IMPLANT SUPPORTED FIXED PROSTHESES

BY; DR. SUNDUS WAHID DR. XAINAB RASHEED

Introduction to implants

Definition:
Implants are surgically fixed substitutes for roots of missing teeth and dental implantology is the study of arts and science concerned with surgical insertion and restoration of materials and devices restoring partially or totally edentulous patient to function.

History & evolution of dental implants

The history of dental implants goes back to thousand of years. Traces of root forms includes civilizations such as the ancient chinese(4000years ago), Eygptians(2000years ago) & Incas(1500years ago). However, the first screw implants are credited to Stock 1939 with a prior introduction to implant material Co-Cr-My in 1938. Co-Cr-

Indications of implants
     

Particularly any edentulous space. Patient with history of trauma Congenitally missing teeth Periodontal disease Failure of fixed or removable prosthesis Oro and maxillofacial clefts and other defects Esthetics

Contraindications of implants


 

 

Debilitating or uncontrolled disease like uncontrolled diabetes ,cardiac valves, dialysis, liver failure Pregnancy. Lack of adequate training of practitioner. Immunocompression e.g.,HIV,radiation therapy. Poor patient motivation. Psychiatric disorders.

Contraindications of implants (contd.)

 

  

Inability of patient to manage oral hygiene. Patient hypersensitivity to specific components of the implant. Acute bone resorption Chronic inflammation History of smoking and alcoholism Unattainable prosthodontic reconstruction.

Structural components of an implant

Structural components of an implant (contd.)



Crest module for retention of prosthetic component in two piece system. Body either screw type or cylindrical or combined

Other components


Cover screw prevents debris contamination Transepithelial portion known as the healing portion Abutments retains the prosthesis Superstructure provides attachment for fixed prosthesis in the framework Transfer coping is used to position die in an impression

Other components (contd.)



Prosthetic coping fits the abutment for screw connection .

Healing gingiva Abutment

Positioning of abutment Cast

Classification of implants
On the basis of implant tissue interface  Direct bone implant interface (osseointegration)  Indirect bone implant interface (blade and subperiosteal)

On the basis of location and stress response  Submucous  Supraperiosteal  Subperiosteal  Endosseous  Transosseous  endodontic

On the basis of function  Retentive  Supportive On the basis of implant material  Metallic  Polymer  Ceramic  Vitreous carbon

On the basis of implant design  Branemark implantimplantthreaded screw  Core vent implant-open implantbasket vents with threads  IMZ-rough plasma IMZsprayed implant surface  Stryker implant-fluted implantdesign

Success criteria for dental implants

  

     

No peri-implantitis periNo peri-implant radiolucency periMarginal bone loss of about 1.0-1.5mm 1.0first year after placement; then < 0.1mm bone loss per year Tissue integration: bone/soft tissue ("osseointegration") Absence of mobility Stable clinical attachment level Absence of bleeding. Absence of discomfort Success rate varies with bone quality, loading dynamics etc

lower jaw, front lower jaw, back upper jaw, front upper jaw, back

90 95% 85 90% 85 95% 65 85%

PeriPeri-implantitis


Is an inflammatory reaction with loss of supporting bone in the tissues surrounding a functioning implant. Causes can be bacterial, systemic or overloading of an implant.

Treatment planning & general considerations for dental implants



Initial evaluation
 

 

 

chief complaint medical/dental history review intra/extraoral exam evaluation of existing prosthesis diagnostic impressions/articulated casts radiographs photographs

treatment options/informed consent explanation of long-term longcommitment restorative - surgical joint consult

    

TwoTwo-stage surgery Restorative phase Regular recall Payment policy Form, function and esthetics

Problem list & considerations

   

Number of remnant teeth Relationship to adjacent teeth Root angulations quality, quantity, width, support of the bone MD width of edentulous space (min of 6-7mm space 6b/w teeth,>than 1.5mm b/w tooth & implant) for edentulous 7mm from the center of implant

Problem list & considerations (contd.)

       

Crown/root ratio Mobility Oral hygiene Furcations Probing depths Systemic manifestations Destructive habits Mucogingival problems

  

Periapical pathology Radiopaque/radiolucent regions Adequate vertical bone height in edentulous area 10mm alveolar bone Implants should be placed at a minimum of 2mm from the inferior alveolar canal or below the maxillary sinus Adequate interradicular area - 8mm interradicular bone width

Radiographic analysis (periapical,panaromic,CT,R/G stents)

Implant replacement options



Immediate implant placed at time of tooth extraction Delayed immediate (8-10 week delay from (8extraction) Delayed (9-10 months (9or longer)

Surgical analysis


Surgical handling of the tissues with minimal heat generation is necessary. (< 47 . for one minute or less) provides the most predictable healing response.

Esthetic analysis
   

 

Smile line Lip shape full Vs. thin Existing ridge defect Implant emergence profile (360 degree) Occulosal analysis MaxMax-mand relations

Procedure of implant insertion

1. Raising of surgical flap

2. Bone contouring

3. Osteotomy

4. Implantation by fixture mounts

5. Removal of fixture mounts

6. Placing cover screws

7. Closure

8. Healing period (3-4 months)

9. Transfer coping fixed

10. Impression made & implant analogue fixed

11. Cast poured

12. Abutment fixed

13. Abutment manipulated for the construction of superstructure

14. Abutment transferred into the oral cavity & final contouring done

15. Fixation of manufactured superstructure using luting agent

Teeth in an Hour.flv

Our job, your smile!

Thank You.