Implant introduction Wednesday 30 April...
Transcript of Implant introduction Wednesday 30 April...
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Implant introduction Wednesday 30th April
2013 9.00am – 4.30pm
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Prior Precise Planning Prevents a Pi** Poor Performance (The 7P rule)
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Is the Rx plan within my skill range?
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Re-cycling – warnings – nothing lasts forever
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Dentists are now twice as likely to get sued as a Doctors!
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Lets look at a case we saw at St G’s in 2007
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• What further special tests would aid your examination of Miss LT?
• Pulp testing of UR4 & UR1 • Mounted study models
Questions
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• What options could be used to restore UR3 – including the ups and downs of each?
• Chrome Denture • Resin-Bonded Bridge(s) • Conventional Bridge • Implants
Questions
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• What option would you suggest and why?
Questions
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• Do you think NHS money should be used to fund her implant treatment?
Questions
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• Assuming there is funding and the patient wants implants – how would you go about planning it?
• Diagnostic wax up / surgical stent / PA radiographs • Temporisation RBB 4PP1/ or RPD?
Questions
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• Would you go for cemented or screw-retained crowns?
• Would you link the crowns or go for individual restorations?
Questions
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• RBBs is it a good predictable option? • What RBB design would you be suggesting – cantilevers
or FF? • If implants – a RP and NP? • Screw-retained or cemented implant crowns – what
factors would you take into consideration? • Link them or single units?
Dilemmas
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Fixture head impressions in an open tray
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Link fixtures together or not?
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How would you take a jaw registration and what would be your occlusal scheme?
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12 months later
Why do you think the incisal edge of the UR3 #’d? Who’s to blame?
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Miss LT 2010 – in group function with better metal support of UR3 VMK
2010
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Resorbed / Pink spot lesion UL1
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Angulated / customised abutments
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Single tooth anterior gap in anterior maxilla – guide from evidence
• If adjacent teeth intact perfect then ideally a single tooth implant crown has a 89.4% survival at 10 years (94.5% at 5 years)
• Resin-bonded bridge has higher failure rate 65% survival at 10 years (87.7% at 5 years) but minimal biological damage
• If adjacent teeth damaged then conventional fixed dental prosthesis 89.2% survival at 10 years (93.4% at 5 years)
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Single incisor gap in anterior mandible
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Single incisor gap in anterior mandible
• Implant-crown and conventional FDP have similar survival outcome. • However FDP more likely to cause pulpal damage of abutments. • So single tooth implant is most ideal where bone is sufficient and
where mesio-distal space allows. • One lower incisor is a challenge for OI; although 3mm diameter
now available • If not resin bonded bridge is best option where neighbouring teeth
are good condition. • These go better when replacing lateral incisors compared to
centrals (Hussey and Linden 1996)
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Multiple bound anterior incisor spaces • Similar approach – clearly a move away from FPD
and the conventional preparation of intact teeth
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Double maxillary incisor space • More difficult treatment planning • UR2 UL2 8.5mm crown widths • Watch out for convergence of the roots into potential
Pontic sites • Can cantilever implants (need good length and diameter)
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The game changes with missing canine(s) • OI gold standard FPD option • Conventional fixed and RBBs are much less successful
in this situation (Roberts 1970 a & b; Schwartz 1970 & Foster 1991)
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LT – missing canine and lateral
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Large anterior span • More than 2 pontics think RPD or OI • Evidence that 6 unit FPD can be used to replace 4
missing incisors – but what will happen on failure with young patient?
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Single posterior spaces • First consider accepting the space
• RBBs de-bond at an annual rate of 5.17% posteriorly - do not go well in this part of the mouth
• If patient wants restoration we need to consider health of adjacent teeth
• Ideally a single tooth implant
• Conventional FDP only if adjacent teeth require crowns (damaged abutments)
• Conventional FDPs will do poorly if abutments are previously RCT’d (Palmqvist 1991) or go on to require RCT after cementation (Reuter and Brose 1984)
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RBBs struggle to restore molar teeth – avoid losers as you will damage natural teeth
unnecessarily
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Multiple missing adjacent teeth in the posterior region
• Consider accepting space and SDA
• Gold restorative standard an implant-supported FDP as shorter extension than conventional bridgework (no retainers) - greater risk of technical complications (e.g. porcelain chipping) due to functional position and lack of periodontal ligament bounce
• Conventional FPD only where abutments are damaged and require cuspal protection
• Forget RBBS
• Bounded RPDs can work very well with good oral health
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Restoring free end saddles and the shortened arch
• Consider implant-supported crowns and FPDs as RPD will not improve patient’s QoL
• OI surgery gets more difficult the further you go back in the mouth due to anatomical features
• Consider Cantilever conventional FPD / RBBs to increase number of occlusal units
• Other options include distal tooth-supported cantilever and tooth-implant supported FDP but these have higher failure rates.
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Summary Hopefully we have covered:
• Clinical implant stages • What clinical things need to be in place • Which restoration types are / are not most appropriate
to fill prosthodontic spaces? • How well are our different types of restoration likely to
perform in given clinical situations? • Where is an implant better than others
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I hope this has been interesting and educational
The End