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Pacific Northwest Dental Conference - Dr. Stover
1. Welcome to the
2009 Pacific Northwest Dental Conference!
PNDC is green! Please visit: www.wsda.org/speakers/defaultpdf.view to download lecture
handouts.
Please turn off all cell phones and pagers.
There is no photography or recording of any kind allowed during the presentation.
CDE verification forms will be available at the END of the course.
WSDA members may have your ADA card scanned by our room host at the END of the course.
AGD members fill out a CDE verification form and take it down to the AGD counter in the
registration area.
Please fill out the yellow course evaluation form and leave it on the back table or with your host.
Visit the Exhibit Hall & Relaxation Lounge, get free massages and other giveaways. There are
drawings throughout the day, including 2 HD TVs and a Scooter. Please support our exhibitors
who support the PNDC!
Thank You.
19. Complete Dentures in Atrophic
Patients
Limitations:
• Continued resorption
• Individual propensity
• Patient with marked
resorption
• Crestal IAN position
Atwood, D.: Reduction of residual ridge: a major oral disease entitiy. J Prosthet Dent 26: 266-279, 1971.
Tallgren A: The continuing reduction of the residual alveolar ridges in complete denture wearers: a mixed-
longitudinal study covering 25 years. J Prothet Dent 27(2):120-132 1972
19
24. Common Attachments
Attachments
1.Form
A. Bar and clip
- Dolder, Ackerman, Hader
B. Stud attachments
1. Magnetic
2. Matrix / Patrix
- Locator, Ball and socket, ERA
2.Function
A. Resilient
B. Non-resilient
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31. Mini Implants
Small diameter implants
• Victor Sendax
• Titanium alloy (Ti6Al4V)
• 1.8-3.25mm diameter
• 10, 13, 15, 18mm length
• FDA approval*
– Interim & on-going retention
• US intro 1999
• 2008 3M subsidiary
Ulatoqski, TA. Nov 1997. FDA written communication,.Office of Device Evaluation, Center for Devices &
Radiological Health, FDA.
31
32. Mini Implants
Small diameter implants
• Interim overdenture retention
Shatkin TE, et al. Mini dental implants for long-term fixed and removable prosthetics: a retrospective analysis of
2514 implants placed over a five-year period. Compend Contin Educ Dent 2007; 28(2):92-99.
Griffitts TM, et al. Mini dental implants: an adjunct for retention, stability and comfort for the edentulous patient.
Oral Surg,Oral Med Oral Pathol Oral Radiol Endod 2005;100(5):e81-e84.
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35. Mini Implants
Contemporary indications:
• Mandibular overdenture
• Cost effective
• Poor surgical candidates
• Compromised medical history
• Adverse to extensive surgery
• Inadequate bone for conventional
implants
Christensen, Gordon J. Feb 2001. Simplified Implant Surgery Techniques. DentalTown Magazine, pg 32.
Christensen, Gordon J. June 2009. The Increased Use of Small-Diameter Implants. JADA, Vol 140, pp 709-712.
Bulard, RA. Dec 2005. Multi-Clinic Evaluation Using Mini-Dental Implants for Long-Term Denture Stabilization:
A Preliminary Biometric Evaluation. Compendium, 26(12):892-897.
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41. Biomechanics – Force Analysis
A-P spread based
• 1½ x (A-P spread)
• 15-20mm / minimum
10mm A-P spread
• maximum implants
maximum spread
McAlarney et al (2000). Theoretical cantilever lengths versus
clinical variables in fifty-five clinical cases. J Prosthet Dent;
83:332-43.
Rangert, B, T Jent, L Jorneus (1989). Forces and moments on Branemark Implants. Int J Oral Maxillofac Implants; 4:241-7.
English CE (1990). The critical A-P spread. Implant Soc J; 1:2-3.
Taylor R and G Bergman (1990). Laboratory techniques for the Branemark System (ed 1). Chicago, IL, Quintessence.
Skalak R (1983). Biomechanical considerations in osseointegrated prostheses. J Prosthet Dent; 49:843-48. 41
42. Biomechanics – Force Analysis
Guidelines for Cantilever
Length
Compression
• 2-3 premolars
• <20mm with 5-6 implants
• <15mm with 4 implants
Tension
McAlarney et al (2000). Theoretical cantilever lengths versus
clinical variables in fifty-five clinical cases. J Prosthet Dent;
83:332-43.
Branemark, PI, GA Zarb, T Albrektsson (1985). Tissue Integrated Prostheses. Chicago IL, Quintessence, pp 51-70, 117-128.
Zarb GA and A Schmitt (1990). The longitudinal clinical effectiveness of osseointegrated dental i9mplants: the Toronto study,
part II, the prosthetic results. J Prosthet Dent; 64:53-61. 42
43. Biomechanics – Force Analysis
Occlusion
• Increased force / area on implants
Richter E (1989). Basic biomechanics of dental implants in prosthetic dentistry. J Prosthet Dent 61:602-9.
• More force on rigid integrated fixtures
Brunski JB, JA Hipp, M El-Wakad (1984). Dental implant design: Biomechanics and interfacial tissues. J
Oral Implantol 12:365-77.
• Cantilevers may increase loading 1½-2x
Skalak R (1983). Biomechanical considerations in osseointegrated prostheses. J Prosthet Dent; 49:843-
48.
• Large moments generated by cantilevers
Rangert B, T Jent, L Jorneus (1989). Forces and moments on Branemark Implants. Int J Oral Maxillofac
Implants; 4:241-7.
Rangert B, J Gunne, DY Sullivan (1991). Mechanical aspects of a Branemark implant connected to a
natural tooth: an in vitro study. Int J Oral Maxillof Implants 6:177-85.
43
46. Treatment Sequence
•CC:
“I have a lack of bone on the
bottom and I can’t get my
denture to fit.”
•Expectations:
“I want to be able to wear
bottom dentures comfortably
for the rest of my life.”
•CD prognosis:
max: good
man: extremely guarded/poor
Englemeier, R. and R. Phoenix (1996). Patient Evaluation and Treatment Planning for Complete-Denture Therapy. DCNA
40:1-18, 1994 46
60. NobelGuide ®
1. Fabricate complete dentures
a. Good fit to anatomy
b. Adequate extensions
c. Ideal tooth set-up
2. Radiographic guide
a. Acrylic
b. 6-#4 round burr
reference points
c. Fill with GP
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61. NobelGuide ®
3. CT scan
a. Double scan technique
Radiographic Index First CT Scan Second CT scan
Secures correct Radiographic Guide only
Patient
positioning and
seating of the Radiographic Guide
Radiographic Guide Radiographic Index
during CT scan
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63. NobelGuide®
Surgical Template Fabricate Stone Model Design Prosthesis
Order sent electronically Use Surgical Template as Definitive prosthesis
Stereolithograpy the “impression” Implant Bridge
Provisional
short term
63
64. Treatment Plan
• IAN lateralization
• Implant-supported bar overdenture
• 2 posterior bars
• 1 anterior bar
• Supported by 6 implants
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65. Justification for Treatment
• Inability to tolerate complete denture
• Cost effective
• Oral hygiene access
• Stability
• Retention
• Support
• Esthetics
• Preservation
• Bilateral nerve impingment in premolar area of
edentulous ridge
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