copyright 2017 acorn dental · 2018-05-24 · 1. enable you to confidently introduce dental...

IntroductiontoImplantology

ManojSParmarBDS,MFDS,MJDF,MSc(impl),PGCert(rest),PGCert(MedEd)

Aims

1. Enableyoutoconfidentlyintroducedentalimplantstoyourpractice

1. Establishastudy-clubforyourcontinuedlearning

Objectives

1. Whyimplantsshouldformanintegralpartofyourpractice

2. Anatomyofanimplantanditscomponents

TeethvsImplants

Implantsmustnotberegardedasreplacementsforteethbutameanstorestoreedentulousspaces

Whyintroducetoyourpractice?

1. Predictableformoftreatment2. Developrangeofservicesofferedtopatients3. Medico-legalobligation4. Keeptreatmentin-house5. Additionalincomestream6. Stimulatefurtherlearning7. Increasingpatientdemand8. Unlikelythatasubstitutewilldevelopedinnext10yrs

Concerns

1. Manydentistsplacingimplants2. Limitedexperienceasdentist3. Corporaterunweekendcourses4. Nomentoring5. Lackofevidencebasedlearning6. Poorplanning7. Poorbasicsurgicalknowledge8. Needatoolboxoftechniques

Complications Theidealimplantologist…

…needstobeaprosthodontistwiththesurgicalexpertiseofanoralsurgeonandthe

finesseofaperiodontist

Introduction to implants copyright manoj parmar 30july2016 handout - 30 July 2016

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Everycloud……

GDP’snaturallyhavetheskillsrequiredtoplaceandrestoreimplants.Theyjustneed

tobeappliedinastructuredmanner.

Restoringimplants

Thejourneystartswiththevisualisationandsimulationoftheendresult


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AnatomyofanImplant

ImplantBody

Abutment

Suprastructure

AnatomyofanImplant

ImplantBody

• Numerousmanufacturers• Grade4titanium• Varioussurfacecoatings

AnatomyofanImplant

Abutment

CoverScrew Healingabutment

AnatomyofanImplant

Abutment

• Internalorexternalhex• Differenttypes• Availableinvaryingheightsandwidths

AnatomyofanImplant

Abutment

Cement Retained Restoration Screw Retained Restoration

✓

✓

✓

✓

Direct-Casting

Screw Abutment & Cylinder

Temporary (Ti / Plastic)

CombiDual

Dual Milling

Angled (15° / 25°)

AnatomyofanImplant

Suprastructure

Singletoothcrown

AnatomyofanImplant

Suprastructure

Implantsupportedbridge

AnatomyofanImplant

Suprastructure

Implantsupportedoverdenture


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AnatomyofanImplant

Suprastructure

Fullarchbridge

Assessment&TreatmentPlanning


Objectives

1. KnowwhatfactorstoconsiderwhendecidingtokeeporXLAteeth

2. Understandwhenimplanttreatmentmaynotappropriate

3. Highlightwhatinformationisrequiredfromtheassessmentandwhy

Periodontitis

1. Gingivitis–virtuallyeveryone2. Perio–10-15%ofpopulation3. BalancebetweenBiofilm(20%)andHostResponse(80%)4. AimofRx-<biofilm&<hostresponse5. PerioisnotC/Itoimplantplacementprovidedthat?

1. Perioistreated2. Pthasgoodplaquecontrol3. Maintenanceprotocolisinplace4. Surgicalandrestorativedentistryisofhighquality

Periodontitis

1. Survivalratesoffixedprosthesissupportedbyseverelyreducedbuthealthyperiodontium–systematicreview.(Lilacetal,2007)1. 96.4%at5yrs2. 92.9%at10yrs

2. XLAif>70%boneloss–atptsrequest

Periodontitis

1. Ifthereissufficientboneheightandwidthtoplaceimplantevenafterboneloss–treatperioandmonitor

2. Iffurtherbonelosswouldcomplicatefutureimplanttreatment–considerextraction

3. Iffurtherbonelosswillnotalterthetreatmentforanimplant–considerkeepingthetooth

Periodontitis

1. Canfurtherbonelosscompromisetheabilitytoplaceanimplantinthefuture?

2. Canfurtherbonelosscompromisetheaestheticsofanimplantrestorationinfuture?

3. Aretheteethfunctionallyacceptable?4. Canthisberesolved?5. Cantheperiobetreated?


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Endodontics

• Atoothwithagoodrootfillinghasasimilarprognosistoanimplant

• Restorativefactorswillinfluencethechoice• Implantsmayhaveahighersurvivalthanteethrequiring

difficultendodontics:• FailedRCT• Overfilledcanals• Apicallesions

• Outcomewillalsobedependentonwhodoestheendo

PostvsImplant

• Complications–10%• Postshorterthancrown• <1-2mmferrule• Thindentinewalls• Occlusion• Ptpreference• Canalwaysdoimplantfollowingfailureofpost/crown


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Faileddentition

• Inthepresenceofextensivefailureonteeth,implantsmaybetheonlyoptionforfixedrestorations

• Assesstheadjacentteethnotjustthespaces

RationaleforImplants

1. Preservationoftoothstructure2. Preservationofbone3. Provisionofadditionalsupport4. Resistancetodisease

Age

• Agedoesnotprecludetreatment• MHassociatedwithagingmight• >cariesriskinagingpopulation• Nocariesriskwithimplants

• Implantsshouldnotbeplacedbefore18yrsofageinmales

• 16yearsofageinfemales

Diabetes

• Impairedwoundhealing• Notusuallyaproblemincontrolleddiabetics• Hb1ac

Bleeding

1. Dyscrasias1. Heamophillia2. VonWillebrands3. Liverdamage(alcoholics)

2. Warfarin–INR<4

3. Anti-platelet–Asprin,Clopidogrel,dualtherapycanbeproblem

Smoking

Affectsperioandimplants.Notethatifperiofailsimplantscanbeconsidered,however,ifimplantfailsperiocannotbeconsidered

Lotsofstudies–BainandMoy(1993)landmarkpaper

Failurerelativetotheamountsmoked

Roughlydoublestherateoffailure


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Bisphosphonates

OralPriortotaking–teethorimplantsUpto3poss5yrsoftaking–teethorimplants>5yrs–saferonteeth

IVPrior–teethorimplantsAfter-teeth

Cancer

• Mostpeoplewithcancerwillnotevenconsidertreatment!!

• Defertreatmentforatleast6monthsafterchemo

• >riskofosteoradionecrosis.Waitatlease12monthsandeventhenseekopinionfromradiologistandmaxfaclead.

Localfactors>failures

1. Contaminationofimplantatplacement2. Poorinitialstability3. Placementinpreviouslyirradiatedbone4. Placementinareaofinfection5. Placementinpreviouslygraftedbone6. Placementwithsimultaneousgrafting7. Subjectedtoearlyloading8. Overheatingoftheboneduringsurgicalpreparationofsite9. Injurytotheadjacentperiodontalligamentofaneigbouring

tooth

ClinicalExamination

1. Access2. Restorativevolumeavailable3. Bonevolumeavailable4. Anatomicalhazards5. Restorations6. Occlusalfactors7. Periodontalandhygiene8. Softtissuesandlipline

2.Restorativevolume

1. Numberofmissingteeth2. Spaceclosureasaresultofdrifting/tilting3. Overeruption4. Spacingformultipleunits

3.BoneVolume

1. Boneresorption–patternofresorptionmandibleandmaxilla

2. Adequateheight:1. ballbearing5mmonplainfilmorOPG

3. Adequatewidth:1. ridgemapping–sharpenedperioprobe,calipers2. CBCT

4. Angulationinanteriormaxilla

4.Anatomicalhazards

1. Mandible:1. IDN2. Mentalforamen3. Mylohoidridge4. Floorofmouth

2. Maxilla:1. Sinus2. Palatalarteries


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5.Restorations

1. Doafullchart2. Diagnosisandprognosisofeverytooth3. Vitality4. BWs–cariesandbonelevels5. PA’s–LEO’s

6.Occlusion

1. Isthereadequateposteriorsupport?2. Isthereevidenceofparafunction?3. IsthereTMJDS?4. Interferences?5. Lookatarticulatedcasts6. Nonegativelinkbetweenocclusionandimplantsbut

needstobemanagedcarefully.Teethmove,implantsdonot.

7.Perio

1. NeedBPE2. DPCforcode3andabove3. Mustbetreatedandmaintainedbeforeimplant

treatment4. Smokingandperio–NOIMPLANTS5. Willproceedtoperi-implantitis6. Willbelargestareaoflitigationinimplantdentistry

8.SoftTissueAssessment

1. Pathology2. Gingivalbiotype3. Papillae4. Keratinisedtissuevsnon-keratinised5. Grafting6. Denturebearingareas–candida

Radiographs

1. OPGmagnifybyapprox20%2. PA’smoreaccurate3. Use5mmballbearingtocalibrate4. Actualamountofbone=(boneonimagex5mm)/

diameterofballbearingonimage5. CBCTnecessaryformoredetailedinfoondepth

Photographs

1. Veryusefulfortreatmentplanningandcommunication

2. Usefulforrecordkeeping3. Excellentforreflectionandlearning4. UseSLRwithmacrolensandringortwinflash5. Usemobilephone–betterthannothing


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Typeofcase

1. Aestheticzone2. Posteriorzone3. Edentulousmaxilla4. Edentulousmandible

TreatmentPlanningintheAestheticZone


Aim

Tohaveanimprovedunderstandingofthefactorsinvolvedwhenplanningimplanttherapyinthe

anteriormaxilla.

Objectivesfortoday

1. Assessmentoftheedentuloussite

2. Surgicalconsiderationsforaestheticoutcome

3. Restorativeconsiderationsforaestheticoutcome

4. Managingpatientexpectations

Assessment

1. Heightoflipline2. Gingivalbiotype3. Shapeofmissingandsurroundingteeth4. Infectionatimplantsiteandbonelevelatadjacent

teeth5. Restorativestatusofadjacentteeth6. Characteroftheedentulousspace7. Widthofhard&softtissuesinedentulousspace8. Heightofhard&softtissueinedentulousspace

Assessment

Low:Cannotseegingivae.Usuallyseelowerteeth.

MediumDisplaymostofmaxillaryteeth.Verylittlegums.

HighDisplaymaxillaryteethinfull,includinggingivalprofile.

Assessment Assessment


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Assessment



Assessment

ThickResistanttorecession,increasedriskofscarring,bluntpapillae,canmaskunderlyingmetal.

MediumIn-betweenthickandthin

ThinCangetexcellentresultsifadjacentteethhavegoodbonelevels,friabletissue,recessionprone



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Assessment

Assessment



Assessment

• Chronicapicalinfections

• Acuteinfections

• Bonelossonadjacentteethdeterminespapillaheight

• Blacktriangle



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Assessment



Assessment

Healthyadjacenttooth=predictableresult

Assessment



Assessment

• Goodaestheticoutcomewithsinglemissingteeth

• Multipleadjacentmissingteethposegreaterchallengeduetolackofinterdentalboneandthereforepapilla

• Implant-implant• Implant-tooth• Implant-pontic• Pontic-pontic• Tooth-tooth• Tooth-pontic




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Assessment

• Tissuedeficienciesinthehorizontalplanecanposeaesthetictreatmentrisk.

• Ifthedefectisrestrictedtothehorizontaldimensionandotherconditions,suchasperiodontalandrestorativestatusofadjacentteetharesatisfied,thensiteenhancementispredictable.

Assessment

Assessment

• Willgethorizontalbonelossfollowingtoothloss• AtraumaticXLAimportant–preservebuccalplate• Chronicinfections–fenestrationsanddehiscence's• Immediateplacementdoesnotpreventboneloss• Thinridgemayleadtodeeperplacement• GBRonalmostallanteriorplacements• CTGmayalsoberequired

Assessment



Assessment

• Lossofverticalheightisthegreatestchallenge• CannotPREDICTABLYreplace• Highaestheticriskespwithhighlip-line• Mayrequireonlayblockgraft• Mayneedpinkporcelainorlongercrown• Ptexpectationsmustbemanaged• Palatalboneheightisthedeterminingfactor

Assessment


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Surgicalconsiderations

1. Flapdesign2. Implantsize3. Correct3Dpositioning4. Timing5. GBR




3sidedflap2sidedflapCurvilinearflap


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Avoidtheuseofwideneckimplantsintheanteriormaxillabecausetheshouldermarginislikelytobelocatedtooclosetotheadjacentteethortoofar

buccally.




Theplacementofanimplantinthecorrectthree-dimensionalpositionisoneofthekeyconsiderationsinachievinganaestheticoutcome.

Thethree-dimensionsare:1. Mesiodistal2. Bucco-palatal3. Coronoapical


Mesiodistal


Buccopalatal


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Coronoapical

3mm




RationaleforImmediateplacement:

• Reducestreatmenttime• Fewersurgicalprocedures• Noneedtoraiseflap• Preservationofbuccalplate?


But:

• Moretechnicallydemandingimplantplacement• Cannotclosethesocketthusneedtemprestoration• Managingthegapbetweentheimplantandbone• Stillgetboneloss.• >2mmgapGBR


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• Resorptionwillcontinueovertime

• Ageofpatient

• Ideallyneed2mmofbuccalbone-rare

• Augmenteverycase?

• Choiceofbiomaterials


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Restorativeconsiderations

1. Interimrestorations2. Provisionalimplantcrown3. Abutmentselection4. Crownselection






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PatientExpectations

1. Recentriseinpublicawarenessofimplanttherapy2. Mostpatientsunawareofwhattheprocessentails3. Wealthofinfooninternet,someofitmisleading4. Samedayteeth!5. Determinept’sultimatedesiresattheconsultation6. Focuson3aspects:

1. Form2. Function3. Aesthetics

PatientExpectations

FORMa. canthespaceberestoredatall?b. areorthodonticorrestorativeprocedures

requiredbeforeimplanttherapy?c. usediagnosticwax-upsandphotographsto

visualizethecased. thiswillprovideusefulinfoontheamountofhard

andsofttissuesupport

PatientExpectations

FUNCTION

a. occlusalevaluationb. restorativevolumec. diagnosticwax-up

PatientExpectations

AESTHETICS

a. whatarethept’sexpectations?b. aretheyrealistic?c. Howcanyouavoiddisappointment?

PatientExpectations

UNDERPROMISE&OVERDELIVER


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ImplantImpressions


Aim

Teachtheskillsrequiredtotakeanimplantlevelimpressionandfitasingleunitrestoration

Objectives

1. OverviewoftheDentiumsystemandcomponents2. Restorativearmentarium3. Impressionmaterials&trays4. Restorationchoice5. Abutmentchoice

Restoringimplants

Beginwiththeendinmind

Dentium

1. Koreansystem2. Establishedin20003. HasownR&Dcenter4. Worldwidedistribution5. Rangeofimplantsystems6. www.dentium.com

SuperLine–keyfeatures

1. Taperedimplant2. SLAsurface3. Idealthreadpitchanddepth4. Comprehensivesizerange5. Bonelevel6. Conical-hexinternalconnection7. Sameinternalconnectionforall

implants

WhyIuseSuperline

1. Easysystemtouse2. Taperedimplant3. Greatprimarystability4. Sameinternalconnectionforallimplantsizes5. Limitedstockofprostheticcomponentsrequired6. Costeffective7. Goodsupportnetwork

Internalconnection


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Emergenceprofile

Thecontoursofthetooth/crownastheytraversethesofttissuetowardsthecontactpointinterproximally,faciallyand

palatally.

Emergenceprofile

Emergenceprofile Emergenceprofile

Restoringasingleimplant

1. Armentarium2. Takingimpressions–materialchoice&trayselection3. Impressioncopingselection4. Abutmentselection5. Fitting



ProstheticsKit ProstheticsKit


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ProstheticsKit Restoringasingleimplant


Trayselection Impressionmaterials

Impressionmaterials Impressionmaterials



Impressioncopingselection

• Opentraytechnique(pick-upimpressioncoping)• Closedtraytechnique(transferimpressioncoping)


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Closedtraytechnique-transfer Opentraytechnique–pick-up



Abutmentselection

ConsiderationsinAbutmentSelection

1. Aestheticrequirement2. Implantangulation3. Implantlocation4. Interarchdistance5. Prosthesistype6. Dentist&Technicianpreference

ScrewvsCement

ScrewRetainedProsthesis1. Retrievable2. Canplacemarginmoresub-

gingivally3. Nomicrogapbetween

abutmentandrestoration4. Canmoldsofttissuesbetter5. Easiertoensureseatof

restoration6. Accurateimplantplacement7. Increasedcost

Cementretainedprosthesis1. Lessdemandingofimplant

placement2. Marginsneedtobemoresupra-

gingival3. Novisibleaccesshole4. Moredifficulttocreate

emergenceprofile5. Riskofperi-cementitis6. Cheaperthanscrewretained




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FitappointmentCementRetainedProsthesis

1. Removehealingabutment2. Positionabutmentusingjig3. Ensurehexisengaged4. Torqueintoplaceto30Ncmwaitandthenre-torque5. Trythecrownandcheckfitandocclusion6. SealabutmentaccesswithcottonorPTFEandcomposite7. Cementcrown&meticulouslyremoveexcess8. TakePAtocheckforseatandanyremainingexcesscement

Fitappointment

ScrewRetainedProsthesis

1. Removehealingabutment2. Positionrestorationandensurehexisengaged3. TakePAtocheckseat4. Torqueintoplaceto30Ncm,waitfewminsandre-torque5. SealabutmentaccesswithcottonorPFEandcomposite6. Checkstaticanddynamicocclusion7. TakePAtocheckfit

Restoringasingleimplant Restoringasingleimplant-imps

Abutmentin-situ Abutmentremoved Impressioncoping Impressionwithcoping

Restoringasingleimplant-lab

Modelwithanalogue

Abutmentin-situ Abutmenttransferjig

Finalcrown

Restoringasingleimplant-fit

H/Aremoved Abutmentlocationwithjig

Abutmentin-situ Finalcementedcrown


TreatmentPlanninginthePartiallyDentate



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Aim

Tohaveanappreciationofthefactorsinvolvedwhendecidingonthenumber,sizeandpositions

ofimplantsinthepartiallydentate.

Considerations

1. Availablebone2. Bonequality3. Softtissueaesthetics4. Loading/occlusion5. Cost

Implantsize

1. Toothsize2. Distancefromadjacenttooth/implant3. Amountoffacialbone4. Amountofinterdentalbone5. Loadingforces

Implantsize

Horizontaldefectaroundimplantofapproximately0.5mm–1.4mm

Classificationofspaces

1. Singletoothspace

2. Multipletoothspace• shortedentulousspaces• extendededentulousspaces

1. Edentulousarch


1. Singletoothspace

2. Multipletoothspace

1. Edentulousarch

Singletoothspace

KeyPoints:• Keepdistanceof1.5mm

betweenshoulderofimplantandadjacentteeth

• SelectimplantaccordingtoM-DandB-Lspaceavailable

• Widthofimplanttoreflectthesizeofthetoothitisreplacing


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1. Singletoothspace


1. Edentulousarch

Multipletoothspaces

1. Shortspan:a. 2adjacentmissingteethb. 3adjacentmissingteeth

2. Extendedspan:a. 4missingteethb. morethan4missingteeth

Multipletoothspaces

2missingteeth

Keypoints:• Keepdistanceof1.5mm

betweenshoulderofimplantandadjacentteeth

• Minimumof3mmbetweenimplants

Multipletoothspaces

2missingteeth–options


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Multipletoothspaces

3missingteethKeypoints:• Usuallyonly2implants

required• F/Fconfigurationideal• orcantilever• or3individualorsplinted

crownsifusingshortimplants(<8mm)

Multipletoothspaces

3missingteeth–options

Fixed-Fixed Cantilever 3Shortimplants


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Multipletoothspaces

4(+)missingteethKeypoints:• Notalwaysnecessaryto

replacealltheteeth• 2implantsenoughinanterior

sextant• 2-3implantsintheposterior

sextant• Startwithpre-determined

prostheticplan

Multipletoothspaces

4Missing–Anterior

• Incentralsposition• Inlateralsposition• Everyothertooth

withonecantilever• Oneimplantfor

eachtooth

Multipletoothspaces

4Missing–Anterior



eachtooth

Multipletoothspaces

4Missing–Anterior



eachtooth


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Multipletoothspaces

4Missing–Anterior



eachtooth

Multipletoothspaces

4Missing–Posterior

Decideonhowmanyteethneedreplacing

1.Premolaronly

Multipletoothspaces



2.Firstmolar

Multipletoothspaces



3.Secondmolar

Multipletoothspaces


Exampleconfigurations

Maxilla2implantsinfirstpremolarandfirstmolarregionavoidingthesinus


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Multipletoothspaces



Maxilla3implantsinfirstpremolar,secondpremolarandsecondmolarregionwithsinusaugmentation

Multipletoothspaces



Mandible2implantsinfirstpremolarandsecondmolarsites

Multipletoothspaces



Mandible2implantsinsecondpremolarandsecondmolarsitewithcantilevertoavoidmentalforamen

Multipletoothspaces



Mandible3implantswithsecondmolarasaseparateunitand3unitshortspanbridge


1. Singletoothspace


1. Edentulousarch


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TreatmentPlanningfortheEdentulous


Aim

Identifytreatmentoptionsfortheedentulousarchesanddiscusshowtotheselectthemost

appropriatesolutionforyourpatient

Considerations

1. Thechanginganatomyofthemaxillaandmandiblepostextraction

2. Problemsencounteredwhentreatingtheedentulousarches

3. Treatmentgoals4. Identificationoftreatmentoptions5. Principlesoftreatmentplanning6. Treatmentsequence7. Costs

Anatomicalchangesinedentulousjaws

• Maxillaeresorbsuperiorly,posteriorlyandmedially

• Mandiblesresorbinferiorly,anteriorlyandlaterally

• Neteffectisthatyouendupwithaclass3relationshipbetweenthejaws

Anatomicalchangesinedentulousjaws Anatomicalchangesinedentulousjaws

Problemsinthemaxilla

Bonequality


Bonequantity


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MaxillarySinus


Domeshape

Problemsinthemandible

Bonequality


Bonequantity


IDN


Jawfracture


Mentalforamenandanteriorloop


Mylohyoidridge


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Treatmentgoals

1. Improvedfunction–chewing

2. Aesthetics–Smileline,lipcontours,pink&white

3. Speech–Palatalcontourandpositionofteeth

4. SelfConfidence–Retentionandstability

ProstheticDecisions

Treatmentoptions-overview

1. Removablesolutions:a. ConventionalF/Fb. ImplantretainedO/Dc. Miniimplants

2. Fixedsolutions:a. Ceramo-metalbridge(s)b. Hybridbridgec. All-on-4d. Zygomaticimplants

Treatmentoptions-mandible

Formandible:McGillConsensusStatement2000states“themandibulartwo-implantoverdenturewasthefirst-choiceminimally-invasivetreatmentchoiceforedentulouspatient”.

Treatmentoptions-maxilla

• Maxillamuchmorecomplexanddecisionmakingcanbequiteconfusing.

• Decisionsinclude:• FixedvsRemovable• Correctnumberandpositionsofimplants• Oneunitbridgevssegmentedbridge• Materials

Overdentures

• Notafall-backsolution• Indicatedwhensubstantialresorptionhasoccurred• Moreflexibleimplantplacement• Easiertoclean• Mostaffordable• Easiesttorepairorrenew• Butstillaremovableprosthesis

Overdentures

• 2implantsinmandible:inter-foramina• 4implantsmaxilla:anteriortosinus• GoodAPspread–minimisecantileveringforces• Minimisedivergencetoavoidtheneedtouse

bars• Locators/Kerratorsprovideexcellentretention

andserviceability• Angledversionsavailabletocorrectminor

discrepanciesinangulation

Overdentures


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Overdentures Overdentures

Ceramo-metalbridge

• Excellentaestheticresultespeciallywhenbonelossisminimal

• Lessflexibleimplantpositions• Moretechnicallydemanding• Longertreatmenttime• Mostexpensivesolution• Moredifficulttorepair/renew• Moredifficultforpatientstokeepclean

Ceramo-metalbridge

• 6-8implantsinthemaxilla–dependingonbridgedesign

• 4-6implantsinmandible–mayneedtocantilever• Bridgecanbeonepieceorsegmented• Severalbridgedesignoptions

Maxilla–8implantswithsegmentedbridge Maxilla–6axialimplants

Mandible–6implantswithsegmentedbridge HybridBridge

• 4axialimplantsinmandible• 6axialimplantsinmaxilla• Limitedbyanatomicalstructures• Supra-structurehasmetalsub-framewhichis

thenlayeredwithcompositeorcanusedentureteethandpinkacrylic

• Goodsolutionformoderatebonelosscases


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HybridBridge

• Offerstheadvantageofafixedsolutionwhilstbeingabletoreplacehardandsofttissuealso

• Canusuallybesupportedbyfewerimplantsthanfixedceramo-metal

• Canberepairedrelativelyeasilybutwillneedreplacingin5-10years

• Canachieveexcellentaesthetics• Moreaffordableforpatientthanceramo-metal

bridge

Maxilla–6axialimplants

Maxilla–6implantswithcantilever Mandible–4implants

All-on-4

• Indicatedwherestraightimplantscannotbeplacedparalleltoeachother.4implants

• Toavoidsinusaugmentation,implantscanbepositionedandtiltedanteriortotheanteriorsinuswall

• Toavoidaugmentationproceduresinatrophicmandibles,theimplantscanbepositionedandtiltedanteriortothementalformen

• Canbeimmediatelyloadedifconditionsarefavourable

Maxilla–4tiltedimplants

Patientfactors

1. Aetiologyoftoothloss2. Maybepartiallydentatewithsomegoodteeth3. Howlonghasthepatientbeenedentulous4. Hardandsofttissueloss5. Palatalcoverage6. Availabilityfortreatment7. Finances

Principlesoftreatmentplanning

1. CorrectIncisaledgeposition• Determinestoothdisplay• Occlusalplane• Speech–F&Vsoundsvermillionborder• OVD


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2. Cervicaledgeposition:• Averagecentralincisoris10.5mminlengthand8.5mm

width• Thisthenleavesthegapbetweenthecervicalmarginand

theresidualridge• Decisionsneedtobemadewhethertofillthisspacewith

pinkacrylic/composite/porcelainormaketheteethlonger.Thisdependson…......


3. Maxillarylipposition:• Positionoftheupperlipinmaximumsmile• Averagesmiledisplays75-100%oftooth• Highliplinedisplays100%oftoothandgingiva• Willthejunctionbetweenprosthesisandresidualridge

(PTJ)bevisible–gummysmile?• Howcanthisbehidden?


4. Gingivaldisplay-gummysmilecausedby:a. Verticalmaxillaryexcessb. Dento-alveolarextrusion(class2divII)c. Passivedento-alveolarcompensationd. Hyper-mobilelip

Solutions:1. LeFort1osteotomyoralveolopasty2. Matchthepinkacrylic/compositetothemucosa3. Botox

Treatmentsequence–partiallydentate

1. DecisiontokeeporXLA2. Theremainingteethcanbeusefulfor:

a. ProvidingocclusalstopsandinfoonOVDb. Infoonincisaledgepositionc. Infoontoothinclinationsd. Infoontoothformandshadee. ServingasabutmentsfortemporarybridgeworkorP/

whilstwaitingforimplantstointegrate

Treatmentsequence–edentulous

1. CreateconventionalF/Fwithidealtoothpositionsandoptimumaestheticoutcome• Inptswithmildtomoderateboneloss,thisshouldbe

performedwithouttheanteriorlabialflangetovisualisetoothpositionsinrelationtoridge

• Inptswithsignificantatrophy,thedentureteethwillgenerallybepositionedmoreanteriorandinferiortoridgeandthusflangeandbaseplatereq

TreatmentPlanning–edentulous


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2. Thisthenbeusedtocreate:• Theinterimprosthesis• Radiographicstent• Surgicalguide

3. TakeaCBCTwiththeradiographicstenttoestablishbonevolume


4. Decideonprostheticsolutionbasedon:• Tissuereplacementrequired(pink&white)• Availabilityofboneandneedforgrafting/sinuslift• Numberofimplants• Ptsfinances

Costs

1. Planningtimeandwax-upsx£?2. CBCTimaging,radiographicandsurgicalstents-£2503. GuidedsurgeryincCBCT-£5004. NumberofImplantsx£10005. Overdenturex£20006. Hybridx£60007. Ceramo-metal-£10,000plus8. Mustdiscusslabcostswithtechnicianbeforequoting

FeesPlanning


Feesplanning

SurgicalFees

Procedure Fee

Implantplacement £1000

Augmentation £295

Crestalsinuslift £295

Lateralwindowsinuslift £795

Blockbonegraft From£1000

Incpost-opcare,secondstagesurgery,coverscrew/healingabutment

Feesplanning

ProstheticComponentsandLabcosts

Restoration Fee

Cementretainedbondedcrown £290

Screwretainedbondedcrown £290

Bondedporcelainpontic £140

Zirconiaabutment&Emaxcrown £395

Temporaryabutment&crown From£100

Preciousmetal £rate/gram

Incanalogue,abutmentsandcrownwithnon-preciousmetal

Feesplanning

Illustration

PtCharge

£1800

Surgery

£1000

Prosthetics

£300

PROFIT

£500

TimeSpent1hour

Singleunitbondedcrown

Referralprocess

1. Sendemailto: [email protected],xraysandclinicalphotos

2. Sendletterto: 208SwanshurstLane,Moseley,Birmingham.B130AW

3. SendSMSto: 07958424643

4. Visitwebsite: www.aidp.co.uk


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Professionalcodeofconduct

Ourpledgetoyou:

1. Wepromisetoreturnyourpatientbacktoyouafteryourreferral2. WepromisetodevelopyourskillwhileatthesametimeyouearnCPD

hours3. Wepromisetosupportandmentoryouwithourteam4. Wepromisetoinvolveyouindecisionmakingwithyourpatient5. Wepromisetolookafteryourpatientandoffertheverybestcarefor

them

Whyintroducetoyourpractice?

1. Additionalprofessionalskills–increasedconfidence2. Professionalservicesforpatients3. Norisk–NoCapEx,Expertisewithoutcost4. Turn-keysupport–you’reinsafehands5. CPDStudygroup–twobirdswithonestone6. Easyprofits–Idoallthework!

Leadingmentoringsupportinafriendly,informalandsafeenvironment

Summary&Actionplan

1. Extractioninformationleafletwithoptionstorestoreedentulousspaces

2. Lookforasimplefirstcase–premolar/molar3. Letsgetstarted!!!

THANKYOUFORLISTENING


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copyright 2017 acorn dental · 2018-05-24 · 1. enable you to confidently introduce dental...

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