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
loading protocols in dental implants about indications and contraindications of conventional , immediate,progressive and delayed loading of dental implants
Hybrid abutments consist of a titanium insert, which is connected to a ceramic mesostructure using a resin cement
These types of abutments have the advantages of both ceramic and titanium abutments, including improved esthetics, optimal biological response, and superior mechanical properties, with no adverse effects on the implant–abutment interface.
Screw versus cement for implant prosthesis installation part 2Emil Svoboda
Screw versus Cement, dental implants, 2015, Implant Prosthetics, Crowns and Bridges, Cementation, Screw retained Part 2
Citation:
Screw versus Cement for Implant Prosthesis Installation. Part 2: The Game Changer the Tips the Balance to Favour Intra-oral Cementation. Emil LA Svoboda, Published to www.ReverseMargin.com, November 12, 2015
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
loading protocols in dental implants about indications and contraindications of conventional , immediate,progressive and delayed loading of dental implants
Hybrid abutments consist of a titanium insert, which is connected to a ceramic mesostructure using a resin cement
These types of abutments have the advantages of both ceramic and titanium abutments, including improved esthetics, optimal biological response, and superior mechanical properties, with no adverse effects on the implant–abutment interface.
Screw versus cement for implant prosthesis installation part 2Emil Svoboda
Screw versus Cement, dental implants, 2015, Implant Prosthetics, Crowns and Bridges, Cementation, Screw retained Part 2
Citation:
Screw versus Cement for Implant Prosthesis Installation. Part 2: The Game Changer the Tips the Balance to Favour Intra-oral Cementation. Emil LA Svoboda, Published to www.ReverseMargin.com, November 12, 2015
Dental implants require different biomechanical considerations from natural teeth. Also, with one of the criteria for long-term implant success being “occlusion,” it becomes imperative for the clinician to be well
versed with the different concepts when rehabilitating with an implant prosthesis.
Description :
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
Implant Loading Protocols Journal Club-Comparative evaluation of the influenc...Partha Sarathi Adhya
This journal club deals with different loading protocols and comparative analysis among them. this basically deals with immediate and delayed loading protocols.
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
differences between natural tooth periodontium and implant bone connection, biomechanics of implants, implant protected occlusion , occlusal principles for single tooth implant prosthetics and implant supported prosthesis on edentulous arch, shortened arch concept, therapeutic occlusion
Dental implants require different biomechanical considerations from natural teeth. Also, with one of the criteria for long-term implant success being “occlusion,” it becomes imperative for the clinician to be well
versed with the different concepts when rehabilitating with an implant prosthesis.
Description :
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
Implant Loading Protocols Journal Club-Comparative evaluation of the influenc...Partha Sarathi Adhya
This journal club deals with different loading protocols and comparative analysis among them. this basically deals with immediate and delayed loading protocols.
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
differences between natural tooth periodontium and implant bone connection, biomechanics of implants, implant protected occlusion , occlusal principles for single tooth implant prosthetics and implant supported prosthesis on edentulous arch, shortened arch concept, therapeutic occlusion
Award Winning AAID Table Clinic PresentationEmil Svoboda
The Effects of Gingiva and Abutment-Prosthesis Design on Cement Flow during Intra-oral Cementation An “In Vitro” StudyDr. Emil L.A. Svoboda PhD, DDS April 9, 2016
Preventing peri implantitis by safer prosthesis installationEmil Svoboda
Svoboda Emil LA. Preventing Peri-Implantitis by Safer Prosthesis Installation. A PDF PowerPoint Presentation www.ReverseMargin.com. Update April 24, 2018
Taming the Old Dragons of Implant ProstheticsDr Emil Svoboda
Dr Svoboda has discovered how the old Dragons of Dentistry continue to frustrate the efforts of Dentists to prevent implant-abutment misfits, overhanging, overextended and open margins and residual subgingival cement. Dr Svoboda offers a way to tame these Dragons and prevent all of the above problems for dentists and their patients. The Reverse Margin products are the solution. Designed specifically for the purposes of preventing mechanical and related biological complications related to current prosthesis installation techniques.
Short Implants and their role in prosthetic replacement of missing toothSivaRaman Sms
This is an seminar on short implants related to implant dentistry .
This gives the insight on what has happened since the evolution of short implants and its role in implantology .Their role as replacement of missing tooth in the atrophied maxillary and mandibular posterior regions
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
Implants & prosthetics / /certified fixed orthodontic courses by Indian denta...Indian 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.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
Taming the Old Dragons of Dental Implant Prosthetics Part 3Emil Svoboda
Part 3
Citation: Svoboda Emil LA. Taming the OLD Dragons of Dental Implant Prosthetics. PDF Slide Presentation Published to www.ReverseMargin.com. June 2, 2019, 1-149.
Influence of fractured instruments on the success rate of endodontic treatmentsaad1957
The fracture of an instrument is a recognized complication in endodontics. The immediate response to a fractured instrument is
frequently to regard the treatment as a failure. Several factors must, however, be taken into account to evaluate the prognosis of the tooth
in this situation. The objective of the endodontic treatment with or without a fractured instrument remains the same, namely to disinfect
the root canal system and prevent its recontamination. The time at which file fracture occurred during treatment and the degree of canal
infection should be considered when determining the potential effect of instrument fracture on treatment outcome. Patients must be
informed about an instrument fracturing in their tooth for ethical and legal reasons. The aim of this paper is to attempt to place fractured
instruments in context, not to provide an in depth description of fractured instrument management techniques.
Clinical Relevance: To understand the influence of fractured instruments on prognosis in endodontics.
A 10 years retrospective study of assessment of prevalence and risk factors o...Dr. Anuj S Parihar
Aim: The present study was conducted to determine the prevalence rate of dental implants failure and risk factors affecting dental implant outcome.
Materials and Methods: The present retrospective study was conducted on 826 patients who received 1420 dental implants in
both genders. Length of implant, diameter of implant, location of implant, and bone quality were recorded. Risk factors such as habit of smoking, history of diabetes, hypertension, etc., were recorded.
Results: In 516 males, 832 dental implants and in 310 females, 588 dental implants were placed. Maximum dental implant failure was seen with length <10 mm (16%), with diameter <3.75 mm, and with type IV bone (20.6%). The difference found to be significant (P < 0.05). Maximum dental implant failures were seen with smoking (37%) followed by
hypertension (20.8%), diabetes (20.3%), and CVDs (18.7%). Healthy patients had the lowest failure rate (4.37%).
Conclusion: Dental implant failure was high in type IV bone, dental implant with <3.75 mm diameter, dental implant with length <10.0 mm, and among smokers..
Complication & failure of dental implants / cosmetic dentistry trainingIndian dental academy
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.
Effect of Surgery Difficulty According to Impaction Level on the Incidence of...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
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.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
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We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Screw Vs Cement for Dental Implant Prosthesis Installation Part 1: The Logic Behind the Argument
1. Screw Versus Cement
For Implant Prosthesis Installation.
Part 1: The Logic Behind the Arguments.
Emil L.A. Svoboda PhD, DDS,
Published to www.ReverseMargin.com
Update January 2, 2016
1
Next View Part 2: The Game Changer that tips the
balance to Favour Intra-oral Cementation.
2. Abstract
Part 1: The Logic Behind the Arguments
This subject has been reviewed many times over many years. Some conclusions do not follow from the evidence presented in the articles, or they simply ignore pertinent
evidence from the literature. Ignoring evidence about problems in the system makes it difficult to make informed conclusions.
The recent reviews are unable to show a difference in survival of implants on the bases of prosthesis insertion technique - screw or cement. It appears to be too difficult to
see through the many variables contained in the studies that are the foundations of the reviews. Let us say the failures using either system, are about 5% for 5 years and 8
% for 10years, and the implants require significant home and professional care to reduce the impact of peri-implant disease.
What is causing the implants attached to Screwed-in Prosthetics to Fail? This is an important question. Let us review some of the less visible causes of these failures. Some
failures appear to be related to implant-abutment misfit and exacerbated by mechanical challenges created by a need for prosthesis retrievability. These problems of
screwed-in prosthetics appear to be very difficult to solve. They are discussed here.
Intra-oral cementation can optimize the fit of the implant-abutment connection. However, subgingival residual excess cement is a known risk factor for peri-implant
disease. We know that it can be removed and thus reduce peri-implant disease by 60% (Slide #12). What if it could be prevented? That could surely reduce implant failure.
That will be discussed in Part 2 below.
Part 2: The Game Changer that tips the balance to Favor Intra-oral Cementation.
During 100 years of intra-oral cementation, nobody seems to have published on the effect of Gingiva on the flow of cement during the intra-oral cementation process.
Understanding this process is the key to mitigating its negative effects.
Dr. Svoboda has created an “in vitro model”, that sheds New Light on the dynamics of intra-oral cementation. This is a “Game Changer”. Understanding the “Gingival
Effects” changes the logic behind the approach to intra-oral cementation. This is the basis of a new Cement Control System™ that allows us to prevent the poorly
controlled injection of cement into the subgingival environment. This cement can be difficult to detect and remove.
This presentation refers to design features of the abutment-prosthesis complex and the dental cementation process that can make intra-oral cementation safer. Safer
cementation also helps the clinician optimize the fit of the implant-abutment junction, unlike that seen with screw-in prosthesis techniques. The herein described
innovations will likely tip the balance in favor of intra-oral cementation and hopefully reduce the incidence of implant treatment failure. Failure is expensive for patients,
clinicians and the entire implant industry. It can be especially damaging to the patient-dentist relationship.
See Both Slide Presentations at www.ReverseMargin.com
2
3. “Many advances in the
Field of Implant Dentistry have improved the quality
of care we can offer our patients.”
3
There are still significant problems contributing
to the deterioration of the
Foundations
of our restorations through
loss of implant osseointegration.
4. Review 2013 of Peri-implant Disease
Mucositis 30.7% of Implants 63.4% of the patients
Peri-implantitis 9.6% of Implants 18.8% of the patients
Based on 6,283 implants and 1,497 patients
Average 4.2 Implants /Patient
Average time 8.9 years ( Range 5 to 13 years)
No Difference Between Cement or Screw Installation
Atieh MA et al. The Frequency of Peri-implant diseases: A systemic
review and meta-analyses. J Periodontol 2013:84(11):1586-1598
4
5. Review 2014 of Peri-implant Disease
2,387 Cemented-in & 3,471 Screwed-in Prostheses
5 years Survival Rates about 96%
10 years Survival Rates about 92%
No Difference Between Cement or Screw Installed
Prosthesis Survival Rates
Whittneben et al. Clinical Performance of Screw- Versus Cement Retained
Fixed Implant-Supported Reconstructions: A Systemic Review. The Int J Oral
Maxillofac Implants; 2014:29(Suppl):84-98.
5
6. Review 2014 of Peri-implant Disease
Systematic Review included 2882 Dental Implants - 25 papers
Major failures ( implant or prosthesis failure )
No Significant Difference in Implant Survival, related to Installation
Technique - Screw versus Cement
6
Sherif S et al. A Systematic Review of Screw- versus Cement-Retained Implant
Supported Fixed Restorations. J of Prosthodontics 2014 (23)1-9
7. Review 2015 of Peri-implant Disease
Mucositis 33% of Implants 48% of the patients
Peri-implantitis 16% of Implants 26% of the patients
Failure Rate 8.3% of implants 13% of the patients
Based on 225 implants and 96 patients
Average 2.3 Implants /Patient
Average time 10.9 years, implant survival rate 91.7%
No Difference Between Cement or Screw Installation
Daubert DM et al. Prevalence and predictive factors for peri-implant
disease and implant failure: a cross-sectional analyses. J Periodontol
2015:86(3): 337-347
7
8. Conclusions from the Reviews
Considering that these Reviews seem to be “tilling the same old soil”, is there any
wonder that the results are similar?
The details differ, but success and failure of dental implants is where the “Rubber meets
the Road”
No Difference Between Cement or Screw Installation
However there is however One BIG Difference that I see!
With Peri-implant Disease, it is often possible to remove excess cement and expect an
improved result! How do you treat Peri-implant Disease when dealing with the
Screwed-in Technique? It is very difficult to correct the implant-abutment misfit! What
about implant distortion due to this misfit? Not even a remake will solve these
problems! Let’s look at this in more detail …….
8
9. Study by TG Wilson 2009
Residual Excess Cement & Peri-implant Disease
1. All patients received cemented single unit implant crowns
2. 39 consecutive patients with 42 implants had peri-implant disease - test
3. 12 of the same patients had 20 implants without disease and without detectable
subgingival cement – controls-- 32%
4. 34 of 42 the test implants had Residual Subgingival Cement ( 81%) and thus 8
(19%) had Peri-implant disease without subgingival cement.
5. After Cement Removal 25 of the 33 (lost one patient) no longer has signs of
peri-implant disease after 1 month. (An additional 8 (20%) patients still had
disease) - Therefore 40% of peri-implant disease implants had no detectable
residual cement !
Thomas G Wilson Jr. The Positive Relationship Between Excess Cement and Peri-implant Disease: A
Prospective Clinical Endoscopic Study. J. Periodont 2009;1388-1392
9
10. Data Re-Interpretation
“Incidence of Residual Cement”
Observation 1
With the Cementation System Used
45% had no Visible Residual Subgingival Cement!
(20+8 = 28, 28/62= 0.45)
Thomas G Wilson Jr. The Positive Relationship Between Excess Cement
and Peri-implant Disease: A Prospective Clinical Endoscopic Study. J.
Periodont 2009;1388-1392
10
“Not every cementation case ends up with Residual Subgingival Cement”
This is also an underestimate, as the group was pre-selected to represent the work from clinicians who
had restored single cemented crowns to have at least 1 implant with peri-implant disease.
11. Peri-implant Disease
“Some Get Disease without Cement”
Observation 2
With the Cementation System Used
13% had No Visible Residual Subgingival Cement but had Peri-
implant Disease! (8/62= 0.13)
Thomas G Wilson Jr. The Positive Relationship Between Excess Cement and Peri-implant Disease: A
Prospective Clinical Endoscopic Study. J. Periodont 2009;1388-92
11
“However the rate of peri-implant disease is much less than the 30-50% expected from
the Reviews cited.
Does cementation create a better fit of implant-abutment connection and thus decrease disease by
more than 50%? This could be very interesting!”
12. Peri-implant Disease Reduced by Cement
Removal!
Observation 3
About 60% of the peri-implant disease cases
were helped by removing
Residual Subgingival Cement
And appeared to be disease free after 30 days
Thomas G Wilson Jr. The Positive Relationship Between Excess Cement
and Peri-implant Disease: A Prospective Clinical Endoscopic Study. J.
Periodont 2009;1388-1392
12
“Most cases get better when Residual Subgingival Cement is removed”
13. Not Only Cement Causes
Peri-implant Disease
Observation 4
About 40% of the peri-implant disease cases
had NO Residual Subgingival Cement!
(8+8=16, 16/42 = 0.40, Sample Size Small)
Thomas G Wilson Jr. The Positive Relationship Between Excess Cement and Peri-implant Disease: A
Prospective Clinical Endoscopic Study. J. Periodont 2009;1388-92
13
“There is more to the story than Residual Subgingival Cement. The impact of the
implant-abutment fit and its stability under load conditions needs to be investigated
further under controlled conditions.”
14. There are still Significant Weaknesses in the
Implant-Prosthesis Connections
Affected by Installation Technique.
14
1) Implant-Abutment Connection at the
alveolar bone level
2) Prosthesis-Abutment Connection at
the more superficial gingival level
15. The Screw-in Technique 15
1. Abutments and prosthesis are cemented
together Extra-orally into a rigid Complex.
2. This complex is made to fit on a model
representing the mouth.
3. This Complex is then screwed onto dental
implants already in the mouth.
It is difficult to asses fit or adjust contacts during
prosthesis installation. The implant-abutment connection
can be prevented from seating properly by tight contacts
with adjacent teeth and inherent prosthesis-model
inaccuracies.
16. Extra-oral Cementation Makes the
Implant-Abutment Connection Worse!
16
1. Solidifies Impression-Model Error because is
assembled on the model not in the mouth. This
error in dimension is huge!
2. Makes Abutment Installation more complex
3. Makes Prosthesis Installation more complex
4. Limits Use. Implant Position more important
5. In the anterior, it often requires technique
related cantilevers for hiding screw access holes.
Screwed-in Prosthetics introduce unnecessary mechanical and biological risk factors that affect the
survival of implant treatment. These risk factors can be very difficult to mitigate.
17. 17
1. Abutments are individually screwed onto
dental implants inside the mouth.
Implant-abutment connections are not affected
by contacts or prosthesis-model inaccuracies.
Their fit is optimized.
2. The prosthesis is cemented onto the custom
abutments.
It is relatively simple to adjust occlusion, fit and
contacts prior to cementation. Implant angle is
not so critical. The abutment-prosthesis
connection is easier to control than the implant-
abutment connection.
Cementation Technique
18. Screw-in versus Cement-in Prosthetics
Prosthetic Insertion Technique Screw-in Cement-in
Abutment-Prosthesis
Complex
Assembled on and fit to
an inaccurate model
before installation
Assembled in mouth
after installation of
Abutment(s)
Adjusting Contacts/Occlusion Difficult Easy
Optimized Implant-Abutment Fit Unknown/No Yes
Path of insertion considerations Yes No
Screw access hole considerations &
repair
Yes No
Cause Technique Related
Cantilevers
Yes No
Removable Yes Yes/No*
Residual Excess Cement No Yes/No**
18
*Many can be removed by creating an access hole.
**Presentation Part 2: The Game Changer that tips the balance to Favour Intra-oral Cementation.
19. What about
Screwed-in Prosthetics?
They do have Benefits too!
Easy to remove and reinsert
Avoid problems related to residual
subgingival cement
They can be used in short crown situations
19
We will discuss these Relative Benefits later ….
20. Further Analysis
of the Process of
Screwing-in the Assembled
Abutment-Prosthesis Complex
“The Screw-in Technique”
20
21. What about Problems related to Screwed-
in Prosthetics?
The BIG PROBLEM is: They Cause a
“MISFIT or OPENING”
at Implant-Abutment Connection,
at the deep subgingival bone level.
Dental Implant Prosthetics. Carl Misch, 2nd Edition, Elsevier-Mosby, 2015,Ch 28.
Passive Fit in Screw Retained Multi-unit Implant Prosthesis Understanding and Achieving: A Review
of the Literature. M.M.Buzaya and N.B. Yunus. J Indian Prosthodont Soc. 2014, Mar;14(1):16-23 – an
elusive goal!
Bacterial leakage of different internal implant/abutment connections. Nasar HI and Abdalla M. Future
Dental Journal 2015
21
22. What Puts the Abutment Retaining Screw at
Risk of “Failure to Prevent” an Open
Implant-Abutment Connection?
1. Lower screw torque levels
2. Tight contacts and Increased distance from implant-abutment
connection to contact point with adjacent teeth
3. Smaller implant platform diameters
4. Cantilevers (off axis forces)
5. Multi-unit Prosthesis inaccuracies
6. Function
22
Let’s Look at the above problems More Closely ………..
23. 1. Using Lower Torque to Tighten Abutment Screws
When an abutment screw is tightened, it clamps the abutment to the
implant base. Anything that reduces the Clamping Force (red arrow)
reduces its’ ability to hold the Prosthesis onto the implant.
35 NCm torque can give 741 Newtons Clamping Force
20 NCm torque can give 423 Newtons Clamping Force
Reducing Torque from 35 to 20 NCm
reduces clamping force by a whopping 43%
Size and shape, metal, thread shape, thread frequency and fit all affect the optimal
magnitude of this force for specific clamping screws.
23
24. Reducing torque to 35 to 20 NCm
reduces clamping force by a whopping 43%
Many of our smaller diameter implants, including those commonly
used for incisors, specify a 15 or 20 NCm insertion torque for the
Implant-Abutment Screw
Prosthetics screwed into place at these lower torques would be
much less able to resist displacement by a functional load and by
*tight contacts with adjacent teeth.
24
*see 2 below
25. 2. Tight Contacts Can Cause Misfits of the
Implant-Abutment Connections!
This misfit can be very difficult to detect at the
time of affixing the prosthesis. Tactile senses and
x-ray imaging only detect gross misfits, even with
optimal perpendicular imaging.
This misfit can cause early screw loosening and
peri-implant disease!
25
Figure from “Dental Implant Prosthetics, Carl E. Misch,2nd Edition
Elseier Mosby, 2015 Pg 739
“The final torqueing down of the retaining screw can tend to shift or realign the abutment on its base.
This can cause a tight contact on one side and a loose one on the other. At best, you will have a open
and/or tight contact, at worst the abutment will be prevented from seating!”
26. What About Prosthesis Contact Position?
Torque on Clamping Screw 35 NCm (20 NCm)
Load Force (LF) is Screw Clamping Force 741 N (423 N)
Radius of 4.5 mm (3.0) Implant Top (D1) = 2.25 mm (1.50 mm)
Length of Lever Arm (D2) = 10 mm
Effort Force (EF) = the minimum Resistance that the Contact must provide to
keep the abutment from seating
EF = LF X D1/D2 = 167 N (63 N)
Effort Force (Resistance offered by a tight contact with an
adjacent tooth) needs to be only 22.5% of the Clamping Force to
keep the Abutment from seating!
Class 1 Lever Mechanics - Google Lever Mechanics -
https://en.wikipedia.org/wiki/Lever
LF
EF
D1
D2
26
“It is not possible with office dental imaging or tactile techniques to detect such misfits in the 15 micron
range. Too bad since oral pathogens are about 1 micron in diameter and less.”
27. Varied Lever Arm Lengths to Contact Position
and Implant Diameters
0
100
200
8 mm 10 mm 12 mm
Force Threshold (N) Exerted Against Proximal Contact
that could keep Abutments from Seating
(Abutment Screw Torque 20 NCm, 423 N Clamping
Force)
3 mm 3.5 mm 4.5 mm 5.7 mm
As distance from implant-abutment connection to the contact increases, so does the
risk of a tight contact preventing an abutment from seating.
27
LF
EF
D1
D2
28. Varied Lever Arm Lengths
and Implant Diameters
EF
LF
D1
D20
100
200
8 mm 10 mm 12 mm
Force Threshold (N) Exerted Against Proximal Contact
that could keep Abutments from Seating
(Abutment Screw Torque 20 NCm, 423 N Clamping
Force)
3 mm 3.5 mm 4.5 mm 5.7 mm
As the Lever Arm Length Increases so does the risk of
forces generated by function opening the implant-abutment connection.
28
29. 0
100
200
300
423 741
Force Threshold (N) Exerted Against 10 mm High
Proximal Contact that could keep Abutments from
Seating during Installation
3 mm 3.5 mm 4.5 mm 5.7 mmImplant Diameter
Newtons
3. Varied Implant Platform Diameter
29
Many implants reduce implant radius for perceived benefits of “Platform Switch”.
This also reduces the mechanical advantage of the clamping screw. This may not be ideal in
the posterior of the mouth!
30. 4. What about Effect of a 3 mm Lateral Cantilever
on Various Implant Diameters.
EF implant implant D2 LF Abutment Mechnical
diameter radius (D1) Horizontal
Screw
Torque Disadvantage
N mm mm mm N NCm
*212 3.0 1.50 3 423 20 50%
245 3.5 1.75 3 423 20 58%
494 4.0 2.00 3 741 35 67%
556 4.5 2.25 3 741 35 75%
618 5.0 2.50 3 741 35 83%
679 5.5 2.75 3 741 35 92%
741 6.0 3.00 3 741 35 100%
*33 3.0 1.50 3 423 20
+10mm
vertical lever
Fulcrum
D2
=3 mm
EF
“We often create cantilevers to accommodate lingual access holes for anterior teeth.
This puts the implant-abutment connection at additional risk!”
30
31. Example: Lets take a lateral incisor with a 3.0 mm abutment base and use a
20 NCm torque to seat it into place. There is a 10 mm distance from the
implant-abutment connection to the contact with an adjacent tooth and
we need to create a 3 mm cantilever to create abutment screw access from
the lingual.
Fulcrum
D2
=3 mm
EF
“We often create additional cantilevers to accommodate lingual screw access holes for anterior teeth.
This puts all the implant-abutment connections at increased risk of failure!
This additional risk of failure is technique related.”
31
1. -Narrow Diameter 3 mm platform for incisors or platform switch purposes
2. -Reduced 20 NCm torque force on screw. Clamping force that would seat crown is
423 Newtons
3. -Effort Force (EF) by a tight contact that would keep the abutment from seating or the
functional force required to dislodge the crown from the abutment would be : EF=
423X1.5/10= 65 N *** Start Sweating!
4. -Creating a 3 mm Lateral Cantilever for screw access reduces the Effort Force by 50%
to dislodge crown from abutment – 33N ***** Bingo! No Hope!
Average Force often used to cement a crown is 40N – That finger pressure alone can
open the above implant-abutment connection! Is that not scary to you?
32. 5. Multiple unit screw retained prosthetics just amplify
the effect of stress and misfit between units!
The stress caused by the misfit of the individual retainers plus the pontic(s) between
them, tends to push or pull the connected retainers and thus increases the amount
of misfit and opening of their margins – at the bone level!
There is at least one major implant company that voids their “Warrantee” when
clinicians choose to insert a multi unit prosthesis in such a fashion!
They take this type of misfit seriously! You should too.
32
Figure of implants
above from “Dental
Implant Prosthetics,
Carl E. Misch, Elseier
Mosby, 2015 Pg 740
33. Acceptable Levels of Misfit at the Implant–Abutment Interface -
An error of 100 to 150 microns is considered clinically
acceptable*.
*Review: Passive Fit in Screw Retained Multi-unit Implant Prosthesis Understanding and Achieving: A Review of the
Literature. M.M.Buzaya and N.B. Yunus. J Indian Prosthodont Soc. 2014, Mar;14(1):16-23
*Passive Fit could not be achieved with Screwed-in Prosthetics!
Comparison of the Accuracy of Different Transfer Impression Techniques for Osseointegrated Implants. Zen BM et al.
JOI Vol 41 No 6 2015: 662-667
Branemark PI, Zarb GA, Albrektsson T. Tissue -integrated prostheses. Chicago: Quintessence; 1985. p. 253
33
Figure of implants
above from “Dental
Implant Prosthetics,
Carl E. Misch, Elseier
Mosby, 2015 Pg 740
Even the theoretical suggestion of “not more than
10 microns error”, by PI Branemark in 1985, could
be considered sloppy when considering that
periodontal pathogens are only 1 micron in
diameter and less.
34. Overdenture retaining a “Screwed-on
framework” was removed - Smells Bad!!
Undersurface of framework and tops of intra-oral abutments reveal the
extent of a noxious Biological Brew!
34
35. Stress on Retainers keeps abutments from seating
and creates misfit of components!
Abutment on
Driver with
retaining screw
facing upwards
35
Top of implant “external
hex” showing residual
biological mass !
This patient’s immune system was able to resist peri-implantits in spite of a massive bacterial inoculum.
36. Can You Imagine that some
“All-On-4” Screwed in Prosthetics are
removed 1X /Year for Cleaning under their
Huge Non-cleanable Cantilevers!
It takes only 4 hours for bacterial colonies to be seen on abutment surfaces.
Nakazato, G., Tsuchiya, H., Sato, M.,Yamauchi, M., In vivo plaque formation on implant materials. Int J
Oral Maxillofac Implants 1989; 4(4):321-6
36
“I wonder what happens to the screw threads inside the implants after 10-20 years ….
10-20X removal and tightening? Do the tops of the implants distort when loaded
unevenly? Can that be fixed? I know this removal process is expensive …. Does this
particular service even have a remote chance of being effective long term?”
37. 6. What makes the fit worse?
Intra-oral Function
The machining process for the mass produced dental implants
and abutments creates irregularities between mating surfaces
…. tiny hills and valleys. Mating surfaces can settle as a result of
intra-oral function and the resulting micromovement.
This can loosen screws and create openings between implant
components. These openings allow for the ingress and
proliferation of bacteria which are known to be able to cause
premature loss of osseointegrated dental implants.
37
Dental Implant Prosthetics, Carl E. Misch, Elseier Mosby, 2005 Pg 453
Zipprich Micro Movements on Implant Abutment Interfaces. Part 1&2.
http://youtu.be/AssjiYjmTLE, June 12, 2013.
38. “Intra-oral Function”
What do you think would resist the loads of function better?
a) An optimized implant-abutment connection or …..
b) A stressed and perhaps deformed implant-abutment
connection that is already open due to misfit?
I am sure your answer is a) – So make it your priority to optimize
this important connection! Today this can only be done by the
process of intra-oral cementation.
38
39. How do you correct an Implant-
Abutment Misfit?
How do you repair a deformed or
damaged Implant Platform?
Not Even A Remake Can Solve these
BIG Problems!
39
40. In Summary - When a Prosthesis is Cemented together
with its Abutment Outside of the Mouth ...
It becomes a larger rigid and more complex unit that amplifies dimensional errors through
extended length, and it is difficult to manipulate intra-orally.
The model on which the prosthesis is assembled, is not accurate enough. Thus the
assembled prosthesis will push or pull the abutments off their intended base(s) and cause
increase implant-abutment misfits when screwed into place inside the mouth.
When installing the prosthesis into the mouth, it can be very difficult to create ideal
contacts with adjacent teeth. “How tight is too tight?” When the abutment screw is finally
torqued into place, the prosthesis can tend to shift to accommodate the physical reality of
the matching implant-abutment platforms. This can cause a change in contact pressure and
cause additional stress and misfits of the implant-abutment connection.
All of the above issues are BiG PROBLEMS that can and do cause damaging
misfits at the implant-abutment junction that is at the deep alveolar bone level!
40
41. What else causes a misfit
of screw retained prosthetics?
Adjacent structures (gingiva, alveolar bone, calculus, residual graft
material) can get trapped between mating surfaces of abutments
and dental implants.
This misfit is often very difficult to detect, especially with the larger
pre-assembled units of screwed in prosthetics.
“Some dental implants with flat mating surfaces are probably worse
than other abutment-implant designs at trapping tissues between
them” – Dr. ES
41
42. What about
Screwed-in Prosthetics?
They do have Benefits too!
Easy to remove and reinsert
Avoid problems related to residual
subgingival cement
They can be used in short crown situations
42
We will now discuss these Relative Benefits ….
43. What about the Benefits of Screwed-in Prosthetics?
1. Easy to remove and re-insert 43
Many loose screws that require tightening are probably loose because of abutment
prosthesis misfits and design related cantilevers.
A misfit may lead to a permanent deformation of the top of the retaining implants.
This is not so good for a replacement prosthesis. This is a disaster.
Removal of most crowns and fixed bridges are for porcelain repair or open contacts.
They are usually remakes anyway. Cutting them to engage an access screw is often
not such a disaster.
Removal and re-insertion will probably not make a multi-unit prosthesis fit better.
This is a disaster.
Multiple removals for hygiene is expensive and will probably damage the inside of the
implant that engages the clamping screws. This may become a disaster.
Removal of a hybrid acrylic prosthesis for repair purposes or an acute problem is
probably beneficial. Some procedures can also be done without removal.
44. What about the Benefits of Screwed-in Prosthetics?
2. Avoid problems related to residual subgingival cement.
44
Yes, but do not forget, Screwed in Prosthetics are cemented (assembled) in the lab on inaccurate
models. This causes additional inaccuracies and stress on the implant-abutment connection.
They are also more difficult to install because of their complexity and contacts with adjacent teeth.
Unlike the non-assembled abutment and prosthesis, the assemblies are difficult to sterilize prior to
delivery, because the cement may degrade at high temperature. (see Part 2: all abutments, prosthetics
and models are sterilized (not sanitized) prior to delivery to patient’s mouth)
What if Intra-oral Cementation Just Became Safer??
It’s a trade-off between the misfits of the Implant-Abutment Junction and Residual
Subgingival Cement. Cement can often be accessed surgically or by endoscopic means
and cleaned away. What can you do about misfits??
45. What about the Benefits of Screwed-in Prosthetics?
3. They can be used in short crown situations
45
Yes, the screw-in technique can be useful in these situations.
As the adhesive properties of dental cements have improved, the definition of a short crown also
changes. Crowns are already cemented onto natural teeth without traditional mechanical retention.
With the screwed-in prosthesis technique, the crowns are already cemented onto their abutments in
the lab. They seem to hold.
The Reverse Margin™ Design can add 1 or 2 mm to crown length by lowering the base of the margin.
The inflected part of the margin plus the additional central post length can effectively increase the
retentive surface area.
Adhesive technology and other properties of cement have improved dramatically over
the years. Margin designs have also improved. Short crowns are not so much of a
problem as before. However, it is always nice to have another tool in your toolbox to
handle site-specific problems.
46. Intra-oral Cementation
onto already installed Abutments allows for the
creation of an Optimal Passive Fit
between the Prosthesis and its Retainers
The cement space (40 to 120 microns), created between
the prosthesis and the retainer allows for some tolerance
in the system.
This is very important!
46
What if Intra-oral Cementation Just Became Safer??
47. Screw Versus Cement
For Implant Prosthesis Installation.
Part 2: The Game Changer that tips the balance in
Favour Intra-oral Cementation.
Emil L.A. Svoboda PhD, DDS,
Published to www.ReverseMargin.com
Update January 2, 2016
41
Go to View the Very Exciting
Editor's Notes
According to Wilson*, even cases with residual subgingival cement may take 4 months to 9 years to be discovered in cases with peri-implant disease.