Prosthodontics Lecture 1: Dental Implants History

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Questions and Answers

What is one of the primary mechanical complications associated with implants?

  • Allergic reaction
  • Implant migration
  • Porcelain fracture (correct)
  • Bone resorption

Which factor is NOT considered in Misch’s treatment planning approach?

  • Implant marketing strategies (correct)
  • Bone density in edentulous areas
  • Available bone in edentulous areas
  • Prosthesis design

What is the expected impact of cantilever designs in implant cases?

  • Increased long-term stability
  • Accumulation of stress on the anterior implant (correct)
  • Reduction of stress on adjacent implants
  • Decreased overall treatment costs

Which of the following is a biomechanical factor that may contribute to implant failure?

<p>Excessive stress transmission (C)</p> Signup and view all the answers

What is the failure rate for implants placed in soft bone regions shorter than 10 mm?

<p>15% (C)</p> Signup and view all the answers

What is a recommended approach when treating an edentulous mandible with weak bone?

<p>Increase the number of implants (D)</p> Signup and view all the answers

Which position is considered ideal for key implants in an edentulous maxilla treatment plan?

<p>2 first molars, 2 canines, 1 central incisor (B)</p> Signup and view all the answers

What is a disadvantage of independent crowns compared to splinter crowns?

<p>Higher risk of marginal bone loss (D)</p> Signup and view all the answers

What should be prioritized to manage stress in an implant treatment plan?

<p>Positioning implants posteriorly (A)</p> Signup and view all the answers

In terms of masticatory dynamics, which aspect do splinter crowns improve?

<p>Increased AP spread (D)</p> Signup and view all the answers

What is the ideal diameter for a single-tooth implant when considering adjacent teeth?

<p>At least 1.5 mm away from adjacent teeth. (B)</p> Signup and view all the answers

Which of the following statements about the use of resin-bonded prostheses in the aesthetic zone is accurate?

<p>They are commonly used during the implant healing period. (D)</p> Signup and view all the answers

What is the recommended diameter for an implant when replacing a first molar that has a mesiodistal size of 10 mm?

<p>5-6 mm. (B)</p> Signup and view all the answers

Which factor is crucial in determining the implant's placement diameter in relation to the buccolingual dimension of bone?

<p>It should be 3 mm narrower than the buccolingual dimension of the bone. (C)</p> Signup and view all the answers

What is typically necessary before placing maxillary premolar implants?

<p>Bone grafting is often required. (C)</p> Signup and view all the answers

What occurs if a cantilever of 4-5 mm is created at the marginal ridge of a crown due to incorrect implant selection?

<p>Not considered a good outcome. (D)</p> Signup and view all the answers

Which treatment planning method is optimal when the mesiodistal space is between 12-14 mm?

<p>Enamelplasty and orthodontic treatment. (D)</p> Signup and view all the answers

What is a common challenge when placing implants, particularly concerning abutment screws?

<p>Loosening of abutment screws is a frequent issue. (D)</p> Signup and view all the answers

Flashcards

Implant treatment ideal

Short procedure time, affordable cost, reduced surgical steps, increased patient comfort, higher acceptance, and fewer potential complications.

Implant failure risk (soft bone)

Implant failure is 15% higher in areas of soft bone regions less than 10 mm deep.

Biomechanical implant factors causing issues

Excessive stress (high biting forces), male gender, bruxism (teeth grinding), opposing implant supported structures, and group function occlusion. These factors can hurt implants.

Maxillary posterior implant limitations

Maxillary posterior implants need to be less than 6 mm in depth for a successful treatment plan.

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Treatment cost comparison (Max posterior)

In the posterior maxillary area, a sinus lift with 3 implants is cheaper than 2 implants and a cantilever, but the 2 implant/ cantilever approach might be more successful.

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D1 bone: Ideal implant placement?

D1 bone offers the best results for implant placement due to excellent bone contact and favorable titanium elastic modulus.

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Weak bone: Implant strategy?

When bone is weak, consider using more implants or increasing their diameter to distribute forces more effectively.

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Edentulous mandible: Implant count?

A minimum of 5 implants are typically required for an edentulous mandible, with at least 4 between the mental foramina.

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Independent crowns: Advantages?

Independent crowns offer hygienic advantages, individual repair options, and avoid compatibility issues with splinted designs.

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Splinted crowns: What's the benefit?

Splinted crowns enhance support, increase retention, facilitate prosthesis removal, and reduce risks associated with implant failure.

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RPD Temporary Prostheses

Resin-bonded prostheses used as temporary replacements during implant healing in aesthetic areas.

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Implant Abutment Loosening

A common problem with dental implants, often leading to the loosening of the connecting screw.

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Anti-Rotational Implant Features

Features built into dental implants designed to prevent them from rotating in the jawbone.

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Ideal Implant Diameter

The optimal size of a dental implant, determined by the width of the missing tooth and surrounding bone.

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Premolar Implant Placement

First premolars are the most suitable posterior teeth to be replaced with an implant, often requiring bone grafting.

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First Molar Implant Replacement

Replacing lost first molars with implants, which need implants with larger diameters.

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Implant Diameter to Tooth Size Ratio

Maintaining a critical gap between the implant diameter and the tooth width to avoid significant cantilevers with an optimum implant size.

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Bone Stimulation for Implant Placement

Procedures designed to encourage bone growth and support implant stability in the jawbone.

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Study Notes

Prosthodontics - 2nd Committee - 1st Lecture: History and Components of Implants

  • Branemark's Research: Swedish orthopedic professor, Branemark, observed revascularization in rabbit fibula in 1952 via light microscopy.
  • Osseointegration: Implant directly contacts bone in 1965. First dental implant placed on an edentulous patient.

Types of Dental Implants

  • Subperiosteal: Metal framework placed on jawbone, posts protrude above gum tissue.
  • Transosteal: Metal framework below gum tissue, posts run through jawbone.
  • Endosteal: Metal framework inserted within jawbone.
    • Cylinder
    • Blade
    • Screw

Implant Indications

  • Tooth loss
  • Congenital tooth absence
  • Poor oral muscle coordination
  • Discomfort from removable dentures

Implant Applications

  • Single tooth replacement
  • Partial/complete edentulism
  • Maxillofacial prosthetics
  • Craniofacial prosthetics

Implant Components

  • Implant body:
    • Titanium screw-shaped
    • Hydroxyapatite-coated screw-shaped
    • Titanium plasma-sprayed cylinder
    • Hydroxyapatite-coated cylinder
    • Types: Smooth, machined, textured, coated
  • Crown, abutment, abutment screw

Implant Abutments

  • Stock, tissue level, straight, angled, bone level, custom, milled, UCLA, locator, screw-retained, cemented, temporary.
  • Tissue level abutments are closely related to the implant platform.
  • Bone-level abutments are closely related to the abutment platform, especially in anterior teeth.
  • Temporary abutments include impression and healing, using metal or plastic.

Contraindications

  • Uncontrolled systemic disorders
  • Psychiatric disorders
  • Radiation therapy
  • Smoking
  • Poor oral hygiene

Permanent Abutments

  • Material: Titanium, Zirconia
  • Manufacturing: Stock, custom (UCLA).
  • Retention: Screw-retained, cement-retained.
    • Screw-retained advantages: Easy removal, solves retention issues, no cement issues. Disadvantages: Aesthetic concerns, difficult passive fit control.
    • Cement-retained advantages: Easier passive fit, more resistant to screw loosening, easier occlusal alignment, easier occlusal alignment. Disadvantages: Prosthesis may need removal if a problem arises; cement residue is possible.

Internal vs. External Connection

  • Internal connections (Morse taper, cone screw) are advantageous in maintaining platform switching and reducing stress.
  • External connections are used but have disadvantages that need to be accounted for in dental procedures.

Platform Switching

  • Emerged in 1991
  • Advantages: reduced bone loss when used supracrestally
  • Platform switching involves making the abutment diameter smaller than the implant diameter.

2nd Lecture: Stress in Dental Implants

  • Biomechanical stress is an important risk factor in implant dentistry
  • Patient factors (parafunction, crown height, chewing dynamics) influence stress.
  • Occlusal guards can help reduce stress conditions

3rd Lecture: Stress in Single-Tooth Implants

  • Agenesis, trauma, and endodontic failure are causes of maxillary anterior single-tooth loss.
  • Possible replacement options: Classic fixed prostheses (fixed dental bridge), Removable partial dentures (RPD), Resin-bonded fixed prostheses (temporary).

4th Lecture: Single-Tooth Replacement Treatment Options

  • Maxilla distributes force; mandible absorbs force.
  • Different bone densities (D1-D4) affect implant placement.
  • Alternative options: removable partial dentures, resin-bonded bridges, fixed partial dentures, implant-supported prostheses.

5th Lecture: Maxillary Anterior Single-Tooth Replacement

  • Patient considerations: Compliance, anxiety, treatment duration, consequences, cost.
  • Aesthetic considerations: patient age, mobility of adjacent teeth, crown height, bone, soft tissue coverage, available bone.
  • Various prostheses with advantages and disadvantages are given based on certain factors.

6th Lecture: Implant Key Positions and Treatment Plans

  • Ideal implant treatment is quick, inexpensive, comfortable, minimal complications, and appropriate.
  • Treatment planning logic involves pre-loading and post-loading failure rates.
  • Biomechanical factors (stress, male patients, bruxism, opposing implants, etc.) influence the position.

7th Lecture: Implant Body Size, Biomechanics, and Aesthetics

  • Implant body size is an important indicator of stress.
  • Increasing the implant diameter reduces stress and increases functionality reducing stress and increasing functional area and reducing risk of fracture during parafunction.
  • Stress is affected by characteristics of the patient (bite-force, masticatory muscle characteristics, gender, age, etc.).
  • Wide-diameter implants increase surface area.

Summary of Aesthetic Considerations

  • Aesthetic treatment should match the natural tooth diameter.
  • Distance between implant and adjacent tooth should be 1.5 mm minimum.
  • Distance between implants should be at least 3 mm.

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