Implant Position - Prosthetic Considerations

Question 1

D i ag n o s i s
➤ 5 Classes
* Class A -
* Class B -
* Class C -
* Class D -
* Class X -

Answer 1

Good prognosis
Fair prognosis
Questionable prognosis
Compromised prognosis
Non-salvageable/Hopeless

Question 2

D i ag n o s i s
(14)
OTHER CONSIDERATIONS

Answer 2

➤ What is your treatment plan? Maintaining a questionable or compromised
tooth is better than having no tooth!
➤ Are implants a possibility? (lack of space, systemic diseases, radiotherapy,
medications)
➤ For some teeth it might be worth going the extra-mile (canines are known
to be the last teeth to be lost for a reason)
➤ Residual ridge resorption (bone preservation procedures vs root
preservation)

Question 3

Treatment plan sequence
(5)

Answer 3

1.Diagnosis
2.Address Urgent needs / Pain
3.Active disease control
4.Surgical Phase
5.Restorative Phase

Question 4

I n di cat i on s
(3)

Answer 4

• Whenever there are no contra-indications for replacing missing or
  non-salvageable/hopeless teeth.
• Always remember that natural teeth have better esthetics.
• Hopeless teeth are not useless teeth

Question 5

Cont rai ndi cat i ons
Absolute
(4)

Answer 5

• High dose radiation near area of implant placement
• Severe psychiatric disorders
• Patients on high levels of anticoagulants (INR > 3-3.5 ; Platelet count
  < 50.000/mm 3 )
• Uncontrolled diabetes

Question 6

Cont rai ndi cat i ons
Absolute
(3)

Answer 6

• Bone Pathology at implant site - Osteomyelitis
• MI within the last six months
• History of IV Bisphosphonate use

Question 7

Cont rai ndi cat i ons
Relative
(15)

Answer 7

• Pathology of hard or soft tissues
• Bleeding disorders
• Low dose radiation
• Inability to maintain the implants due to mental or physical challenges (stroke,
  arthritis…)
• Active periodontal disease
• Parafunctional habits
• Smoking
• Immunocompromised patients (Crohn’s disease, HIV positive, Organ transplant…)
• Osteoporosis
• Pregnancy
• Maximum mouth opening < 35mm in the anterior area
• Age: Females need to be over 18, Males over 21 (hand-wrist radiograph to verify that
  growth has ended)
• DM: history of erratic control (HbA 1c of 6.5 - 7.0 is good, < 8 is acceptable)
• Poor plaque control
• Long term use of oral bisphosphonates

Question 8

A s s e s s m e n t
C h e c k l i s t

Answer 8

Symptoms
Pathology
Aesthetics
Socket integrity
Probing
Fistulae
Dehiscences
Bone level
Density
Root anatomy
Root inclination
Interdental space
Root width

Question 9

I n i t i a l
E v a l u a t i o n
(4)

Answer 9

• Comprehensive medical and dental
  evaluation
• Articulated diagnostic casts
• Radiographs (full-mouth, panoramic)
• Cone-beam CT

Question 10

D i ag n o s t i c Wo r k -u p
S t a r t w i t h t h e e n d i n m i n d !
— is the most important factor
REVERSE TREATMENT PLAN!!

Answer 10

Tooth position

Question 11

Prosthetically Driven
Implant placement
Implant placement in a 3-D position
based on

Answer 11

the final tooth position.

Question 12

Prosthetically Driven
Implant placement
The angulation of an implant may need to be

Answer 12

adjusted
(buccopalatally) to avoid perforating the labial plate of
bone if there is an undercut apical (labial depression)

Question 13

Minimum Space for Cement
Retained Restorations
—mm Implant Platform - opposing arch

Answer 13

≥7

Question 14

Minimum Space for Cement
Retained Restorations
–mm abutment colar
–mm casting+porcelain
–mm abutment height

Answer 14

≥1
≥2
≥4

Question 15

Minimum Space for Screw
Retained Restorations
– mm Implant Platform - opposing arch

Answer 15

≥4