treatment planning pt.1-2

Implant Dentistry

Course goals

Students will improve their clinical decision making skills when treatment planning patients

requiring prosthodontic care.

Students will understand how dental implantscan be used to improve masticatory function

and quality of life issues.

Instructional Objectives

• Students will be familiar with implant component identification and the steps involved in completing an implant crown for a patient requiring a single tooth implant.

• Students will understand how to treatment plan using implants being aware of patient assessment, biomechanical issues, and risk factors with implants.

• In the partially and completely edentulous patient, students will understand the options for treatment using dental implants as opposed to traditional prosthodontic treatment.

My vision of the UCSF graduate– a good decision maker: an example

Decision making

Decision Making Gather appropriate information for assessment

of what went wrong and why. Next, determine the treatment options.

If Implants:• The type, position, diameter and length of

implants• The number of implants• Internal or external connection• Splinting?• Treatment sequence

• Caries process/ RCT• Weakened tooth perio, structurally• Root proximity• Difficult maintenance• Crown lengthening

FPD Success Rates

• 87% 10 yr success rate,69% at 15 years

• Failure by recurrent caries (18%),loose retainer (7%), porcelain fracture 6.1%, Endo 5%, Perio 4%.

• Please read Goodacre et al.

Removable partial denture

• RPD is often a good option; especially if there is support from teeth

• Less expensive than FPD, Implants

• Increased plaque accumulation 25%.

• Psychological

Shortened Dental Arch

• Article by Armellini et. al.

• Function and stability of bicuspid occlusion

• Evaluated over time

What would you do here?

To restore:

• Root canal, post build-up, crown• Would you do crown lengthening; no, why

not? Crown lengthening would compromise soft tissue esthetics and compromise a future implant site because you are removing bone.

• How would you develop sufficient ferrule if you were to try to save this tooth? This could be done by orthodontic extrusion.

Issues with an implant?


Please read: Curtis et al. Treatment planning in the 21st century.

Implants are not always the best treatment

Treatment planning

• Treatment plan based on functional need rather than anatomic loss– Some patients may have a substantial

anatomic loss but QOL may be satisfactory

• Today’s lecture: 1/7/09• What do the implant components look like

and how do the parts work together. Nomenclature

• Reasons dental implants should be considered when providing prosthodontic care.

• What are the success rates of dental implants and what factors influence success?

• Treatment planning dental implants using efficacy and benefit/risk as outcome assessments.

Articles for this week and next week

• Curtis et al. Occlusal considerations for Implant restorations… Please read entire article carefully.

• Curtis et al. Treatment planning in the 21st Centruy; What’s new. Please read introduction and section on prosthodontics on page 505.

• Curtis et al. The use of dental implants to improve quality of life…. Please read entire article carefully.

• Goodacre et al. Clinical complications with implants and implant prostheses

Supplements for this week

Implant DVD; please look over the treatment planning section and single tooth implant section

Course goals for 2009 handout; outlines goals for this course

Short answer essay questions; outlines most of the major concepts I hope you will learn

Optional essay

• Any topic related to implants

• Previous national awards

Assessments

• Some MC, some essay, some slide identification

• The only make up and/or remedial exams will be essay exams

What are dental implants??

Materials: (Ti-99) or (ti-6Al-4V)

Threaded or not threadedTi or HA

Smooth or acid etchedDiameter

Tapered or parallelLength

Distribution

Nomenclature: please also see DVD

• Healing abutment

• Fits into implant

• Maintains access through tissue

Nomenclature

• Transfer assembly

Nomenclature

• Transfer assembly that is used to transfer the position of the implant in the patient to the cast

Nomenclature

• Transfer assembly with implant analogue attached so the impression can be poured up in stone

Nomenclature

• Implant analogue; this has the same geometry as the top of the implant

• The implant analogue is in the same position on the cast as the implant is in the mouth.

Traditional protocol

4 to 6 implants

added between foramen

4 to 6 implants

added between foramen

Traditional protocol

for implant prosthesis

A 15 year study of osseointegrated implants in

the edentulous jaws

A 15 year study of osseointegrated implants in

the edentulous jaws

ADELL, R. et al. 1981

91%81%96% 100%

0%

50%

100%

150%

MAXILA MANDÍBULA

CIRURGIA

PROTESESurgery

prosthesis

maxilla mandible

Overdenture option45% increase in

chewing efficiency.

Adaptations to the traditional protocol

Adapted for single tooth implants

Steps for a single tooth implant

Nomenclature

• Implant (sometimes called a fixture)

Nomenclature • Implant abutment

(solid)

• Implant abutment (to be waxed up

Nomenclature • Healing abutment

• Transfer assembly

Nomenclature

• Implant analogue

Nomenclature

• Implant screws

• Today’s lecture: 1/7/09• What do the implant components look like and

how do the parts work together. Nomenclature• Reasons dental implants should be

considered when providing prosthodontic care.

• What are the success rates of dental implants and what factors influence success?


Why implants should be considered

• Over 40 million• 65% affects quality of

life- Curtis article• 50% of patients are

limited in food choices• 150 million on denture

adhesives• Psychosocial

implications

Why consider implants?

• About 60%, or over 21 million Americans that use a prosthesis report at least one major problem with their prosthesis that limits their ability to masticate the foods they would like to eat.

• 29% of edentulous patients are able to eat only soft or mashed foods.

• 50% of edentulous patients state they avoid many foods.

• Today’s lecture: 1/7/09• What do the implant components look like and

how do the parts work together. Nomenclature• Reasons dental implants should be considered

when providing prosthodontic care.• What are the success rates of dental

implants and what factors influence success?


Success rates

• Integration above 95%

• Some compromises (esthetics, function, timing) when treatment is not coordinated

• Success is if the patients expectations are met; be careful to outline limitations of functional improvement and/or esthetic issues.

• Space

Treatment Planning with dental implants: what is possible and what is best?

5 patient examples

treatment planning pt.1-2

Education