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    Implant Key Position Final

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    amr.abdellatief19

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    Implant Key Position Final

    Uploaded by

    amr.abdellatief19
    2 views30 pages

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    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    2 views30 pages

    Implant Key Position Final

    Uploaded by

    amr.abdellatief19

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 30

    KEY IMPLANT

    POSITIONS
    IN THE PAST
     Treatment plan developed according to available
    bone
    NOWADAYS
     Treatment planning developed by esthetics and
    ideal biomechanics
     Ideal position dedicated by prosthesis
     If no available bone (augmentation)
    FAILURE
     Failure with prosthesis 3-6 times than surgical failure

    Meta analysis
     Surgical failure 15%
     Failure with prosthesis more than 30%
    EARLY LOADING FAILURE
     Failure within 18 months of loading related to
    biomechanical factors

    Due to:
     High occlusal stresses
     Bone too weak to support
    HOW TO AVOID?
     Eliminating cantileveer
     Ideal implant position
     Adequate implant number
     Splinting implant
    MECHANICAL COMPLICATIONS
    MAY BE EXACERBATED BY
     Parafunctional habits
     Unfavoravble opposing dentition
     Improper occlusal scheme
    MISCH TREATMENT PLAN
     SEQUENCE
    1. development of the prosthesis design
     2. evaluation of patient force factors
     3. determination of bone density in the edentulous sites
     4. determination of key implant positions and implant
    number *
     5. determination of implant size
     6. determination of available bone in the edentulous sites
    KEY IMPLANT POSITION RULES OF
    FIXED IMPLANT PROSTHESIS (4)
     1. Cantilevers on the prosthesis reduced or eliminated (especially in the
    maxilla); therefore the terminal abutments in the prosthesis are key
    positions

     . 2. More than three adjacent pontics should not be designed in the


    prosthesis.

     3. The canine and first molar sites are key positions

     4. The arch is divided into five segments. When more than one segment
    of an arch is being replaced, a key implant position is at least one
    EXAMPLES
    EXAMPLES
    EXAMPLES
    EXAMPLES
    IMPLANT NUMBER
     One of the most efficient methods to increase surface area and decrease
    stress is to increase the implant number
     . Additional numbers are most often required and are primarily related to
    the patient force factors and to bone density in the edentulous sites.
    MANDIBLE
     As a general observation the number of implants range from five to nine,

    at least four between the mental foramina.

     When fewer than six implants are used, a cantilever must be designed
    in a fixed prosthesis as a result of the mandibular flexure.
    MAXILLA
     A greater number of implants is generally required in the maxilla to
    compensate for the less-dense bone and more unfavorable
    biomechanics of the premaxilla

     from 7 to 10 implants, with at least 3 implants from canine to canine


    ADDITIONAL PRINCIPLES
    1. Independent prosthesis
    2. Splinted implants
    3. Treatment planning should not be dedicated by finances
    INDEPENDENT PROSTHESIS
     As a general rule an implant-supported prosthesis should be independent
    from the natural adjacent teeth.
    WHY
     To reduce the risk for marginal decay on the natural teeth.

     The incidence of decay on a tooth splinted in a fixed partial denture


    whereas individual crowns have less than 1% risk for decay within this time

     A second common complication of teeth-supported fixed prosthetic


    restorations is endodontic-related factors that occur in approximately 15%
    of cases within 10 years.
    SPLINTED IMPLANTS
     The splinting of dental implants is controversial. Many clinicians use the
    same existing treatment planning principles from natural teeth as they do
    for dental implants.

     implants and teeth are much different biomechanically. teeth adapt to


    forces much differently from implants is significant when deciding to splint
    versus nonsplint
    1. increase the functional surface area of support,
    distribute force over a larger area,

    2. increase cement retention of the prosthesis,

    Advantages 3. decrease the risk for abutment screw loosening,


    of splinting decrease the risk for marginal bone loss, and

    implants.
    4. decrease the risk for implant component fracture.
    IN ADDITION
     if an independent implant fails over time, the implant is removed, the
    site is grafted, the site is reimplanted, and a new crown is fabricated.

     When multiple splinted implants have an implant that fails, the affected
    implant sectioned below the crown, and the implant or crown site
    converted to a pontic using the same prosthesis., rather than several
    surgical and prosthetic procedures over an extended period when
    independent units are restored, the
     The splinted implants distribute less force to the implant bodies, which decreases
    the risk for marginal bone loss and implant body fracture.

     . The exception to the splinted implant rule is a full-arch mandibular implant


    prosthesis. The body of the mandible flexes distal to the foramen on opening and has
    torsion during heavy biting with potential clinical significance for full-arch implant
    prostheses.

     As a result a full-arch mandibular implant prosthesis replacing the first or second


    molars should not be splinted to molars on the opposite side. Therefore full-arch
    mandibular restorations should have a cantilever or be made in two or three sections
    to accommodate the mandibular dynamics during function
     many clinicians and patients complain about
    the ability to perform interproximal hygiene.
    However, this concept is not as significant with
    implants for two reasons.

     First, a very low percentage of the population


    flosses regularly, especially if floss threaders are
    indicated.Because the implants are usually 3 mm
    or more apart, if a patient does wish to perform
    interproximal hygiene, most aids (e.g., floss
    threader, proxy brush, water-pik) can easily clean
    this region.
     A second reason that splinted units are not popular is the inability to
    repair restorative material fracture.

     However, when As independent units the margins of porcelain-to-metal
    crowns are most often placed under shear loads, which increase the risk for
    fracture.

     However, the increased use of monolithic zirconia has decreased


    material fracture significantly. Also, screw-retained prosthetic
    restorations are becoming more popular; therefore the prosthesis may be
    removed and repaired much easier
     when natural teeth are splinted together, decay at the interproximal
    margin often occurs
     A single crown has an endodontic risk of 3% to 5.6%. Splinted teeth have
    an endodontic risk of 18%
     Therefore independent units reduce the incidence of complications
     However, implants do not decay or need endodontic therapy. As a result,
    independent units would not be required to address these complications
    TREATMENT PLANNING SHOULD
    NOT BE DEDICATED BY FINANCES
     Many patients have unrealistic expectations with regard to treatment
    duration and implant treatment.

     It is not uncommon for a patient to demand that the treatment be


    “completed faster,” especially when bone augmentation is ideally
    indicated.
    THANK YOU

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