jacobson - last one Flashcards
why CBCT?!
so many reasons
Like anterior loo ● Is instead of the mental foramen turning out ● It just like turns in on intself You could have double mental foremant ● And theres like two The nerve can go through the roots Impacted wisdom teeth ● Can be hugging the inferior alveolar nerve ● So thir dmolar removal you need it Sinus septae ● Like oyu can have it neraby Superficial IAN ● If its like right on the ridge ● You will have major ain ● Whenever you touch the gingiva
You can have impacted teth
● And you will have a better idea of where the impacted teeth are
● You can find where nerves are in the jaw
● Like you can map where the impacted teeth
anterior loop
with mental foramen
- can seem like theres 2
can like turn out
CBCT can show you this
so want to stay within 5mm
2 mm anterior
3 mm above
superficial IAN?
like can come up closer to the tooth
poses complication
need CBCT
study with complications #1?
complications due to extractions
TOTAL CASES = 63
INFECTIONS severed lingual nerve IAN nerve sinus perforation fractured mandible TMJ injuries extraction of wrong teeth
study with complications #2?
endodontic procedures
total cases = 41
infections instruments broken nerve damage sinus stuff etc
study with complications #3? ***
dental implant surgery
25 cases
unrestorable implants placed implants interferring with nerves implant loss post op infection fracture jaw
third most common alleged negligence involved?
dental implant surgery
4 complication
complications due to crown and bridge treatment
universal lack of treatment planning in these cases
20 total cases
5 complication
alleged negligence was failure to diagnose or treat perio disease in a timely fashion
- x rays were not taken and perio probing not recorrded
19 cases
important component of the informed consent
that the patient understands that no tx is also an option
but this document basically spells out everything that the patient needs to know
informed consent say no method to
My doctor has explained that there is no method to accurately predict the gum and the bone healing capabilities in each patient following the placement of the implant.
refund in informed consent?
no
Replacement will be made at fee for costs or replacement components only. There will be no refund in the case of failure
if fails within first year?
consent says will look at it
- re- evaluate and maybe do it for free
witness on informed consent
yes
T/F never attach to the natural tooth
true
one implant one tooth
single standing implant no shorter than?
10 mm
minimum of ___ of bone around the implant
minimum 1 mm of bone around the implant
diameter f implant?
should be close to diameter of the tooth being replaced
what makes a cement retained retrievable
add the retrievable knob and cement with temporary cement
breakdown of complete dentures
bars
studs
abutment selection
posterior - not as important but in the anteior - becomes v important in terms of esthetics
color of abutment??
color of abutment has no effect on color of all ceramic crown is the ceramic is at least 1.6 mm thick
cement / screw crown
yes an option for single tooth replacement
T/F splinted can be screw retained and cement retained
true
hybrids are always
screw retained
implant abutments for fixed restorations
custom made
pre fab
- can be angulated or non angulated
or non prepable or prepable
one piece implants
custom made abutments?
UCLA
CAD-CAM
can be metal or porcelain?
CAD CAM use?
custom made abutments this way
crown materials
PFM vs lithium disilicate vs zirconia
abutment material (main ones)
titanium vs zirconia
he said he perfers titanium
the color of ___ restoration is not affected by the abutment color if there is ___ thickness
● COLOR O ABUTMENT HAS NO EFFECT ON COLOR OF ALL CERAMIC CROWN S
● IF THE CERAMIC IS AT LEAST 1.6MM THICK
if EMPRESS – no effect if 1.5 mm
which abutments are stronger
titanium abutments > than ceramic abutments
__ could lead to substantial strength degradation and reduced reliability of prefac zirconia
grinding
fracture strenghts of metal cermic crowns on cemented titanium abutments vs ceramic crowns cemented on milled abutments?
fracture strengths are higher regardless of loading direction
indication for implant over denture
these are removable prosthesis (bar or stud retained)
- sever ridge resorption
- knife edge ridge
- palatal defect
- severly atrophic maxillae
- financial limitations
breakdown ofimplant supported restorations for completely edentulous
fixed
- metal ceramic implant supported FPD
- cement retained
- screw retained - fixed complete denture = HYBRID
REMOVABLE
- implant overdenture
- bar retained
- stud attachment
advantages of implant overdentures
hygeine access (number 1 benefit)
lip and facial support
ease of repair
economics
contraindications to implant overdentures
patient is comfortable with complete dentures and has no complaints
residual ridge is not adequate for the standard placement of implants
general health conditions do not allow a minor surgical intervention
theray with immunoscompromised , long standing intake of corticosteroids
metabolic disease not under control
first disadvantage of implant over dentures
having to take it out all the time
pschological more post insertion maintenance - attachments - denture base - artificial teeth
Overdenture needs more post insertion maintaince:
The attachment might loss its retention or becomes losse or get fracture
The denture base will need to reline and repair with time
And the denture teeth will wear down or pump out with the time and will need to be changed
implant over dentures advantages over fixed prosthesis
fewer implants improved esthetics soft tissue considerations less costly transitional prosthesis
fixed denture prosthesis needs transitional?
yes
design principles for implant supported over denture depends on what 4 factors
- number of implants
- type of support
- distribution of implants
- attachment system
7 year survival of implant overdenture with 2 vs 4 implants on maxilla
76 % vs 99.3% when used 2 vs 4 respectively
breakdown of attachment system
which to use?
bar
- most retentive with least mechanical complications
stud
- intermediate retention but more mechanical complications
magnets
- lowest retentino and limited denture stability
breakdown of stud attachment
ball attachment
- there are ball attachment which the male part is on the implant
- the male part is on the implant and the retention comes from the o-ring
locator
-which the female in screw on the implant
retention comes from where on the ball attachment
under the stud attachments
comes from the o - ring
the male part is on the implant
locators
part of the stud attachment options
The Locator attachment features a denture component with a skirt that easily locates the
mating implant abutment. This self-aligning feature of the attachment aids the patient
in seating their prosthesis in a similar manner as a guide plane created by a milled bar
OT bar falls under the
bar clip attachments
OT bar is basically U shaped
hader bar details
Hader clips come in different retention. the clip damage is usually found in this type. It is because there is a little ledge coming out from the housing, everytime pt put in and take out the denture, this ledge can be distorted easily. Finally it will break.
bar or stud depends on?
how?
SPACE available
- need to do a space assessment to know which type of attachment we can do
space assessment
The way how we do the space assessment is by doing a teeth set-up, as regular steps of making a complete denture, then we dewax them, and see how much space we have from the mucosa to the occlusal/incisal surface of the teeth
space needed for stud
8-10 mm
from the mucosa to the occlusal table
space needed for bar attachment
14-16 mm
mechanical problems associated with verdentures
loss of screws
breakage
accelerated wear of acrlyic resin artifical teeth
- Goodacre in 2003 did a study for evaluating the mechanical implant complication / failure and what he found is that
loss of retention / adjustment = 30%
denture relines = 19%
overdenture clip and attachment fracture which was = 17%
goodcare also found main problems with implant loss?
maxillary over denture had highest amount of implant loss at 19% vs
mandibular at 4%
2010 did a study to evaluated the effects of implant design and attachment type on marginal bone loss in implant-supported overdentures, and they stated that
no difference in marginal bone loss around implants retaining / supporting mandibular OVERDENTURES relative to implant type or attachment designs
advantages of fixed complete dentures
more efficient / improved function
more psychologically acceptable
less potential for sore spots
MAINTENANCE OF ALVEOLAR BONE
less prosthetic maintenance
not subject to mishandling
disadvantages of fixed complete dentures
cost
more implants
may have esthetics and phonetics problems
more difficult to clean for the maxilla
contraindications for fixed complete dentures
off ridge relation
esthetic concerns
phonetic concerns
hygeine considerations
cost
fixed complete dentures require how many implants in maxilla
6
The reason for placing more implants in the maxilla is related to the challenges that can be encountered due to bone resorption patterns in the edentulous maxilla, it is more likely that the implants will not be located directly beneath the prosthetic teeth or they will be facially inclined, thereby placing unfavorable forces on the implants
fixed complete dentures require how many implants in mandible?
mental foramina?
5
It has been determined that up to 4-5 implants can be placed between the two mental foramina since the mean circumferential distance between these 2 landmarks is 47 millimeters. According to Pokorny and others.
number or distribution is more important in the mandible for imlpants
DISTRIBUTION
A-P spread on maxilla for fixed compelte denture
10 mm
Antero-posterior spread is the distance between the center of the most anterior implants and line drown through the center of the two most posterior implants. To ensure the mechanical integrity of the final prosthesis, the A-P spread should be at least 10mm, For the maxilla, a cantilever of 10 mm (the dimension of the mandibular bicuspids) is possible .
mandibular implant distance
14-16 mm from center to center
case planning
diagnostic wax up
surgical template
CT scan
surgical phase
prosthetic phase
most common complications associated with implant fixed complete dentures
- max implant loss 10%
- prosthesis screw loosening 8%
- gingival inflammatin / proliferation
- implant dehiscence prior to surgical uncovery 6%
- metal framework fracture 6%
