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Questions and Answers
What is the primary concern when dealing with mandibular first molar sites?
What is the recommended diameter of the implant in this case?
Why were two 4 mm diameter implants placed in the first molar site?
What type of restoration was fabricated in this case?
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What is the primary concern for occlusal guidelines?
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What is recommended for bruxors?
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What should be considered while selecting an abutment?
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What is the minimum interarch distance recommended in the posterior sites?
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When the ridge position dictates a lingual implant position, what might occur?
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What is the ideal crown/implant ratio for sound biomechanics?
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Why is the prognosis of adjacent teeth important in implant placement?
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What should be reviewed to identify deficits that might impact the esthetic outcome?
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What should be carefully analyzed to understand the occlusal pattern?
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What might occur if the position of adjacent teeth is not addressed properly?
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What is the minimum distance required between the natural tooth and the implant for viable bone and papilla?
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What is the consequence of a distally placed implant when chewing force is applied at the mesial?
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For screw-retained restorations, where should the faciolingual position of the anterior implant be aligned?
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What is the primary goal of centering the implant mesiodistally?
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Why is it essential to ensure accurate implant positioning?
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In posterior implant placement, where should the faciolingual position of the implant be aligned?
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What is the consequence of a faulty mesiodistal implant placement?
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What is the primary purpose of evaluating the adjacent teeth in implant restoration?
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How does the rotation of #10 affect the papilla height and contact position?
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What type of restoration transmits more forces on the implant?
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Why is it essential to evaluate the occlusal scheme in implant restoration?
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What is the purpose of a diagnostic prototype in the missing tooth site?
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What is the significance of a surgical template in implant restoration?
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What is the purpose of barium sulfate mixed with clear acrylic in the surgical template?
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Why is it essential to maintain harmonious gingival levels in implant restoration?
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What is the potential impact of a compromised tooth opposed by a rigid implant restoration on the canine guidance?
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What is the minimum interarch distance recommended in the anterior sites?
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What may cause overloading of the implant when the ridge position dictates a lingual implant position?
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Why is the prognosis of adjacent teeth important in implant placement?
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What should be carefully matched for good esthetic results in the anterior region?
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What is the ideal crown/implant ratio for sound biomechanics?
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What is the primary factor in evaluating the prognosis of adjacent teeth in implant restoration?
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What is the primary purpose of analyzing the study casts in implant restoration?
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Why is it essential to maintain harmonious gingival levels in implant restoration?
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What is the primary purpose of the surgical template in implant restoration?
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What is the consequence of a faulty mesiodistal implant placement?
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What occurs when an implant is placed too far beneath the gingiva?
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What is the ideal location for the head of the implant in relation to the adjacent gingival margin?
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What is the purpose of creating an emergence profile from the implant's round form to a natural tooth's elliptical form?
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What technique is employed to raise a flap for tissue esthetics in implant placement?
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What is the direction of the osteotomy in screw-retained restorations?
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What is the primary consequence of a distally placed implant when chewing force is applied at the mesial?
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What is the recommended faciolingual position of the anterior implant for cement retained restorations?
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What is the minimum distance required between the natural tooth and the implant to ensure viable bone and papilla?
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Why is it essential to center the implant mesiodistally?
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What is the consequence of a faulty mesiodistal implant placement?
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What is an advantage of a cement retained restoration over a screw retained restoration?
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What is a disadvantage of a screw retained restoration?
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What is a consideration in selecting an abutment for a screw retained restoration?
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What is a consequence of a faulty abutment selection for a screw retained restoration?
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Why is it essential to consider the patient's smile line when selecting an abutment for a screw retained restoration?
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Study Notes
Treatment Planning
- Biomechanical considerations for mandibular first molar sites: mesio-distal distance should be carefully studied, especially when it's over 10 mm (e.g., 12 mm in this case).
- Placement of a wide body implant (5 mm diameter) along with narrowing the occlusal plane can compensate for overloading.
- Two 4 mm diameter implants can be placed in the first molar site with over 12 mm mesiodistal distance, and a splinted restoration can be fabricated using custom abutments and screw-retained PFM crowns.
Occlusal Guidelines
- Light centric contact should be established.
- Shim stock should only be grasped when the musculature is fully engaged.
- Eccentric contacts should be avoided.
- Over-engineering and night guards are suggested for bruxors.
- Mild cusp heights are preferable to avoid bending moments and load magnification.
Abutment Selection Guidelines
- Screw or cement retained implant restorations can be fabricated.
- Various reasons (retrievability, amount of space, esthetics, occlusion, ease of operation, etc.) can be considered in choosing one over the other option.
- The decision should be made prior to the placement of the implant, as the position of the implant might be slightly different in each option.
Diagnosis - Clinical Evaluation
- Residual edentulous space: interarch distance should be minimum 2 mm in anterior sites and 4 mm in posterior sites.
- Mesio-distal distance should be about 7 mm.
- When there is over 10 mm of distance, implant size and number should be carefully considered to avoid implant overloading.
- Crown/implant ratio should be kept to 1:1 for sound biomechanics.
Adjacent-Teeth Clinical Evaluation
- Prognosis of the adjacent teeth is very important for avoiding potential implant failure inflicted from adjacent pathology.
- Soft tissue contours and levels should be reviewed to identify any deficits that might have direct impact on the esthetic outcome.
- Position of the adjacent teeth (rotated, tilted, out of curve, extruded, intruded) along with position of proximal contacts can cause functional and esthetic problems if not addressed properly.
- Wear facets should be carefully analyzed to understand the occlusal pattern.
Surgical Placement
- Biomechanical success and restoration/tissue esthetics depend on the correct positioning of the implant in the bone.
- Implant should be centered mesiodistally for minimizing cantilevering effect and creating normal emergence profile.
- Accurate implant position provides natural tissue contours.
- Faciolingual position of the anterior implant should be aligned under the cingulum of the proposed crown for screw-retained restorations and under the incisal edge for cement-retained restorations.
- Posterior implant should be centered faciolingually for reducing the potential for overloading.
Restorations and Materials
- Restorations and materials on the adjacent teeth would assist in designing the optimal implant restoration.
- Prognosis of endodontically treated teeth should be assessed and pathology should be ruled out.
- Integrity of the restorations should be examined.
- Existence and maintenance of harmonious gingival levels provide esthetic outcome.
Diagnosis - Opposing Teeth
- Plane of occlusion and occlusion play an important role on the loads exerted on the implant restoration.
- Occlusal scheme should be carefully evaluated for planning the centric and laterotrusive contacts.
- Type of restoration; Fixed would transmit more forces than the removable restoration.
Study Casts
- Edentulous site along with the adjacent structures can be analyzed in detail on the casts.
- Diagnostic prototype in the missing tooth site would help visualize the proposed restoration.
- Location and alignment of the proposed implant can be studied through the diagnostic work up.
Surgical Template
- It is used for imaging and surgical purposes.
- Fabricating a good template would enhance the diagnostic value of imaging and then guide successful placement of the implant.
- The template contains barium sulfate mixed with clear acrylic at the missing tooth site for radio-opaque marking during tomographic imaging.
Diagnosis - Clinical Evaluation
- Residual edentulous space:
- Minimum 2 mm interarch distance in anterior sites and 4 mm in posterior sites
- Mesio-distal distance should be approximately 7 mm
- Implant size and number should be carefully considered to avoid overloading
- Buccal cantilevering might cause overloading due to off-axial loads
- Crown/implant ratio should be kept to 1:1 for sound biomechanics
Adjacent Teeth Clinical Evaluation
- Prognosis of adjacent teeth is very important for avoiding potential implant failure
- Soft tissue contours and levels should be reviewed to identify any deficits that might impact esthetic outcome
- Position of adjacent teeth (rotated, tilted, out of curve, extruded, intruded) can cause functional and esthetic problems if not addressed properly
- Wear facets should be carefully analyzed to understand the occlusal pattern
- Restorations and materials on adjacent teeth would assist in designing the optimal implant restoration
Opposing Teeth Clinical Evaluation
- Plane of occlusion and occlusion play an important role in the loads exerted on the implant restoration
- Occlusal scheme should be carefully evaluated for planning centric and laterotrusive contacts
- Type of restoration (fixed or removable) affects the transmission of forces to the implant
- Prognosis of compromised teeth might be negatively impacted when opposed by rigid implant restoration
Study Casts
- Edentulous site and adjacent structures can be analyzed in detail on the casts
- Diagnostic prototype in the missing tooth site helps visualize the proposed restoration
- Location and alignment of the proposed implant can be studied through the diagnostic work-up
Surgical Template
- Used for imaging and surgical purposes
- Fabricating a good template enhances diagnostic value of imaging and guides successful implant placement
- Template contains barium sulfate mixed with clear acrylic at the missing tooth site for radio-opaque marking during tomographic imaging
Surgical Placement
- Biomechanical success and restoration/tissue esthetics depend on correct positioning of the implant in the bone
- Optimal 3-D position of implant can be achieved by:
- Centering mesiodistally for minimizing cantilevering effect and creating normal emergence profile
- Avoiding faulty mesiodistal implant placement (lack of sufficient space between tooth and implant)
- Achieving faciolingual position under the cingulum of the proposed crown for screw-retained restorations and under the incisal edge for cement-retained restorations
- Centering posterior implant for reducing potential for overloading
- Creating emergence profile from implant's round form to natural tooth's elliptical form for achieving natural esthetics
- Positioning the head of the implant 2-4 mm below the adjacent gingival margin
- Faulty implant placement can lead to esthetic harmony issues, bone loss, and peri-implantitis
Surgery - Implant Placement
- Flap is raised by employing papilla preservation technique for tissue esthetics
- Osteotomy is oriented through the cingulum for screw-retained restoration
Screw-Retained UCLA Abutment Restoration (Two-Piece)
- Resin pattern of custom abutment which changes the direction of the implant long axis
- Full-contour wax pattern of custom labially inclined implant abutment
- Metal coping for the second piece fits over the first piece, and a PFM crown is placed
Abutment Selection
- Cement-retained restoration can also be fabricated as an alternative
- Advantages: more esthetic, especially at posterior sites, and similar to conventional crown
- Disadvantages: risk of leaving cement in the sulcus, not being able to seat the crown due to hydraulic pressure, and increased need for space to accommodate two-piece restoration
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Description
This quiz covers biomechanical considerations in dental implant treatment planning, specifically for mandibular first molar sites. It discusses the importance of measuring the mesio-distal distance and placement of wide body implants.
