Implant Supported Prosthesis/ISP
Transcript of Implant Supported Prosthesis/ISP
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Fixed Partial Dentures /FPDs/,
Implant Supported
Prosthesis/ISP/
in implant prosthodontics
Prof.dr.Tamas Divinyi
Semmelweis University, Faculty of Dentistry
Department of Oral and Maxillofacial Surgery
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Glossary terms
• Fixed Partial Denture /FPD/
Non removable partial prosthesis supported and
retained by teeth and/or implants.
• Implant Supported Prosthesis /ISP/
Replacement for missing natural teeth that
receives retention, support, and stability from
dental implants.
/Laney W.R.edit.:Glossary of oral and Maxillofacial Implants .
Quintessence.2007/
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Partial tooth loss Conventional proshetic therapy:
FPD
Removable prosthesis
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Partial tooth loss Conventional proshetic therapy:
FPD
Removable prosthesis
Bone loss in long term?
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IMPLANT THERAPY:
•Single, implant supported crowns
•Implant supported and retained FPD
Partial tooth loss
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IMPLANT THERAPY:
•Single, implant supported crowns
•Implant supported and retained FPD
Partial tooth loss
Basic rules:
• No cantilevers /exeptions/
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IMPLANT THERAPY:
•Single, implant supported crowns
•Implant supported and retained FPD
Partial tooth loss
Basic rules:
• No cantilevers /exeptions/
• No three adjecent pontics
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The span of the pontics in the
ideal treatment plan should be
limited to the size of two
premolars /13.5-16.0 mm/.
/ Misch 2006/
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Partial tooth loss
Implant prosthodontics differ
from the conventional therapy:
• Splinting of implants, if possible
• Precise mesio-distal, oro-vestibular
positioning,
• „Tripodial” placement?
• Axial loading?
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What about the different
clinical situations?
How does a FPD
look like?
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Partial tooth loss
Clinical situations:
Replacement of maxillary central and lateral incisor
Replacement of maxillary lateral incisor and canine
Replacement of maxillary central incisors
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Partial tooth loss Clinical situations:
• Missing central, lateral incisors and
canine
• Missing central incisors and
lateral one
• Missing 4 incisors
• Missing 4 incisors ,2 canines
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Partial tooth loss Clinical situations:
•Missing premolars
• Missing premolars and molar
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Basic questions
in implant prosthodontics:
•support
•retention ?
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Partial tooth loss Clinical situations:
Mandibular incisors
and
canines
Mandibular premolars, molars
Support and retention?
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Types of implant restorations
Fixed partial denture/FPD/
(mode of retention)
cementation
Removable /overdenture/
(support, retention)
implant mucosa
implant + mucosa
screw
(support)
tooth+implant
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IMPLANT-TOOTH SUPPORTED
FIXED PARTIAL DENTURE
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Precision attachement in implant-tooth supported FPD
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Implant-tooth supported fixed
partial denture Advantages:
- less implants necessary
- proprioceptive reflexes through natural
teeth
- similar to conventional restorations
Disadvantages:
- sacrificing tooth substance
- different kinematics between abutments
- uncertain predectibility because of decay
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Splinting of teeth in implant-tooth supported FPD
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Types of implant restorations
Fixed partial denture/FPD/
(mode of retention)
cementation
Removable /overdenture/
(support, retention)
implant mucosa
implant + mucosa
screw
(support)
implant
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Precise placement of implants
for implant supported FPD
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Implant supported fixed partial
denture
Advantages:
- saving tooth structure
- similar kinematics between abutments
- implants preserve bone volume
- predectibility
Disadvantages:
- impaired sensory innervation
- higher costs
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Partial tooth loss Clinical situations:
Mandibular incisors
and
canines
Mandibular premolars, molars
Support and retention?
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Types of implant restorations
Fixed partial denture/FPD/
(mode of retention)
cementation
Removable /overdenture/
(support, retention)
implant mucosa
implant + mucosa
screw
tooth+implant implant
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Cemented fixed partial denture
/FPD/ Advantages
• passive suprastructure
• conventional laboratory work
• easy completing procedure
• good esthetics
Disadvantages
• no retrievibility, correction is difficult
• larger abutment, extended intermaxillary space is needed
• possible excess of cement
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Preparing cemented fixed partial denture
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Types of implant restorations
Fixed partial denture/FPD/
(mode of retention)
Removable /overdenture/
(support, retention)
implant mucosa
implant + mucosa
screw
implant
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Screw retained prosthesis
Advantages
• shorter superstructure - less intermaxillary space is needed
• divergencies can be easily corrected
• easy retrievibility – correction of failures
Disadvantages
• more difficult completion
• very precise laboratory work is needed
• screw openings may cause esthetic problems
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Screw retained FPD
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Screw-retained FPD, in the case of
limited intermaxillary distance
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Preparation of screw-retained FPD:
Direction of screw: VERTICAL
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Preparation of screw-retained FPD:
Direction of screw: HORIZONTAL
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Screw retained
FPDs
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Implant supported and screw-retained
fixed partial dentures
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Screw openings
covered by
composit
resin
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Possibilities for impression
• Possibility A Possibility B About the impIant About the abutment
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Impression methods on implant
level
Closed
impression-
tray
Open
impression-
tray
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How to use Impression Coping
1. Connect Imp. Cap 2. Apply impression
material
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3. Remove impression body 4.Connect Lab analog
How to use abutment level implant cap
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Possibilities for impression
• Possibility A Possibility B About the impIant About the abutment
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Closed tray technique
How to use implant level - transfer imp. coping
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How to use implant level - transfer imp. coping
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How to use implant level - transfer imp. coping
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How to use implant level - transfer imp. coping
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How to use implant level - transfer imp. coping
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How to use implant level - transfer imp. coping
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How to use implant level - transfer imp. coping
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How to use implant level - transfer imp. coping
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How to use implant level - transfer imp. coping
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How to use implant level - transfer imp. coping
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How to use implant level - transfer imp. coping
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When using closed impression tray
method?
• When the implants relatively paralell to
each other
• Cement retained restoration on 1-3
implants
• Screw retained restoration on 1-2 implants
• Preliminary impression for open tray
• When fabricating a provisional restoration
• Limited mouth opening
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Impression methods on
implant level
Closed
impression-
tray
Open
impression-
tray
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Possibilities for impression
• Possibility A Possibility B About the impIant About the abutment
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Open tray impression technique
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When using an open impression
tray method?
• When the implants are not so paralell to
each other
• Cement retained restorations on 4 or more
implants
• Screw retained restoration on 3 or more
implants
• In case of a bar type implant overdenture
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Maxillary „free end”
edentulism Conventional
prosthetic therapy
Implant therapy
•No treatment
•FPD with cantilever
•Partial removable denture
•Orthodontic treatment:
distalization of tooth
•Implant supported and
retained FPD
•Implant-tooth supported and
retained FPD
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Maxillary „free end”
edentulism
Anatomic limitations: •Maxillary sinus
•Poor bone quality
Concept: Each missing roots to be replaced
by implants
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Screw retained FPD
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?
?
?
Mandibular „ free
end” edentulism:
replacement until first
molar
?
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Totally edentulous jaws
Conventional therapy: Removable denture
Implant therapy:
•Implant retained ,/supported/ overdenture
• Fixed hybrid prosthesis • Implant supported prosthesis
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Totally edentulous jaws
Conventional therapy: Removable denture
Implant therapy:
•Implant retained ,/supported/ overdenture
• Fixed hybrid prosthesis
• Implant supported prosthesis
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Edentulous mandible
Implant supported prosthesis
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Edentulous maxilla
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Edentulous maxilla Implant supported prosthesis with cantilevers
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Biomechanics of a
cantilever fixed bridge
Masticatory force
Lever arm Moment arm
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Cantilever may be acceptable in
following clinical situations:
• edentulous jaws /distal/
• pontic replacing lower
first premolar /mesial/
• pontic replacing lateral upper
incisor /mesial, distal/
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Totally edentulous jaws
Implant supported prosthesis
Support:
Implant
Retention:
Implant
Advantages:
•Stability
•Psychological aspects
Disadvantages:
•High costs
•Optimal bone conditions
•Esthetic problems
•Phonetic problems/Maxilla/
•Hygenic problems
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Totally edentulous jaws
Conventional therapy: Removable denture
Implant therapy:
•Implant retained ,/supported/ overdenture
• Fixed hybrid prosthesis • Implant supported prosthesis
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Hybrid prosthesis: Fixed,removable
or maxillofacial prosthesis designed
and fabricated with an atypical combination
of materials or structural components.
/Laney W.R.: Glossary of oral and maxillofacial implants/
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Edentulous mandible
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Implants with abutments
for screw retention
Abutments with
hygenic caps
Edentulous mandible
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Screw retained,
implant supported
hybrid prosthesis
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Totally edentulous jaws
Fixed hybrid prosthesis:
Support:
Implant
Retention:
Implant
Advantages:
•Stability
•Less precise implant
positioning is necessary
Disadvantages:
•High costs
•Difficult hygenic
access
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Totally edentulous jaws
Conventional therapy: Removable denture
Implant therapy:
•Implant retained ,/supported/ overdenture
Next
lecture