Transcript of Angled implants
- 1. Dental Implants Angled (tilted) implants John Beumer III
DDS, MS Allesandro Pozzi DDS Division of Advanced Prosthodontics,
UCLA Thisprogramofinstruc1onisprotectedbycopyright.Nopor1onofthis
programofinstruc1onmaybereproduced,recordedortransferredbyany
meanselectronic,digital,photographic,mechanicaletc.,orbyanyinforma1on
storageorretrievalsystem,withoutpriorpermission.
- 2. Tiltedimplants Fourimplants Siximplants Pterygoid implants
Zygoma1c implants
- 3. TiltedImplantsEdentulousMaxilla
Whenrestoringtheedentulousmaxillawhatdoesthistermindicate?
Posteriorimplantsare1lteddistallyatabouta30degreeangleandplaced
paralleltotheanteriorwallofthemaxillarysinus
- 4. TiltedImplantsEdentulousMaxilla
Whyaretheyadvantageousintheedentulousmaxilla?
vLongerimplantsinthedistalposi1ons vImprovedprimarystability
vDistalimplantsexitmoreposteriorlyreducingthelengthofthecan1lever
- 5. Eliminatestheneedforsinusaugmenta1on
Eliminatestheneedforzygoma1cimplants
Enablesfabrica1onofanimplant-supportedrestora1oninmany pa1ents
Enablesimmediateloadinginselectedpa1ents
TiltedImplantsEdentulousMaxilla
- 6. Biomechanicsarefavorable Moreanteriorposterior(A- P)spread
Longerimplantsinthedistal posi1onsthanifplaced axially
Shortercan1leversrequired torestoretheposterior occlusion A-P
Spread TiltedImplantsEdentulousMaxilla Whydotheywork?
Notethedierence betweenthepa1ents rightwhereimplantsare
angled,andtheleVwhere implantsareplacedaxially
CourtesyDr.O.Jensen
- 7. Biomechanicsarefavorable
Finiteelementanalysishasshownthattheuseof1ltedimplants
ismuchmorefavorablebiomechanicallythanusingshorter
implantswithaxialinclina1ons(Bevilacquaetal,2010).
CourtesyDr.P.Pera TiltedImplantsEdentulousMaxilla
Whydotheywork?
- 8. Successratesareabove90%(Ma^ssonetal,1999;Krekmanovetal,
2000;Maloetal,2011;Tealdoetal,2014).Tealdoetal(2014)has
themostlongtermfollow-updata. TiltedImplantsEdentulousMaxilla
- 9. Threeapproaches Allonfour(Nobel) Onlyfourimplantsareplaced
Angledabutmentsusedtoosettheanglesoftheimplants
Prosthesisisplacedimmediately Columbusbridgeprotocol
Fourtosiximplantsareplaced
Angledabutmentsusedtoosettheanglesoftheimplants
Prosthesisisplacedwithin24hours Co-axisimplants
Fourmoreimplantsareplaced
Co-axisimplantsareused.Angula1oncorrec1onissubgingival
andeectedbytheangula1onoftheimplantplaborm
- 10. AllonfourMaxilla (perNobel) Veryspecicdeni1on:
Useof4implantstosupportanimmediatelyloadedxedprosthesis
usedtorestoreeithertheedentulousmaxillaandmandible
- 11. Allonfour (perNobel)
Computerguidedtreatmentplanningandandfully
guidedimplantplacementispreferred Whatiscomputerguidedtreatment
planningandsurgicalplacement?
- 12. Fullyguidedsurgeryimpliesthatthe
surgicaltemplateswiththeirdrill sleeves(bushings)controltheposi1on,
angula1on,diameteraswellasthe depthoftheimplantosteotomysites*
Thesurgicaltemplateissecuredwith bonescrewsoranchorpins Allonfour
(perNobel)
*Seelectureen1tledcomputerguidedtreatmentplanningandimplantsurgeryfordetails.
Drill Sleeves (Bushings)
- 13. Allonfour (perNobel)
Theprosthesisispreparedpriortoimplantsurgeryand
deliveredimmediatelyaVerimplantplacement
Forimmediateloadingtheimplantsmustbeanchoredwithsucient
primarystabilitytowithstandocclusalfunc1on
Thismayrequirethattheapicalpor1onoftheposteriorimplants
engagethecor1callayersofboneassociatedwiththeparanasal
sinuswalls.
- 14. AllonFourMaxilla (perNobel) Posi1onandangula1on Conven1onal
Anteriorimplantsplacedinthelateral-centralinterproximal
regionsandareparalleltooneanother
Posteriorimplantalignedparalleltotheanteriorwallofthe
maxillarysinus
Angledabutmentsareonlynecessaryfortheposteriorimplants
- 15. Ineortstoimproveprimaryimplantanchoragetwoother
implantcongura1onshavebeenproposed(Jensenetal,2015) M-4Congura1on
V-4Congura1on AllonFourMaxilla (perNobel) Posi1onandangula1on
CourtesyDr.O.Jensen
- 16. M-4 Fourimplantsplacedat30degreeanglestomissnasalandsinus
pneuma1zedcavi1esinanM-shapedcongura1onwhenviewed
onpanoramicradiography(Jensenetal,2015). AllonFourMaxilla
(perNobel) Posi1onandangula1on CourtesyDr.O.Jensen
- 17. WhenabundantboneispresentM-4implantcongura1onsin
pa1entsprovidesexcellentsupportoftheprosthesiswith20mm
betweenimplants.Thisarrangementrequiresli^leifanydistal can1lever.
Angledabutmentsareusedonallfourimplants AllonFourMaxilla (perNobel)
Posi1onandangula1on CourtesyDr.O.Jensen
- 18. Pa1entwithmoderateresorp1onandtherecommendedimplant
posi1oningwiththeaimofmaximizingA-Pspread
Angledabutmentsareusedonallfourimplants
A-Pspreadmaybysubop1malinthesepa1entsandunless
primaryimplantanchorageisop1mal,loadingshouldbedelayed
AllonFourMaxilla (perNobel) Posi1onandangula1on
CourtesyDr.O.Jensen
- 19. V-4 TheV-4designa1ondenotesfourimplantsplacedat30degree
anglestomissthesinusandnasalcavi1esallconvergingtoward
themidlineinaV-forma1on(Jensenetal,2015).
Angledabutmentsareusedonallfourimplants AllonFourMaxilla (perNobel)
Posi1onandangula1on
- 20. (V-4implantcongura1onwithtrans-sinusimplants)
Pa1entswithadvancedresorp1on.Thereiscommonlyadeciencyofbonemass
suchthatposteriorimplantsgainlimitedxa1oninathinlateralnasalwall.
Anteriorvomerimplantsareusuallywellxedinthenasalcrest.
Apalatalviewdemonstra1ngimplantanchoragepoints.Theposteriorimplants
aredirectedtowardmaximalbonemassatthelateralpyriform,whilethe
anteriorimplantsareaimedtowardthemaximumavailablemidlinebonemass
whichusuallyextendssuperiorlyintothenasalcrest(Vpoint).
AllonFourMaxilla (perNobel) Posi1onandangula1on
CourtesyDr.O.Jensen
- 21. AllonfourMaxilla (perNobel)
(V-4implantcongura1onwithtrans-sinusimplants)
Underthesecircumstancesdelayedloadingis recommended
CourtesyDr.O.Jensen
- 22. Deni1veprostheses Allonfour (perNobel) CourtesyDr.M.Adams
Consistsofaxedhybrid prosthesis Resindentureteeth Acrylicresin
Metalsubstructure imbeddedwithinthe acrylicresin
- 23. Allonfour (perNobel) Deni1veprostheses Consistsofaxed
hybridprosthesis Resindentureteeth Acrylicresin Metalsubstructure
imbeddedwithinthe acrylicresin CourtesyDr.M.Adams
- 24. AllonFour (perNobel) Deni1on:
Useof4implantstosupportanimmediatelyloadedxedprosthesis
usedtorestoreeithertheedentulousmaxillaandmandible
Exclusionarycriteria(Maxilla)
Pa1entswithsignicantparafunc1onalac1vity
Pa1entswithsevereClassIIorClassIIIjawrela1ons
Anchoringthesurgicaldrillguideisdicult Unfavorablebiomechanics
Pa1entswithopposingarchcomposedprimarilyofnatural den11on
Itisdiculttoproperlycontroltheocclusioninsuchpa1ents
- 25. Asmen1onedearlierthedeni1ontheAllonfour
approachisuses4implantstosupportan
immediatelyloadedxedprosthesisusedtorestore
eithertheedentulousmaxillaandmandible
Whataretheprerequisitesforimmediateloading?* AllonFour
(perNobel)
- 26. ImmediateLoading vFortheimplantstobecomeosseointegrated
theymustremainimmobilizedduringthe healingperiod.
vThereforeoneofthekeystosuccessful immediateloadingcon1nuestobethe
eec1venessofprimaryimplantstability
- 27. Ini1alPrimaryStability (Firstday) Func1onof:
vLocalbonequan1tyandquality vImplantgeometry
Taperedbe^erthancylindricalbecauseyou
haveabe^erchanceofmaximizingbone contactwiththeinternalandexternal
diametersoftheimplant vSurgicalprocedure(skill)
Inser1ontorqueinexcessof45N/cm ISQs70andabove Twomainfactors:
1.Amountofini1albonecontact
2.Lateralcompressionoftheosteotomysitecrea1nglocal
compressionstresses CourtesyDr.C.Stanford
- 28. ImmediateLoadingWhenIsitFeasible?
Thedegreeofini1alboneanchorage v
Skillofthesurgeon.Immediateloadingisnotfor beginners
Considerbicor1calstabiliza1onwhenpossible
Youmusta^empttoengagetheinnerandouterdiameterof
theimplantwithbonewhenappropriate Inser1ontorqueinexcessof45N/cm
ISQs70andabove v Volumeanddensityoftheboneassociatedwithimplant
site Siteswithdensetrabecularbonearepreferred
Longerimplantsaregenerallypreferred
Bicor1calanchoragemaybenecessary Clinicalissuestobeconsidered:
- 29. Implantselec1on Tapered,selftappingwithsharply
pitchedthreads Implantplacementprocedure
Semi-guidedorfullyguidedispreferred overfreehandprepara1onofthe
osteotomysiteandinser1onofthe implants Immediateloading
Allon4perNobel Requirementsforsuccessfuloutcomes
- 30. Immediateloading Allon4perNobel
Requirementsforsuccessfuloutcomes Assessmentofimplantanchorage
Torquevalues-45N/cmormore RFAvalues(resonancefrequency
analysis)70andabove Dontovertorqueforthismayimpair
thebalanceofthebiologicprocesses associatedwithosseointegra1on
(OSullivanetal,2000;Bashutskietal2009;Cha etal,2015)
Excessivelevelsoftorqueincreasesthezoneof
deadanddyingosteocytesleadingtoincreased
resorp1onandadisrup1onofthebalanceof
remodelingandrepairmechanisms
- 31. Characteris1csoftheimmediateloadprosthesis*
Rigidityandcrossarchstabiliza1on Passivet
Minimizethecan1leverandbendingmoments Occlusion Clinicalremounts
Balancedar1cula1on
*Asuccessfuloutcomerequiresthattheimplantsremainimmobile
(lessthan100micronsofmovement)(Maniatopoulosetal,1986;
Szmuckler-Moncler,2000)duringthehealingphase. Immediateloading
Requirementsforsuccessfuloutcomes
- 32. Compliantpa1ent Manipulateoralhygieneaids
Followpostopera1veinstruc1ons.Theyinclude:
Liquiddietfortherst3weeks
Frequentoralrinseswithwarmsaltwaterrinsesbeginning
24hoursaVersurgery.
Twiceperdayoralrinseswithchlorhexidinebeginning4
dayaVerdeliveryandcon1nuingfor10days.
MechanicalsoVdietforanother3weeks. Avoidclenchingandbruxing
Immediateloading Requirementsforsuccessfuloutcomes
- 33. AllonfourMaxilla (perNobel) Why?
Thesurgeryistechniquesensi1ve Requiresbicor1calstabiliza1oninmany
pa1ents Oldtechnologyandmaterials Itsaxedprosthesis
Poorlipandfacialsupport SpeechandhygieneaccessareoVen incompa1ble
Requiresagreatdealofinterocclusalspace Esthe1cs Cost Twoprostheses
Angledabutmentsareexpensive Bewareofonesizetallapproach
AtUCLAwebelievefewpa1entsarewellservedwiththisapproach
CourtesyDr.M.Adams
- 34. Allonfour-Maxilla Issuesofconcern
Thesurgeryistechniquesensi1ve
Bicor1calstabiliza1onofimplantsisoVenrequired
TranssinusimplantsoVenrequiredtoachievethe desiredamountofA-Pspread
Highlevelofsurgicalskillrequired
Ifyouloosejustoneimplantyouloosetheprostheses
CourtesyDr.O.Jensen
- 35. AllonfourMaxilla (perNobel) Issuesofconcern
Deni1veprosthesis(Fixedhybridprosthesis)usesold
technologyandmaterials Dentureteethsubjecttowearandfracture
Acrylicresinsubjecttowearandoralcontamina1on
CourtesyDr.M.Adams
- 36. Issuesofconcern
Deni1veprosthesis(Fixedhybridprosthesis)usesold
technologyandmaterials Dentureteethsubjecttowearandfracture
Acrylicresinsubjecttowearandoralcontamina1on AllonfourMaxilla
(perNobel) CourtesyDr.K.Lyons
- 37. AllonfourMaxilla (perNobel) Issuesofconcern
Deni1veprosthesis(Fixedhybridprosthesis)usesold
technologyandmaterials Dentureteethsubjecttowearandfracture
Acrylicresinsubjecttowearandoralcontamina1on
- 38. AllonfourMaxilla (perNobel) Issuesofconcern
Itsaxedprosthesis Poorlipandfacialsupport
SpeechandhygieneaccessareoVenincompa1ble
Requiresagreatdealofinterocclusalspace
Ifinsucienttheprosthesismaynotbeabletowithstandthe rigorsoffunc1on
Esthe1csTheprosthesisjunc1onisdesignedtobesuperiorto
thesmileline
- 39. AllonfourMaxilla (perNobel) Issuesofconcern-Maxilla
Esthe1csandlackoflipsupport
Pa^ernofresorp1onfollowinglossofteethleadstoa
pseudoclassIIIjawrela1on
Itisnotpossibletoproperlysupportthelipofmostsuch pa1ents
Adentureangeisneeded
- 40. AllonfourMaxilla (perNobel) Issuesofconcern
Hygieneaccessandspeechar1cula1on
Whenyouprovidehygieneaccess,speechar1cula1onis compromised.
Whenyouclosethespacesusedforhygieneaccesstopermit
properspeechar1cula1on,hygieneiscompromised.
CourtesyDr.M.Adams
- 41. AllonfourMaxilla (perNobel) Issuesofconcern
Hygieneaccessandspeechar1cula1on
Whenyouclosethespacesusedforhygieneaccesstopermit
properspeechar1cula1on,hygieneiscompromised.
Notetheplaquethathasaccumulatedonthe1ssuesideofthisAllon
Fourprosthesis CourtesyDr.M.Adams
- 42. Asaresultmanyprosthodon1stsprefertheuseofeither
implantsupportedorimplantassistedoverdentures. Advantages:
Be^erhygieneaccess Be^erlipsupport Be^eresthe1cs
Lesscostlyforthepa1ent Whatarethealterna1ves?
- 43. Alterna1vetreatment Overdenture Implantassisteddesign
CombinedimplantandsoV 1ssuesupport
Resilienta^achmentsposteriorly
- 44. Alterna1veTreatment Overdenture Implantsupporteddesign
Supportderived fromimplants Milledbarwith a^achments
- 45. AllonfourMaxilla (perNobel) Addi1onalissuesofconcern
Interocclusalspace 15-17mm Smileline
ManycliniciansusingtheAllonfourapproach
adviseplacingthejunc1onbetweenthe
prosthesisandthemucosaabovethelipline duringahighsmile
Thismayrequireremovalofexcessiveamounts ofbone CourtesyDr.S.Lewis
CourtesyDr.P.Pera
- 46. AllonfourMaxilla (perNobel) Addi1onalissuesofconcern
Interocclusalspace 15-17mm Smileline
Becauseofthedesignoftheprosthesis,
addi1onalreduc1onofboneisrequiredifthe
smilelineishigh.Onemmofaddi1onal bonereduc1onnecessaryforeverymmthe
smilelineisabovetheCEJ CourtesyDr.S.Lewis CourtesyDr.P.Pera
- 47. AllonfourMaxilla (perNobel) Addi1onalissuesofconcern
Interocclusalspace 15-17mm Smileline
Wefeelthatthereareotheralterna1ves whichbe^erservethepa1ent(i.e.the
Columbusbridgeprotocolanddelayed
loadingusingmetal-ceramicoramonolithic zirconiaprosthesis)
CourtesyDr.S.Lewis CourtesyDr.P.Pera
- 48. Addi1onalissuesofconcern Interocclusalspace
Fractureoftheprosthesismayoccuerwhenthereisinsucient
interocclusalspacetofabricateaprosthesisofsucientbulkto
withstandocclusalfunc1on. AllonfourMaxilla (perNobel)
- 49. Allon4conceptEdentulousMaxilla Overdenturesmaybepreferred
Advantages Implantsupported Be^eresthe1cs
Lipsupportprovidedbyadentureange Be^erspeechar1cula1on
Be^erhygieneaccess
- 50. Whatabouttheuseof1lted implantsintheedentulousmandible?
Maybenecessarywhenanappropriateanteriorposterior
(A-P)spreadcannotbeobtainedusingaxialinclina1ons.
- 51. WhatistheminimalA-Pspreadnecessarytofabricate
axedprosthesisfortheedentulousmandible? Lengthofimplants
Minimumlength-7mm Numberofimplants Minimumnumber-4 A-PSpread
Minimumamount1cm (A-Pspread) (A-Pspread)
- 52. AnteriorPosteriorSpreadandthelengthofthecan1leverextension
A-PSpread (1cmormore)
Can1leverlengthshouldnotexceed21mestheA-Pspreadora maximumof20mm.
WhenA-Pspreadislessthan1cmitmaynotbepossibleto
restoretheposteriorden11onbecauseoflimitsofthecan1lever Can9lever
Length WhatistheminimalA-Pspreadincombina1on
withthelengthofthecan1lever,necessarytofabricate
axedprosthesisfortheedentulousmandible?
- 53. Anterior Posterior Spread A-P Spread (1 cm or more)
Cantilever length should not exceed 2 times the A-P spread.
CantileverLength WhatistheminimalA-Pspreadincombina1on
withthelengthofthecan1lever,necessarytofabricate
axedprosthesisfortheedentulousmandible?
- 54. ConsequencesofinsucientA-P
spreadandexcessivecan1leverlength Result Mechanicalfailures
Implantoverload Inthispa1enttheresult wasrecurrentfracturesof
theprosthesisretaining screws(arrows).
- 55. InsucientA-Pspreadcombinedwithexcessivecan1leverlength(34
mmontheleVsideand26mmontherightside) Result:
Mechanicalfailure-Implantfracture
Implantoverloadandlossofboneanchoringtheimplant
Inthispa1entacombina1onofexcessivecan1leverlengthand
insucientA-Pspreadleadtoimplantoverloadandaresorp1ve
remodelingresponseoftheadjacentboneandimplantfracture.
ConsequencesofinsucientA-P spreadandexcessivecan1leverlength
- 56. ImplantOverloadandBoneResorp1on MechanismsofImplantFailure
vExcessiveocclusalloads vResul1ngmicrodamage(fractures,
cracks,anddelamina1ons [arrows]) vResorp1onremodelingresponse
ofboneisprovoked vIncreasedporosityofboneinthe
interfacezonesecondaryto remodeling vViciouscycleofcon1nuedloading,
moremicro-damage,more porosityun1lfailure
(Howshawetal,1995;Brunskietal,2000;Myataetal,2002;Myamotoetal,2008;Nagasawaetal,2013)
- 57. BiomechanicsandA-PspreadCasereport
Siximplantshavehavebeenplaced,A-Pspreadisonlyabout5mm.Thecan1lever
extensionmustbelimitedto10mmandthisisinsucienttorestoretheposterior
den11onwithaxedprosthesis.
Whatwouldhaveabe^erop1onforthispa1ent?
- 58. BiomechanicsandA-PspreadCasereport Either
Tiltedimplantswithfourimplantsandaxedprosthesis
Placementoftwoimplantsandanoverdenture
- 59. TiltedimplantsMandible Pa1entselec1on
Pa1entswithsquarearchforms Pa1entsdemonstra1ngananteriorloop
ofthementalnerve Thistechniquewillimproveimplant
distribu1onpa^ern(increasetheA-P
spread)formorefavorablebiomechanics
- 60. TiltedimplantsMandible Usesandadvantages Squarearchforms
Avoidtheanteriorloopoftheinferioralveolarnerve Shortensthecan1lever
Minimizestheriskofbiologicandmechanicalfailures
- 61. Anteriorimplantsshouldbe placedinthelateralincisor posi1ons
Notetheposi1onofthese anteriorimplants TiltedimplantsMandible
Posi1oningofimplants CourtesyDr.N.Barakat
- 62. Inpa1entswithaCawoodClassVorVImandiblethereis
li^leaddi1onalbenetfrom1ppingtheposteriorimplants Treatment of the
rely Resorbed Mandible ferior rows) e of the
Underthesecircumstancesit isbesttoplacetwoimplants
andmakeanoverdenture TiltedimplantsMandible
- 63. Exclusionarycriteria CawoodClassVorVImandible
Tippingtheposteriorimplantposteriorisonlyvaluablewhen
thereisatleast3-4mmofboneoverthenerve TiltedimplantsMandible
CourtesyDr.O.Jensen
- 64. Computerguidedtreatmentplanningandimplantplacement
preferred Theprosthesismaybedeliveredimmediatelyifop1mal
anchorageisachieved TiltedimplantsMandible
- 65. TheColumbusBridge
Useofangledimplantstorestoretheedentulousmaxilla
Onlyselectgroupofpa1entqualify
Pa1entswithfavorablejawrela1onsandbone
contoursarepreferred.ThosewithpseudoclassIII
jawrela1onsarenotconsideredgoodcandidates
Prosthe1cvolumeandsmilelineiscarefully evaluated
4-6implantsareplaced Pterygoidimplantsusedwhennecessary
- 66. TheColumbusBridge
Useofangledimplantstorestoretheedentulousmaxilla Surgicalprotocol
Tapered,selftapingimplantswith externalhexused
Anteriorimplantsplacedintooth posi1ons
Implantsofatleast13mminlengthare desired
Implantsplacedwithfreehanddrilling withtheaidofasurgicaltemplate
Implantinser1ontorqueshouldexceed 40N/cm
Angled,conicalabutmentsareusedin theposteriorposi1ons
Noboneregenera1vetechniquesused CourtesyDr.P.Pera
- 67. TheColumbusBridge
Useofangledimplantstorestoretheedentulousmaxilla
Impressionsmadeimmediatelyfollowingimplantplacement
Metalframeworkwaxedandcastbasedonadiagnos1cwax-up/
trialdenturesetup Itmustbesucientlyrigidtoresistbending
Rigidgoldorpalladiumalloysareused
Theprosthesisisdesignedwithoutcan1levers
Thefunc1onalandesthe1csurfacesoftheprovisionalarerestored
withdentureteethandacrylicresin Prosthesisisscrewretained
Prosthesisdeliveredwithin24hoursofimplantplacement
Deni1veprosthesisfabricated4monthsfollowingimplantsurgery
Prosthodon1cprotocol
- 68. TheColumbusBridge (Avariantoftheallonfourconcept)
Provisionalisdeliveredwithin24hoursandisresinwithametalsubstructure
CourtesyDr.P.Pera
- 69. Finishedprosthesis.Usuallytheprovisional
isreplacedduringtherstyear. TheColumbusBridge
(Avariantoftheallonfourconcept) Delivery Oneyearlater
CourtesyDr.P.Pera
- 70. CourtesyDr.D.Howes Subcrestalvssupracrestal
angula1oncorrec1on However,surgicalplacementismoredemanding
Co-axisimplants Co-axisimplantsareused Twoprostheses
$825/angledabutment Subcrestalispreferred
- 71. Advantagesof Coaxisimplant Lesscost Screwretained
Prosthodon1candtechnicalsimplicity Standardprosthe1ccomponentry
CourtesyDr.D.Howes Subcrestalvssupracrestalangula1oncorrec1on
AngledabutmentsvsCoaxisimplants
However,surgicalplacementismoredemanding Co-axisimplants
- 72. DataTiltedimplantsandimmediateloading CourtesyDr.P.Pera)
Retrospec1vestudiespublishedduringthelastseveralyearsand
recentliteraturereviews(Papaspyridakosetal,2014,Gallucciet
al,2014)appeartoindicatethatimmediateloadprosthesescan
beemployedwithsuccessintheedentulousmaxilla.However
thereportofTealdoandcolleagues(2014)isperhapsthemost
revealing.
- 73. Thepa1entsweredividedintotwogroupsanimmediateloadgroup(34
pa1ents)(prosthesisdeliveredwithin24hours)andadelayedloadinggroup
(15pa1ents)(prosthesisdeliveredanaverageof8.75monthsaVerimplant
placement).Thegroupswereunmatched.
Allimplantsusedinthestudyhadacidetchedsurfaces,were4mmin
diameterandatleast10mminlength.Straightwalledimplantswereplaced
intohealededentuloussitesandtaperedimplantsplacedintoextrac1on
sites. Fourtosiximplantswereplacedintheimmediateloadgroup,thedistal
implantswere1lteddistallyandallimplantsachievedinser1ontorquesofat
least40Ncm. DataTiltedimplantsandimmediateloading
CourtesyDr.P.Pera)
- 74.
Theprosthesesfortheimmediateloadpa1entsweredesignedwithoutdistal
can1levers,customizedmetalframeworkswerefabricatedofpalladiumalloy,
occlusalsurfaceswererestoredwithresin,andtheocclusalschemeusedwas
groupfunc1on.
Reproducibleperiapicalradiographsusingcustomizedlmholderswere
obtainedatdeliveryandatsubsequent12monthintervalsinordertoassess
bonelevelsaroundtheimplants.
Thecumula1veimplantsurvivalratewas93.9%fortheimmediateloadgroup
and95.9%forthedelayedloadgroup.Nopa1entlostmorethanoneimplant.
Inbothgroups,almostalloftheimplantlosseswerewithin12monthsof
implantplacement. DataTiltedimplantsandimmediateloading
CourtesyDr.P.Pera)
- 75. Alloriginalxedprosthesesremainedinfunc1onbutseveralrequired
altera1onsorrepairs,mostsecondarytofracturesassociatedwiththeresin
veneers.Howevertherewerenofracturesassociatedwiththemetal
frameworks.
Meanbonelossaroundimplantswasgreaterforthedelayedgroupthanfor
theimmediateloadgroup. DataTiltedimplantsandimmediateloading
CourtesyDr.P.Pera)
- 76. Allon6withPterygoidImplants
Preferredwhenopposingmandibleisdentate
- 77. Withguidedworkupandsurgicalprocedurestheprosthesis
canbedesignedandfabricatedpriortoimplantplacement
Allon6withPterygoidImplants
- 78. Avoidssinusaugmenta1on
Improvesimplantdistribu1onpa^erns,A-Pspreadand biomechanics
Preferredifimmediateloadingisconsidered
Successratesofpterygoidimplantscloseto90% (Candeletal,2012)
Allon6withPterygoidImplants
- 79. Usedtoprovideposteriorsupportinfullarchandposterior
quadrantprostheses Successratescloseto90%(Candeletal,2012)
Allon6withPterygoidImplants
- 80. Allon6withPterygoidImplants
- 81. Allon6withPterygoidImplants Frameworkismadeof
monolithiczirconia Crownsaremadeoflithium disilicateandcementedto
theframework
- 82. Tiltedimplants-Posteriorquadrants
Analterna1vetosinusaugmenta1on
Computerguidedtreatmentplanningandimplant placementispreferred
- 83. Tiltedimplants-Posteriorquadrants
Anteriorguidanceprovidedbynaturalden11on
- 84. Pterygoidimplants Combina1onof1ltedand pterygoidimplant
Longerimplants Improvedbiomechanics Eliminatestheneedforsinus
augmenta1on
- 85. Pterygoidimplants Iffullyguidedsurgeryisused,abutmentscanbe
chosenormilledpriortosurgicalplacement
- 86. Pterygoidimplants Implantsplaced withtheaidofa
surgicaltemplate Semi-guided surgical placementwas employed
- 87. Pterygoidimplants
Combina1onof1ltedimplantandapterygoidimplant
Eliminatestheneedforsinusaugmenta1on
Occlusionisanteriorguidance
- 88. Zygoma1cimplants IntroducedbyBranemarkinthelate1980s
Pa1entswithmoderatelyresorbedmaxillae
Designedtobeusedinconcertwith2-4implantsplacedinthe anteriormaxilla
Successrateshavebeenveryhighinconven1onalpa1ents
(Branemark,2004;Aparicioetal,2006;Bedrossianetal,2006;Kahnbergetal,2007;
Bedrossianetal,2012).
- 89. Zygoma1cimplants Complica1onsrarebutsignicant
Oralantralstula Postopera1vemaxillarysinusi1s Peri-orbitalhematoma
Facialswelling Penetra1onoftheorbit
- 90. Zygoma1cimplants
Nolongerrecommendedforpa1entswithanintactpalate
Distor1onofpalatalcontours Otherop1onsavailablethataremoreeec1ve.
Tiltedimplants Pterygoidimplants Sinusaugmenta1on
- 91. Zygoma1cimplants Pa1entwasallergictoacrylicresin
Zygoma1cimplantsusedtoavoidsinus augmenta1on
Zygoma1cimplantsdidnotalterthecontours
oftherestora1onorimpairthetonguespace
- 92. Zygoma1cimplants
Usedforpa1entswithmajordefectsofthehardpalate
UsefulforincompleterepairedcleVlipandpalatepa1ents
Edentulousmaxillectomypa1entswithlargedefects
Successrateshavebeengood (Schmidtetal,2004;Schmidt,2007)
CourtesyA.Sharma
- 93. Zygoma1cimplants Issues Radia1oneects Hygieneaccess
Longtermsurvivabilty Bestsuitedfortotalpalatectomydefects
CourtesyA.Sharma
- 94. Zygoma1cimplants Prosthodon1cissues Twoimplantsperside
Splintallimplantstogether Implantsupportedvsimplant
assisteddesigndependson implantdistribu1onpa^ern
Bestsuitedfortotalpalatectomydefects CourtesyA.Sharma
- 95. vVisitofr.orgforhundredsof addi1onallecturesonComplete
Dentures,FixedProsthodon1cs ImplantDen1stry,Removable
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