Implant Restorative Options for Edentulous Patients Flashcards
CHIEF COMPLAINT
(5)
- Retention
- Ridge soreness or numbness
- Function (chewing efficiency or bite force)
- Esthetics
- Sensitive gag reflex
Anatomy
(3)
- Amount and quality of bone
- Jaw relation
- Resorption pattern of the maxilla and mandible
Implant Restorative Options
(3)
- Removable Restorations
- Fixed Restorations
- Hybrid Restorations
Removable Implant Prostheses
(2)
- Implant Retained - Tissue Supported
- Implant Retained – Implant & Tissue Supported
Implant Retained – Tissue Supported
* Uses:
* Recommended # of implants
* – on the maxilla
* – on the mandible
Locator Attachments
4
2
In the event the maxilla is dentate and the mandible is
edentulous, it is recommended to have – implants
placed on the mandible to avoid excessive resorption of
the posterior mandibular ridge
4
Implant Retained – Tissue Supported
* Issues Addressed
(4)
- Retention
- Chewing Efficiency
- Minimal increase in biting force
- Gag reflex
The Process
(3)
- Fabricate the denture first
- Utilize the denture to fabricate a radiographic and
surgical template - May use CAD/CAM fabricated template
Denture Duplication
- A denture duplicator flask is used to duplicate the
mandibular denture.
One side of the flask is filled with alginate
The denture is then placed in the flask so the cameo
surface is submerged in the alginate. (tooth side down)
Remove any alginate that may have covered the intaglio
surface of the denture.
The alginate should then be coated with Vaseline.
The other half of the flask is filled with alginate.
The flask is then closed and the nut is tightened to insure
the flask is fully closed
After the alginate has set, the flask is opened and the
denture is removed to reveal a negative impression of the
denture.
Clear orthodontic resin will be used to fabricate the
duplicate denture.
Mix acrylic resin with a 2:1 powder to liquid ratio and
fill both sides of the flask impression.
The flask is closed and locked while the resin sets.
The flask is opened to reveal the duplicated denture.
The duplicated denture is polished and a remount cast is
fabricated with plaster
Radiographic Template Fabrication
The duplicated denture is surveyed and the ideal areas for
implant placement are identified
The drill press is used to place the pilot holes in the
template
Pindex sleeves may be placed in the pilot holes.
The Pindex sleeves can then be filled with gutta-percha
for use in the CT scan.
Surgical Template Fabrication
The gutta-percha can be removed from the pindex
sleeves to fabricate the surgical template.
Surgical placement of Implants
(3)
- Ensure enough height is present per arch from the
collar of the implant* - Vertical alveoplasty may be needed
- Utilize 2 stage surgery
To construct an overdenture, vertical
restorative space should be assessed
in 2 distinct locations: sites where the
prosthetic teeth are located and more
palatally or lingually where implant
components are positioned.
For components, the absolute minimal
vertical space requirement is
7 mm:
- 2 mm height of locator
- 2.5 mm height of metal housing
- 2.5 mm acrylic thickness
The minimum needed horizontal space,
which is assessed apical to the most
inferior aspect of the prosthetic tooth,
needs to be approximately
10 mm.
This includes:
* 4 mm locator width
* 1 mm metal housing on each side of
the locator
* 2 mm acrylic buccally and lingually
Surgical placement of Implants
* Implant would have to be placed
— deep for a successful
outcome in this case.
* — can be done to
determine tissue height.
5-7mm
Bone sounding
Surgical placement of Implants
* Desired final outcome
* 10 by 10 guideline: suggests that
ideally, — mm is needed in both
vertical and horizontal
dimensions to offer enough
required restorative space
10
Locator abutment selection
* Measure tissue height from implant
platform
* — point determines abutment height
* Round — to closest abutment height,
never —
Highest
UP, down
Seat the denture in the mouth with the bite index and syringe material through vent
holes. Do one abutment at a time for approximately — minutes, always extrude
some material outside for control
10
Issues Addressed
(4)
- Retention
- Soreness or numbness on the ridge
- Pressure on the mental foramen
- Gagging
- Chewing efficiency and bite force
Implant Retained/Implant Supported
(4)
- Usually utilizes 4-6 implants connected by a bar
- Cost of the bar ($2500 to $4000)
- Retained by Hader clips or locators
- Supported by the bar and soft tissue
Implant Supported Dentures
A bar SHOULDN’T be cantilevered off
the most distal implant MORE THAN –
times the A-P distance of the implants.
1.5
Difference in A-P Distance
* Do NOT exceed – times the A-P distance of the implants for cantilevers.
* – should be the maximum length of the cantilever regardless of the A-P spread.
1.5
18mm
Fabrication Process
(3)
- Fabricate a transitional denture
- Conventional or immediate
- Duplicate the denture for a radiographic and surgical
template - Utilize 2 stage surgery
Fabrication Process
- Impress the implants and fabricate the bar
- Open vs. closed tray
- Fabricate the permanent dentures in a similar fashion
to conventional dentures
Fabrication Process
The restorative space is measured
lingual to the tooth position from the
implant platform to the external
surface of the prosthetic base.
For components, the absolute minimal
vertical space requirement is
11 mm:
- 2 mm soft tissue around the
abutment
- 1 mm soft tissue under the bar
- 5 mm for the bar and attachment
- 2.5/3 mm acrylic thickness
Bar:
(2)
- Advantageous when there is
excessive space between the
maxillary and mandibular arches
owing to differences in residual
risge trajectories, which result in a
horizontal prosthetic cantilever - Facilitate achieving ideal
parallelism of retentive elements
irrespective of implants
angulation.
Locator:
(4)
- Less space required
- Cheaper
- Easier to clean and maintain
- Increased retention
Fixed Implant Prostheses
(4)
- Most like natural teeth
- Excellent chewing efficiency and bite force
- Stronger than removable appliances
- Acrylic resin vs. metal and porcelain
- Decreased gagging and speech issues
Pink porcelain may be necessary to improve esthetic
issues associated with:
(3)
- High smile line
- Excessive bone loss
- Poor implant placement
Fixed Implant Process
(4)
- Detailed diagnostic wax-up
- Fabricate a radiographic template for a CBCT
- Utilize CAD/CAM surgical guide
- Place 6-8 implants per arch
Temporization
(3)
- Transitional Complete Denture
- Transitional Hybrid Denture
- Fixed Provisional FPD (Jet)
Final Prosthesis
Similar impression technique to single implants
* Closed tray -
* Open Tray-
should be used as a preliminary impression to
facilitate fabrication of verification Jig and Open Tray
copings
more accurate when multiple implants are
connected, if possible connect impression copings
Advantages of Hybrid Appliances
(5)
- Retention
- Support
- Chewing efficiency and bite force
- Gagging
- Cost (when compared to fixed options)
Conventional Hybrid Appliances
(3)
- Primarily utilize 4-6 implants
- Screw retained
- Can be resin (denture-like) or metal/porcelain
Conventional Hybrid Appliances
(2)
- Screw access covered with plumber’s tape (PTFE),
cotton, wax or impressions material then sealed with
acrylic resin or composite - Appliance can be unscrewed at maintenance
appointments if necessary
All on Four
Utilizes fewer implants (4) to retain and support a hybrid
appliance when inadequate bone height is present in the
posterior quadrants
An abutment-level hybrid prosthesis
requires at least
15 mm of vertical
restorative space.
To achieve such measurments it often
requires:
- Alveoplasty
- Increase of the VDO
Hybrid Provisional Appliances
(2)
- Interim conventional denture
- Hybrid Appliance
- Hybrid Appliance
(2)
- Utilize an existing denture
- Utilize a new denture
Fabricating the Hybrid Provisional
After the implants are placed seat provisional abutments
Cut holes in the denture to allow the abutments to pass
through passively without engaging the denture
Insure the denture seats completely
Use autopolymerizing resin to affix the provisional
abutments to the denture
After polymerization is complete, unscrew the appliance
and contour the intaglio surface
Torque the appliance to 15 Ncm and cover with
plumber’s tape and composite resin
