Aust Dent J. 2008 Jun;53 Suppl 1:S60-8. doi: 10.1111/j.1834-7819.2008.00043.x. Occlusion in implant dentistry.

A review of the literature of prosthetic determinants and current concepts. Gross MD. Source Department of Oral Rehabilitation, Tel Aviv School of Dental Medicine, Tel Aviv University, Israel. grossmd@post.tau.ac.il Abstract Today the clinician is faced with widely varying concepts regarding the number, location, distribution and inclination of implants required to support the functional and parafunctional demands of occlusal loading. Primary clinical dilemmas of planning for maximal or minimal numbers of implants, their axial inclination, lengths and required volume and quality of supporting bone remain largely unanswered by adequate clinical outcome research. Planning and executing optimal occlusion schemes is an integral part of implant supported restorations. In its wider sense this includes considerations of multiple interrelating factors of ensuring adequate bone support, implant location number, length, distribution and inclination, splinting, vertical dimension aesthetics, static and dynamic occlusal schemes and more. Current concepts and research on occlusal loading and overloading are reviewed together with clinical outcome and biomechanical studies and their clinical relevance discussed. A comparison between teeth and implants regarding their proprioceptive properties and mechanisms of supporting functional and parafunctional loading is made and clinical applications made regarding current concepts in restoring the partially edentulous dentition. The relevance of occlusal traumatism and fatigue microdamage alone or in combination with periodontal or peri-implant inflammation is reviewed and applied to clinical considerations regarding splinting of adjacent implants and teeth, posterior support and eccentric guidance schemes. Occlusal restoration of the natural dentition has classically been divided into considerations of planning for sufficient posterior support, occlusal vertical dimension and eccentric guidance to provide comfort and aesthetics. Mutual protection and anterior disclusion have come to be considered as acceptable therapeutic modalities. These concepts have been transferred to the restoration of implant-supported restoration largely by default. However, in light of differences in the supporting mechanisms of implants and teeth many questions remain unanswered regarding the suitability of these modalities for implant supported restorations. These will be discussed and an attempt made to provide some current clinical axioms based where possible on the best available evidence. Clin Oral Implants Res. 2005 Feb;16(1):26-35. Occlusal considerations in implant therapy: clinical guidelines with biomechanical rationale. Kim Y, Oh TJ, Misch CE, Wang HL. Source Department of Periodontics/Prevention/Geriatrics,

University of Michigan School of Dentistry, 1011 North University Avenue, Ann Arbor, MI 48109, USA. Abstract Due to lack of the periodontal ligament, osseointegrated implants, unlike natural teeth, react biomechanically in a different fashion to occlusal force. It is therefore believed that dental implants may be more prone to occlusal overloading, which is often regarded as one of the potential causes for peri-implant bone loss and failure of the implant/implant prosthesis. Overloading factors that may negatively influence on implant longevity include large cantilevers, parafunctions, improper occlusal designs, and premature contacts. Hence, it is important to control implant occlusion within physiologic limit and thus provide optimal implant load to ensure a longterm implant success. The purposes of this paper are to discuss the importance of implant occlusion for implant longevity and to provide clinical guidelines of optimal implant occlusion and possible solutions managing complications related to implant occlusion. It must be emphasized that currently there is no evidence-based, implant-specific concept of occlusion. Future studies in this area are needed to clarify the relationship between occlusion and implant success. Int Dent J. 2008 Jun;58(3):139-45. Guidelines for occlusion strategy in implant-borne prostheses. A review. Rilo B, da Silva JL, Mora MJ, Santana U. Source benitorilop@yahoo.es Abstract Medium- or long-term failure of endosseous dental implants after osseointegration, when it has occurred, has been associated in the great majority of cases with occlusal overload. Overload depends ultimately on the number and location of occlusal contacts, which to a great extent are under the clinician's control. Much of our current understanding of occlusal contacts in this context is based on concepts derived from non-implant-borne prosthetics and has not been rigorously tested. The present article reviews occlussal contact designs and offers occlusion strategy guidelines for the main types of implantborne prostheses. Considerations when planning occlusal rehabilitation: a review of the literature. R W Wassell, J G Steele, G Welsh Department of Restorative Dentistry, Dental School, University of Newcastle upon Tyne, UK. As one of the most demanding tasks facing the restorative dentist, planning and executing an occlusal rehabilitation should not be undertaken lightly. The stakes are high and failure is costly. Treatment planning decisions should be undertaken on the basis of scientific evidence, where this is available, or on the basis of documented experience where it is not. This review article identifies the major biological and clinical considerations used when planning an occlusal rehabilitation. These include the indications for reorganising the occlusion, the choice of condylar position and occlusal scheme, the implications of and

indications for increasing the vertical dimension, replacing missing teeth and the choice of materials. Finally, the literature surrounding the controversial issue of occlusal rehabilitation as a means to treat temporo-mandibular disorders is also reviewed. Keywords: occlusal; rehabilitation; plan; when plan; consideration when; condylar position; consideration; condylar; review; occlusal scheme; literature; temporomandibular; vertical dimension; dentist; miss teeth; Nihon Hotetsu Shika Gakkai Zasshi. 2008 Jan;52(1):25-30. [Significance of occlusion for dental implant treatment. Clinical evidence of occlusion as a risk factor]. [Article in Japanese] Hosokawa R. Source Department of of Oral Functional Reconstruction, Kyushu Dental College, Japan. hosokawa@kyu-dent.ac.jp Abstract It is believed that one of the potential risk factors for peri-implant bone loss and failure of the implant /implant prosthesis may be occlusal overloading. Overloading factors, e.g parafunctions, may negatively influence on implant longevity, however, It must be emphasized that currently there is little evidence regarding implant failure caused by overloading. The purposes of this paper are to discuss the importance of implant occlusion for implant longevity and to provide possible solutions managing complications related to parafunctions. This paper summarizes the lecture presented at the International Congress of Prosthodontics 2007 in Kobe. Nihon Hotetsu Shika Gakkai Zasshi. 2008 Jan;52(1):1-9. [Does evidence of implant occlusion exist?]. [Article in Japanese] Matsushita Y, Sasaki K, Koori H, Esaki D, Haruta A, Koyano K. Source Division of Oral Rehabilitation, Kyushu University, Japan. matsushi@dent.kyushu-u.ac.jp Abstract This article reviews epidemiologic studies and basic researches concerning the mechanical risk factors that cause overload in implant occlusion. When natural teeth are adjacent to an implant, occlusal contact on the implant prosthesis requires a reduced initial mechanical load on the implant. This is called the implantprotected occlusion concept. However, few studies support this concept, and several researchers are concerned about the influence on the temporomandibular joint and the adjacent teeth when using this occlusal concept. It is thought that the same initial mechanical load on the implant and adjacent teeth does not result in an overload on the implant itself. The influence of a non-axial load, large cantilevers, and offset loading with a large occlusal table is greater than that of the axial load because of the bending moment. However, no epidemiologic study supports the biological influences of overloading. Meta-analysis of the

connection of natural teeth and implants shows the biological and prosthetical risks Dent Update. 2010 Nov;37(9):610-2, 6156, 619-20. Occlusal considerations in implantology: good occlusal practice in implantology. Davies SJ. Source TMD Clinic, Manchester University Dental School, UK. Abstract This article is concerned with implants that are being used for fixed crown and bridgework rather than removable prostheses. The huge increase in the provision of implants over the past two decades is set to continue. Most of the research is related to avoiding failures in implants. This research, in the main, has concentrated on the essential interface between the artificial implant and living bone: osseointegration. The other interface, which is worthy of our full attention, is the one between the implant-supported crown and the antagonist tooth: the occlusion. CLINICAL RELEVANCE: This article aims to provide the basis for guidelines for good occlusal practice in implantology. It will consider these under two headings: those which could be considered as basic occlusal principles; and those occlusal considerations that are specific to implants. Republished in SADJ. 2011 Mar;66(2):62, 64-9. Occlusal considerations in implantology: good occlusal practice in implantology. Davies SJ. Source: TMD Clinic, Manchester University Dental School, UK. Abstract This article is concerned with implants that are being used for fixed crown and bridgework rather than removable prostheses. The huge increase in the provision of implants over the past two decades is set to continue. Most of the research is related to avoiding failures in implants. This research, in the main, has concentrated on the essential interface between the artificial implant and living bone: osseointegration. The other interface, which is worthy of our full attention, is the one between the implant-supported crown and the antagonist tooth: the occlusion. Compendium. 1994 Nov;15(11):1330, 1332, 1334 passim; quiz 1344. Implant-protected occlusion: a biomechanical rationale. Misch CE, Bidez MW. Source Oral Implant Center and Residency, University of Pittsburgh, School of Dental Medicine, Pennsylvania, USA. Abstract The clinical success and longevity of endosteal dental implants are controlled, in a large part, by the mechanical milieu within which they function. The occlusion is a critical component of such a mechanical environment. "Implantprotected occlusion" refers to an occlusal schema that is often uniquely specific to the restoration of endosteal implant

prostheses. Implant orientation and the influence of load direction, the surface area of implants, occlusal table width, and protecting the weakest area are blended together from a biomechanical rationale to provide support for a specific occlusal philosophy. Odontology. 2009 Jan;97(1):8-17. doi: 10.1007/s10266-008-0096-x. Epub 2009 Jan 29. Dental occlusion: modern concepts and their application in implant prosthodontics. Carlsson GE. Source Department of Prosthetic Dentistry, The Sahlgrenska Academy, University of Gothenburg, Box 450, SE 405 30, Gteborg, Sweden. g.carlsson@odontologi.gu.se Abstract The aim of this article was to review the literature on various aspects of occlusion related to implant prosthodontics, using PubMed and the Cochrane library. Even if the number of studies on implants and prosthodontics is very large, no randomized controlled trials or Cochrane reviews were found on the possible influence of occlusal design or characteristics of occlusion on treatment outcome. Therefore, studies and articles of a lower evidence level were accepted as the main part of the review. The widely spread opinion that implants are superior to natural teeth was refuted by two recent consensus conferences, which concluded that the long-term outcome of implant restorations is not better than that of natural teeth. No controlled studies on the optimal features of a harmonious natural and/or restored occlusion, including implant prostheses, were found. Nor was there any evidence that more sophisticated methods in jaw registration, e.g., using face-bows and adjustable articulators, compared with simpler methods, will yield better clinical prosthodontic results. This article discusses, among other things, concepts of occlusion of implant-supported restorations, occlusal material, cantilevers, and occlusal risk factors. Within the limitations of the review, it was concluded that many factors can influence implant failure and peri-implant bone loss but that little is known of the relative importance of such factors. Most probably, however, occlusal factors and details of occlusion are in general of minor importance for the outcome of implant restorations. Occlusion can be managed successfully by using simple methods for jaw registration and different occlusal concepts. J Oral Implantol. 2003;29(5):230-4. Occlusal principles and clinical applications for endosseous implants. Jackson BJ. Source Slajacburdds@aol.com Erratum in

prosthetic stages of treatment should follow a disciplined sequence. This article reviews occlusal principles and clinical applications for long-term success of endosseous implants. J Can Dent Assoc. 2001 Oct;67(9):522-6. Occlusal stability in implant prosthodontics -- clinical factors to consider before implant placement. Saba S. Source saba@qc.aira.com Abstract The success of any prosthetic design depends on proper management of the occlusion. The clinical variables influencing occlusal stability must be determined and considered in the design of the final prosthesis. This paper outlines some of these variables. Br Dent J. 2002 Jan 26;192(2):79-88. Good occlusal practice in the provision of implant borne prostheses. Davies SJ, Gray RJ, Young MP. Source University Dental Hospital of Manchester. stephen.j.davies@man.ac.uk Abstract The increased use of endosseous dental implants means that many dentists will encounter patients with dental implants in their everyday practice. Dental practitioners might be actively involved in the provision of implant borne prostheses at both the surgical and restorative phases, or only at the restorative stage. This section is written for all dentists and aims to examine the subject of occlusion within implantology. It aims to provide guidelines of good occlusal practice to be used in the design of the prosthesis that is supported or retained by one or more implants. As implantology is a 'new' discipline of dentistry, there are fewer standard texts and this section, therefore, is much more extensively referenced than the subjects that have been considered to date. J Calif Dent Assoc. 2000 Oct;28(10):7719. Occlusal considerations for implant restorations in the partially edentulous patient. Curtis DA, Sharma A, Finzen FC, Kao RT. Source UCSF School of Dentistry, Department of Preventive and Restorative Dental Sciences, 707 Parnassus Ave., San Francisco, CA 94143-0758, USA. Abstract The type and frequency of complications associated with dental implants has changed during the past decade. As more-successful rates of osseointegration have resulted from improved surgical protocols and materials, the major complications have become restorativerelated rather than surgery-related. Recent studies indicate that restorative complications with implant-retained restorations occur at rates of 10 percent to 77 percent over a three-year period. Many of the restorative complications can be minimized with careful treatment planning and coordination of care. However, because implants lack the stress release associated with a periodontal ligament, impact loading to

J Oral Implantol. 2003;29(6):314. Abstract Endosseous implant dentistry has become a predictable clinical modality. The role of the restorative dentist is to minimize overload to the crestal bone by utilizing implant occlusal principles. The

restorative materials and the crestal bone remains potentially more damaging with implant-supported restorations. This article discusses the biomechanical implications of implant restorations and outlines occlusal considerations designed to decrease restorative complications.

Eskitascioglu G, Usumez A, Sevimay M, Soykan E, Unsal E. J Prosthet Dent. 2004 Feb;91(2):144-50. PMID: 14970760 [PubMed - indexed for MEDLINE] Related citations The prosthetic management of a poor implant 4. treatment is presented in this case report. The Loading of a single implant in simulated recommended occlusion concepts for implantbone. supported prostheses were applied for the resolution Rungsiyakull P, Rungsiyakull C, Appleyard Journal of Prosthetic Dentistry Volume of the case. The rehabilitation of the posterior 81, Issue 5 , Pages 553-561, May 1999 R, Li Q, Swain M, Klineberg I. Toward an understanding of implant segments ... Int J Prosthodont. 2011 Mar[Abstract] [PDF (757 KB)] [Add to Favorites] occlusion and strain adaptive bone Apr;24(2):140-3. modeling and remodeling PMID: 21479281 [PubMed - indexed for Presented at Academy of Prosthodontics MEDLINE] Related citations Implant protected occlusion? Dont count on it. meeting, Colorado Springs, Colo., May 5. Immediate occlusal loading of Gene McCoy 1998. Brnemark System TiUnite implants Journal of Oral Implantology (-Not available-) pp. Clark M. Stanford, DDS, PhDa, Richard placed predominantly in soft bone: 4-year doi: http://dx.doi.org/10.1563/AAID-JOI-D-13A. Brand, MDb results of a prospective clinical study. 00066 University of Iowa, Iowa City, Iowa Glauser R, Ruhstaller P, Windisch S, Abstract aAssociate Professor, Dows Institute for Zembic A, Lundgren A, Gottlow J, Dental Research, College of Dentistry. Hmmerle CH. This commentary questions the credibility of bProfessor, Department of Orthopaedic Clin Implant Dent Relat Res. 2005;7 Suppl Implant Protected Occlusion Surgery, College of Medicine 1:S52-9. [Abstract] [PDF (374 KB)] [Add to Favorites] Abstract PMID: 16137088 [PubMed - indexed for Statement of problem. Dental implant MEDLINE] Related citations failure rates for osseointegration are 6. Evaluation of stress induced by implant Management of Dental Implant Fractures. A Case greater in the highly atrophic maxilla. type, number of splinted teeth, and History Presuming higher failure rates relate to variations in periodontal support in toothFiras A. M. AL Quran, Bashar A. Rashan and Ziad strain-driven adaptation, an enhanced implant-supported fixed partial dentures: N. AL-Dwairi understanding of formative bone a non-linear finite element analysis. Journal of Oral Implantology Aug 2009, Vol. 35, response to loading (modeling) and Lin CL, Wang JC, Chang SH, Chen ST. No. 4 (August 2009) pp. 210-214 maintenance of an integrated state J Periodontol. 2010 Jan;81(1):121-30. doi: doi: http://dx.doi.org/10.1563/1548-1336-35.4.210 (remodeling) should improve treatment. 10.1902/jop.2009.090331. Abstract Purpose. To understand the role of PMID: 20059424 [PubMed - indexed for occlusal loading on long-term MEDLINE] Related citations osseointegration in areas of compromised The widespread use of endosseous osseointegrated 7. The effect of implant diameter, implants to replace missing natural teeth increases cancellous bone, a review of the salient restoration design, and occlusal table the chances of implant complications and failures, features of adaptive bone modeling and variations on screw loosening of posterior despite the high initial success rate reported in the remodeling is presented with an single-tooth implant restorations. literature. Implant fracture is one ... emphasis on cancellous bone responses. Bakaeen LG, Winkler S, Neff PA. [Abstract] [Full Text] [PDF (2131 KB)] [Add to Conclusions. The ability for dental J Oral Implantol. 2001;27(2):63-72. Favorites] implants to maintain a long-term stable PMID: 12498429 [PubMed - indexed for interface in the maxilla lies in the ability MEDLINE] Related citations of trabecular bone to maintain adequate 8. Restoration of partially edentulous Occlusal Principles and Clinical Applications for local material (strength) and architectural patients using dental implants with a Endosseous Implants (connectivity) properties. In this microtextured surface: a prospective Brian J. Jackson discussion, an emphasis has been placed comparison of delayed and immediate full Journal of Oral Implantology Oct 2003, Vol. 29, No. on understanding how trabecular bone occlusal loading. 5 (October 2003) pp. 230-234 can respond to the mastication-induced Cannizzaro G, Leone M. doi: http://dx.doi.org/10.1563/1548loading environment on an implant. (J Int J Oral Maxillofac Implants. 2003 Jul1336(2003)029<0230:OPACAF>2.3.CO;2 Prosthet Dent 1999;81:553-61.) Aug;18(4):512-22. Abstract PMID: 12939002 [PubMed - indexed for Factors to consider in selecting an occlusal MEDLINE] Related citations Endosseous implant dentistry has become a concept for patients with implants in the 9. Implant-supported fixed prostheses for predictable clinical modality. The role of the edentulous mandible Original Research Article the rehabilitation of periodontally restorative dentist is to minimize overload to the The Journal of Prosthetic Dentistry, Volume 74, crestal bone by utilizing implant occlusal principles. compromised dentitions: a 3-year Issue 4, October 1995, Pages 380-384 The prosthetic stages of treatment should follow a ... prospective clinical study. Daniel Wismeijer, Marinus A.J. van Waas, Warner Yi SW, Ericsson I, Kim CK, Carlsson GE, [Abstract] [PDF (423 KB)] [Add to Favorites] Kalk PDF (6249 K) Nilner K. Clin Implant Dent Relat Res. Occlusion on implants - is there a Assessment of the effect of two occlusal concepts 2001;3(3):125-34. problem? for implant-supported fixed prostheses by Finite PMID: 11799702 [PubMed - indexed for Klineberg IJ, Trulsson M, Murray GM. Element Analysis in patients with bruxism. J Oral Rehabil. 2012 Jul;39(7):522-37. doi: MEDLINE] Related citations Evrim Gre and Glmser Evliolu 10.1111/j.1365-2842.2012.02305.x. Epub 10. Biomechanical interactions in toothJournal of Oral Implantology (-Not available-) pp. implant-supported fixed partial dentures 2012 Apr 17. Review. doi: http://dx.doi.org/10.1563/AAID-JOI-D-11with variations in the number of splinted PMID: 22506541 [PubMed - indexed for 00044 teeth and connector type: a finite MEDLINE] Related citations Abstract element analysis. 2. Effects of occlusal inclination and Lin CL, Wang JC, Chang WJ. loading on mandibular bone remodeling: The aim of this study was to evaluate the effects of Clin Oral Implants Res. 2008 a finite element study. bruxing forces on implants configured under 2 Jan;19(1):107-17. Epub 2007 Oct 16. Rungsiyakull C, Rungsiyakull P, Li Q, Li W, different occlusal schemes by dynamic finite PMID: 17944965 [PubMed - indexed for Swain M. element analysis (FEA). A main model consisting of MEDLINE] Related citations Int J Oral Maxillofac Implants. 2011 Maya 5-unit- Fixed Partial Denture (FPD) supported 11. Photoelastic stress analysis of load Jun;26(3):527-37. by ... transfer to implants and natural teeth PMID: 21691599 [PubMed indexed for [Abstract] [PDF (1390 KB)] [Add to Favorites] comparing rigid and semirigid connectors. MEDLINE] Related citations Nishimura RD, Ochiai KT, Caputo AA, 3. The influence of occlusal loading Jeong CM. location on stresses transferred to Occlusal concepts application in resolving implant J Prosthet Dent. 1999 Jun;81(6):696-703. implant-supported prostheses and prosthetic failure: Case Report. PMID: 10347358 [PubMed - indexed for supporting bone: A three-dimensional Vanessa Helena Jamcoski, Fernanda Faot, Ivete MEDLINE] Related citations finite element study. Aparecidade Mattias Sartori, Rogria Acedo Vieira and Rodrigo Tiossi Journal of Oral Implantology (-Not available-) pp. doi: http://dx.doi.org/10.1563/AAID-JOI-D-1100164 Abstract

12. The influence of occlusal design on simulated masticatory forces transferred to implant-retained prostheses and supporting bone. Kaukinen JA, Edge MJ, Lang BR. J Prosthet Dent. 1996 Jul;76(1):50-5. PMID: 8814635 [PubMed - indexed for MEDLINE] Related citations 13. Photoelastic stress analysis of implant-tooth connected prostheses with segmented and nonsegmented abutments. Ochiai KT, Ozawa S, Caputo AA, Nishimura RD. J Prosthet Dent. 2003 May;89(5):495-502. PMID: 12806328 [PubMed - indexed for MEDLINE] Related citations 14. Influence of prosthetic parameters on the survival and complication rates of short implants. Tawil G, Aboujaoude N, Younan R. Int J Oral Maxillofac Implants. 2006 MarApr;21(2):275-82. PMID: 16634499 [PubMed - indexed for MEDLINE] Related citations 15. Occlusion in implant dentistry. A review of the literature of prosthetic determinants and current concepts. Gross MD. Aust Dent J. 2008 Jun;53 Suppl 1:S60-8. doi: 10.1111/j.1834-7819.2008.00043.x. Review. PMID: 18498587 [PubMed - indexed for MEDLINE] Related citations 16. Immediate occlusal loading of Brnemark TiUnite implants placed predominantly in soft bone: 1-year results of a prospective clinical study.

Glauser R, Lundgren AK, Gottlow J, PMID: 15730446 [PubMed - indexed for Sennerby L, Portmann M, Ruhstaller P, MEDLINE] Related citations Hmmerle CH. Clin Implant Dent Relat Res. 2003;5 Suppl 1:47-56. Guidance for the Maintenance Care PMID: 12691650 [PubMed - indexed for of Dental Implants: Clinical Review MEDLINE] Related citations Sylvia Todescan, Salme Lavigne, 17. Osseoperception: sensory function Anastasia Kelekis-Cholakis, and proprioception. J Can Dent Assoc 2012;78:c107 Klineberg I, Murray G. Occlusion: Occlusion schemes Adv Dent Res. 1999 Jun;13:120-9. should provide for adequate Review. PMID: 11276734 [PubMed - indexed for posterior support at an appropriate MEDLINE] Related citations occlusal vertical dimension. 18. Immediate loading using cross-arch Eccentric guidance should be used fixed restorations in heavy smokers: nine to ensure optimal distribution of consecutive case reports for edentulous the potentially destructive effects arches. of excursive occlusal Romanos GE, Nentwig GH. Int J Oral Maxillofac Implants. 2008 Mayparafunction.47,48 If technical Jun;23(3):513-9. complications occur, they should PMID: 18700376 [PubMed - indexed for be treated accordingly. MEDLINE] Related citations 19. Retrospective evaluation of complete- Parafunctional habits should be documented and treated, since arch fixed partial dentures connecting teeth and implant abutments in patients application of excessive with normal and reduced periodontal concentrated force can cause rapid support. and substantial peri-implant bone Cordaro L, Ercoli C, Rossini C, Torsello F, loss.17 Feng C. 17. Humphrey S. Implant maintenance. Dent J Prosthet Dent. 2005 Oct;94(4):313-20. Clin North Am. 2006;50(3):463-78. PMID: 16198167 [PubMed - indexed for 47. Gross, MD. Occlusion in implant dentistry. A MEDLINE] Related citations review of the literature of prosthetic 20. Sensory and motor function of teeth determinants and current concepts. Austr Dent and dental implants: a basis for J. 2008;53(Suppl 1):S60-68. osseoperception. 48. Kim Y, Oh TJ, Misch CE, Wang HL. Occlusal considerations in implant therapy: clinical Trulsson M. guidelines with biomechanical rationale. Clin Clin Exp Pharmacol Physiol. 2005 JanOral Implants Res. 2005;16(1):26-35. Feb;32(1-2):119-22. Review. posterior teeth in protrusion and whether the working side An Overview Regarding Contemporary Biomechanical Aspects on discludes the non-working side in latero-protrusive movements Immediate Loading Dental Implants (anterior disclusion). Mutual protection is directly dependent Jos Mauricio dos Santos Nunes Reis, Lgia Antunes Pereira on posterior support, in which the molars protect the anterior Pinelli, teeth during occlusion and the anterior teeth protect the Nicolau Conte Neto, Marcelo Silva Monnazzi and Jos Cludio posteriors in excursive movements. Martins Segalla Gross also recommends to avoid creation of excursive UNESP - Univ Estadual Paulista / Araraquara Dental School guidance on single implant restorations in order to prevent Brazil overloading to the prosthesis, abutment, implant and, www.intechopen.com therefore, to bone-implant interface. Cantilevers must be also 10. Occlusion aspects avoided (Figure 26) or decreased (Figure 27) when possible. It Although the etiological factors underlying bone loss have not must be remembered that the greater the buccolingual (Figure been fully established (Prosper et al., 2009), Canay & 28), mesial, distal or vertical cantilever, the greater will be the Aka (2009) stated that the main contributory factors of bone biomechanical failure risk. Finally, the decreasing of the loss are occlusal overload and peri-implantitis. Current functional surface of the crowns, the loads being directed to concepts are mixed regarding the peri-implant response to the long axis of the implants, the absence of cantilevers during occlusal overload. Gross (2008) reported that a phenomenon the provisionalization and an adequate occlusal adjustment of fatigue microtrauma has been proposed as the process of seem to favor the immediate loading implants results (Misch cervical and progressive bone loss as bone modeling due to & Bidez, 1995). excessive occlusal load. When the rate of fatigue microdamage exceeds the reparative rate, cervical bone is irreversibly lost. According to Kozlovsky et al. (2007), the overloading aggravated plaque-induced bone resorption, and increased bone loss of the dental implants. The decreasing of the functional surface of the dental crowns, the loads being directed to the long axis of the implants, the provisionalization and an adequate occlusal adjustment seem to favor the immediate loading implants result. In addition to poor bone Fig 21 Initial clinical aspect quality, unfavorable force direction and concentration may increase failure rates of implants (Becktor et al., 2002; Chen et al., 2008). The question of splinting is also relevant to a discussion of occlusion as previously described. Some authors (Nokar et al., 2010; Zarone et al., 2003) advocated separation of mandibular superstructures in the midline (Figures 21 to 24) and cite mandibular flexure as a potential source of distal implant morbidity in full-arch restorations. However, additional studies about bone loss and prosthesis failure are necessary to confirm these findings. Gross (2008) suggested that the occlusion should be viewed as consisting of three basic elements: posterior support, Fig 22 Cast after impression of immediately loaded implants occlusal vertical dimension (Figure 25) and eccentric or anterior guidance. The degree of vertical and horizontal overlap determines whether the anterior teeth disclude the

5.

Fig 23 Bar casted in 2 rigid segments with minimal separation in anterior region

Fig 24 Final aspect of oral rehabilitation

Becktor, J.P.; Eckert, S.E.; Isaksson, S. & Keller, E.E. (2002). The influence of mandibular dentition on implant failures in bone-grafted edentulous maxillae. The International Journal of Oral & Maxillofacial Implants, Vol. 17, No.1, January-February 2002), pp. 69-77, ISSN 08822786 6. Chen, Y.Y.; Kuan, C.L. & Wang, Y.I. (2008). Implant occlusion: biomechanical considerations for implant-supported prostheses. Journal of Dental Sciences, Vol.3, No. 2, pp. 65-74, ISSN 1991-7902 7. Nokar, S. & Baghai Naini, R. (2010). The effect of superstructure design on stress distribution in peri-implant bone during mandibular flexure. The International Journal of Oral & Maxillofacial Implants, Vol.25, No.1, (January-February 2010), pp. 31-37, ISSN 0882-2786 8. Zarone, F.; Apicella, A.; Nicolais, L.; Aversa, R. & Sorrentino, R. (2003). Mandibular flexure and stress build-up in mandibular full-arch fixed prostheses supported by osseointegrated implants. Clinical Oral Implants Research, Vol.14, No.1, (February 2003), pp. 103-114, ISSN 0905-7161 9. Misch, C.E. & Bidez, M.W. (1995). Implant-protected occlusion. Practical Periodontics and Aesthetic Dentistry, Vol.7, No.5, (June-July 1995), pp. 25-29, ISSN 1042-2722 Connecting Teeth to Implants: A Critical Review of the Literature and Presentation of Practical Guidelines Gary Greenstein, John Cavallaro, Richard Smith, and Dennis Tarnow Compendium September 2009Volume 30, Number 7 Theoretical Concept: Occlusion Related to Bone Loss The influence of occlusal forces on peri-implant bone was reviewed by Isidor.68 He concluded the literature had conflicting information as to whether overloading an implant can lead to implant failure, which can consist of progressive bone loss or total deosseointegration. It was also noted that animal studies have shown occlusal load may contribute to complete loss of osseointegration69 or marginal bone loss.70 However, in human clinical investigations, despite many authors referring to occlusal trauma as a cause for implant loss,3,11,50,67,71,72 others indicated this relationship has not been clearly demonstrated.2,68,73-76 A review by Vidyasagar and Apse77 reached the same conclusion as Isidor. Therefore, it can be summarized that in some situations, occlusal forces may affect the bone around implants; however, numerous confounding variables (eg, density of bone, strength of loading force) make it difficult to delineate the circumstances when this occurs. 68.Isidor F. Influence of forces on peri-implant bone. Clin Oral Implants Res. 2006;17(suppl 2):8-18. 69.Isidor F. Loss of osseointegration caused by occlusal load of oral implants. A clinical and radiographic study in monkeys. Clin Oral Implants Res. 1996;7(2):143-152. 70.Miyata T, Kobayashi Y, Araki H, et al. The influence of controlled occlusal overload on peri-implant tissue. Part 3: a histologic study in monkeys. Int J Oral Maxillofac Implants. 2002; 15(3):425-431. 3. Naert IE, Quirynen M, van Steenberghe D, et al. A six-year prosthodontic study of 509 consecutively inserted implants for the treatment of partial edentulism. J Prosthet Dent. 1992;67 (2):236-245. 11.Kim Y, Oh TJ, Misch CE, et al. Occlusal considerations in implant therapy: clinical guidelines with biomechanical rationale. Clin Oral Implants Res. 2005;16(1):26-35. 50.Quirynen M, Naert I, van Steenberghe D, et al. Periodontal aspects of osseointegrated fixtures supporting a partial bridge. An up to 6-years retrospective study. J Clin Periodontol. 1992; 19(2):118-126. 67.Jemt T, Lekholm U, Adell R. Osseointegrated implants in the treatment of partially edentulous patients: a preliminary study on 876 consecutively placed fixtures. Int J Oral Maxillofac Implants. 1989;4(3):211-217. 71.Esposito M, Hirsch JM, Lekholm U, et al. Biological factors contributing to failures of osseointegrated oral implants. (I). Success criteria and epidemiology. Eur J Oral Sci. 1998;106(1): 527-551. 72.Esposito M, Hirsch JM, Lekholm U, et al. Biological factors contributing to failures of osseointegrated oral implants. (II). Etiopathogenesis. Eur J Oral Sci. 1998;106(3):721-764. 2. Lang NP, Wilson TG, Corbet EF. Biological complications with dental implants: their prevention, diagnosis and treatment. Clin Oral Implants Res. 2000;11(suppl 1):146-155. 73.Engel E, Gomez-Roman G, Axmann-Krcmar D. Effect of occlusal wear on bone loss and Periotest value of dental implants. Int J Prosthodont. 2001;14(5):444-450.

Fig 25 VDO determined by Lucias JIG

Fig 26 Total implant supported prosthesis with no cantilever

Fig 27 Shortened dental arch concept reducing the length of cantilever by using one premolar for each quadrant.

Fig 28 Unsatisfactory implant supported prosthesis. See Bucco-lingual cantilever and inadequate orientation of teeth.

1.

Prosper, L.; Redaelli, S.; Pasi, M.; Zarone, F.; Radaelli, G. & Gherlone, E.F. (2009). A randomized prospective multicenter trial evaluating the platform- switching technique for the prevention of postrestorative crestal bone loss. The International Journal of Oral & Maxillofacial Implants, Vol.24, No.2, 9 (March-April 2009), pp. 299- 308, ISSN 0882-2786 2. Canay, S. & Aka, K. (2009). Biomechanical aspects of bone-level diameter shifting at implant-abutment interface. Implant Dentistry, Vol.18, No.3, (June 2009), pp. 239- 248, ISSN 1538-2982 3. Gross, M.D. (2008). Occlusion in implant dentistry. A review of the literature of prosthetic determinants and current concepts. Australian Dental Journal, Vol.53, No.1, (June 2008), pp. S60-S68, ISSN 1834-7819 4. Kozlovsky, A.; Tal, H.; Laufer, B.Z.; Leshem, R.; Rohrer, M.D.; Weinreb, M. & Artzi, Z. (2007). Impact of implant overloading on the periimplant bone in inflamed and non-inflamed peri-implant mucosa. Clinical Oral Implants Research, Vol. 18, No.5, (October 2007), pp. 601- 610, ISSN 0905-7161

74.Wennerberg A, Carlsson GE, Jemt T. Influence of occlusal factors on treatment outcome: a study of 109 consecutive patients with mandibular implant-supported fixed prostheses opposing maxillary complete dentures. Int J Prosthodont. 2001; 14(6):550-555. 75.Lindquist LW, Carlsson GE, Jemt T. A prospective 15-year follow-up study of mandibular fixed prostheses supported by osseointegrated implants. Clinical results and marginal bone loss. Clin Oral Implants Res. 1996;7(4):329-336. 76.Lindquist LW, Carlsson GE, Jemt T. Association between marginal bone loss around osseointegrated mandibular implants and smoking habits: a 10-year follow-up study. J Dent Res. 1997;76(10):1667-1674. 77.Vidyasagar L, Apse P. Biological response to dental implant loading/overloading. Implant overloading: empiricism or science? Stomatologija. 2003;5:83-89.