IMPLANT SUPPORTED

FIXED PROSTHESIS
http://hi-
dentfinishingschool.blogspot.
com
/
http://apexiondental.com/
 INTRODUCTION
 EVIDENCE OF IMPLANTS SEEN IN
ANCIENT CIVILISATION LIKE INCAS
AND MAYANS
 MODERN IMPLANTOLOGY HAS
EVOLVED FROM 1980 ONWARDS
 IN 1940 DAHLSE INTRODUCED
SUBPERIOSTEAL IMPLANTS
 LINKOW INTRODUCED BLADE
IMPLANTS
 1980PER INGVAR BRANEMARK
INTRODUCED CONCEPT OF
OSSEOINTEGRATION

DEFINITION:A SUBSTANCE THAT IS PLACED

INTO THE JAWS TO SUPPORT A CROWN OR
FIXED OR REMOVABLE DENTURE
INDICATIONS :
1. FOR COMPLETELY EDNTULOUS PATIENTS
WITH ADVANCED RESIDUAL RIDGE
RESORPTION
2.FOR PARTIALLY EDENTULOUS ARCHES
WHERE REMOVABLE PARTIAL
DENTURE MAY WEAKEN THE
ABUTMENT TEETH
3.FOR SINGLE TOOTH PREPARATION
4.PATIENTS DESIRE
 CLASSIFICATION
 DEPENDING ON PLACEMENT WITHIN THE
TISSUES :
1. EPIOSTEAL IMPLANTS :DENTAL
IMPLANT THAT RECEIVES ITS PRIMARY
SUPPORT BY RESTING ON IT Eg:sub periosteal
implants
2. TRANSOSTEAL IMPLANTS:IT’S A DENTAL
IMPLANT THAT PENETRATES BOTH
CORTICAL PLATES AND PASSES THROUGH
ENTIRE THICKNESS OF ALVEOLAR BONE
3.ENDOSTEAL IMPLANTS:IT IS DENTAL
IMPLANT THAT EXTENDS IN TO THE BASAL
BONE
4.ROOT FORM IMPLANT:THEY ARE USED
OVER VERTICAL COLUMN OF BONE
5.PLATE FORM IMPLANT:THEY ARE USED FOR
HORIZONTAL COLUMN OF BONE
 PARTS OF IMPLANTS
1. IMPLANT OR FIXTURE

2. HEALING SCREW

3. HEALING CAPS

4. ABUTMENTS

5. IMPRESSION POST
 CONSIDERATION FOR SYSTEMIC
,LOCAL AND PROSTHODONTIC
TREATMENT
MEDICAL HISTORY
CONTRAINDICATING TRETMENT:
 Systemic condition that precludes a mnor

surgical procedures eg:diabetics,blood

dyscrasias,immunologically compromised
 History of chemical dependency

 History of orofacial irradiation

 Psychatric prosthesis
 LOCAL CONSIDERATION
 Size of oral opening and interarch spaces
 Status of opposing dentition
(supraeruption,occlusal relation )
 Quality and quantity of proposed host site
 Height of smile line
PROSTHETIC CONSIDERATION
 POSSIBLE SHORTCOMING IN
APPEARANCE ,OCCLUSION SUPPORT
OF PREVIOUS DENTURES
 RELATIONSHIP OF PROSTHETIC TEETH
POSITION TO UNDERLYING RESIDUAL
RIDGES
 PATIENT SELECTION
 Patient who benefits most significantly are
those with maladaptive denture experience
 Current research suggests any patient whose
systemic health does not preclude minor
surgical intervention and whose proposed host
bone sites can quantitatively or qualitatively
accommodate dimension of dentists implant
system can be regarded as candidate for
ossoeintegration
 DIAGNOSTICS AIDS
 Diagnostic casts and previous prosthesis
analysis
 Panoramic and cephalometric films
 CAT scans
 These technique offer the surgeon additional
infection about potential sites for implant
placement
Treatment decision influenced by :
 Magnitude of residual ridge resorption
 Relationship to key anatomical landmarks
incisive foramen,maxillary sinus ,mental
foramen ,inferior alveolar canal
 Percieved quality of host bone sites
 Preliminary prosthodontic design
1. Number of implant abutment :
Clinical success with implant supported fixed prosthesis suggests
a quasi-general formula
*five implants placed between mental foramina to support a
10-12 unit fixed mandibular prosthesis
Formula did not address
 Arch form
 Length of implant
 Length of cantilever
 In maxilla additional provision that six or more implants
compromise a starting point for a fixed design
2.Location of implants :favorable when its distribution
or configuration is curved rather than flat .
The former allows more occlusal units and optimal
cantilever design
A flat arch form is better for over denture design

3.Quality of host sites: loosely textured cancellous

bone potentially vulnerable osseointegrated response
length of cantilever depends on patient occlusal activity
because patient exhibits different degrees of loading
4.Quantity of host bone:residual ridge reduction is a problem in
maxilla where grafting is required if fixed prosthesis is
planned
Surgical approaches include sinus lift procedure and
consideration of implants in zygoma or pterygoid plate
5.Amount of circumoral activity :
In maxilla both combination of high lip line and advanced
residual ridge resorption .
Former requires use of visible labial flange
Patient with extensive vertical horizontal anterior maxillary
resorption
 Presurgical treatment
 The edentulous mouth is prepared for
osseointegration technique by ensuring tissue
health
 Soft and hard tissue lesion may have an impact
on surgical phase of osseointegration
 If there is inadequate bone surgical procedure
designed to generate bone
 Once an appropriate site is established a
surgical template is prepared
 Surgical stages
 First flaps are raised and holes are carefully and gently drilled
into selected host bone sites, the holes confirm to chosen
implants dimension and accommodate threaded tooth root
analogue
 The reflected mucoperiosteal flaps are readapted to completely
cover the implant which are to be submerged and unloaded
during healing period
 Implants are provisionally sealed with cover screen during
healing period.
 soft tissues are sutured and left to heal undisturbed .during 4-6
months healing period designated time required for
osseointegration to occur in maxilla and mandible denture is
relieved liberally
 When second stage surgery is required transepithelial
abutment of selected dimension are attached to
implants and prosthodontics started

Prosthodontics protocol
Objectives
Fabrication of cast prosthesis base that joins the implant
together and provides distal cantilever extension
.artificial teeth and soft tissue analogue then
processed onto framework
 Clinical protocol used are
 Impression are made in dentist material of choice .an
occlusal opening provides access to transfer coping
that are screwed to abutments .transfer coping are
withdrawn in impression and filled with lab
analogues the impression is powered in artificial
stone
 A trial denture base stabilised with two prosthetic
coping used to register jaw relation records .same
base is used for trial arrangement of artificial teeth
.After confirmation of jaw relation records an index
of position of artificial teeth is made
 Proposed framework is designed in context of teeth
index position and cast ,surrounded by acrylic
resin .metallic frame are cast in silver-palladium alloy
or class iv gold alloy
 Framework is tried in the mouth and nonpassive fit
noted
 Processing of metallic framework and stock acrylic
resin is completed with a commercial acrylic resin
 Completed prosthesis is inserted in mouth new jaw
relation records made ,occlusion refined on articulator
 Each patient is counseled tissue and prosthesis care

Advantages:
1. A cure for people with maladaptive denture
2. Conceptually brilliant
3. Enormous psychological and functional benefits
Disadvantages :
1. limited application
2. Expensive
3. Complex to undertake
4.Maintanace not easy
5.Esthetic outcome difficult and unpredictable
6.Size of occlusal table reduced
 SUMMARY
 THE AVAILABILITY OF FIXED
TREATMENT OPTION IS REMARKABLE
ADVANCE.IT IS ONE OF DENTISTRYS
MOST GRATIFYING TREATMENT
MODALITIES BUT DEMAND SKILL
,JUDGEMENT AND PATIENT
COMMITMENT AND UNDERSTANDING
THANK YOU