Technical Complications in implant dentistry46.pptx

Technical Complications in implant dentistry46.pptx

• 1.
  Chapter 46
• 2.
  1. Implant fractures 2.Implant complications 3. Abutment and abutment screw complications 4. Residual cement as a technical problem 5. Prosthesis attrition and fracture 6. Prevention of technical complications
• 3.
  increased implant length Maxilla highinsertion torque implant-abutment connection designs ( Imp design)
• 4.
   repeated andfrequent abutment loosening  vertical bone loss adjacent to the implant fracture  Circumferentially around the implant Radiographic image of bone loss associated with vertical implant fracture (not observed radiographically)
• 5.
   implant maybe buried or remove  altering the prosthesis to connect with the residual portion of the implant  multi-implant cases  Alternative prosthesis : overdenture
• 6.
   Iatrogenic damageto an implant:  remove overtightened cover screws or abutments  remove broken abutment screws : hand instrumentation  Iatrogenic damage upon implant insertion:  Improper engagement of implant drivers  non-axial forces to internal connection implants  High torque upon insertion
• 7.
   Too facially/lingually  Too shallow/deep  too close to an adjacent tooth  two implants are too closely approximated
• 9.
   mechanical advantages:  reducing or eliminating micromotion  favorable distribution of forces along the implant and to bone  potential complication  ‘settling’ of the abutment and related screw loosening implant itself is deformed, permitting conus interfaces to seat deeper within the implant
• 10.
   Several studieshave shown that internal connection (particularly internal conus/more taper interfaces)demonstrate less abutment screw loosening than external hex implants  the load on the screw is reduced in internal implant‐abutment connections  higher strength and resistance to bending of internal abutment  Externally connected abutments : technical problems  internally connected abutment: biologic problems
• 11.
   superior abutmentsurvival for metal versus ceramic abutments  zirconia abutments provide for high success when used for single tooth, anterior implant restorations  esthetic crown : gold or gold hue abutment with a zirconia coping  Peri-implant soft tissue coloration: zirconia abutments  zirconia has minimal effect on mucosal color difference when placed beneath 1.5 mm of mucosa (pig model)
• 12.
   higher for: full arch and multi‐implant prostheses  Recurrent screw loosening of a multi‐implant prosthesis : check passive fit  single tooth implants : crown to implant ratio  crown‐to‐implant ratios of 1–2 did not demonstrate significant technical complications
• 13.
   Construction ofthe prosthesis at the abutment level: 1. force transmission from the prosthesis to the implant abutment interface (abutment screw) 2. places the restorative margin at a distance from the implant/bone interface (reduce inflammation)  Construction at the implant level: 1. forces are directed to the abutment screw (deformation/loosening/fractue) 2. Micromotion and bacterial leakage ( inflammation)
• 14.
   Proper cementation: 1.shallow crown margin locations circumferentially (<1.0 mm) 2. Cementation techniques : venting of crowns, monolayer application with brush 3. Where peri‐implant mucositis is observed : cause must be the presence of residual cement  Type of cement  zinc oxide eugenol vs resin cements
• 15.
   implant‐retained metalacrylic prostheses (hybrid)  high level of occlusal function  lack of proprioception  low strength denture tooth  wear often occurs on the posterior aspect leading to anterior tooth fracture  Time dependent increase in the incidence of prosthesis complications  Predominant risk factor: frame work design
• 16.
   porcelain-fused-to-metal prosthsesis: high porcelain chipping complication  increased risk of chipping was greater for (× 4.6) for ceramic versus metalacrylic type prosthesis  Increased ceramic chipping  Bruxism  Absence of nightguard use  higher rates of mechanical (and biologic) complications were observed for cement-retained prostheses
• 17.
   monolithic zirconiarestorations for full arch:  veneered zirconia prostheses vs monolithic zirconia  higher incidence of technical complications  chipping in the veneered zirconia prostheses  zirconia failures  dimensional requirements for full arch zirconia implant prostheses  10 mm of vertical  Larg and tall connectors  Thickness : greater than 3 mm