surgical and surgical methods are discussed, including alveoloplasty to reshape ridges and remove undercuts or projections, as well as the importance of a thorough examination and developing a treatment plan with the patient.
There are three basic phases of the digital workflow when designing and/or fabricating removable partial denture frameworks; data acquisition, designing (computer aided design (CAD)), and computer-aided manufacturing (CAM). The bulk of this presentation is dedicated to the design steps used in this workflow utilizing sample maxillary and mandibular casts
There are three basic phases of the digital workflow when designing and/or fabricating removable partial denture frameworks; data acquisition, designing (computer aided design (CAD)), and computer-aided manufacturing (CAM). The bulk of this presentation is dedicated to the design steps used in this workflow utilizing sample maxillary and mandibular casts
This document discusses prosthodontic procedures and complications in posterior quadrants. It covers topics such as exam and workup, selection of implants, platform switching, abutment selection, provisional restorations, and new technologies like shape memory sleeve abutments. Key points addressed include that no implant design has been proven superior for marginal bone loss, and custom abutments offer better control of margins and occlusal thickness than prefabricated abutments. New technologies aim to simplify procedures and improve retrievability of restorations.
This document discusses implant biomechanics and treatment planning considerations for restoring posterior quadrants. It notes that implant restorations must be designed to avoid overload, as excessive loads can lead to bone loss and implant failure over time. Key factors discussed include implant number, length, alignment relative to curves of Spee and Wilson, and linear versus curvilinear configurations. Curvilinear arrangements are emphasized as withstanding more load than linear arrangements due to greater cross-arch stabilization. Case examples demonstrate successful long-term outcomes and failures where biomechanics were not adequately considered.
This document discusses the use of implants to supplement removable partial dentures (RPDs) in various clinical situations. Implants can be used to improve support, stability, and retention of RPDs when existing dentition is compromised. Common scenarios include using implants in extension base RPDs, with questionable implant anchorage or unfavorable configurations, to replace lost implants in key locations, replace a lost natural tooth abutment, or supplement insufficient existing dentition. Resilient attachments are often used to retain implant-assisted RPDs while avoiding implant overload. Complications can include peri-implantitis, loose abutments, and wear of attachments. Overlay RPDs are also discussed as an option to
This document discusses computer guided treatment planning and implant placement. It describes how computer guided planning allows visualization of potential implant sites in 3D and more precise placement compared to free-hand drilling. Fully guided surgery uses surgical templates to control position, angle, depth and diameter of osteotomies, while semi-guided surgery controls initial position and angle only, allowing more flexibility. Fully guided is used for edentulous patients, while semi-guided is preferred for partially edentulous patients where soft tissue manipulation or bone grafting may be needed.
This document discusses dental implants, specifically angled (tilted) implants used to restore edentulous maxillas. It describes several approaches for using tilted implants, including placing 4-6 implants with angled abutments to offset the implant angles, or using co-axis implants where angulation correction is subgingival. Tilted implants provide advantages like longer distal implants, improved primary stability, and eliminating the need for sinus augmentation. Studies show success rates above 90% for tilted implants.
Crowns significantly improve the success of endodontically treated posterior teeth but do not improve the success of anterior teeth. Posterior teeth require crowns more often than anterior teeth due to greater cuspal deflection after root canal treatment. The main purpose of a post is to retain a core, not strengthen teeth. Posts should extend to retain 5mm of gutta percha and not exceed 7mm in molars. The diameter of posts should not exceed one-third of the root diameter and range between 0.6-1.2mm. A ferrule of at least 2mm helps prevent tooth fracture.
Charles J. Goodacre presents on provisional restorations in fixed prosthodontics. He discusses the functions and requirements of provisional restorations including protection, mastication, esthetics, positional stability, and providing diagnostic information. He describes various provisional restoration resins and their properties. Goodacre also outlines different types of provisional restorations including prefabricated, custom-fabricated, direct and indirect techniques. He demonstrates techniques for direct provisional restorations using templates and indirect restorations fabricated by a laboratory.
This document discusses secondary impression materials used in fixed prosthodontics. It defines an impression as a negative reproduction of prepared teeth that provides information to fabricate a crown or fixed prosthesis. Impressions can be physical materials or digital scans. Physical impressions include reversible hydrocolloid, condensation silicone, polysulfide, polyether, and addition silicone. Custom trays are often used and are fabricated from autopolymerizing or light-cured resin. Ideal impressions accurately record all prepared surfaces and maintain dimensional stability until the laboratory casts are made.
This document discusses techniques for fluid control and tissue management during fixed prosthodontic impressions. It describes the need to displace gingiva to record tooth structure below the finish line. Various methods of fluid control are outlined, including retraction cords, suction, and isolite systems. Retraction cords should be moistened with hemostatic agents before gentle placement to displace tissue. The document recommends a two-cord technique using different diameter cords and additional hemostatic agents if needed to control bleeding and produce accurate impressions. Proper fluid management is essential for high quality fixed prosthodontic impressions.
This document provides an overview of ceramics used in fixed prosthodontics. It discusses various types of ceramics including glass ceramics, glass infiltrated mixtures, and polycrystalline ceramics. Examples mentioned include lithium disilicate, zirconia, and alumina. The document reviews clinical indications and uses of different ceramics, as well as case considerations, preparation designs, and causes of failure. An outline is provided of the topics to be covered in the presentation on ceramics in dental practice.
1) There are two main hardening mechanisms for dental cements - acid-base reactions and polymerization reactions. Common cements that use acid-base reactions include zinc phosphate, polycarboxylate, and glass ionomer cements. Resin cements use a polymerization reaction.
2) Zinc phosphate cement has a long history of success but lacks adhesion and fluoride release. Polycarboxylate cement bonds to tooth structure and has short mixing/working times. Glass ionomer cement releases fluoride and bonds to tooth structure.
3) Resin-modified glass ionomer cement combines the benefits of glass ionomer cement with the strength and handling of resin, providing good early strength and reduced moisture sensitivity.
1. Single tooth defects in the posterior quadrants can often be restored with either fixed dental prostheses or dental implants, depending on the clinical situation and anatomical factors.
2. Implant placement can be immediate, delayed, or staged depending on factors like infection, bone quality, and proximity to anatomical structures.
3. Site enhancement procedures may be needed to augment bone in order to place implants in ideal positions and ensure adequate bone volume.
This document summarizes research on the success rates and complications of resin bonded prostheses (RBPs). It finds that on average, 26% of RBPs experience complications within 4 years, increasing to 28% after 5 years, with debonding being the most common at 21%. Debonding rates are higher for posterior teeth, longer spans, and cantilever designs. Tooth preparation techniques like covering lingual and proximal surfaces, adding proximal grooves or pinholes, and occlusal rests can reduce debonding. Maintaining a minimum of 0.5mm occlusal clearance and 1mm metal thickness also impacts success. Proper diagnosis, treatment planning and cementation techniques are keys to optimizing longevity
This document is a lecture on fixed partial denture (FPD) designs by Charles J. Goodacre from Loma Linda University School of Dentistry. The lecture discusses key considerations for FPD treatment planning including tooth stability, occlusal forces, abutment selection, and material choices. It provides examples of different FPD designs for single and multiple tooth replacements in the maxilla and mandible. Challenges with each case such as cantilevers, oral hygiene access, and risk of failure are evaluated. The goal is to create the best online programs of instruction in prosthodontics.
Crowns significantly improve the success of endodontically treated posterior teeth. Posts are primarily used to retain cores and do not strengthen teeth. The appropriate post length is to extend to the radiographic apex with 5mm of gutta percha retained. Post diameter should not exceed 1/3 of the root diameter and range from 0.6-1.2mm. A ferrule of at least 2mm is recommended to prevent root fracture.
This document discusses various dental cements and cementation procedures. It describes the compositions, characteristics, and mixing procedures of different cement types including provisional cements, zinc phosphate cement, polycarboxylate cement, glass ionomer cement, resin-modified glass ionomer cement, resin cement, and calcium aluminate cement. It also outlines various clinical procedures for cementation such as provisional crown removal, tooth preparation, crown placement, adjustment, and cement cleanup.
This document discusses provisional restorations in fixed prosthodontics. It describes the functions and requirements of provisional restorations, including protection, mastication, esthetics, positional stability, and providing diagnostic information. It discusses different materials used for provisional restorations like methyl methacrylate, ethyl methacrylate, and composite resins. It also describes different types of provisional restorations including prefabricated shells, custom-fabricated templates, and cast metal. Both direct and indirect techniques are covered.
This document contains a lecture by Dr. Charles Goodacre on the importance of cervical contour, marginal fit, and surface smoothness of dental restorations for optimal gingival health. Over several decades of practice, Dr. Goodacre observed many cases where poor contours, fit or smoothness led to gingival inflammation and tissue loss. The lecture reviews key principles for contouring provisional and definitive restorations, and highlights cases with favorable as well as unfavorable outcomes related to restoration design. Dr. Goodacre emphasizes the importance of biologic principles and attention to detail for achieving and maintaining healthy peri-implant and periodontal tissues.
More from www.ffofr.org - Foundation for Oral Facial Rehabilitiation (20)
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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2. Single Tooth Implants
The goal with the single tooth implant restoration is to mimic function
and esthetics of the natural tooth.
A sound esthetic result is dependent upon:
! Optimal bone and gingival contours
! Accurate 3-D implant positioning
! A good ceramist
3. Single Tooth Implants
! Successfully used since late 1980s to replace
!
!
!
!
single teeth, both in the anterior and posterior
sites.
Implant loss has been reported to be < 5%.
No difference has been noted between sites in
maxilla and mandible.
Failures -About 50% have been pre-prosthetic
and 50% post-prosthetic
Complications include screw loosening, fistulas
at the implant –abutment level, esthetic
problems and post-operative neurosensory
disturbances.
Esposito et al, 1998
4. Working up The Single Tooth
Implant Case
! Diagnosis: Assessing hard and soft tissues, and their
relations to each other
-Clinical Evaluation
-Study Models
-Implant Template
-Imaging Evaluation
! Treatment Plan: Designing and sequencing surgical
and restorative aspects of the treatment.
-Restorative Design
-Surgical Design
! Therapy: Execution of the clinical procedures.
5. Diagnosis - Clinical Evaluation
! A- Edentulous tissues
! B- Residual edentulous space
! C- Adjacent teeth
! D- Opposing teeth
Functional and esthetic outcome of the single tooth implant therapy
depends on the proper clinical analysis of these four elements.
6. Diagnosis - Clinical Evaluation
A- Edentulous tissues
Amount of attached tissue is important in establishing periodontal
health around the implant crown.
! Achieving ideal soft tissue form and implant position is dependent
upon residual tissue contours. Interdental papilla height and buccal
plate should be carefully analyzed for deficiencies. These deficiencies
might effect functional and esthetic outcome of the implant restoration.
!
Flat papilla causing dark space
Adequate plate
Deficient plate
7. Diagnosis - Clinical Evaluation
Buccal plate deficiency in single tooth site
! Following extraction, particularly if traumatic, the
labial plate resorbs
! Resorption creates a site that dictates a palatal
placement and a ridge lapped restoration
Implants placed in
such sites lead to :
8. Diagnosis - Clinical Evaluation
Labial or Buccal plate deficiencies - Single tooth sites
! Ridge lapped restorations
! Hygiene is made more difficult
! Esthetics is compromised in patients
with a high smile line who display
significant amounts of gingiva
! Esthetics is compromised because
most such patients lack an
interdental papilla (arrow)
9. Bone augmentation for building the site
Horizontal Deficiencies
Woven Bone
Grafting anterior horizontal deficiencies
has been relatively predictable due to
minimal loads usual in this region.
11. Horizontal Deficiencies
Bone augmentation
Normal Bone vs. Grafted Bone
Lamellar
Bone
The bone implant
interface is
compromised in sites
with woven bone. At
some sites, the
woven bone is not
replaced with dense
lamellar bone.
Woven Bone
Result: The load carrying capacity of implants in
grafted bone may be compromised.
12. Diagnosis - Clinical Evaluation
B- Residual edentulous space
!
!
!
Interarch distance should be minimum 2 mm in the anterior sites
and 4 mm in the posterior sites.
Mesio-distal distance should be about 7 mm. When there is over
10 mm of distance, implant size and number should be carefully
considered for avoiding implant overloading. Also, when ridge
position dictates the implant position to be lingual to the tooth
position, buccal cantilevering of the restoration might cause
overloading.
Size of the missing tooth space in relation to contralateral tooth
in the anterior region should be carefully matched for good esthetic
results. Crown/implant ratio should be kept to 1:1 for sound
biomechanics.
13. Diagnosis - Clinical Evaluation
B- Residual edentulous space
Adequate interarch distance (yellow)
More mesio-distal distance than contralateral (green)
Extra width due to rotation of #10 (red)
Buccal cantilevering (red)
might cause overloading
due to off-axial loads.
14. Diagnosis - Clinical Evaluation
C- Adjacent teeth
!
!
!
!
!
Prognosis of the adjacent teeth is very important for avoiding
potential implant failure inflicted from adjacent pathology.
Soft tissue contours and levels should be reviewed to identify any
deficits that might have direct impact on the esthetic outcome.
Position of the adjacent teeth (rotated, tilted, out of curve,
extruded, intruded) along with position of proximal contacts can
cause functional and esthetic problems if not addressed properly.
Wear facets should be carefully analyzed to understand the
occlusal pattern.
Restorations and materials on the adjacent teeth would assist in
designing the optimal implant restoration.
15. Diagnosis -Clinical Evaluation
C- Adjacent teeth
?
?
Prognosis of endodontically treated teeth should be
assessed and pathology should be ruled out. Also,
integrity of the restorations should be examined.
Existence and maintenance of harmonious
gingival levels provide esthetic outcome.
Rotation of #10 decreases papilla height
and causes less than ideal contact
position.
16. Diagnosis - Clinical Evaluation
D- Opposing teeth
!
!
!
Plane of occlusion and occlusion play an important role on the loads
exerted on the implant restoration. Occlusal scheme should be
carefully evaluated for planning the centric and laterotrusive
contacts.
Type of restoration; Fixed would transmit more forces than the
removable restoration.
Prognosis of a compromised tooth might be negatively impacted
when opposed by rigid implant restoration.
Canine guidance
Centric
Protrusive
17. Diagnosis
Study Casts
Edentulous site along with the
adjacent structures can be
analyzed in detail on the casts.
Diagnostic prototype in the missing
tooth site would help visualize the
proposed restoration. Location and
alignment of the proposed implant
can be studied through the
diagnostic work up.
Proposed tooth contours
18. Diagnosis
Surgical Template
It is used for imaging and surgical
purposes. Fabricating a good
template would enhance the
diagnostic value of imaging and
then guide successful placement
of the implant. This template
contains barium sulfate mixed
with clear acrylic at the missing
tooth site for radio opaque
marking during tomographic
imaging.
Proposed implant alignment
19. Diagnostic Imaging
Radiological exam can be done with PA’s and
PAN’s, however, further information can be
obtained via tomograms. Below items are
studied in the radiological exam:
• Pathology at and around the site,
• 3-D bone volume,
• Bone quality through distribution of cortical and
trabecular bones in the proposed site,
• Anatomic structures/restrictions,
• Restoration contours in relation to bone,
• Optimal alignment of implant (perpendicular to
the occlusal plane) within the bone.
Ideal alignment seems to be possible in the facial view (yellow),
however, proposed implant alignment would end up perforating
the buccal plate (red) in the sagittal view. Therefore, implant
axis needs to be redirected within bone (green) which would
cause screw access hole buccally positioned.
20. Time Frame of Traditional Implant
Therapy
Pre-operative
~1 month
(Dx & Tx Plan)
Post-operative
~4-6 months
(First 10-14 days no pressure,
then Tx RPD as interim)
Final restoration
~2 months
(min. 2 weeks soft tissue healing
before impression)
Total
minimum 7-9 months
21. Treatment Planning
Restorative Design
Fabricating the implant template initiates the
restoratively driven implant therapy. This process would
identify restorative concerns and possible
restorative/surgical solutions.
Implant restorations should have similar emergence
profile as natural teeth for establishing and maintaining
esthetic soft tissue architecture. This can be achieved
by proper 3-D placement of the implant.
Biomechanical guidelines:
1. Crown/implant ratio should not exceed 1:1.
2. Implant single crown should not extend lateral to the implant more
than one implant diameter. Narrow occlusal table, using two implants
or wide diameter implant are methods to compensate for potential
overload. (Rangert et al. Forces and moments on Branemark
implants. Int J Oral Maxillofac Implants 1989)
22. Treatment Planning
Restorative Design
Biomechanical considerations: Especially mandibular first molar
sites should be carefully studied, since mesio-distal distance is
usually over 10 mm.
M-D distance measures about 12mm in this
case. Placement of a wide body implant (5
mm diameter instead of 4 mm) along with
narrowing the occlusal plane is intended to
compensate for overloading.
12 mm
5 mm
23. Treatment Planning
Restorative Design
! Biomechanical consideration for first molar site:
M-D >12 mm
Two 4 mm diameter implants were placed in the first molar
site with over 12 mm mesiodistal distance. A splinted
restoration was fabricated by using custom abutments and
screw retained PFM crowns. Note the hygiene access.
24. Treatment Planning
Restorative Design
Occlusal guidelines:
! Light centric contact should be established. Shim stock should only be
grasped when the musculature is fully engaged.
! Eccentric contacts should be avoided. Over-engineering and night
guards are suggested for bruxors.
! Mild cusp heights are preferable since, otherwise bending moments and
load magnification can cause overloading of the implant.
Abutment selection guidelines:
! Screw or cement retained implant restorations can be fabricated. Various
reasons (retrievability, amount of space, esthetics, occlusion, ease of
operation, etc.) can be considered in choosing one over the other option.
However, the decision should be made prior to the placement of the
implant, since position of the implant might be slightly different in each
option.
! The implant restoration should easily be cleansable.
25. Treatment Planning
Surgical Placement
Biomechanical success and restoration/tissue
esthetics depend on the correct positioning of the
implant in the bone. Optimal 3-D position of implant
can be achieved by following below guidelines;
Implant should be centered mesiodistally for
minimizing cantilevering effect and creating normal
emergence profile.
Accurate implant position
provides natural tissue
contours.
26. Treatment Planning
Surgical Placement
Faulty mesiodistal implant placements
Distally placed implant
causes mesial lever arm
when chewing force is at the
mesial. This might initiate
screw loosening and
fracture.
Lack of sufficient space
between the tooth and
the implant resulted in
lack of papilla. There
should be over 1.5 mm
distance between the
natural tooth and the
implant for viable bone
and papilla.
27. Treatment Planning
Surgical Placement
Faciolingual position of the anterior implant
should be aligned under the cingulum of the
proposed crown for screw retained restorations
and under the incisal edge for cement retained
restorations. Posterior implant should be centered
faciolingually for reducing the potential for
overloading.
Implant is centered.
Implant was aligned
under the cingulum for
screw retained PFM
Implant along the
incisal edge for
cement retained PFM
28. Treatment Planning
Surgical Placement
Faulty faciolingual implant placement
The body of the
implant was facially
positioned and
inclined.
Esthetic harmony could not be
achieved due to variations in
gingival levels and teeth lengths.
29. Treatment Planning
Surgical Placement
Incisocervical/occlusocervical position of the
implant is mainly dependent on the location of the
existing bone. However, there is a need to create
emergence profile from implant’s round form to
natural tooth’s elliptical form for achieving natural
esthetics. The head of the implant should be 2-4 mm
below the adjacent gingival margin. Implant template
should represent the CEJ of the proposed restoration
for guiding the surgery.
Diagnostic work up
leads to the implant
template.
2-4 mm
30. Treatment Planning
Surgical Placement
Faulty incisocervical/occlusocervical implant position
This implant has been placed too far
beneath the gingiva.
Result: The depth of the peri-implant is
excessive leading to an increased risk of
peri-implantitis and progressive bone loss
around the implant.
30 months later
Attachment
level
Gingival margin
31. Surgery – Implant Placement
Flap is raised by employing papilla preservation technique for tissue esthetics.
2-4 mm
Osteotomy is oriented through the cingulum for screw retained restoration.
32. Interim restoration
Treatment Removable Partial Denture is worn
following the surgery. The interim prosthesis should
not exert pressure on the site/implant for undisturbed
bone healing around the implant.
Over the healing abutment
Tx RPD should be relieved
underneath the prosthesis
at the time of healing
abutment placement.
33. Implant supported provisional restoration
The provisional restoration is the prototype of the final restoration. It is used
to form the most ideal gingival contours for the definitive crown and also
helps to test and reevaluate the restorative plan. Another use of the
provisional restoration would be to keep it for long term evaluation if the
osseointegration of the implant is questionable.
Screw retained provisional
34. Implant supported provisional restoration
Implant is excessively inclined
towards the facial. Technical
details of the crown fabrication
would be considered at this time.
The screw access hole can be readily
visible at the incisal edge of the
provisional restoration. In this situation
unsupported porcelain cannot be built at
the incisal edge for the final restoration,
therefore restorative decision should be to
make a custom abutment.
35. Abutment selection
The final restoration can be either screw or cement retained.
Various abutments can be used to facilitate the connection between the
implant and the final crown. The UCLA abutment is the most versatile
abutment, since it can be used for both screw and cement retained options.
Screw retained restorations are used when retrievability of the
restoration is desired and minimum incisocervical/occlusocervical height is
available. The single piece restoration uses UCLA abutment and is
screwed onto the implant through the access hole in the cingulum or central
fossa of the crown. This method is used when the position and the
angulation of the implant is ideal. However, a two piece restoration is
used when the access hole exits the crown in an undesirable way. In these
situations a custom abutment is fabricated to accommodate a crown piece
with a lingual set screw. By this way, first piece (custom abutment) gets
screwed onto the implant and the second piece (crown) is screwed onto the
abutment.
36. Screw retained UCLA abutment
restoration (single piece)
Screw access through the cingulum.
38. Screw retained UCLA abutment
restoration (single piece)
#30 was replaced with an implant
restoration. Patient presented with a
healing abutment after second stage
surgery. Impression analog was placed
onto the implant and full seating was
confirmed with a PA. A PFM implant crown
was fabricated and tried in. PA showed
that the PFM was not seated all the way
due to proximal contacts holding (arrow).
After adjustments, implant restoration was
fully seated and the connection screw was
torqued onto the implant with a torque
driver. The access hole was sealed with
gutta- percha and composite on the
occlusal surface.
Tight contacts holding full seating of the crown.
39. Screw retained UCLA abutment
restoration (single piece)
Light centric contact was established while excursive contacts were avoided.
Ideal position of the implant created natural emergence profile which lead to
natural gingival and tooth esthetics.
40. Screw retained UCLA abutment
restoration (two piece)
Resin pattern of the
custom abutment
which changes the
direction of the
implant long axis.
Full contour wax
pattern of a labially
inclined implant.
Completed custom
abutment (first
piece) with lingual
screw access
(arrow).
41. Screw retained UCLA abutment
restoration (two piece)
Metal coping for the second
piece fits over the first
piece.
PFM crown
Screw lapping
Completed and assembled
PFM restoration.
Note the level of the
gingiva.
Retention
screw
Abutment
screw
Custom abutment
42. Screw retained UCLA abutment
restoration (two piece)
Lingual
set screw
Gingival levels do not match but the patient does not
display his gingiva due to low smile line.
43. Abutment selection
The final implant crown can also be fabricated as cement retained
restoration. It is more esthetic especially at the posterior sites due to lack
of screw access hole through the occlusal surface. It can also be argued
that clinical and laboratory procedures for cement retained restoration are
less technique sensitive and similar to conventional crown. However, risk of
leaving cement in the sulcus, not being able to seat the crown due to
hydraulic pressure and increased need for space to accommodate two
piece restoration are disadvantages for this type of implant restoration.
Various abutments can be used to facilitate the connection
between the implant and the final crown for cement retained restorations.
These are all two piece restorations where the first piece is prepared like a
tooth to receive a crown and screwed onto the implant. The second piece is
fabricated just like a conventional PFM crown to be cemented over the first
piece. The first piece can either be custom abutment (using UCLA
abutment) or prefabricated abutment (metal and porcelain) provided by
the implant manufacturer.
44. Cement retained restoration with
UCLA abutment
The UCLA abutment is utilized to fabricate the custom cement-on abutment in the
desired form. Once the custom abutment is screwed and torqued onto the
implant, the screw access hole is sealed with gutta percha. Then the PFM is
cemented permanently in the conventional way.
45. Cement retained restoration with
prefabricated metal abutment
Gingi-hue abutment is provided by the implant
manufacturer to be prepared like a natural tooth
abutment. It is gold color plated to avoid showing
gray hue through the tissue with metal color.
A conventional PFM crown is fabricated on the abutment. First, the abutment is
screwed on the implant and torqued for maximum stability. then the crown is
cemented permanently.
46. Cement retained restoration with
prefabricated porcelain abutment
The prefabricated porcelain abutment is
made from zirconia. It is considered the
most esthetic abutment for the tissue
and the crown. It has no greying effect
on the tissue because of its white color.
For best esthetic results, an all-porcelain
crown can be placed on this abutment.
The zirconia abutment is prepared like a
natural tooth in the laboratory and a high
strength porcelain crown is fabricated.
47. Cement retained restoration with
prefabricated abutment
WARNING: If the margin for the crown is placed very deep subgingival on the
abutment, removal of the excess cement might be difficult during cementation.
A temporary crown was cemented onto the prefabricated abutment. Two
days later note the inflammatory reaction associated with the gingiva
around the crown. These reactions are caused by impaction of cement
into the sulcus upon cementation.