Prosthetic options in implant dentistry

Prosthetic options in implant dentistry

Bibin bhaskaran

Index

• Introduction.

• Treatment options.

• Treatment planning for implant supported prosthesis.

• Classification of prosthesis movts.

• Completely edentulous prosthesis design.

Index

• Advantages of removable implant supported prosthesis in completely edentulous patient.

• Partially edentulous design.

• Advantages of implant supported FPD.

• Guidelines for joining tooth with implant.

• Prosthetic options.

• Summary.

Introduction

• Goals of implant dentistry-replace pts missing teeth to normal contour, comfort,function,esthetics,speech and health.

• Final restoration – not implants.

• In stress Rx theorem final restoration first planned-after abutments designed.

Traditional Treatment Options

• Removable partial dentures.

• Fixed partial dentures.

• Complete dentures.

Treatment planning for implant supported prosthesis

• Designing the prosthesis [to satisfy patients needs and desire].

• Individual areas of abutment support are determined.

• • Bone in that area is evaluated for type of

implant

Classification of prosthesis movement

Classification of prosthesis movement :-

• PM-O• PM-2• PM-3• PM-4• PM-6

Classification of prosthesis movement

PM-0 – prosthesis rigid – no movt (implant support similar to FPD).

• 0-ring attachments (6 directions).• 4 0-rings placed on complete arch and

prosthesis rests on the bar- PM-0.

PM-2 – prosthesis with hinge motion (2 planes).

• Hinge attachment (Dolder bar without a spacer or Hader bar and clip).

Classification of prosthesis movement

PM-3 – prosthesis with an apical and hinge motion.

• Dolder bar with spacer and clip.

PM-4 – movts in 4 directions.

• Rarely used in O.D.• Magnets are used.(no lateral force).

PM-6 – all ranges of prosthesis movt.

• O-ring attachment or extra coronal resilient attachment (ERA).

• Implants independent of each other.(no bar)

Completely edentulous prosthesis design

• Pts desires-fixed or removable.

• To assess ideal final prosthetic design-existing anatomy evaluated.

• An axiom of implant Rx is to provide ,most cost effective Rx that will satisfy pts anatomical needs and personal desires.

• In completely edentulous pt a removable implant supported prosthesis offers several advantages over a fixed implant restoration.

Completely edentulous prosthesis design

• However some completely edentulous patients require a fixed restoration because of their desire or because their oral condition makes fabrication of teeth difficult if a super structure and removable prostheses are planned.

• For eg when pt has abundant bone-implants already placed-lack of crown height space-removable prosthesis.

• Too often Rx plans for completely edentulous pts-max denture and mand over denture with 2 implants.

Completely edentulous prosthesis design

• Long term-disservice to pt-parasthesia, facial changes and reduced posterior occlusion on max prosthesis are to be expected.

• Important to visualize the final restoration at the onset with a fixed implant restoration.

• Individual areas of ideal or key abutment determined.

Completely edentulous prosthesis design

• Pts force factors and bone density in region of implant support are evaluated.

• Only then available bone is evaluated to assess whether it is possible to place implants to support the intended prosthesis.

• In inadequate natural or implant abutment situations-oral conditions altered-augmentation.

Completely edentulous prosthesis design

• A fixed implant restoration-partially or completely edentulous pt.

• Fixed lasts longer.(acrylic teeth wear,attachments replacement-removable prosthesis).

• No food entrapment.

Advantages of removable implant-supported prostheses in completely

edentulous patient

• Facial esthetics enhanced with labial flanges.

• Prosthesis – removed at night - nocturnal parafunction.

• Fewer implants.

Advantages of removable implant-supported prostheses in completely

edentulous patient

• Less bone augmentation-before implant insertion.

• Shorter RX-no bone augmentation.

• Less expensive.

• Daily home care is easier.

Partially edentulous design

• A common axiom-FPD.

• Fewer natural teeth missing-better indication for FPD.

• Ideally FPD-completely implant supported.

• Added implants-fewer pontics-less stress.

Advantages of implant supported FPD

• When Compared conventional tooth supported FPD Im FPD has –

• No caries.• No endodontic problems. • No retention failure.• No periodontal breakdown.• Easier to clean.

Guidelines for joining implant with tooth

• No clinically observed mobility of the natural tooth.

• Use of rigid connectors.

• Less lateral forces to the prosthesis

[occlusion].

• Rarely connect to anterior tooth.

Prosthetic options

Misch-1989.

• FP-1

• FP-2

• FP-3

• RP-4

• RP-5

FP-1

• Anatomical crowns.

• Minimal loss.

• Root of natural tooth.

FP-1

• Max anterior region.

• FP-1 restoration-crown –natural tooth.

• Width or height – augmentation.

• Soft tissue augmentation – black .

FP-1

• Restorative material-porcelain to noble metal.

• A single tooth FP crown-Al2O3 or ceramic.

• Fracture in latter.

FP-2

• Anatomical crown and portion of root.

• Bone more apical (1-2mm).

• Incisal edge correct-gingival 3rd overextended.

FP-2

• Prosthetic teeth – longer.

• Multiple FP-2 – no specific implant position.

• Implant position – width, angulation, hygiene.

FP-2

• Embrassure b/w teeth – mand ant teeth.

• Material of choice – precious metal to porcelain.

FP-2

• Contour of metal different – FP-1.

• Unsupported porcelain in final prosthesis.

FP-3

• Missing crowns and gingival color and portion of edentulous site.

• Dec bone height – resorption.

• Unnatural long teeth – esthetics,function,support.

FP-3

• Pt – high max lip line – smiling.

• Low lip line – speech.

FP-3

• Ideal high smile line-interdental papilla of max ant teeth-not soft tissue-mid cervical regions.

• Complain-display of longer teeth.

• Gingival color of FP-3-esthetic.

• Gingival acrylic-multiple abutments-bone loss.

FP-3

2 basic approaches-FP-3.

a) Hybrid restoration-denture teeth & metal.

b) Porcelain metal restoration.

FP-3

• Restorative material-amt of crown height space.

• An FP-3 porcelain to metal-difficult-FP-2.

• Pink porcelain-more baking-risk of porosity.

FP-3

• Alternative-PFM-hybrid restoration.

• Highly esthetic-denture teeth & acrylic soft tissue.

FP-3

• Crown height space for hybrid prosthesis versus PFM – 15mm from bone to occlusal plane.

• FP-2 or FP-3 prosthesis-high lip lines-implant abutments.

FP-3

• Greater crown height-force-implant cervical regions.

• Additional implant abutments or shorter cantilever lengths.

• In max arch open embrassures-food impaction.

• Mand restoration-above tissue-sanitary pontic.

Cement Vs Screw retained

Cement retained• Passive castings.• Enhanced esthetics.• Improved direction of

loading.• Reduced crestal bone loss.• Improved access.• Reduced

complications,cost, time.

Screw retained• Retrievability.• No cement in the sulcus.• Low profile retention.• Possible with limited inter-

arch space .

RP-4

• Removable prosthesis-implants.

• Restoration rigid when inserted.

• Overdenture attachments-tissue bar or super structure that splints the abutments.

RP-4

• 5 -6 implants-mand & 6-8-max – implant supported.

• Implant criteria-RP-4-different-Fixed prosthesis.

• Denture teeth & more acrylic-removable restoration.

RP-4

• Super structure and O.D attachments-abutments.

• Lingual and apical implant placement-FP.

• Implants for RP-4 and an FP-2 or FP-3 – mesiodistal.

• Occasionally attachment-6mm spacing b/w implants.

RP-4

• Reduce No of implants-mental foramina.

• RP-4 same – FP-1,FP-2 or FP-3 restoration.

• PFM prosthesis C attachments-abutments-esthetics.

• O.D attachments-oral hygiene-nocturnal bruxism.

• Hader bar with PM-0.

RP-5

• Removable prosthesis-implant & soft tissue.

• Completely edentulous mand O.D may have :-

• 2 ant implants independent.• Splinted implants in canine.• 3 splinted implants in P.M and central

incissor.• Implants splinted with a cantilevered bar.

• Advantage :- reduced cost.

RP-5• Preimplant denture :- esthetics.

• Guide.

• Healing stage.

• Converted - RP-4 or RP-5.

• Bone resorption – soft tissue borne areas.

• Relines and occlusal adjustments.

• Bone resorption – 2 – 3times faster – RP-5.

FP-3

FP-3

Summary

• Benefits of implant dentistry realized-prosthesis.

• 5-prosthetic options available.

• Amt of support required initially designed.

• Once prosthesis designed-implant Rx established.