Partially Edentulous Patients Flashcards
Cement Retained
Use of — as a final cement for implant
supported cement retained restorations
TempBond
Retrievability -
Radiographic Detection
— demonstrated the highest
grey level values for the cements tested.
TempBond (zinc oxide with eugenol)
- All cements containing zinc (TempBond, TempBond NE, Fleck’s)
could be
detected radiographical
- Undetected excess cement is a major concern of cement retained prostheses due to its strong association to —
periimplantitis
— washes away over time and the restoration will become loose. This creates some
problems and may compromise the implant as well.
- TempBond (zinc oxide with eugenol)
- The — of cements have increased radiopacity
new generation
- — Resin based cements are the most radiolucent and difficult to detect radiographically, the hardest to retrieve, most
difficult to remove excess, and the majority contain fluoride (associated to titanium corrosion), and should therefore be avoided
whenever possible
Definitive
- Implant Resin based cements are specifically made for
implant prostheses, combining radiopacity, resistance to wash-out and
secure retention, improved retrievability and non fluoride formulation (Ex: Premier Implant Cement; Telio CS CEM Implant)
- — is to use a cement that is as radiopaque as possible, take precautions to avoid any excess during cementation, and
insure retrievability of the prostheses
Bottomline
Implant Position in Partially Edentulous Patient
* only when the implants are in
native (not grafted) bone
Implant Supported Cantilevered Fixed
Dental Prosthesis(ICFDP)
When a force is applied to the cantilever by
an opposing tooth (vertical white arrow), the
approximate center of the terminal implant
acts as a —, and the approximate
center of the mesial implant acts as the
—
fulcrum (F)
resistance (R)
Technical complications associated with ICFDP
(5)
- Implant Fractures
- Veneer Fracture
- Abutment Screw Fracture
- Screw Loosening
- Loss of Retention
Recommendations for treatment with ICFDPs
(10)
- Number, diameter, length and position of implants.
- Mesiodistal length of the cantilever (premolar size).
- Dimensions of the connector.
- Preloading (tightening of the screw/torque to the manufacturers’
recommendations) - Technological improvements to implant components and design
(wider implants more bone to implant contact / stronger walls). - Occlusion and occlusal prosthesis material
(infra occlusion, low cusp height, narrow occlusal table). - Retention of abutment crowns (maximum wall length, minimum taper)
- Fit of prosthesis (passive fit).
- Precautions regarding patients with bruxism (avoid ICFDP in bruxers).
- Mesial cantilever is more favorable than distal (less force, class III lever system)
Greenstein et al. Cantilevers extending from unilateral implant-supported fixed prostheses: a review of the literature and presentation of practical guidelines. JADA 2010 Oct; 141(10): 1221-30
Implant Supported Cantilevered Fixed
Dental Prosthesis(ICFDP)
Unilateral, short-span ICFDP is a predictable and dependable
solution for the restoration of a — of the
mouth when there is a lack of bone to support an implant or there
are anatomical structures that need to be avoided.
partially edentulous area
Recommendations for treatment with ICFDPs
* Implant supported distal cantilever prostheses,
have —% implant survival rate
95
Technical Problems
(8)
- Implant fracture
- Tooth intrusion
- Intrusion of teeth with telescopic crown
- Cement bond breakdown
- Abutment tooth fracture
- Abutment screw loosening
- Fracturing of veneers
- Prosthesis fracture
Biologic Problems
(6)
- Peri-implantitis
- Endodontic problems
- Loss of an abutment tooth
- Loss of an implant
- Caries
- Root fracture
Clinical Recommendations for Tooth-Implant Supported FPD (TISP)
(12)
- Select healthy teeth—periodontally stable and in dense bone.
- Rigidly connect the tooth and implant (no stress breakers), employ large solder joints to enhance rigidity, or use one-piece
castings. - Avoid telescopic crowns (no copings).
- Provide retention form with minimal taper of axial walls on abutment teeth. Enhance resistance form with boxes and
retention grooves if the clinical crown is not long.
Greenstein G. et al. Connecting teeth to implants: A critical review of the Literature and Presentation of Practical Guidelines. Compendium 2009, Vol 30, Number 7
Do we connect teeth with implants ? - Parallel the implant abutment to the preparation of the tooth and use a rigid connection.
- Use permanent cementation (no screw retention or temporary cementation).
- The bridge span should be short. Preferably, place one pontic between two abutments. However, with additional tooth
or implant support or cross-arch stabilization, additional pontics can be used. - Occlusal forces should be meticulously directed to the opposing arch.
- In general, do not use TISPs in patients with parafunctional habits. If they are treated with TISPs, overengineer the case
by maximizing the number of implants and splinting. - Cantilever extensions should be used cautiously; however, they may be employed when tooth or implant support is
adequate (E.g. cantilever-implant-implant- pontic-tooth-tooth). - TISPs in patients with uncontrolled caries should be avoided; ISPs are preferred.
- Pulpless teeth with extensive missing coronal tooth structure or root canal anatomy that is inadequate to predictably retain
a core or post and core should not be used in a TISP
Teeth
CRR=
0.5(1:2)
– is minimum clinically acceptable ratio
1:1
Prime indicator of the long-term prognosis of a given tooth.
CRR
Class – lever for evaluating abutment teeth with the fulcrum lying in
the middle portion of the root residing in alveolar bone
I
has no implication on the success of the final restoration
CIR (crown to implant ratio)
The main implication when using shorter implants is that any amount
of — may compromise the implant
bone loss
When utilizing short implants for FDPs, it is reccomended to use
one
per tooth if possible and to splint them together.
