Implant Supported Fixed Prosthesis

8/6/2019 Implant Supported Fixed Prosthesis

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IMPLANT SUPPORTEDIMPLANT SUPPORTED

FIXED PROSTHESISFIXED PROSTHESIS

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INTRODUCTIONINTRODUCTION

EVIDENCE OF IMPLANTS SEEN INEVIDENCE OF IMPLANTS SEEN INANCIENT CIVILISATION LIKE INCASANCIENT CIVILISATION LIKE INCASAND MAYANSAND MAYANS

MODERN IMPLANTOLOGY HASMODERN IMPLANTOLOGY HASEVOLVED FROM 1980 ONWARDSEVOLVED FROM 1980 ONWARDS

IN 1940 DAHLSE INTRODUCEDIN 1940 DAHLSE INTRODUCED

SUBPERIOSTEAL IMPLANTSSUBPERIOSTEAL IMPLANTS LINKOW INTRODUCED BLADELINKOW INTRODUCED BLADE

IMPLANTSIMPLANTS



19801980PER INGVAR BRANEMARK PER INGVAR BRANEMARK INTRODUCED CONCEPT OFINTRODUCED CONCEPT OFOSSEOINTEGRATIONOSSEOINTEGRATION

DEFINITION:DEFINITION:A SUBSTANCE THAT IS PLACEDA SUBSTANCE THAT IS PLACEDINTO THE JAWS TO SUPPORT A CROWN OR INTO THE JAWS TO SUPPORT A CROWN OR FIXED OR REMOVABLE DENTUREFIXED OR REMOVABLE DENTURE

INDICATIONS :INDICATIONS :

1.1. FOR COMPLETELY EDNTULOUS PATIENTSFOR COMPLETELY EDNTULOUS PATIENTSWITH ADVANCED RESIDUAL RIDGEWITH ADVANCED RESIDUAL RIDGERESORPTIONRESORPTION



2.FOR PARTIALLY EDENTULOUS ARCHES2.FOR PARTIALLY EDENTULOUS ARCHES

WHERE REMOVABLE PARTIALWHERE REMOVABLE PARTIAL

DENTURE MAY WEAKEN THEDENTURE MAY WEAKEN THEABUTMENT TEETHABUTMENT TEETH

3.FOR SINGLE TOOTH PREPARATION3.FOR SINGLE TOOTH PREPARATION

4.PATIENTS DESIRE4.PATIENTS DESIRE



CLASSIFICATIONCLASSIFICATION

DEPENDING ON PLACEMENT WITHIN THEDEPENDING ON PLACEMENT WITHIN THETISSUES :TISSUES :

1.1. EPIOSTEAL IMPLANTSEPIOSTEAL IMPLANTS :DENTAL:DENTAL

IMPLANT THAT RECEIVES ITS PRIMARYIMPLANT THAT RECEIVES ITS PRIMARYSUPPORT BY RESTING ON IT Eg:sub periostealSUPPORT BY RESTING ON IT Eg:sub periostealimplantsimplants

2.2. TRANSOSTEAL IMPLANTS:TRANSOSTEAL IMPLANTS:IT¶S A DENTALIT¶S A DENTAL

IMPLANT THAT PENETRATES BOTHIMPLANT THAT PENETRATES BOTHCORTICAL PLATES AND PASSES THROUGHCORTICAL PLATES AND PASSES THROUGHENTIRE THICKNESS OF ALVEOLAR BONEENTIRE THICKNESS OF ALVEOLAR BONE



3.ENDOSTEAL IMPLANTS:3.ENDOSTEAL IMPLANTS:IT IS DENTALIT IS DENTAL

IMPLANT THAT EXTENDS IN TO THE BASALIMPLANT THAT EXTENDS IN TO THE BASAL

BONEBONE

4.ROOT FORM IMPLANT:4.ROOT FORM IMPLANT:THEY ARE USEDTHEY ARE USED

OVER VERTICAL COLUMN OF BONEOVER VERTICAL COLUMN OF BONE

5.PLATE FORM IMPLANT:5.PLATE FORM IMPLANT:THEY ARE USEDTHEY ARE USED

FOR HORIZONTAL COLUMN OF BONEFOR HORIZONTAL COLUMN OF BONE



PARTS OF IMPLANTSPARTS OF IMPLANTS

1.1. IMPLANT OR FIXTUREIMPLANT OR FIXTURE

2.2. HEALING SCREWHEALING SCREW

3.3. HEALING CAPSHEALING CAPS

4.4. ABUTMENTSABUTMENTS

5.5. IMPRESSION POSTIMPRESSION POST



CONSIDERATION FOR SYSTEMICCONSIDERATION FOR SYSTEMIC

,LOCAL AND PROSTHODONTIC,LOCAL AND PROSTHODONTIC

TREATMENTTREATMENTMEDICAL HISTORYMEDICAL HISTORY

CONTRAINDICATING TRETMENT:CONTRAINDICATING TRETMENT:

Systemic condition that precludes a mnor Systemic condition that precludes a mnor surgical procedures eg:diabetics,bloodsurgical procedures eg:diabetics,blood

dyscrasias,immunologically compromiseddyscrasias,immunologically compromised

History of chemical dependencyHistory of chemical dependency

History of orofacial irradiationHistory of orofacial irradiation

Psychatric prosthesisPsychatric prosthesis



LOCAL CONSIDERATIONLOCAL CONSIDERATION

Size of oral opening and interarch spacesSize of oral opening and interarch spaces

Status of opposing dentitionStatus of opposing dentition

(supraeruption,occlusal relation )(supraeruption,occlusal relation ) Quality and quantity of proposed host siteQuality and quantity of proposed host site

Height of smile lineHeight of smile line



PROSTHETIC CONSIDERATIONPROSTHETIC CONSIDERATION

POSSIBLE SHORTCOMING INPOSSIBLE SHORTCOMING IN

APPEARANCE ,OCCLUSION SUPPORT OFAPPEARANCE ,OCCLUSION SUPPORT OF

PREVIOUS DENTURESPREVIOUS DENTURES

RELATIONSHIP OF PROSTHETIC TEETHRELATIONSHIP OF PROSTHETIC TEETH

POSITION TO UNDERLYING RESIDUALPOSITION TO UNDERLYING RESIDUAL

RIDGESRIDGES



DIAGNOSTICS AIDSDIAGNOSTICS AIDS

Diagnostic casts and previous prosthesisDiagnostic casts and previous prosthesis

analysisanalysis

Panoramic and cephalometric filmsPanoramic and cephalometric films CAT scansCAT scans

These technique offer the surgeon additionalThese technique offer the surgeon additional

infection about potential sites for implantinfection about potential sites for implant placement placement



Treatment decision influenced by :Treatment decision influenced by :

Magnitude of residual ridge resorptionMagnitude of residual ridge resorption

Relationship to key anatomical landmarksRelationship to key anatomical landmarks

incisive foramen,maxillary sinus ,mentalincisive foramen,maxillary sinus ,mentalforamen ,inferior alveolar canalforamen ,inferior alveolar canal

Percieved quality of host bone sitesPercieved quality of host bone sites



Preliminary prosthodontic designPreliminary prosthodontic design

1.1. Number of implant abutmentNumber of implant abutment ::

Clinical success with implant supported fixed prosthesis suggestsClinical success with implant supported fixed prosthesis suggestsa quasia quasi--general formulageneral formula

*five implants placed between mental foramina to support a*five implants placed between mental foramina to support a1010--12 unit fixed mandibular prosthesis12 unit fixed mandibular prosthesis

Formula did not addressFormula did not address

Arch formArch form

Length of implantLength of implant

Length of cantilever Length of cantilever

In maxilla additional provision that six or more implantsIn maxilla additional provision that six or more implantscompromise a starting point for a fixed designcompromise a starting point for a fixed design



2.Location of implants :2.Location of implants :favorable when its distributionfavorable when its distributionor configuration is curved rather than flat .or configuration is curved rather than flat .

The former allows more occlusal units and optimalThe former allows more occlusal units and optimal

cantilever designcantilever designA flat arch form is better for over denture designA flat arch form is better for over denture design

3.Quality of host sites: 3.Quality of host sites: loosely textured cancellousloosely textured cancellous

bone potentially vulnerable osseointegrated response bone potentially vulnerable osseointegrated responselength of cantilever depends on patient occlusal activitylength of cantilever depends on patient occlusal activity

because patient exhibits different degrees of loading because patient exhibits different degrees of loading



4.Quantity of host bone:4.Quantity of host bone:residual ridge reduction is a problem inresidual ridge reduction is a problem inmaxilla where grafting is required if fixed prosthesis ismaxilla where grafting is required if fixed prosthesis is

planned planned

Surgical approaches include sinus lift procedure andSurgical approaches include sinus lift procedure and

consideration of implants in zygoma or pterygoid plateconsideration of implants in zygoma or pterygoid plate

5.Amount of circumoral activity5.Amount of circumoral activity ::

In maxilla both combination of high lip line and advancedIn maxilla both combination of high lip line and advancedresidual ridge resorption .residual ridge resorption .

Former requires use of visible labial flangeFormer requires use of visible labial flangePatient with extensive vertical horizontal anterior maxillaryPatient with extensive vertical horizontal anterior maxillary

resorptionresorption



Presurgical treatmentPresurgical treatment

The edentulous mouth is prepared for The edentulous mouth is prepared for osseointegration technique by ensuring tissueosseointegration technique by ensuring tissuehealthhealth

Soft and hard tissue lesion may have an impactSoft and hard tissue lesion may have an impacton surgical phase of osseointegrationon surgical phase of osseointegration

If there is inadequate bone surgical procedureIf there is inadequate bone surgical procedure

designed to generate bonedesigned to generate bone Once an appropriate site is established aOnce an appropriate site is established a

surgical template is preparedsurgical template is prepared



Surgical stagesSurgical stages

First flaps are raised and holes are carefully and gently drilledFirst flaps are raised and holes are carefully and gently drilledinto selected host bone sites, the holes confirm to choseninto selected host bone sites, the holes confirm to chosenimplants dimension and accommodate threaded tooth rootimplants dimension and accommodate threaded tooth rootanalogueanalogue

The reflected mucoperiosteal flaps are readapted to completelyThe reflected mucoperiosteal flaps are readapted to completelycover the implant which are to be submerged and unloadedcover the implant which are to be submerged and unloadedduring healing periodduring healing period

Implants are provisionally sealed with cover screen duringImplants are provisionally sealed with cover screen duringhealing period.healing period.

soft tissues are sutured and left to heal undisturbed .during 4soft tissues are sutured and left to heal undisturbed .during 4--66months healing period designated time required for months healing period designated time required for osseointegration to occur in maxilla and mandible denture isosseointegration to occur in maxilla and mandible denture isrelieved liberallyrelieved liberally



When second stage surgery is required transepithelialWhen second stage surgery is required transepithelialabutment of selected dimension are attached toabutment of selected dimension are attached toimplants and prosthodontics startedimplants and prosthodontics started

Prosthodontics protocolProsthodontics protocol

ObjectivesObjectives

Fabrication of cast prosthesis base that joins the implantFabrication of cast prosthesis base that joins the implant

together and provides distal cantilever extensiontogether and provides distal cantilever extension.artificial teeth and soft tissue analogue then.artificial teeth and soft tissue analogue then processed onto framework processed onto framework



Clinical protocol used areClinical protocol used are

Impression are made in dentist material of choice .anImpression are made in dentist material of choice .anocclusal opening provides access to transfer copingocclusal opening provides access to transfer copingthat are screwed to abutments .transfer coping arethat are screwed to abutments .transfer coping are

withdrawn in impression and filled with labwithdrawn in impression and filled with labanalogues the impression is powered in artificialanalogues the impression is powered in artificialstonestone

A trial denture base stabilised with two prostheticA trial denture base stabilised with two prostheticcoping used to register jaw relation records .samecoping used to register jaw relation records .same base is used for trial arrangement of artificial teeth base is used for trial arrangement of artificial teeth.After confirmation of jaw relation records an index.After confirmation of jaw relation records an indexof position of artificial teeth is madeof position of artificial teeth is made



Proposed framework is designed in context of teethProposed framework is designed in context of teethindex position and cast ,surrounded by acrylic resinindex position and cast ,surrounded by acrylic resin.metallic frame are cast in silver .metallic frame are cast in silver--palladium alloy or palladium alloy or

class iv gold alloyclass iv gold alloy Framework is tried in the mouth and nonpassive fitFramework is tried in the mouth and nonpassive fit

notednoted

Processing of metallic framework and stock acrylicProcessing of metallic framework and stock acrylic

resin is completed with a commercial acrylic resinresin is completed with a commercial acrylic resin Completed prosthesis is inserted in mouth new jawCompleted prosthesis is inserted in mouth new jaw

relation records made ,occlusion refined on articulator relation records made ,occlusion refined on articulator



Each patient is counseled tissue and prosthesis careEach patient is counseled tissue and prosthesis care

Advantages:Advantages:

1.1. A cure for people with maladaptive dentureA cure for people with maladaptive denture2.2. Conceptually brilliantConceptually brilliant

3.3. Enormous psychological and functional benefitsEnormous psychological and functional benefits

Disadvantages :Disadvantages :

1.1. limited applicationlimited application2.2. ExpensiveExpensive

3.3. Complex to undertakeComplex to undertake



4.Maintanace not easy4.Maintanace not easy

5.Esthetic outcome difficult and unpredictable5.Esthetic outcome difficult and unpredictable

6.Size of occlusal table reduced6.Size of occlusal table reduced



SUMMARYSUMMARY

THE AVAILABILITY OF FIXEDTHE AVAILABILITY OF FIXED

TREATMENT OPTION IS REMARKABLETREATMENT OPTION IS REMARKABLE

ADVANCE.IT IS ONE OF DENTISTRYSADVANCE.IT IS ONE OF DENTISTRYS

MOST GRATIFYING TREATMENTMOST GRATIFYING TREATMENT

MODALITIES BUT DEMAND SKILLMODALITIES BUT DEMAND SKILL

,JUDGEMENT AND PATIENT,JUDGEMENT AND PATIENT

COMMITMENT AND UNDERSTANDINGCOMMITMENT AND UNDERSTANDING



THANK YOU THANK YOU

Implant Supported Fixed Prosthesis

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