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SINGLE TOOTH IMPLAANT
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SINGLE TOOTH IMPLAANT

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Questions and Answers

What is the primary concern when dealing with mandibular first molar sites?

  • Mesio-distal distance being over 10 mm (correct)
  • Abutment selection
  • Occlusal plane being too narrow
  • Mesio-distal distance being less than 10 mm
  • What is the recommended diameter of the implant in this case?

  • 5 mm (correct)
  • 4 mm
  • 6 mm
  • 3 mm
  • Why were two 4 mm diameter implants placed in the first molar site?

  • Due to insufficient mesio-distal distance
  • To distribute the load more efficiently (correct)
  • Since the patient had bruxism
  • To reduce the risk of overloading
  • What type of restoration was fabricated in this case?

    <p>Screw retained PFM crowns</p> Signup and view all the answers

    What is the primary concern for occlusal guidelines?

    <p>Establishing light centric contact</p> Signup and view all the answers

    What is recommended for bruxors?

    <p>Night guards and over-engineering</p> Signup and view all the answers

    What should be considered while selecting an abutment?

    <p>Retrievability, amount of space, esthetics, occlusion, and ease of operation</p> Signup and view all the answers

    What is the minimum interarch distance recommended in the posterior sites?

    <p>4 mm</p> Signup and view all the answers

    When the ridge position dictates a lingual implant position, what might occur?

    <p>Buccal cantilevering of the restoration</p> Signup and view all the answers

    What is the ideal crown/implant ratio for sound biomechanics?

    <p>1:1</p> Signup and view all the answers

    Why is the prognosis of adjacent teeth important in implant placement?

    <p>To identify potential implant failure due to adjacent pathology</p> Signup and view all the answers

    What should be reviewed to identify deficits that might impact the esthetic outcome?

    <p>Soft tissue contours and levels</p> Signup and view all the answers

    What should be carefully analyzed to understand the occlusal pattern?

    <p>Wear facets</p> Signup and view all the answers

    What might occur if the position of adjacent teeth is not addressed properly?

    <p>Functional and esthetic problems</p> Signup and view all the answers

    What is the minimum distance required between the natural tooth and the implant for viable bone and papilla?

    <p>1.5 mm</p> Signup and view all the answers

    What is the consequence of a distally placed implant when chewing force is applied at the mesial?

    <p>Screw loosening and fracture</p> Signup and view all the answers

    For screw-retained restorations, where should the faciolingual position of the anterior implant be aligned?

    <p>Under the cingulum of the proposed crown</p> Signup and view all the answers

    What is the primary goal of centering the implant mesiodistally?

    <p>Minimizing cantilevering effect</p> Signup and view all the answers

    Why is it essential to ensure accurate implant positioning?

    <p>To achieve a natural tissue contour</p> Signup and view all the answers

    In posterior implant placement, where should the faciolingual position of the implant be aligned?

    <p>Centered faciolingually</p> Signup and view all the answers

    What is the consequence of a faulty mesiodistal implant placement?

    <p>Lack of sufficient space between the tooth and the implant</p> Signup and view all the answers

    What is the primary purpose of evaluating the adjacent teeth in implant restoration?

    <p>To rule out pathology and assess the integrity of restorations</p> Signup and view all the answers

    How does the rotation of #10 affect the papilla height and contact position?

    <p>It decreases papilla height and causes less than ideal contact position</p> Signup and view all the answers

    What type of restoration transmits more forces on the implant?

    <p>Fixed restoration</p> Signup and view all the answers

    Why is it essential to evaluate the occlusal scheme in implant restoration?

    <p>To plan the centric and laterotrusive contacts</p> Signup and view all the answers

    What is the purpose of a diagnostic prototype in the missing tooth site?

    <p>To visualize the proposed restoration</p> Signup and view all the answers

    What is the significance of a surgical template in implant restoration?

    <p>It guides successful placement of the implant</p> Signup and view all the answers

    What is the purpose of barium sulfate mixed with clear acrylic in the surgical template?

    <p>To provide radio opaque marking during tomographic imaging</p> Signup and view all the answers

    Why is it essential to maintain harmonious gingival levels in implant restoration?

    <p>To ensure optimal esthetic outcome</p> Signup and view all the answers

    What is the potential impact of a compromised tooth opposed by a rigid implant restoration on the canine guidance?

    <p>It negatively impacts the canine guidance</p> Signup and view all the answers

    What is the minimum interarch distance recommended in the anterior sites?

    <p>2 mm</p> Signup and view all the answers

    What may cause overloading of the implant when the ridge position dictates a lingual implant position?

    <p>Buccal cantilevering</p> Signup and view all the answers

    Why is the prognosis of adjacent teeth important in implant placement?

    <p>To identify potential implant failure due to adjacent pathology</p> Signup and view all the answers

    What should be carefully matched for good esthetic results in the anterior region?

    <p>Size of the missing tooth space with the contralateral tooth</p> Signup and view all the answers

    What is the ideal crown/implant ratio for sound biomechanics?

    <p>1:1</p> Signup and view all the answers

    What is the primary factor in evaluating the prognosis of adjacent teeth in implant restoration?

    <p>Assessing the integrity of the restorations</p> Signup and view all the answers

    What is the primary purpose of analyzing the study casts in implant restoration?

    <p>To analyze the edentulous site and adjacent structures</p> Signup and view all the answers

    Why is it essential to maintain harmonious gingival levels in implant restoration?

    <p>To ensure optimalesthetic outcome</p> Signup and view all the answers

    What is the primary purpose of the surgical template in implant restoration?

    <p>To guide successful implant placement</p> Signup and view all the answers

    What is the consequence of a faulty mesiodistal implant placement?

    <p>It compromises the prognosis of adjacent teeth</p> Signup and view all the answers

    What occurs when an implant is placed too far beneath the gingiva?

    <p>The risk of peri-implantitis and progressive bone loss around the implant is increased.</p> Signup and view all the answers

    What is the ideal location for the head of the implant in relation to the adjacent gingival margin?

    <p>2-4 mm below the adjacent gingival margin</p> Signup and view all the answers

    What is the purpose of creating an emergence profile from the implant's round form to a natural tooth's elliptical form?

    <p>To achieve natural esthetics</p> Signup and view all the answers

    What technique is employed to raise a flap for tissue esthetics in implant placement?

    <p>Papilla preservation technique</p> Signup and view all the answers

    What is the direction of the osteotomy in screw-retained restorations?

    <p>Through the cingulum</p> Signup and view all the answers

    What is the primary consequence of a distally placed implant when chewing force is applied at the mesial?

    <p>Mesial lever arm and increased risk of screw loosening</p> Signup and view all the answers

    What is the recommended faciolingual position of the anterior implant for cement retained restorations?

    <p>Under the incisal edge</p> Signup and view all the answers

    What is the minimum distance required between the natural tooth and the implant to ensure viable bone and papilla?

    <p>1.5 mm</p> Signup and view all the answers

    Why is it essential to center the implant mesiodistally?

    <p>To minimize cantilevering effect and create a normal emergence profile</p> Signup and view all the answers

    What is the consequence of a faulty mesiodistal implant placement?

    <p>Cantilevering effect and altered emergence profile</p> Signup and view all the answers

    What is an advantage of a cement retained restoration over a screw retained restoration?

    <p>Less technique sensitivity in laboratory procedures</p> Signup and view all the answers

    What is a disadvantage of a screw retained restoration?

    <p>Presence of a visible screw access hole</p> Signup and view all the answers

    What is a consideration in selecting an abutment for a screw retained restoration?

    <p>Facial or lingual screw access</p> Signup and view all the answers

    What is a consequence of a faulty abutment selection for a screw retained restoration?

    <p>Unesthetic restoration</p> Signup and view all the answers

    Why is it essential to consider the patient's smile line when selecting an abutment for a screw retained restoration?

    <p>To hide the screw access hole</p> Signup and view all the answers

    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.

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