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Contents
Diagnosis
Medical history
Dental history
Oral examination
Radiographic examination
Additional bone evaluation
Consultation
Case selection
Single tooth replacement
objectives
Increase the ability of each candidate to diagnose
and select the suitable cases for implants.
Be able to select the best treatment option predictably.
Give you step by step the best way in single tooth
replacement with implants
indication
Implant is indicated as a treatment option available for
any patient, regardless of sex or age.
The exceptions for this treatment are patients with
chronic diseases, or abnormalities of mucosal
membrans and/or jawbones.
Osseointegrated implant is ideal treatment for patients
unable to wear complete denture.
contraindications
Absolute contraindications for osseointegrated implants
High dose irradiated patients
Patients with psychiatric problems
Hematologic system disorders.
Relative contraindications
Pathology of the hard and soft tissues
Patients with drug, alcohol, or chewing tobacco abuse
Patients with chronic disease such as diabetes or high
blood pressure.
Diagnosis
It is important that the general physical condition of the
patient is checked accurately in order to obtain an overall
health assessment.
Medical history
Dental history
Radiographic study
Study cast
Photographs
Medical history
Determine if the patient is currently under
the care of a physician
Determine if the patient has ahistory of
abnormal bleeding tendences.
Determine if the patient is under care for
psychological problems
Dental history
Extraction dates should be verified if they were
within a minimum of three months.
Oral examination
A thorough oral examination should include
evaluation of soft tissue condition
Radiographic examination
Radiographs help determine the quantity and quality
of residual ridge bone
Necessary radiographs include
periapicals
occlusals
orthopantograph
cephalometric
CT-Scan
Smile line
Case selection
Case selection
Clinical Findings
Diagnosis
Definition
Thearapeutic Goals
Treatment Considerations
Outcomes Assessment
Treatment Planning
Treatment options
Chief Complaint
I want to have my upper front teeth treated or replaced
and clean the other teeth because I dont want to loss
them
Medical History
Medication: Non
Allergies: Non
Social History: Normal
Head and Neck: Normal
Extra-oral Examination: Normal
Intra-oral Examination:
Bucal Mucosa: Normal
Gingiva: Moderate inflamation
Bucket Depth: 4 5 mm average
Teeth mobility: Grade II &III in the upper arch
Diagnosis
Early-onset periodontitis(EOP) OR Aggressive periodontitis
These terms are used to describe deferent forms of clinical
entities which occurs in localized or generalized forms.
Definition
Aggressive periodontitis encompasses distinct types of
periodontitis that affect people who, in most cases otherwise appear
healthy. It tends to have a familial aggregation and there is a rapid
rate of disease progression. Aggressive periodontitis occurs in
localized and generalized forms.
Treatment Planning
Maxilla Option 1
Periodontal treatment that include SRP, antibiotic therapy
and Perio Surgeries if needed.
Extraction of teeth no.#1, #2, #4, #5, #7, #8, #9, #10, #12, #13
.
Fabrication of metal reinforced provisional using teeth
no#3, #6, #11& #14 as abutments extended from tooth #3 to
#14.
Bilateral sinus grafts if needed
Placement of 8 implants ,4 in each side to support 12 PFM
separated FPD.
Mandibular option 1
Periodontal treatment that include SRP, antibiotic therapy
and Perio Surgeries if needed.
Extraction of tooth #19.
Resin bonded bridge to replace tooth #19.
Fabrication of metal reinforced provisional to replace the
existing bridge #28 - #31 to adjust the occlusion.
Placement of implants in area #19, #29& #30.
Crowning of teeth #28 & #31.
Aesthetic zone
Upper anterior teeth
Aesthetic zone
Over denture
introduction
Advantage of overdenture:
Reduced bone resorption
Better chewing efficiency
Retention of proprioception (root
implant )
Stability of denture
Patient has better control of occlusion
Speaking efficiency
Adaptable to changing
circumstances:
-additions
-clean ability
Chick list:
Extra oral
Fixed
Removable
Lip line
Low
High
Tooth
Little(6)
Distinct>8
display
Facial
support
No need necessary
Intra Oral
Fixed
Removable
Ridge shape
Vertical
Buccal
concavity
<10 mm
>15mm
Neutral Skeletal 3
Result:
Mencske_stern
JPD 1994;543
Mericska_stern,COIR
1994:9_14
Conclusions:
.mandibular overdenture faillures 3,3%
.maxillary overdenture faillures 27%
.cast bar with parallel sided or oval shape
.4implant in maxilla
.1-4 retention clips
.extension bars
1996;11:291
1988
81%
Jemt
1992
83%
Hutton
1995
72%
Jemt
1996
72%
Denture problems:
.reduced stability
.insufficient retension
.impaired load bearing capacity
Conclusion:
.Ball /o_ring attachments transferred
Prosthetic Components
less is better
The more components the more Surgical
and Diagnostic error
Treatment Planning:
.patient desires
.smile line /aesthetic demands
.condition of remaining /opposing dentitions
.occlusion/bruxer/smoker
.mounted models/wax up
.dental scan
.evaluation_surgeon/restorative
Diagnostic Phase:
.clinical examination
.occlusal analysis(bruxer)_mounted
diagnostic casts
.provisional wax up _final tooth position
.radiographic stent with marker
.dentascan _analyze with simplant
.modification of diagnostic stent for surgery
.fixture installation
Diagnosis:
.smile line:high/low
.tissue:thin /thick
.implant/implant
.implant/tooth (contact area greater
than 5mm,nice gingival papilla for
aesthetic reason)
.inter proximal height bone
Preoperative Evaluation:
.opposing occlusion
.number of teeth to be replaced
.implant size /number
.implant arrangement
.bone quality/quantity
Clinical determinants:
.phonetics
.musculature support _lip
.ease of hygiene _extent of
cantilevering
.trial tooth set up
Surgical Templates
Are they necessary?
Transfer of prosthetic parameters
.soft tissue emergence profile
.arch form
.vertical dimension-----lead to ideal
placement
.occlusal plane