Immediate Function and Esthetics in Implant Dentistry

7/21/2019 Immediate Function and Esthetics in Implant Dentistry

1/114

Edited by

Peter MoyPatrick PalacciIngvar Ericsson

&Immediate Function

Esthetics in Implant Dentistry

Quintessence Publishing Co. Ltd.

London, Berlin, Chicago, Tokyo, Barcelona, Istanbul, Milan, Moscow,

New-Delhi, Paris, Beijing, Prague, So Paulo, Seoul, and Warsaw


2/114

Peter Moy Patick Palacci lngva Eicsson

1 ction

Esthetics in lmpla strv


3/114

u i

h l r1 Publicaton D

M. K

Im J e implan

. D s

I T II l Ecc r

616'93

ISBN-13: 97850

Al tradenms k, includgk Proea, Tthi-H TUie owes.

gt 20

by Qen C L

T work i _ A !i rgt w ts prhbd z he ls pa l 10 f d o ad o n lv

P Bi: fb pis

SBN: 7 8857--

n G


4/114

v

General technical developments, especially in the

area of computers, have led to new and fascinating

tools becoming available for medicine and den-

tistry.

Contemporary methods within radiology, such as

computerized tomography and medical imaging,

have made patient information available for

diagnosis in a totally new way. Furthermore,

ongoing development has made these technol-

ogies less costly and therefore more readily avai-

able for doctors and patients.

Guided surgery is an example of a technology that

has developed in this way. The utilization of new

powerful technologies has to be conducted in

close consultation with experienced clinicians. The

technology is just a tool, no matter how powerful.

This book describes and documents how to use

NobelGuide in various clinical situations. It is

based on long-term clinical ambitions, thorough

knowledge of the development of this technology,

and the ambition to strive for what is the best for

the patient.

Matts Andersson, DDS PhD

Chief Scientist, Nobel Biocare AB

Gothenburg

Foreword


5/114

vii

Professor Per Ingvar Brnemark first introduced

the concept and principles of osseointegration to

North America during the Toronto Conference in

1982 after years of research and clinical trials. The

protocol presented at that time recommended a

non-loaded healing period of between 3 and 6

months for dental implants. These recommenda-

tions were made from experience using a machine-

smoothed-surface titanium implant. Publications by

other investigators reported very high implant

success rates in completely edentulous jaws, as

well as predictable prosthetic reconstruction when

the delayed loading protocol as advocated by Prof.Brnemark was followed. These articles were fol-

lowed by publications indicating similar success

rates with partially dentate cases.

The demands and expectations of patients to

complete dental implant treatment sooner and

faster have forced clinicians to find new clinical

solutions. Fortunately, improvements in technology

and understanding have provided the means for

clinicians to meet these demands. Thus, with

improvements in implant surfaces, thread patterns

and implant body designs, loading concepts haveevolved into the early loading of implants. Early

loading is the application of load on implants

sooner than the 3- to 6-month healing period, and

immediate loading is the application of load within

48 hours. Early and immediate loading of dental

implants requires clinicians to change their proce-

dural protocols and patient management. To opti-

mize treatment for their patients, clinicians must

take advantage of all available improved technol-

Prefaceogies and clinical techniques, including CAD/CAM-

generated surgical templates and prosthetic

restorations, computer software programs that

permit accurate diagnosis and treatment planning,

and the use of minimally invasive surgical and

prosthodontic techniques.

This textbook introduces the concept of Nobel-

Guide, a complete and practical approach to man-

aging the implant patient who expects immediate

loading and function. The authors take the reader

through the diagnostic process, with a detailed

description of the necessary workup and

generation of the radiographic guide for a CATscan. This allows the clinician to complete the

workup using a specialized computer software

program that shows the available hard and soft

tissues, vital anatomic structures and ideal loca-

tions for tooth/implant positions based on the

prosthetic design. From this planning stage, a sur-

gical template is generated for implant placement,

allowing minimally invasive surgical techniques

while assuring accuracy of implant placement

without the reflection of a soft tissue flap. With

knowledge of implant positions prior to the surgicalplacement, the prosthodontic specialist can fabri-

cate the desired prosthesis before the actual

surgery, thus providing the patient with a function-

ing prosthesis immediately after the implants are

placed.

These new concepts and protocols are

presented in a manner that allows clinicians to pro-

vide their patients with practical and predictable

immediate function.


6/114

Peter K Moy, DMD

Dr Moy received his dental degree from the Uni-

versity of Pittsburgh, a certificate in General Practice

Residency from Queens Medical Center in Hono-

lulu, Hawaii, and completed his surgical training in

oral and maxillofacial surgery at UCLA Hospital in

1982. A Professor in the Department of Oral and

Maxillofacial Surgery at UCLA, he is also Director of

Implant Dentistry at the Straumann Surgical Dental

Center and Nobel Biocare Surgical Fellow Program.

He is a Fellow of Pierre Fauchard Academy and the

Academy of Osseointegration, where he currently

serves as Vice President. He is an associate editorfor the International Journal of Oral and Maxillofacial

Implants and a member of the editorial board for the

International Journal of Oral and Maxillofacial

Surgery, Clinical Implant Dentistry & Related

Research and Oral Surgery, Oral Medicine, Oral

Pathology, Oral Radiology and Endodontology. Dr

Moy maintains his private practice, the West Coast

Oral & Maxillofacial Surgery Center, in Brentwood,

California.

11980 San Vincente Blvd #503Los Angeles CA 90049

USA

Tel: 001 310 820 6691

e-mail: [email protected]

viii

Editors

Peter K Moy

Patrick Palacci

Ingvar Ericsson


7/114

Patrick Palacci, DDS

Dr Palacci received his dental degree from the

University of Marseilles, France; he completed his

periodontal training at Boston University, MA, USA,

where he was appointed as a Visiting Professor. He

is currently in private practice at the Brnemark

Osseointegration Center, Marseilles, which has

mainly been involved in esthetic implant treatment,

developing several techniques related to precision

in osseointegration treatment as well as soft tissue

management, including the papilla regeneration

technique. He has written a number of scientific

articles as well as two textbooks, published byQuintessence, and a chapter related to esthetics

and soft tissue management in Professor Per-

Ingvar Brnemarks textbook From Calvarium to

Calcaneus, also published by Quintessence.

Brnemark Osseointegration Center

8-10 rue Fargs

13008 Marseilles

France

Tel: 00 33 (4) 91 57 03 03


Ingvar Ericsson, DDS, Odont PhD

Prof Ericsson obtained his DDS degree in 1966;

Specialist License in Periodontology in 1977, in Pros-

thetic Dentistry in 1990; and Odont doctorate

degree (PhD) in 1978 at the Faculty of Odontology,

Gteborg University, Sweden. He worked at the

Department of Periodontology in Gteborg from

1973 to 1994, and as Professor at the Prosthodontic

Department, Malm University, from 1994 to 2003.

In addition, he has been working as a private

practitioner in Gteborg since 1967 and as a

consultant at Nobel Biocare since 1993. Prof.

Ericsson has published around 100 original articles,25 review articles and several chapters in textbooks.

He has been an invited speaker at approximately

200 scientific meetings and presented courses

internationally. Prof. Ericsson has vast experience of

the Brnemark System both from a surgical and a

prosthetic point of view. He has been one of the

clinical developers of the Teeth-in-an-Hour concept,

together with the group under Dr Matts Andersson

at Nobel Biocare.

Djupedalsgatan 2S-413 07 Gothenburg

Sweden

Tel: 00 46 707 615044


ix


8/114

x

ContentsChapter 1 Loading principles ........................................................................................................................ 1

Ingvar Ericsson

Delayed, early and immediate loading protocol...................................................................... 2References .................................................................................................................................... 8

Chapter 2 NobelGuide concept ..................................................................................................................... 11Peter K Moy

Background .................................................................................................................................... 12Prerequisites for successful implants ....................................................................................... 15Advantages of the NobelGuide concept ................................................................................. 16Surgical template .......................................................................................................................... 17Additional considerations ............................................................................................................ 20Conclusion ..................................................................................................................................... 21

References ..................................................................................................................................... 21

Chapter 3 Surgical planning ......................................................................................................................... 23Marcus Dagnelid, Jean Veltcheff

Computer-based surgery at a glance ....................................................................................... 24Procera system ............................................................................................................................... 24Computer-based workflow .......................................................................................................... 24Conclusion ..................................................................................................................................... 36References ..................................................................................................................................... 36

Chapter 4 NobelGuide in use ......................................................................................................................... 37

Part I: NobelGuide surgery ..................................................................................................... 38Peter K Moy, Patrick Palacci

Surgical procedure ....................................................................................................................... 38Fully edentulous patients ............................................................................................................ 40Partially dentate patients ............................................................................................................. 44Postoperative patient instructions ............................................................................................ 45

Part II: NobelGuide, zygoma implants and immediate function ...................................... 46Chantal Malevez

Introduction to zygoma implants .............................................................................................. 46Surgical standard protocol ......................................................................................................... 47


9/114

Zygoma implants and NobelGuide .......................................................................................... 47Conclusion ..................................................................................................................................... 48

References ..................................................................................................................................... 49

Chapter 5 Esthetic considerations ............................................................................................................. 51Patrick Palacci

General principles ........................................................................................................................ 52Fully edentulous patients ............................................................................................................ 53Partially edentulous patients ...................................................................................................... 54Esthetic anterior maxilla classification ..................................................................................... 55Treatment planning ...................................................................................................................... 57Treatment options according to different classes ................................................................ 58Case presentations ...................................................................................................................... 62Further reading ............................................................................................................................. 76

Chapter 6 NobelGuide prostheses ............................................................................................................. 77Pelle Pettersson, Christer Dagnelid

General factors for quality assurance ...................................................................................... 78Preparations ................................................................................................................................... 78The radiographic guide .............................................................................................................. 78Postoperative care and follow-up ............................................................................................. 83Case presentations: a prosthetic approach ........................................................................... 83References ..................................................................................................................................... 89

Chapter 7 Avoiding complications when using NobelGuide ............................................................... 91

Peter K Moy, Patrick Palacci, Ingvar EricssonComplications during planning ................................................................................................. 93Complications during surgical procedure .............................................................................. 96Complications during prosthodontic procedure .................................................................. 101Conclusion ..................................................................................................................................... 102

Chapter 8 Conclusion .................................................................................................................................... 103Peter K Moy, Patrick Palacci, Ingvar Ericsson

Index ............................................................................................................................................................. 105

xi


10/114

Chapter1

I ngvar Ericsso

1


11/114

Chp 1 pcp

Delaved, earlv and immediate

protocol

Twstage surgery - delayed loading

n 1969. the origil potocol fo mpn isionws describe by Baemrk nd co-wokers

(Eerk e 969) Te pooco secfes

wo-sge sugicl ocedre, ie two-iece

is used d te imlt s submerged

rg 3 to 6mo eg perod (Fg 1

eree, be coeco s eore he

spr-costctio bicted d scew-reted

o e p illrs e pncile o osseo

egrto ws empszed: ' dec coge of

ipt by te oon o boy sse t e

boe imt inefce s observed he lig

mcroscopc eve

I 9 oowp resus of e tetet out

come of 235 edetos jws 28 mxills nd

07 bes wee presened Brerk et

9 e obsevio perod vred from 9

mohs o 8 yers Dt reveed t 85% o the

sucosrctons sed wee stble Sce

he g prectbity o mpt remet s

been demonsrted i log-ter foow- sudes

(55 yers o edetuous pes eg Ael e 990 Arvdsson e 996 998 nd or pry

ete ets (eg Leko e 999 ere

oe he l mehooogy s sceiic

odio for implt stbilty d edcbe

ongtem ccl success

Onestage sgey - delayed loadinge erk Syste fo nts ws oigy

esged to be wo-sge syse: dug te

til heig pse te mplns were subergedTs poc ws tken to mimie risk of

feco prevet pc mgron of mucos

epte og te tn surce d to m

me he rsk or ue ery og of te n

(erk e 969 9

However snce is deveopmen tere hs been

e-evo o e tdol wo-sge prooco

coeder e {976 97 93 sowed t

s ossibe to cheve rectble osseointegrtion

eve whe usig onestge techique e me

2

dtely foowg slio e imlt p s

eosed te orl cvy n eperent stdes

e pplico of onesge srgic pocedre

o oneece mlts Gotedse et 99

Abmsso e 996 o woece ns

Abhmsso e 996 rcsso e l 996 ssown good ress Tese observons e r

e cored i nuber of wel-coroe cini

c stes usng e Banek yste eg

ery Roseberg 994 en et 995

ecke et 99 icsson e l 99 Cot n

eruyn 998 iberg et 999 ogre e l

2003 occi et l 2003 gquis et l 2005

utemore rcsso et l 99 reored t e

ginl boe eve t tued plns lce

eroy he edetos mdible d su

pog fe sprconstructios s sble bet

ween 2 d 60 ots irespective o whee

pced ccordg to oe- or two-stge srgc

proocol

Becke e l 997 reoted o 35 Eerk

ured mts ced ccordng o e oesge

srgc oocol cobo wit elyed

oig e 36 ots of heng befoe odig;

g ) Imps were pce te xl s we

s i he mndibe demosg iy ete

condos e m surviv e ug the firstye o observto olowig lodig ws 9596%

A oewory fing ws t in is tcu

goup o ptes 32 sige oo elcemes

wee icde Becke e 99

or nd e Byn 99 reed 5

ptes or ptl = 35 o copee = 50

ndbulr eenulousess by mes o fed

surcostcos ete byrnerk tred

ms A otl o 330 is were ced

Of ese 330 mpts 2 were stled ccog o te oe-sge ooco (e 3 monhs o

helg beoe oig 9 ccordg to te

rdio wosge roocol A soewt ge

pecege of ires ws eoed or e tiy

suo h fo e comeely edenous stu

o rrespective o weter he mls wee

pced sng oe- o two-sge srgc p

poc he ove plnt svvl re durng e

u to ye observtio erod ws eoed to be

bo 95% e utors concuded one


12/114

Delaved. ev and immediate loadi procol

I

Surg

Hlig Prid Ladig=Fuci

ehanical S

ab

l

ty

-

Boil Stbilit

Fig 1- Schema iustrationf te twstage ad ne-te prtl it deyai.

OSSEOINTGRAO is conept of bii

tage urgca approach wth omay ubmerged

ype Brneak ipa ca be a predcabe a

he cmo wtage cedre n the

cetey ad aay edetuou andbe'.

Herma ad coworke 1977 treated 3

paent fo edentim i te adbe uig

mant aced i a onage ugca cedue

The ow-up peod wa 3 yea ad te

cumative aie rae eaced te ige te

oerave ecique wa 9% I er wd, a

imia teatme ce wa obtaied or te

o-age tecnique a o the tadioa b

eged oe Bernad et a (995) paced 0 im

pan accordng to a ne-age ugca ecnue ve ede andbe Foowng e ta

3h eaing peiod he pa eved a

eainer or ovedeue N iat aie eier

peri-ia o or ard ue cocatio wa

eoed

Siar cica daa have bee reoted wi

e o ian neece i dieet tuai

(uer e a 997): i edeo mandibe

(ee et a 2 ad i ede maxia

(Beg vit e a 04 tee cnca die teant iar wee no oaded va a xed ura

ctruco unt 3 6 mont heang ad

paed er wd te treaet cocep o

oeage mat ntaain i cbian wt

deayed adng wa aied g urte

e, data o cnica de g Atra Tec

mat wopiece) uort the above-metoned

obeva eg Coper e a 999

a e cica tdie cied abve the iga

dee oe wee adjed ad reied by

a t tiue conditoer week owng

imat itaao to miimize avorabe

cta adng o te pa owever it

ud be aciated a pa itaed

accrdig a oeage ugca rcedre

durig te ia eag perd to ome exet, w

be direcy ad upedctaby oaded dng c

o via the adued and eed dere the

e uc oadig mght be uavabe or he

impat a te deorman aer o comee

deture bae aea dug cna condtio

can be coex and pedctabe (Ga and

Saord 983 Deite Bemak rned

an taed according t a ntage urgicaprocedure demoated he ame ucceul rae

a ideca ipat aed accodng he

rigia woage pocedue eg Eic e a

99 997 Berad et a 995 Becke et a 997a

Hea e a 99 ort ad e By 998

n her wod a niia ad dect oadig

mpant iercg te ucoa via te adjted and

reied dentue obiy doe t jeoparde a

roer eegatn o te ixe co e

a 99 Such a aement i i ageeme whcca data epored by enry ad Roenberg

99 ), w cncded hat coed medi

ae adg adeuatey intaed no-uberged

an, by reinert a mdiied dee doe

o aear o eoardie te poce o oe

tegraon i e aeo madibe urermore

Becer et a 99) caed tat oe-te

Brema ant ay be cdered a iabe

ateatve wotep a ccodg

Gant e a (9a 9b } avoabe adng

3


13/114

Chapter 1 loading principes

conditos are achieved hough a rigid fixed spa

cosrucio ad, herefore t s reasoable to

belee ha a successu treatme outcome could

be reached aso we gid appaces are

coected o te red mpas eary foowng

stallao of the pats (i.e. ealy ctoal

loadig)The impoance of oa hygee has bee hgh

ghed especialy whe applyng the oestage sur

gcal potocol (Goedse e a 199 . Good oal

hygee codos w facate e foraton of a

pope soft isse seaa ie. te tsse porto

separag e oral cavy and te achorg boe.

e aos cocuded ta paque accumaio

o e pant plas resuted i: ( } eteded fl

tated coneie ssue ot oy a vecal t

aso a oizonta drecto; (2) log pocke ep-

4

Fig 1-2 a-c Mari bonelevel au mplats laceaodig o he o-ae al rooo wi ery loadn.() Coo i of a ) A 8 olow. c AI 60 llexaiao. d nd e) Mrlb l ou lslaed !oaded aord o oiil ol: ( io 18' olowu

exaiao ad ( a 5yaroow exaao

telm ad (3 acie boe resopo (e. pres

ece o osteocass of te magal boe cres

copared wth the codos a mplas witou

pesence o paque acculatos

Ostg surgy rly loig

About 20 years ago i was stated tha'.. preatureload o impats leads o te ormato of brous

tsse istead of he foaio of oe tsse (.e.

otogeess Aetsso e al 986. We

plats are paced accodng o he oestage

poocol e implats os liely wl e exposed to

a certa oad immedatey folowg placemet

iporta prereqsie for obtaig a pe

dcae heag process of mpats (osseote

gato} s hat icoio i.e the moeme a

te eace betwee he oe ad he ipa


14/114

g 1- Teae pproh by Sh d cworkrs( 1997). Fve to x mplan wr pac n tl1e nemadibl )\w th oami. a o of hs impas t th 1di was xpsd ab umnt cnnci

immdiatly fllowing iso Raiig s wsubmrgd ames w od 3 4 mosaer. I ao, s o e exit o d bove e ee-vesse bundle, oe short impla w paced billy usinga -stag urg1ca chiq Tus r iplan wr e i al aviy wih w med!ey ccelt ini ixd pa dt T mths !,t mat fid pa enue was bae d -tachd be implts

face i limied (Camero et a 973 Bk

1992, 1999. Plla 995. S0a t a ( 993

port hat t t volv proal w

accept cooo amo to 55 m

Ftoe Bk (99) eporte at c

oto of approxmael m a cote a

treod vae o tre mpla rface o

ootrat poprl

avoal oa codo ca acvd

o e coc o each ot va a d fxe

paal ee Gaz e al 984a 198 How

ever dva mpa plar ae accodto the oeae rcal pocedre ae mot ie

expod to precal loa mmdae after

aato Tro aoal o a

ta plat ave o e jo tothe va a

cocto a oo a pole olow pace

e Mcooto at e erace ewee oe

ad plat rac wl e lmte ad hopel

wi a accpta lvL h acltat h

al poc (ootrao

Rcet oo a prcae el o mplat teame have e epoe the lteate

we mpla ae expoe to eal fcoa loa

the ateo ade e Eco e a

Chow t al 2 e e a25 h rco

t al vaat ocom of oa

ehaltato of eetlo ma fxe

pacorcto coect o e re

ar pla aed accor o ete a

oeae rcal procedre a mmedate

oad, o ora wo-a a

Delaved. earv and immediate loading protocol

loadi protocol w the wok hpothei that

the o frec wee wo mtod

cocr tam otco A total of 88

te mpat 16 pae we plac acco

to e oeae poocol a oade va afxe

applacew da Impat pace accor

o he oial poocol wee loae ao

mo olow pat italao O dive of

th x appace al patt w raoraph

call xae; xamato wa pae at

8 a 6mo' ollow p Aa of te

adoaph reveaed that the e ovato peiod he mea lo o oe ppot

aotd o e a m ao the pat

pctv of whhr a oad o ot 1

Al pa at al oevao tval w o

to ccal ae he aor cocle that t

poie o ccel loa itam etal

plat earlfolow talao va a pemaet

coarch pra-corcto

cl a 25 pod a rto

pectv d he ppoe wa o valat ear l o oae a arl load

a lae op o pate Data ota were

copare wt oe o a fro he ame

cc app the oal potocol e twoa

ad dlad oad h ahor coc a

olow: h pee veao how a h

copar wh h clac wotae ch

qe oewat lowe cmave rvva ae

(CS afe ea o e oea ece

(CS 975% v 997% epcvl

5


15/114


16/114


17/114


gained pominence (Karlsson et a 1998, Cordoi et

a 200, Gofese e a 200 Gotfredsen an

arsso 201 ). To create such a srface the

cca can fo exape bast i appy itaim

pasma spa o perom a aoc oiao of the

suface Hal an Lasmaa 200). Epereta

sties have sown hat he oepa cotact

s ige fo a TUneM anoxize [aoica

oxde] srface compare wh a macie oeAbrektsso et a 200 He e a 20 Rocc et a

3 Zeche et a 3; a observatio whc s

n ageee wt huma soogca fdings

ece repoed Rocc e a 202 Ivaoff e a

23 Schpbach et a 205 Ths is poss e

o oseocodcive propees o he iten

suface. aito Rope et a 00)

emosrated sg a og moe hat a-oiie

UneM pas w antan he pimar

stait beter ta machine ones s observatos suppote cinica ata reported Gause et

a. 2001 eefoe t seems reasoae to state that

Te pats are we ste to exposre to

medate cioa oad oher wods a

paraigm shft as occre regaing te oadg

cocep o deta impats. oda, it s ot o

posse to oa te impats he da of istaao

va a i povisiona spaconstcto bt aso o

arcate te na oe eore pacg he pas

Nobede cocep B usig spa coptere

8

ig 16 Virtua panning ocer: thr-dimnsioa (ft ddd ad w-dimioarigh)

toogap coveed scag ata ad a

avanced via panng proga t s possbe to

... pace te mpats n teir es positon te

jawoe' beoe the rea sger is peormed Fg 1

6 is book w ea wih ts topc o via

panig or mpat srge

References

Ab I Bgnd T, Wnstor J id The

ri had d sf issus at ifft mplant

ssms A aiv udy Jog. Ci Oa

pa R 1996;7:2-219.

Ad R Eiksson B Lk U na - J T. A on

r fw-up udy d ipa i

ay du jw l J a xiac

Ipa 1990534359.

Ark T Za G, Wrhi P rsson RA. e l

ter icay uy ued da ip a evwd oos criia o scss. nt J Ol Mia

Ipa 9825

Abtsson T. Ja C d AK, Sui Y Gottow Jximn sdi on oidz A islom

ra! d iaia ly l Oi

g R 21 2-2

Arvid yd H Fryl A Fivy flwp

h Ara Da Ip y tai

dnu p w J D 199G759(A.

Avd Byd H Fro A nw L Lu E iv

ya iv wp p th A T a

Impt Sys i h a duu ad.C Ora la Rs 99894


18/114

Blsi J Woger GJ Imedte lodg of Bemrkpas in edentous adibles a prelimy repotIpnt De 99768-88.

Becke , Becke BE srlson H cci JP Hndelsa Aons W One-step surca placeent of Beark 'mlts: a rospecve clincl ticenter sudy. ntJ Oal Maxillofac Ipants 199; 2562

Bekvist G Slho S Nile Lind C. Iplnt-sporedfix sthss i dtuos mailla. A yar nal addologial olow of tretn wit nosberged ITimas Cli Oral Ipas es 00


19/114


manswih difeent srfae caractersts: a expeiental sudy in rabits i Imant Det Reat Res 2000;27077

Goredsen K Kalssn U A prospetive 5-yea sdy f ixedatia rosess spored y implants wit cneand O basted srace. J rostodtis 20002-7

Ha ausaa Proeresf a new rous ide srace oitanium plans. Apl Osseogatin Res 2000 1 5-8.

Hatan N. Te Mas New. A ov -day teie f fxedvidalied ilantsupoed psthesis i eedentulus madible usg Bremark Sys impantsApl Osseoegraion Res 001 03

Hee S Karsson U Ale Brune S Astrad Nn-sumerged mplat in the treate of the edenosower jaw a 5-yea rspetve ongtdina dy of ITIow crews mpat Dent Relat Res 200 3:20-2.

Henry Reberg Sgesge sugey for rehabiltati ohe edeous adile. Pelimiary results. Paceriodt Aeset e 19946-8

Hery P, Tn A Aen B Hl Johanssn C eov oquecoariso f iUit ad td p1as in

greyund dog andible Apl Ossintgraon Rs000 1.

ermas M du r. ea Maeve C A singe-sepoea ive ech que sg e Bea system Arospectiv study in te edes mandile. Orampas Res 78437(Asact

Ivanff C da G Jhansso C Wenne)eg Astolgic evaatin f oe resse t oxidized ad

rned nu ic-impas in ma jwne t Oral Mfc Ilants 20031834-34.

Kasson eds Olsson C A 2-yar repo axillry and adiba fed patial enues prtedy Ara Tech dena implants. A comparison f 2 impats

Clin Oral mpants Res 99:342Kasemo B ausmaa J Aspts f sae pysic o iani

mplans Swed De J 188{Sppl)9-6Kasem B ausaa J Biomaeria ad implat surfae

sciece: a srface sene apach Ora MaxllfacIpls 884247-25

Kireterp Anesen Ude . Repacee of exaedne teeh y edately laded el ace Seec HAcoaed las An neyear flw-p o 35 pates ApOssetegat Res 200234043.

ass C T irface betwen ad ilants wiert suce ide ptis. Appl OsseintgraiRs 0001914

Lekl U Gne J eny P gi K Linden U Begstr Svival f e Bear impan in patiay edenuos jaws: a 0-year prospectve mlticee stdy. t Jral Maxlfa Ilats 191463-65.

Mal ibeg B olzz G Gualii Vgagen T, Rage Bedate ey fncon f Break pns pcein te esthetc ze: a -yeapspecie cical ltcetesudy. Clin at et elat es 20035Spl 1 )3746.

Pilliar R\ Qne valuai o the eect oveet aa pros cated lant-boe erfae. avis EJ ed.The ebomaterial ierae ooto Uivesity oTrnto ress 9303

0

Rci A Marigoi M Senerby L Gottlw J eiatelading Brnek Syste imlat with te nitesrfae stlogial evuo fe 9 mont1s . Aplssenei es 20023:25-28

cc A gn M gos M ttlw J Seerby Histogy retrieved medey ad ey ladedidized ats: lgt mcscopc bservatios ater 5 o

9 ts of oadig n 1e posterio adile. Cin Implatet Retat Res 2003a(Spp t :8898

Rci A Margi M Gw J Imedate oadig oBremak system wi TiUie ad achined sfaces inthe sterir madible: a radozed oennded al Ilat Dent Rela Res 2003b5(Spp 1)57-3

Rmpe , aSilva D Lungen AK Gttlw J Seerby Saility easeens of a dobe-readed ttamilant design w une oidzed su face. Anepeietal esonnce fequency nyss sdy edog madile Apl Osseegation R es 200 01 8-20

Scn P Whrle PS, Resen JE a Sva WangNH Ten ye rsults or anemk impants idiately

loadd with e prseses at plat laeent. JOa axillofac Implants 199; 14903.

Sched A ler 0 Ster Gewebseaktion auf ein Titylinderlmplantat it TitaSpi-sctobeche.Sweiz Monatschr Zaheilkd 76673727

Scder A Sch H Sraua Stter be deAngeng Oseoceet a ee eseen mpatatkbe Scwez oaschZne 1788051-058.

Scde A Mgli B Sue F as I-lzyinderipantaty F z Po1eseneen bei zanlsen Kieer.Sweiz Monsc ahilk 198393720733

Schpa P ase R R artgani Seerby undgen AK e an idzed tianium ilant

ierface a ligt crspi sang eectrnirospc lakscaer scaing eecro scopic,and energy-dispersive X-ray sdy of clicay etrieveddentallants lin Implant Den Relat Res 2005;7(Spl1 ):6-43

Sale K Hase ES ockse-susse H. Bger .e efets f stepross ne defciecy, ne gaftingand mcoon fixati pousce ydrxye-coed implas : esi RG aley lT (eds}.Hydrxypate oatigs in rodic sery. New Yrk:Raven ress, 1993 0'3.

va Senbere My Jacbs R Vandeerckhve Buirynen M N I Te imdiate eaban y

eas f a readyade fal ixed psess n the edentuous madl a -yea fow-p sdy of 50 cosecuve patets n ral Implants Res 20041536365.

Weeerg A. n srace rugess and implat ncpraion [ tess. Depatmet BioaterialsHadica esearc tebog Uversity Sweden. 6.

Zece W ang! S Fst G eper G ams vala .Osseus eag charastics three dffee ilanttys. A togcal d sopec sdy in minipgs. C Oal plats Rs 2003140


20/114


21/114


22/114

23 Cnial ptgrah of e failin ef central icisor( 9).

tradtonal teamet prooco Patens who ave

fxed esoatos eqg a emovabe osess

owg o oss o key abutment eet ae deadg

masoed esoatons ta wl e the

to avod sng a emovable dete Ts s esec

aly e o ates wth a sgle mssg oot

the estec zoe hat has a alng boded bdge

(Fg 23 ese paents wl not wa to wat p o

6 oths to ave a ed cow paced to e

edeos sace

o meet e deads o aste eatet tmes,

clcas ave aempted o eose ats

eae ad soe saces pace medatepovsonal esoatos o an mpa hat was js

placed sg emoay comoets g 24 s

aoac has bee sccessl Scnma et a

1990 Bals e a 1997 ece et al 0 b s

vey tme consmg ad demadng o e

estoave secals It also paces te mlat a

s o osg s al sablty og tgheng

and ooseng of messo cogs ad os

thetc coonents o to he lant {g 5 e

NobeGde syse was seccaly deveopedto mee tese demands laced o te clcan

gves the actoner bete coo o the esto

ave coecto to he mpa mmedaely ate

pacee ad t es he aa mal

ao eed to delve the osess by avng

the estoaon abcated o to at lace

en Usg ths system clcans ca edee

e e deal ocato ad oso o mpas)

based on the demands o te detve estoao

fo al clically edelos staons Fg 2-6).

Backrun

a

2-4 () Cusom-fabicaed, emray aumen ahas ee cnneed mmedael afe ia laee.b Pvisina resans sre byear a-e.

Kowng wee e mlas w be ocaedafe paceme wh a high degee o accuacy te

aboatoy eccan ca abcae the defive

esoao g 7) o o mlan sgey ad

ave avalable o delvey medatey ae he

mpas ae laced Ths the maoy o e pos

todoc/laboaoy wo s comleed pooe

F 2- Rc thn tempray cth gngvl mrgn f butt.

13


23/114


24/114

Pqt for succeful implan

Fg 2-8 (a) Mxillry surgicl tempe fed in osio wih hoizontal acor ins. (b dulr srgic eple wi l

iplns pe o pedeere loons.

Prerequisites for

From ealy studies on immedae oadg (Hey e

a 20, Gause et a 201 Osso e a 2003

Roci e a 20) iporat preequsites wee

idenied fo mpans o be scessf we

paced o imediate fuo Ivanof e a 0 .

Aheving tia man saby minmzg

ana mapaon o he pant a was jus

paed and onroing imedae oadg foces

diected o e mpa ae sevea o te eiees dentied Esabshng ia stabiy oe of

the ost mpoan eeusites is aheved

thogh ioeaa ieokig of he ima

to e surodng boe g 2-9: hs s necessay o

preven ooion a e ntefae drng eay

oe heaig oer aco beieved o nuece

oe eaig ad a staty ove e s e

ipan suace caateriis ad texe g a.

To otze e iia bioog esose eseciay

i staios wih ow oe desty s as he posteo axia a modfed a srface iUeM

Nobe Biocae as bee shown to enae

pimay ia saiy g 21 oug ts

ogheed sface ad o acieve seconday

saiy earier han mached sfaes thogh a

hegheed eay oe eag espose o he

sface Wenerberg 996 Lasson 200

Spah e a 205

noe enei of medate fnon s

aon o aua oces paed o e ian

dg e itia eaing peiod te fs 2 o 4

wees s eod o me s ccia o eay cot

omatio ad the ogessve aaon o the

cot ito oseod tisse s a peiod s ofen

vioated i other immedate oading oeps

were e restoration is abrated ae e impan

aeet T ese techiques eue e pace

et ad eova of autes and messon

coings ofen o the second o thd day afe

man acee srgey s pota e of

Fg 2-9 Cose o bewee ere ree oe

i r of l1 iml.

15


25/114

Chapter 2 NobeiGude concept

Fig 2-10 a The rougened iUte sface f a NobelBiocare implan.

g 210 (b) A traducer ro e Oell uni aa1e tothe mplan easure inial stabity.

ISQ 7

g 210 c An implat stabty qt radng fm thOss ni, dii xclln saby

16

24 to 72 hous te implan pceen fo he

rsfoao o bood clot o oseod isse

reqires tt e clot s le nistre d tt

mi oq o oioa srain be pc o

impl o voi movmt (Camo 193,

Brski 992) Ths ms t ny du nig of plns or copones ieaey afe

placemet sold e elimed nl te boe

eig pocess as mred sficiety to a

stiy o t implt

Antages of theconcePt

h NoGie cocpt povies t cic

with th aiiy to corol t loadig forcs ppd

o e plat d elminae te gly aagig

lateral oces trog feqet ispecto o he

occso n coc beig me o th sto

to Hvg t resorto plc idtey

atr iplat pacn prmis th cnca to

cck accrly fo y cotacs durig latrl

excsiv ovees nd o iiize verical co

c we e ptet coses nto centic occlsio.

h se o peiced srgcl tept fogidd srgy d a flapess srgic tchniq

gaty cs e im ird fo plat sr

gy d sof an hr iss r sbjcd to

mnil rma wile periig precse mpt

plcement d acieving igh degee o ptet

satscon by provig te ptiet with imete

cio sg ie posesis Fig - )

T obGd syst difs ro or

ciqus a sgc ppocs y coservg

o e cc's ad prosthodoiss ime admnmizg he cair ime reqie o coplete e

posthec rm te ipnt plcet. Oe

imeite loig chis qui resor

tv spcis to spe sigiic pio o tm

f t mps ar pcd to povi t pt

wit te fe esorton. is may e dig o

e restorive speclist s well as te pten

specily wi e tme eqirmens iedtey

oowig sugic procde o liver e esto

atv prosss oGd avods d fo


26/114

ig 2-1 (a) Facial viw of dnitive prosthesis ade riort mplant sugry. (b) Ligual viw of dhntiv prsessog pg i rr oitio T fii-tiv t t t l

estoraive mnipulto by hvig the estoraion

fbrted pior to he ul plceet of impns.The li y hs delive e postesis mme

dately afe the impls are paced ther tha

hvg e paient rern o e restotive c

a's oe imedatey aer sgery to ave e

poshess aed

template

The NoeGude cocept was also deveoped o

assis te clnin i png mplns witot ele

vig a sgil flap e i focs s plaed o

te faico of a very cate surgical tepe

acounig fo e natomi varaios nd locaio

o critil aatomy, wih wil dre the inicia to

pae plans he exc prplned octos

sng a mimaly invasve sgil enique here

are wo metods to create a prese surgcl

tempe: a mode-ased nd a compue sotwre

Surgical tempate

plnig approa Te wo pproaes ave

nique nd deen eqreens he ed rests te sae eio of surgica empate ha wil

gde te cnica o pce ipns no he desred

positions Folowng s rie descpion of te wo

mehods of pnnig. or moe deied ifoio

o compuerbsed plnnig see Cpte 3.

Mode-based panig

A acrate impession s reired to abricae asudy ode whi will peri plcement o

impn anlogs into the edentlous spces he

tickess o te gngval tsse over he edenuos

se is mesued in the paens out sg a

mppig gude nd tanseed o e mase st

(g 212) Seven ponts o measureens ae pe

fomed three on e cal rea three o the

lingpalat ad one o e mdes o the

veolar dge Fig 13}. Measuements are tns

ferred to e secioned model wee seve

1


27/114

Chapter 2 NobelGuide concept

18

Fig 2-13 (a) Use of a sharp probe placed through the map-

ping guide to determine the thickness of gingival tissue in

one of the three sites on the buccal area. (b) Three mapping

sites on the palate for two implants.

Fig 2-14 (ac) Seven measurement points per implant site

are transferred and marked on master model.

Fig 2-12 A mapping guide fabricated on the master model

showing seven sites of measurement: three on buccal area,

three on palatal and one mid-crestal site.

c)

b)

a)

a)

b)

Computer-based planning

Computer-based planning requires an accurate

radiographic guide, duplicating the dimensions of

the definitive prosthesis as closely as possible. This

diagnostic approach employs a dual computer-

ized-tomography (CT) technique where the

points are connected and the exact thickness of

the gingival tissue is removed from the stone model

(Fig 2-14). Once the stone is reduced, the indexed

segment is replaced back on the base and a

gingival tissue mask is poured onto the trimmed

model to duplicate the exact condition of the

patients edentulous ridge (Fig 2-15).


28/114

scanned images are taken at half-a-millimetre cuts

to create a highly accurate, computerized model of

the patients oral anatomy. The first scan is taken

with the patient wearing the radiographic guide

with an occlusal index to place the guide in the

ideal vertical dimension of occlusion during

scanning (Fig 2-16). It is important to establish and

maintain the proper vertical dimension of occlusion

because the surgical template, which is essentially

a duplication of the radiographic guide, generated

from the software planning will be seated intra-

operatively to this vertical dimension. A proprietarysoftware program, Procera, converts the CT data

by superimposing the two scans, aligning the radi-

opaque markers so that the prosthesis will be

visible over the available osseous anatomy (Fig 2-

17). This permits the clinician to plan the appro-

priate implant position and angulation in the avail-

able bone (Fig 2-18).

The planned position of implants is captured in

a very precise surgical template (Fig 2-19), which

is produced from a computer-aided design/com-

Surgical template

19

Fig 2-15 Model is trimmed to remove the thickness of

stone that mimics the thickness of gingival tissue.

Fig 2-16 Patient is scanned with the radiographic guide

and occlusal index in place.

Fig 2-17 (ac) Procera software planning aligns the

radiopaque markers in the radiographic guide and the

scan showing the patients bone structure.

a)

b)

c)


29/114


30/114

Conclusion

Advanages of the NobelGude sysem o-

pared wih othe imedate-loadig oepts are: educed sgca te becase of te minimally

invasive, flapess sgey ore accae pacee of ipants o desed

oatons usg a guded surgial templae redued healig te, possurgcal swellng .

and dsoot im ized rsk ad complicao ecase f

gded sugey ad accuate identcain o

vta srures o CT reduced prosetc ar e and esoatve

apuaton aer pant paeet owg o

arao o e poshess pror o he surgical

pocedre imediate estecs, as he deeed pshesis

is idenical to the sade cl ad contos of

e pevos appoved resorave seup a ota ad uque sste that provdes a

omplete oa onsuve souton or a

cliical statis.

ReferencesBash TJ, Wofnger GJ Imeate oa of Breark

pats in eeuls abes: a prenry rep.

Ipan De 19976:83-8 8 Becke W Beker BE Huffsee S ay funioa oa

a 5 ays o remak ipas pae o

edeuous adies a pospeve, opeeded, o

udina sdy J Peioool 200;7495-

nak -1 asso 80 Al R e a Osseoinra

ipas in e ea of e deulos jw Expri

e o a 10yar piod Scad J Pls Rcsr SugSpp 19:2

Brs J. Becaca acs aecng e bedeap nerfce C Maer 992-201

ameo H ar V Macnab I Te eec of ovement o

e bg prs ea o oe J Bome Mae es

197330-11

Referenc

Gase R oma M RtJhsaer Lre AK

Hamere CF Goow J ab easueens oimeaey oade aied ad odize mps

e posero maa A ompaaive inia sdy usin

esonae fequeny anayss App Osseoineaio es

200 ;227-29

aser R Ludg A oow nnrby , oan

usa P nrne ousal oadin o 3nekTUn mplas cd pedonany n sof bo: 1ya

ress o prsecve cca sy Cn pa1 D


31/114

Chapr3

Surgical planningMarcus Dagnelid, Jea Vetchef

2


32/114

Chapter 3 Surgical planig

I he area of implanoogy geat advaces have

bee ofeed by compterzed toography (CT}

Reectg a ucopeosea ap ad dlng adpacig a pat wee ee s boe o adequate

volue ad alty s stll he coo surgca

pocedure e poshetc par o te teaten

w cosideratos or te foces eg o te bte

and p sppo w be based o tat surgca

est

W he NobeGde cocep Verseke e a

1996, Van Seebege e a 2002, 2004, 2005},

he clca ca ceae he opa poshetc

est: wi C the cican can pace te mpas

wtthe g eg and aglaos accoding to

the perfec functona ad eshetc outcome C

also gves the clcan gy accae ad detaed

foraton regadng anaocal adarks sch

as he sns foo asal oor ad olne o eves

ad vesses Wl 00).

moder mpatoogy s portat to ana

yze ad pa every eaten accordng to each

pates codto Alhoug te obel Gude

concept ofers a ne opporty for medae

oadg shod aso be see as a sopstcaeddagosc ad plang ool Wong n a te

dmesoal 3D envrome enables te cinca

o pace mpants an opma poso eve

bone wt poor qaty ad quany ad he

cnca ca sseqety wo wt ealy o

deayed loadg

Procera svem

Pocea software s he ool sed whe wokg

wih Nobe Gude. Tis sofwae is o ony a

telgen syse or copte-based sgey t

aso ncdes feaues reatg to he aoatoy

work sch as designg rocera copgs ad

abutes and a rocera mpan Brdge

e software has bee desged to ae ts

se as smpe and sagowad as posse y

creaig a une toolbar based on seve cons

24

ClncP

[!& L1 2 3 4 5 7

Fig - Procer softwae tb, hi guides the liin

trouhh sv stps ofth NbGui o.

te copeased sgey s smpfed Fg 1 }

Te clnca can easily access e sowae at ay

te ad ca beef rom sgical plang a

Cbased 3 evroment

hs chape expoes pates' aatoy

reveaed ew dmensos t aso deonsates

ta the se o rocera software o dfct cases

asssts te clca i ndig e bes implan

pacee ecause o te wde ange of possibl

tes rocera sotware t ca be sed as a

pang too aoe wto ceatg a sgcal

gude f a adoa pooco s prefeed

Capes 2 ad 6 descre te wokfow w

te obel Gude concept. eore comecig

copebased surgca plag tese fuda

entas ad perequises us be fly understood

n orde o succeed ad ave a successl

treate outcome e preplanning phase s as

poant as any dea eamet ad t s theoly way to identy te possble cadidae for the

obeGude cocept

o the pupose of expag and nepetg

te woe obel Gde treaent concept ts

chapter pesents case eports ese wll deo

state e geea worklow and aso e dfeen

toos ad fctos te software

wolow

rocera software se egs by denyg te

posse cadidate o obe Guide Depedg o

wethe he paent s sngle partal o fly ede

tos te detist hen pepaes te rado

gaphc gude see Cape 2} om ts po he

clcia w access te rocera sofware ad

beg he treate accordg to te Noe Gde

cocept


33/114

Te worklow is based on seven steps epe

sented by icos o the sowae:

1. egise and edi aie iomaio

2. sa Pocea sowae C ile covete apli

catio

3 oen ocea sowae plaing ogam -sugica plang

4 impot anig nto oea opueaded

desig (CAD) design

5 ceae sgcal eplae

6 vefy sgica emae

7 veiy odcs dils, ses etc) and pt

opeao speiaton docuens; ode sugca

telate ad sgicalaboaoy odcts

I he clician's a is to use e sowae as a

anig oo te ast o steps ae ecded

Te adiogapc guide can still be au

acued to assst e cliica in lacing te imlat

sateg osios and i a avoable agaon

ahough it s o eeded

is aspec wil be coveed n oe o te case

epos wee he boe quany ad ualy was

nitiy deeied o be iscie ad tis

siede teae ito a aditioa potoco

1. Register and edit patient infoaon

Oce te adogahic guide s pepaed te

atie s egsteed witn te sotwae Tis w!

auomacally eate an e eae denti

ication ) nube based on a eix onneced o

ha se and a nmbe o eac patien

l ipoat omao sc as dae o bt

ad esosible cliician o poshodotis wll

oly be seen by a use e D olows the patethogo te whoe eaent ad apeas o

e sgia emplae a a lae sage Nobel Boae

can easily tace om wc cliica a cope

anig has bee se

Most contes ave esictions egadig

atie daa communicaed ove te iene e

eaet enses ta data ase adhees to

sch gdeies

e umbe ceaed s ten sed i e

ied aet eeal o te adioogis s e

Computer-bad w

coept spees e atie w big to e adi

oogis te eaed adogahic gide ad an

occlsa nde beoe udegoig C wh a

dobesca ecne Cae 2) s pocess

s descbed beow

Double-scan technique

e Nobe Guide oncept ses a doblesan

eche. Tis meas a wo seaae scans ae

made e adoogca examao ( 1 e s

sca s ade o e paet wih he adogahc

gide and occusa de pope poso e

gide eeses bo he mssig teet ad so

sse wile the ide eses he igt bte and

oe osiion duing he sca ) he seond

scan is made o e gde aoe ataced o a pape

bo o a secied oam maea

The densty o e patens sot tissue esembes

e adogapic gude theeoe it is poat to

ave a eac age o e gide oside he

aiens moh

s esseal ta he adioogis as a basc

undestandng o the concept beoe ndeaig

e scanig pocede C canot be poey

peomed wito a coect adogahic gide

ad idex t is also stated a he adoga

gide ms coa a se ube o inseedgutaecha makes woking as eeece pos

he sowae ses te wo mages accodg o

ese oits, ts givig te te poso o he

guide i the mou

The omatio geneated by CT s omosed

o wodimesioa axal sces ese ae bogh

o he cnica n CM oma saved o a C

disk o eom he coptebased sgey i a

vita eviomen the slces mst be conveed

to 30 models

2 Procera soare CT le conveeapplicaon

Conveso o te data deived o CT is he

seond sep i e oea sotwae A intve

mbe o aplaos wll bg e clca om

aial sices o shed 3 odels beoe saig

e acal sgcal anig Fig 3

25


34/114


35/114


36/114


Fig 38 Proea sftwae enbles he ciican to plae m-pts i ee aguio d pos1o oig !O eriogp guide Ts esres good posioig or-

e sposron referr n e prs.

In a uy eeuos pae it is impoan to pace

he access os o te guide abumets in a coec

positon. Te ccan ca choose beween a screw

eaied o cee spraosco (Fg 3-8As entione earler, s impoant o se

Pocer soware as an avaced paning tool n

a aspects of impla teatme ig 3-9). e se

of hs type of surgica gide generates a safe and

ore exac drllng w no wobblg and opmal

se o e paien's boe. s possibe o place e

mpans a e wok w common impresson

ecqes a impla or abtme leve

he aim s o pace the pats as parllel as

possibe splifyig nstallao o a xe paalenture. fter he nsaato of a plan he

poson accoding o impora srcres is easly

vee by rotaig e 30 oel a scrolling

torog diee sices. uteore exposre o

impant theads o either he bucca or e paaal

aspect can be vsaize in the same mane.

I e axla the extenso o he maxillary

sns asal caviy a incisor caa creae bore

lies acilatig placeent plang o impas

Panig i e mandible is even more ened

28

wen t coes o avodng neeence wi ealy

impora srctures. Several oos witi e sot

ware can be se o ghligh or revea ese

sctures Mag he ouie o e nero ave

oa canal a s mesia oop s a proity o cn

icas: ts sowae oe o ess eiates teisks o damaging e neve vessel bue g -9).

Whe pannng o eigboing eet a parti

ay edenos pae he sotware enabes te

useo mak e oline o the roos a crows by

aing pos As escibe in te sectio on C

fe coversion step ). amagam ilngs a crowns create disturbaces in e axial sices. o

geeate a sabe 3D oel o e paient ese

wl be c away and is some cases wl ean

excg inorato abo the crowns o e ee

e ser can stil access e oiginal sices a use

tese fo fnig the correct ote g -.

ered bone uality/esy ca be measued

accoding o Honsiel is; howeve i shod be

oe a he onsied ui s no a dee vae.

e clncan so aso consie a the values

given by peomig t1e geea eamnaio o each

paet riogapc evaaion palpato grae of

bone esopto ad geera heal facors Ding

sugey te inserio oe s peraps e most

impoan vale or boe ay W he advanageso cen iplan sraces an iUie pacular,

ig pimay stabiy ca also be acieve even in

paets wt vey soft bone

a of te NobeGde concept is te stabil

izatio o te sgca gie by means o hozontal

anco pns ependng o e eve o eenls

up o ee pns so be pace hs is ade in

the same sipiied ae as fo placing iplats

but i can oly be perored wt a pope een

son of te aiogapic gide n te vesblmlacement o acor pns wit peetaon to te

liga aspec n he manible o palaay i e

maxilla is absoluely cotaicate Rpte o

arteries n tese egions ca i a wost case

sceao create ireversbe bleedig ad be e

teateg for e patien.

soe cases, te aount of boe can be a

liatio o conainicao. vace esopon

w minal aon a aliy o boe can guie

te clicia nto a raiona pocedure wh


37/114

Compur-basd w

Fig 39 (a-h) Diferet stware tools used t ilit mpt tc lnrks. I ts se te e lveo s sz bh by hgg !sc h s y kg he cg diferent ss T

gt th sgl eml g l sop. s or lss ts t sk g$g th ssl -

29


38/114

Chapter 3 Surcal plan

refleon of a fap The Poea sotwae a e

use as a diagnost oo eveag he aeas wee

one an be fou

Cse 1: emle 3 yers o e

he atie ame to te ii afe any yeas of

asee fo eta teate Se had peviosyoy ee eae y eas o naoss an

aghig gas, an n eenty was eevig

edatio to eat depesso. Te paie was

wig to begin eament an eplace eeth os

hog aies ad ifections Raogaphs

s1owed poes ay i the seon ad hi

quadrant (Fig -11a-): oo 6 was severey deaye ad ad apia

esio: e patet aso had an extra- ad na

oa edea fom te netio

30

Fig -0 (ac) A pay detae tien whee facs by orli-uomt rn v bn xlu h ei Ie timol mo! o e

e Th l ll e e gil i ih diee .

ooth 26 1ad apica esios ad was aso

iosse to save owing to exensive carie hee wee soe aed figs ad seo

dary aes esos

peiodoa isease was in vais stags

athogh oe han exete o a patient at

ha ageEaios of tee wee ae a a emovae

aia ee was deivee (Fig -1 ).Peoonta isease was reaed at e dea

ygienist, a hn igs were peormed Impat

spote estoaios wee ae he seond

ad h qaa

he patie's sbjetive ees was o epae

e teeh os e e axia for esthe easons

an eonomi fatos, which made t possibe o

g treamen aso i te mande. Becase o


39/114

Fig 3-1 (ac) Proprtv ntrorl dohs nt

n suo wh s es lsons of e 26 d 36,s ll s tr flls oJontl os.

h vious anxty ad xm a of dnal

ams, a was o nmz he srgical

auma ad also m sp n cha;

theefoe, a NbGuidera was laed.

A adiogaphc gude was anufaued ad

h lowg do CT was pfmd Usig 3D

csucon Pocra soa,

was apaha good voum and quay w s

s Fig 10W annng for aaly dnous pans

s oe pan o redue the rgnal for

atio in h aal scs xcld dsuancs

sch as PM cwns ad aagam gs I hs

acua cas pr was cad y h

PM xd ara dn n h rs quadanDspt ducg aco desbed the CT-

overson sep e shae of h cwns ad he

Compurbasd w

i 1 Oroom k fr 6 o o

hl

xnson oos can vsazd singos

in h Pca swar.

Th mpla sod avd rfrc with any

s Aso ipora s e sace ndd or h

suga gide or, mo pcsy h sv (ig 311eg

n h go of oo5,

h va sgcal

nvmn ad poss a long mpla ha

orgaly thog Fg h)By turnng e 3D d ad analyznghe pe-

pendcla e-sice he nca coud see tat

n was prs laal o h rd o h

maxiay ss Ths gav coc o a apd

mpa: NoRpac aprd RP 1 mm. hclncan ca aso vy a ccal anchoag o

the imat n posi 26 by ookg no aua

sinus regon (Fig 3 i -k).


40/114


Fig - e-g I P w l l viSJliz oos wl w f ni9borng Tisu f ug 1 ug i fuid l i uic

32

g (h) By i Pce f-wae ad e ute f e adiapi

gd plnig d a lg i igil ug i poin25. Inti Nl

RT

pedRP 13

mm ilnNtice a he eaulio adpiti d dgpigd

g - i I digp postaiv .igi i f lt l i P fw Hg un w cd d mlan l eg peid o 3 mt.

g and k) Intraoral adiograpafer 3 ths' ealiwig u d w y-i. dvdu Pzironi bmns w d w P iconia w


41/114


42/114


43/114

chance of fidg optmal postons o plans, and

o usng e ee eig ad wdt o the boe

avaiabe (Fig 3-12i).

Prosthetic consideraios

Accodg to e Nobe Gd oep e prerequsie or sccessful teaen is proper prereat

et of each paie Exactos ifecions s as

apa lesos and periodota dets sod be

poply had bor sding th patit o C

Haig ms b vrifid by oopatomogra or

peeaby by itaoa adogaps

Gag pocedures o educo o fabby

idges mst be pefored i advane I a ado

gapi gude is fabaed before bo e

odlig and so issu alig as ourd

ss o is rasrd to sgia gud

Ts wl aso ceae a false vale o so tiss thik

ness n Proera softwae geneatig prope

pa paement ad poste ocoe e

lnia ms peo a impesson or a ard re

ig by th dnta thiia

Sgica pang w gards to t supa

consucto is te optma hoce In sew-ead

cosrons a acess oe ca easily be paed

for exampe te oclsa aspect f a very ag

ated positio of a mpla mst be used tecliia a prdt h d of an aguad

abn ad rby so th tan pas

ad smpiy th clia's commnaton.

e oigina oncept o eeh-i-a-our o

wh e obel Gde oept ognates is fo

a proshei poi of vew te opima aet

Cotrollig t plamt of ass hoes and

os importay didig t shi ad

onal oucome advance provide eoros

gas eshes me cofot ad qaly of iefor paties. e spng ad stabzao o te

mpats in a igd supacosto ae me

da oading possb.

t sod b od ta ob Guid is a op

sys: op in e aspect o plaing ly edetu

ous patal o sgle ases Te supracostco

can be provsoal o fial sew retaned o

eened The possby reas o plae ealg

abtts aeth aplss sugy ad wo wt

mprssios o mpan o abtmt v

Computer-bad w

Intactiv commuicatio

n a ids of teatme pope fomaton is te

ey to a scessl teamen ouome so n

ass wh a pait is pssng hsao

detaild noatio abou a spcf pod

a overome insecurty ad aiey e patieoera sofwae i self a be used as a tool o

clde the patiet in the panng phase Te

lia an easy show e pai the flow of e

opt with ompbasd pag Sapsots

a b tan as wl as movi lps planing

phase sg as mateial or omniatio

I mode detisty the am is also to develop

ad widen he omuao bewee e

a ad detal tea. Difent versons o

roa softwar a b usd saig paning

fls and rang a ou fo boh srgal and

postec discussons e esetic ad functonal

oome s a dect rest of ths cose colaboation.

he commnation beween te prosthodonis

ad ia s also a impoa facto fo a

sssl tatt oto ga bot pas

a acss t plag va smia vrsions of t

Pocea software dscussig possible plan

positions ad aglatons ad e infuece ese

wil ave on te poste teamen

41mpon plaig to P

ompled srgc plang s savd a designated

folde o eah pate hs plag wll be mpoed

o e ompeadd dsign sysem and wll

pvid a iniial olin o surgia tmpat

5.ceate surgl templa

his step w geerae te ished sugial em

pla I hr s a ro whi h sga pa

g g osio btw iplas pats and

aco pis o nterence wit te supra-o

srcon he an can return o sgica pla

g (step 3 i te sowae n te surgica pla

g sep te reqed age ca be ade; stps

4 ad 5 will ga th prop otln o t w

sgal pat

35


44/114


45/114

n II NobeiGude, zgoma m

Chapter4

Part 1: NobeiGude suge

Peter K Moy, Patick Palacci

ad mmedateChanal Malevez

3


46/114

Chapr 4 Pn 1: NobeiGude sue

Pan I: surgery

Sie the ioduio of Tee-n-a-Hour i 203

o the ompetely edenuos paiet, e technque

has evolved into one ta a be used for ay

clca sitato: te competey edetos paient(oiuhi e al 2000). e paay denate Gase

et a 201 and e sgle-mssg oo Ersson

et a 201 ah edentulos stuaton reqres

slg odifiatos i te presugia workup ad

he sugca approach e specfc dagosic

workup for ea o the three varetes o edetis

s discssed n deai ! Cape 6.

hs aper otes te surgal echue o

ea sate of edes e poedue is

descred or te competely edentulos paien

ten varatos srgcal ehque used fo

patets wo are paraly denae and ave a snge

mssing oo are discssed

Surgical

Whe usg he NoeGude tehiue he

seqece of twst dis ad suga oponets s

e same o a edentulous ial siatonsWhe te srgca epae is erned rom he

aboraoy, te rst tg tat e clinica soud

g

=

-

-

=w

_

-

_

.

=

-

k -

.

..

i=:_ -

=

,

_

_

.

Fig (a) Order sheet fom NoeGude planning po-ram wit1 Ihe patien1's eaen deificaon number

38

do s perfom a geeral specion to ensue tha

te idetfato nber o e tepate ates

tat of the pang detiaion me assged

to hat patent e ciicia sod eck at the

ofgrato o he gude seeves ad paed

er of pants he srga epae aredeia to te operato iforaon sheet o

te paning softwae Fgs 4-1 ad 4-2 e

teplate sould aso e nspected o ensue tere

s o warpig o daage to he aryc or gude

seeves wthn he tempate

he cican sould one te aboratoy

fabated sugia oclsa dex to te sugical

teplate and esue at te f s eac The sur

ga de st also have a tigt f o the dentio

e opposg denta arc g 3 e preise

ft of te srga oclusal inde esres tat he

sugca empate wl be secred to the denta arc

n e prope vertica dmensio o occusio g

4 I te srga e pae is no paed a te

prope verica dmeso duig e srgey he

plas paed tog e tempae wl o e

seated o te poper vetca poston w te

alveola dge ad the xed parta detue at wi

e coneed afer impant paeet will ete

e nfra- o hyper-ocluso

The sugia poedre is saed y adsering oa aestei wt are o avoid

ecessve dspacee of e ggiva tsse tus

g b) Suia empae w1 pent' rcJeiao uber {;ppe et conr i typially pldby the patal vault of te mxiay teplate and e ingalae te maJiblar teate.


47/114

Pl nn

.

-

__

-

I

. .

.

.

-2 (a) Operati nfa shee ndcag tenube a szes of mplants. as wel as locaions i thevl rge.

3 (a The a eks e o 1e sgaltemplte t the surgicl dex. s well s the psttn

-4 (a) U o a 1.5 amee ws d toh ehna ge seeve Ne t1t gat s ape deyto he etrane of the ge leee of the sga eae.

ensug a optimal fi o he emplae o he

mcosal ssue. Te co-oeao of e aie s

cssay dig sag o sgca a

Surgil pocedure

(b) Infoatn fom the eato rashee s esnd exa to he sga emae

b) Fal et he o atigll pees. Ne the wel-ttg sa ne tpos t.

(b) Ion o th hozont h ostal zaton of the sgia tepae.

as te aet eeds o be gely o e surgical

ex o avo excesse comessio o e

cosa iss y sgcal ma Wn h

39


48/114

Chapr 4 Pn 1: NobiGude sue

Fig 5 The orizntal ach ps assis i rerac l1e lp

surgical tempate s fly seaed, a 1.5 m diameer

ws dill s se hog e oizonta guide

sleeve an a oiontal aco p (Fg 4-4a) snseed o secue he sgca emplae ad

peve t fo otaig.

Fullv edentulous patiems

In he completey edenous stuaio hee hoi

ota acho pis ae sed wh oe pacedaoud e dle ad two posteo ea the

comssues of the lip Whe the aveola idge s

seveey esobed and he shape o te ge is fa

for anco pins ay be necessary to preven

movemen o te sugcal epae (Fig 4b). No

Fig 4-6 () Te s dll w mbies ssue pacJ eskg dll. s place dely nto e veialgde sleeve

oy o he anch pns preven oiona move

ent of the empae hey aso assist

etactg the lp (Fg -5).The fis wo mpants place ae kow as

'sabilato mplants as these estabs e

pope vetcal compesson of the sgica empae on he mcosal ssue The ses fo tese two

iplas ae the next o e most poseo

posios on e sugca epate ateally. Tt1e

drls se o pepae te implant se ae desgedo emove sowy an atauatcally soft sse

ad oe ad to avoid hea geneaio

he fs tws ll s he sta dr whc fnc

ios as a ssue punch an conerboe hs ll

is pace decly no te gue seeve (Fg 6a .A sbseqet ws ds wi have a

coespondig di guie ta wi i pecisey in

he gude sleeve (F 47a whc pevets h ws

dl fom woblng and over-preparng he recen

se. Afer he stat dr, a 2 mm iamete twst d

s sed wh a 2 dill gude Figs ?b c.

Foowng tis a 3 m daee tws dl is sed

a coespodg 3 m ll guie (Fig 8a b t

s poit i e boe s dense e cliican may

use a 2 m damete tws d n he 2 m dl

gde ad fialy a scewtap to enae e

osteooy site o pemi placeme o he mplantwithot overcopessg e oe. e ap oes

not eie a gide an is secenteg whe he

shan conacs e ge seeve The ecipient

bone se s now eady fo he implat

A specally esiged mpant ount is con

g 4-6 ) Ppe se of e s d eqes a heHage l1e dll akes ull ca ih e p l1e

gde sleee.


49/114


50/114


51/114

Fg 41 Guided abutmens hve ee see ino heefinitive prosthesis. in prerai f cecin f epsess e plas

te surgica teplate is removed (Fig 4-11 ). Beorete teplae is eoved, a specal issue punc

(Fig 4-12) wich s desiged to ft ito te gude

sleeves s used o i excess ggival isse. Tis

w aow for easy seati of te prosthesis. Te

clca soud iset te posthetic estorao as

fast as possible because he suroding sof

tssue as a edecy o colapse which ca creae

proems fo poshesis inseio.

Afe a mpats ave ee seated ad excess

ggval tissue ed he prosthesis ca be

delveed. Ealer, the suica-posthodotic eashoud have deteied wic meber of e

team wl pace he posthess Ciica expeiece

suggests tat e clinica peoig surgery is

es sied o nser e ixed prsthesis. Te

clicia has deveoped a eel o he path o

iserto hroug he pacee o he sgca

tempate pacee of pas ad f of sugica

copoes he delivey of te poshess ad

tgeg o te prosec scews are peomed

i a sequenial fasio simlar o te pacee opats. Evey efot sod be made to avoid

seaing o overgeg e screws o oe side.e gided ames wok siiary o te em

pate abutes ere ae or wgs a the op o

te guided abmet tha expad as he abuten

scew s tihtee ito he mpla. Oce the wigs

o the abute screw expad tee s cion

agas he proshetc ame preeig he pos

thesis fro slidg veicay aog the legh of he

abume heeore te auten screws shoud

Fullv edelous pten

g 2 ! he gia tissue soun1 he e o theipa s s eved wi specaly esneJ ssue punc

g 3 The psess shou e cmpete seae one plas Oe his s nfire, e uided abutmensews are ene wi a a-e qe wren an

e csn in centr n aea exsns su e re k as own

e tgheed o where tte ip of the scew is jst

egagg the terna heads of he pat ce

al aben scews ae egagig he mplats he

pate is asked to cose dow genly o the pos

thess A ew tapping close movemes by thepatient wll assis i seag he postesis evely

ad locaig te pope erca esion o occ

sio o he paiet.

Whe a ame screws have ee ad

igteed a adiogaph sould e ake to com

tha a ide atets are seate completely o

to the ops o the mpats. Ae comao tat

e posess is copetey seated o he

mpans he abten scews are tgeedo 35

Ncm usg the aded toqe wrech

4


52/114


53/114

Fg 416 T wdw wl lw, durng gyontl pee sing o 1e gal g

pemt the clnicia o vsaze ad esue a e

tempae s seaed compleey o o the eet (Fgs

16 ad 17) W mted esa-o-dsa spacg, f

ajace oot srucures ae cose to the edentuos

space o wen sng modelbased plang e

orota anco pn s o use. Ts s o avod

amagng oos or eucg e avaale boe o

suppot te pants Sabzao o the sugcal

tempate s aceved y egagng e atual

eo an w the saato plants Oertha tese vaaos om e pooco te sugca

seps ae essentally the sae fo he patay

entae sates as or te competey edeuous

e clncan may wat to chage one aspec of

gded sgery wen opeatg n e esetc

oe of paay enae pates We ggva

boype s t e tsse pc o a fapess

approach sod e avoe A mallap po

ceue s se o avod uese removal of

tssue; ts appoac aso contols excessvecoaco a ecesso o e argal ssue

aoud te meae loae pant ad e

aace aa eo. A nalap poce

e allows o ee conto of e epostoed

lapo place e atace sse wee s eeed

soe clca satons a na-lap poce

e eaes re-esashme of eproma

papa see Capter 5 for a scusson of e

papae egeeaio tecque Wen ggval

cotos ae dece o o poo ggva botype

Postore paent instctios

g 7 T ml g pla: g l - a'>l. d for e opimal ti o be conolledhugh e wdw

the se of guded srgey e esec zone s

corandcae e cca mst e eay to

pefo ope-flap sgey ad ake oe poso

oc eases o povde e paten wth e

ae oang the esetc oe

Postoperaive aien insmcons

e paet so be nsce o ea on a

soft 'ocewg de o a mnmm o 2 wees

By ocsg on a o-cewg de te patent w

e acutey awae of e nee o avod cewig w

the ewy pace pant ad estorao Ohe

oute post-srgca nstcos a soul e

gve ae use of ce o mme swellg wam

sale nses an ora ygee srctons e

olowup scee s exemey pora A eac

post-sgca vst specto of occlson wtatclatng paper sol e peormed Occluso

cages amatcaly oce te local aesetc as

wo of ad e pate sas o fee cooabe

wt e fed esoave postess as ee s

typcay vey ttle pa o dscomfo Drng ths

crcal peo eavy occusal cotacs ms e

ece an mos poatly aeal efe

ences elnated Latea premattes ae te

mos deea oce o meae oa plats

and lea o ealy are o e mplan

4


54/114

Chapter 4 Pan I: NobeiGuid, zoma mpla ad mmediate fuctio

Pn II:ad fuco

troducto to zoma implatsOral ehabiltaion wth impants s we docu

ented and any proocols ave ee deveoped

o siply pocedres for he clincan, e poso

dontst ad e atent May sotions ave been

povided o ehace he estetc ad fctoal

asects of recostrco o the maxla.

xidized srface o pas promotes aster

boe ormaion (Glase et al 22 Ivao et al

203} icreasig pary stay and respods

oe eectively to demadig suatios sc as

so or defcet boe in the axla Sevee resor

ion o e posterior axla ca jeopadize rehabi

ato o y edeos paents y means o

impants.

Good reslts ave een pulsed wit sho

impants placed n he poserior maxlla Reoard

ad Nsad 205

Neverheess reabilitato o te poserio

axla were boe vome s isficien i.e. less

a m reans a calege. Poor achorageowng o isciet heg or wdh o oe has

previosy ed o te eed or addioa teapies

sc as apostion bone gaftng ss gra ad

osteogeesis dsacon Jensen 206)

ns gag is a well-kow and opla

pocede. Despite his oe agmetation and

Fig 418 zoa rplnt wth TUie 5ufc.

te nseo of iplans w o wtot mediae

loadg ofers sccess rates etwee 60 ad 98%

Wallace and From 2003 Usig implats wit

oxided sraces cosdeably iproves e sc

cess aes of hese rocedres Ludgre and

Brechter 202). However some aties may berectan o dergo sch pocedues.

To avoid bone graig ote solos ave

bee proposed: lted pats placed i te ber

osy or e pterygod plae, and plas olowig

te aerio sis wal dimnsng he caeve

appled to the fxed proshess Aaco e al 201

202 Caladreo and Toas 205

sertng pas n te perygod rocess s

demandig becase tis ecniqe as bee

associaed w he s o casng iury o te

descedg maxllary vascare Choi and ar

20)

To address he roe o very poo boe

volme zygoa plas ave roven o e sc

cessl n spporng fxed rosteses wito

bone gratg edrossian e al 202 Maleve e

a 204) e se of ygoma implants come

saes for insficieces in poo axllay suctres

by a acoage n e zygoa.

Zygoma implants are avaable n dfere

legts: 3 3 0 2 7. ad52.5 m. ee ae wo daeters 3.9 a he

top ad 46 m a he evel o he ala wee

as a angatio of 45 correspodg o te

aglao o te zygoa with te axilla ig 4

). hese iplas ae sed eve e axiay

eig s less han m.

y edeos axary siato can e

treated sig ygoma ipants e ygoatic

ancoage is vey strong ad ese ong pats

ave a igh sccess rae. Zygoa mpants ca belaced i addito to two tee or o anteio

stadard plats g 9.

the aeo reag maxllary boe s ess

ta 7 o ygoa implants ca aso e

sfcient o supportng a totally ixed rosthess

g -20).

Zygoa pas can also eneit imedate

loadg edrossa et al 206 s wit sadad

impas, teir oxded srace enaces osseo

itegatio


55/114

Fig 419 Facial mage of two zygoma mplants ad twsaard mpans he cae rgin with a fixd PraImplant Brdg.

sandard protcol

The stndard potcl fo isetng zygom

pts vves opeig wide ucopeose

p ncve e mxi s we as e neio

sis w p e zygic icis Tis

ebes vewg e ot ss wa ad ygoa

(Fig -21 ).Athog te ssciaed pi is dete te

ptet c expeience sweig d dscfor dys owig te sgey Despite , pro

vsi psesis cn be nsed ediey;

s eapy eqres mpessio o be take t

e e srgey ad cae djste o te

ccsion Te ceti of a defiive prostesis is

s ered sme ts e Te de

pcemet of impns ad e eed iimy

vsve sgey e ceges t zyg

mps pvde pppiae soion

pefng mpt theapy

Zoma implant and NobiGuide

Fig 20 Placement of our zgma mplants r srt-

ig a xed roseSIS.

zvuoma and NobeiGde

Te NbeGide cncept ws isertio of

ipts wt gided srgey by eas pe

sgic cpezed prepi. e ee-n

H pocedre nvves setio o e

deve posess t te e e sgey s

pcedre s crety beig deveped zyg

ipts sng a speci sgica gde and d

wae for nserng te pts i te rg posoTis ebes imedite pceen the defntive

psess.

e copeied ogrpy p o e eve

e ygma togete w e adioogca gde

Pocer sfwre enbes vt pstinng of the

zygo mps d he eizain f a fied

psess oce Ipt Bidge) A speci

sgic gde s de or dg d iseti f

e ygom ipats Spec adwe w

seeves o deet diees is viae s

47


56/114

Chapter 4 Pn II: NobeiGud, zoma mpla ad mmedate fucto

Fig 42 Te whole mucosa is refected, showng e axa p o p o 1e zyoa e d dcaes snsnw.

essetia ha zygoa mplas are aced with a

gude becase of eir length ad the eed o

preise osioing

After seo i he moh the sgia gde

is fxed wth ree o for is Dling sarts w

he stadard iplats ollowig e NobeGide

roocol. ext a 2.9 calbated dl serted

a speial sleeve s sed o reare e se of te

ygoa iplats ad e a second dr of

36 diaee ad a oteboe are sed

At he xilary eve o te ygoma ila twoopegs ae ade hrogh te osa: oe o

he mplat and one or vewing the scew o the

ogina e mot, whc wil dcate he eact

poso of e agaed ead

Te ygoa iat s te ed o a seond

xtue out whh s sewed o the first oe;

hs es o idae te oe whe iseo

sod be stoped he wde re o wl be

inseed a sleeve to gide te mplant p to the

op of te ygoaAte isetio o all the plats the surgial

guide s eoved and he proshess s seed It

is srewed o he atero implas ad eeted

o e poserior oes

Advatages o hs ocedure ae that there s

o isio o stces, o swelig ad treatet

e is soeed seo of the ats as wel

as he rostesis a be erored 1 o 15

ines ad mmediate tio s reaed by

eas o a defiive rosess

g 4-22 Ooanomoa 1 o os-se

No casde ipresso o bite egisaon s

requed aer e srgery as e osess is

prepaed beoread ad iserted durig surgey

Conclusion

The developet o ygoa ats used o

juo w the Nobeude oep igligts

the possbiy of ehabag paties wit otaedents and suie boe vole by eas

o nimally invasve surgery ad imediate eco

sruto o the asatory fucio (Fgs 4-22

ad 23)

g 423 Te osess aed on h da o se


57/114


58/114


59/114


60/114

Fig 3 To deermine pecisely the e esu. e aialfage shod be eoved i he aero ego ro cuspio spid whe ryin he e. he ee i be probabypld i mor il poiio o ip sppo oop o h k o il f

obtained wih e esec model ase ad e fa

resu wit e ixed rostesis pace (Fgs 5-3

and 5-4).

The estei mode base us ave a ig labial

age to otain a ere fit ad o posito 1e

salizatio s o te srgca gde. is fage

wi pus e ssues abaly js eow te ose,

and te lip wil oseqely ollapse. If te ia

postio of e teet is sia to te ese odelase tere will e a sgnia ak o so o

the ip o avoid s omlaio te eseti

odel base sold e rst fariaed wtou e

abal lage ad e esetic sold e be

deeed at tis stage of he poedre.

One e oe positog as been o

fied e age s added o te odel ase and

te liian ollows e orma prooo. We

pacg te fxed atia dere esecally o e

axa some adatao oblems may occ. Aste atie s lelyo ae bee weaing a dere

previosly te atie a soees eeee

disomort airow and spee robems wi Us

ew osesis n ace

o avod ese copicatos te prosess

sod be fabiated wh a excess of acyic

eary ilg a te saes ewee e imlants

or at east a wee Fg 55).

Te aet will ten aomodae to tis ew

satio wi a xed prostesis and o aate

Funv edetulous pae

ig 5-4 Fa posess s ' plae, 1!usa a a abialae s no eessar o obai adequae ip suppo Posi-on o he ee is iil o esei sess

ig 5-5 (a and b) he eoa esoraio s abicaedwi an excess of aIi maeia a e rde ee.

53


61/114

Chaper 5 Eetic conideration

5- Aer a week, te pink crylc is reshped ro

mote hygene ad o avo ee oblem. After 3 mots,e phei eoa is re-ealuae a e ebauere mdiied ccrdig he ndge remdeg.

Then te embrasues so be ceate o allow

e opal combiaion bewee maneace

ad ygiee an speec and eseics.

o avod copatios accog to e esthecs

an expeatons of he patets, ay be pefeable

in eain ases to begin wt a tepoay fxe es

oaio o ceck al e paamees (eshetics vei

cal diensio occlsio poecs hygiee ad

eegene prole) ad e seveal mos ae o

abricae a deiive Proea Implan Brge taig

o aot al o ese ators Fgs 5-6 o 5-8

ParalIV paten

obles reate to pataly eelous patets are

sgicay ore omplex ta or he fuy een-

Fg 7 T1e e l (a ee i Fg 5- nd5-G) owed i e lower The i prhei i w

rady o b paed

tos pae As impla posog a sof

tisse cono wl be deiive using NobeGe

specia cae s eee we reaing ese paes

All normatio sould be obaied beoe e ea

men sas s wil inue inoaton abo rige

sape an boe qaiy an qaly as wel as: nube, sape an posio o te ajacen an

opposig eet occsio so sse aly and aiy coo textre a shape o tissues presee o absence o pap< sle lie a p obily pesoal ees o te patet a psycologica

acos

A ese acors eed o be evauae as tis

sugey an be osiee efiitve if sig he

flapless tisse-pc teique

Wt two-sage srgery had a/o so tssue

anaomy can be oie sig difee addve

pocedres b ese ao be odiie we

oosig e obeue opon using te lapess

bas pooo

A tese faos ave o be evaluae a pe

implant srgey may be equied o acieve he

optimal estetic esulBeoe coecig reae e cnica

sold evaate w s te opimal teatme I

soe saes he rge sees aequae an a

tsse-pn techiqe ay be appopiae or

'

g 5 Cii view Proe I Bridge n 1e ue nd ower fter 1 ye


62/114

esthetcs, or thee may be a lack of ssue bt e

esthec needs are not very hg (e.g. whe ere is

a low lip le and ow lip mobily}. I boh o hese

cae, the ovenoal proool may t1ae a sais

acory resul

n ote siuatons here can be sgfcan dgeesoto (hard ad/or so sse) I such cases

the clnca has o decde whch reate o

choose fom he followng opios A prelminay ad/so te agmeaio

andreame g NobeGude aer a ealg

eod Aplcato o the obeGde cocept wt a

modifed sca tecque sng a fa srg-

ca ech iqe togethe wh a papill egee-

ato tecque Avod teatg te patent si his tecnque

f or exae there is lmied space betwee

eeth o bewee eeth and plans Te seeve

o e gude ca be a limting faco ee is a

imied space i ei ad a imied space

bewee mplas; hee may be df iculy wih

Esthetic anteor m asscaon

sof sses. I is dvded no our classes accordng

to verca ad ozoal dmensos of hese two

tpes o isse.

Verca o lfg 5-91

Class 1: nact or slgly educed papill

lass II ted o of pal

(ess an 50% of papill lo

lass Ill severe loss of apll

Cass IV absence o apl edelous dge}

isei e gude, ad oma ipa place )

et may be comised Fo these easos

he followg for asecs shod be careflly

evalaed:

ad sse oft te

prothet eorato

esthec requremens.

o selec adeqae srgcal otons e classf

caio descibed by Paacci and Ercsson n 20

o great hepto he clican, pohodont ad

geea practione i deerng the comene

men and competo e o the deed rea

men. ollowng s a bref sma o e classcato o claiy he eame approac i reao

to esheics

Esetic anerior

Ts aneio axila casscaio s based o he

amount of veical ad ozoa los of hard ad

b

c

)

Immediate Function and Esthetics in Implant Dentistry

Documents

Transcript of Immediate Function and Esthetics in Implant Dentistry