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Prosthetic options in implant dentistry

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Prosthetic options in implant dentistry

  1. 1. Prosthetic options in implant dentistry<br />Bibinbhaskaran<br />
  2. 2. Index <br />Introduction.<br />Treatment options.<br />Treatment planning for implant supported prosthesis.<br />Classification of prosthesis movts.<br />Completely edentulous prosthesis design.<br />
  3. 3. Index <br />Advantages of removable implant supported prosthesis in completely edentulous patient.<br />Partially edentulous design.<br />Advantages of implant supported FPD.<br />Guidelines for joining tooth with implant.<br />Prosthetic options.<br />Summary. <br />
  4. 4. Introduction <br />Goals of implant dentistry-replace pts missing teeth to normal contour, comfort,function,esthetics,speech and health.<br />Final restoration – not implants.<br />In stress Rx theorem final restoration first planned-after abutments designed.<br />
  5. 5. Traditional Treatment Options<br />Removable partial dentures.<br />Fixed partial dentures.<br />Complete dentures.<br />
  6. 6. Treatment planning for implant supported prosthesis<br />Designing the prosthesis [to satisfy patients needs and desire].<br />Individual areas of abutment support are determined.<br />Bone in that area is evaluated for type of implant<br />
  7. 7. Classification of prosthesis movement<br />Classification of prosthesis movement :-<br />PM-O<br />PM-2<br />PM-3<br />PM-4<br />PM-6<br />
  8. 8. Classification of prosthesis movement<br />PM-0 – prosthesis rigid – no movt (implant support similar to FPD).<br />0-ring attachments (6 directions).<br />4 0-rings placed on complete arch and prosthesis rests on the bar- PM-0.<br />
  9. 9. PM-2 – prosthesis with hinge motion (2 planes).<br />Hinge attachment (Dolder bar without a spacer or Hader bar and clip).<br />
  10. 10. Classification of prosthesis movement<br />PM-3 – prosthesis with an apical and hinge motion.<br />Dolder bar with spacer and clip.<br />
  11. 11. PM-4 – movts in 4 directions.<br />Rarely used in O.D.<br />Magnets are used.(no lateral force).<br />
  12. 12. PM-6 – all ranges of prosthesis movt.<br />O-ring attachment or extra coronal resilient attachment (ERA).<br />Implants independent of each other.(no bar)<br />
  13. 13. Completely edentulous prosthesis design<br />Pts desires-fixed or removable.<br />To assess ideal final prosthetic design-existing anatomy evaluated.<br />An axiom of implant Rx is to provide ,most cost effective Rx that will satisfy pts anatomical needs and personal desires.<br />In completely edentulous pt a removable implant supported prosthesis offers several advantages over a fixed implant restoration.<br />
  14. 14. Completely edentulous prosthesis design<br />However some completely edentulous patients require a fixed restoration because of their desire or because their oral condition makes fabrication of teeth difficult if a super structure and removable prostheses are planned. <br />For eg when pt has abundant bone-implants already placed-lack of crown height space-removable prosthesis.<br />Too often Rx plans for completely edentulous pts-max denture and mand over denture with 2 implants.<br />
  15. 15. Completely edentulous prosthesis design<br />Long term-disservice to pt-parasthesia, facial changes and reduced posterior occlusion on max prosthesis are to be expected.<br />Important to visualize the final restoration at the onset with a fixed implant restoration.<br />Individual areas of ideal or key abutment determined.<br />
  16. 16. Completely edentulous prosthesis design<br />Pts force factors and bone density in region of implant support are evaluated.<br />Only then available bone is evaluated to assess whether it is possible to place implants to support the intended prosthesis.<br />In inadequate natural or implant abutment situations-oral conditions altered-augmentation.<br />
  17. 17. Completely edentulous prosthesis design<br />A fixed implant restoration-partially or completely edentulous pt. <br />Fixed lasts longer.(acrylic teeth wear,attachments replacement-removable prosthesis).<br />No food entrapment.<br />
  18. 18. Advantages of removable implant-supported prostheses in completely edentulous patient<br />Facial esthetics enhanced with labial flanges.<br />Prosthesis – removed at night - nocturnal parafunction.<br />Fewer implants.<br />
  19. 19. Advantages of removable implant-supported prostheses in completely edentulous patient<br />Less bone augmentation-before implant insertion.<br />Shorter RX-no bone augmentation.<br />Less expensive.<br />Daily home care is easier.<br />
  20. 20. Partially edentulous design<br />A common axiom-FPD.<br />Fewer natural teeth missing-better indication for FPD.<br />Ideally FPD-completely implant supported.<br />Added implants-fewer pontics-less stress.<br />
  21. 21. Advantages of implant supported FPD<br />When Compared conventional tooth supported FPD Im FPD has –<br />No caries.<br />No endodontic problems. <br />No retention failure.<br />No periodontal breakdown.<br />Easier to clean.<br />
  22. 22. Guidelines for joining implant with tooth<br />No clinically observed mobility of the natural tooth.<br />Use of rigid connectors.<br />Less lateral forces to the prosthesis [occlusion].<br />Rarely connect to anterior tooth.<br />
  23. 23. Prosthetic options<br />Misch-1989.<br />FP-1<br />FP-2<br />FP-3<br />RP-4<br />RP-5<br />
  24. 24. FP-1<br />Anatomical crowns.<br />Minimal loss.<br />Root of natural tooth.<br />
  25. 25. FP-1<br />Max anterior region.<br />FP-1 restoration-crown –natural tooth.<br />Width or height – augmentation.<br />Soft tissue augmentation – black . <br />
  26. 26. FP-1<br />Restorative material-porcelain to noble metal.<br />A single tooth FP crown-Al2O3 or ceramic.<br />Fracture in latter.<br />
  27. 27. FP-2<br />Anatomical crown and portion of root.<br />Bone more apical (1-2mm).<br />Incisal edge correct-gingival 3rd overextended.<br />
  28. 28. FP-2<br />Prosthetic teeth – longer.<br />Multiple FP-2 – no specific implant position.<br />Implant position – width, angulation, hygiene.<br />
  29. 29. FP-2<br />Embrassure b/w teeth – mand ant teeth.<br />Material of choice – precious metal to porcelain.<br />
  30. 30. FP-2<br />Contour of metal different – FP-1.<br />Unsupported porcelain in final prosthesis. <br />
  31. 31. FP-3<br />Missing crowns and gingival color and portion of edentulous site.<br />Dec bone height – resorption.<br />Unnatural long teeth – esthetics,function,support.<br />
  32. 32. FP-3<br />Pt – high max lip line – smiling.<br />Low lip line – speech. <br />
  33. 33. FP-3<br />Ideal high smile line-interdental papilla of max ant teeth-not soft tissue-mid cervical regions.<br />Complain-display of longer teeth.<br />Gingival color of FP-3-esthetic.<br />Gingival acrylic-multiple abutments-bone loss.<br />
  34. 34. FP-3<br />2 basic approaches-FP-3.<br />Hybrid restoration-denture teeth & metal.<br />Porcelain metal restoration.<br />
  35. 35. FP-3<br />Restorative material-amt of crown height space.<br />An FP-3 porcelain to metal-difficult-FP-2.<br />Pink porcelain-more baking-risk of porosity.<br />
  36. 36. FP-3<br />Alternative-PFM-hybrid restoration.<br />Highly esthetic-denture teeth & acrylic soft tissue.<br />
  37. 37. FP-3<br />Crown height space for hybrid prosthesis versus PFM – 15mm from bone to occlusal plane.<br />FP-2 or FP-3 prosthesis-high lip lines-implant abutments.<br />
  38. 38. FP-3<br />Greater crown height-force-implant cervical regions.<br />Additional implant abutments or shorter cantilever lengths.<br />In max arch open embrassures-food impaction.<br />Mand restoration-above tissue-sanitary pontic.<br />
  39. 39. Cement Vs Screw retained<br />Cement retained<br />Passive castings.<br />Enhanced esthetics.<br />Improved direction of loading.<br />Reduced crestal bone loss.<br />Improved access.<br />Reduced complications,cost, time.<br /> Screw retained<br />Retrievability.<br />No cement in the sulcus.<br />Low profile retention.<br />Possible with limited inter-arch space .<br />
  40. 40. RP-4<br />Removable prosthesis-implants.<br />Restoration rigid when inserted.<br />Overdenture attachments-tissue bar or super structure that splints the abutments.<br />
  41. 41. RP-4<br />5 -6 implants-mand & 6-8-max – implant supported.<br />Implant criteria-RP-4-different-Fixed prosthesis.<br />Denture teeth & more acrylic-removable restoration.<br />
  42. 42. RP-4<br />Super structure and O.D attachments-abutments.<br />Lingual and apical implant placement-FP.<br />Implants for RP-4 and an FP-2 or FP-3 – mesiodistal. <br />Occasionally attachment-6mm spacing b/w implants.<br />
  43. 43. RP-4<br />Reduce No of implants-mental foramina.<br />RP-4 same – FP-1,FP-2 or FP-3 restoration.<br />PFM prosthesis Cattachments-abutments-esthetics.<br />O.D attachments-oral hygiene-nocturnal bruxism.<br />Hader bar with PM-0.<br />
  44. 44. RP-5<br />Removable prosthesis-implant & soft tissue.<br />
  45. 45. Completely edentulous mand O.D may have :-<br />2 ant implants independent.<br />Splinted implants in canine.<br />3 splinted implants in P.M and central incissor.<br />Implants splinted with a cantilevered bar.<br />Advantage :- reduced cost.<br />
  46. 46. RP-5<br />Preimplant denture :- esthetics.<br />Guide.<br />Healing stage.<br />Converted - RP-4 or RP-5.<br />Bone resorption – soft tissue borne areas.<br />Relines and occlusal adjustments.<br />Bone resorption – 2 – 3times faster – RP-5.<br />
  47. 47. Fp-3<br />Fp-3<br />
  48. 48.
  49. 49. Summary <br />Benefits of implant dentistry realized-prosthesis.<br />5-prosthetic options available.<br />Amt of support required initially designed.<br />Once prosthesis designed-implant Rx established.<br />