BDS 11120 Different Prosthetic Options for Implant Restoration PDF

NEWGIZA UNIVERSITY Date: / /20 NEWGIZA UNIVERSITY NEWGIZA UNIVERSITY Prosthetic option for implants Fixed Removable Implant Supported Implant Retained prosthesis Prosthesis Cement retained prothesis Screw retained prothesis Factors Affecting selection of treatment options NEWGIZA UNIVERSITY Reten...

NEWGIZA UNIVERSITY Date: / /20 NEWGIZA UNIVERSITY NEWGIZA UNIVERSITY Prosthetic option for implants Fixed Removable Implant Supported Implant Retained prosthesis Prosthesis Cement retained prothesis Screw retained prothesis Factors Affecting selection of treatment options NEWGIZA UNIVERSITY Retention inter-arch bone Number implants hygiene ParaFunctional patient cost Esthetics NEWGIZA UNIVERSITY Fixed VS Removable Resorpative patterns Maxilla: reabsorbs upward and inwards and progressively become smaller Mandible: inclines outwards and progressively become wider These progressive changes makes the patient become prognathic NEWGIZA UNIVERSITY NEWGIZA UNIVERSITY Esthetics/Lip Support The needs of lip support is dictating the use of a removable appliance as the flange aids in providing lip support Esthetics - Lip Support NEWGIZA UNIVERSITY NEWGIZA UNIVERSITY Quality of soft tissues surrounding the implants The ideal quality of the soft tissues around the implants is to be keratinized mucosa and firmly attached to the underlining periosteum Oral Hygiene The patient should be compliant to oral hygiene measures to enhance the implant survival Removable appliance offers easier oral hygiene protocol than fixed ones NEWGIZA UNIVERSITY Number of implants Fewer implants Removable appliances needs less implants than fixed Either finance or anatomical limitations may dictate the possible implant number NEWGIZA UNIVERSITY Diagnostic wax up Diagnostic wax up is very important to predict the size, shape and position of artificial teeth as well as their relation to supporting bone and surrounding teeth NEWGIZA UNIVERSITY NEWGIZA UNIVERSITY Crown Height Space. (C.H.S) Ideally posterior C.H.S 8-10mm. Ideally anterior C.H.S 10-12mm. Crown Height Space. (C.H.S) NEWGIZA UNIVERSITY Interarch Space It is the distance between the platform of the implant and the occlusal plane (prosthetic space or Crown height space) More than 15mm so overdentures or hybrid Less than 15 mm so we can used PFM Restorations NEWGIZA UNIVERSITY NEWGIZA UNIVERSITY Prosthetic option for implants Fixed Removable Implant Supported Implant Retained prosthesis Prothesis Cement retained prothesis Screw retained prothesis NEWGIZA UNIVERSITY Cement vs screw retention Cement retained prostheses NEWGIZA UNIVERSITY Advantages Simplicity Idealize occlusal contacts Cement retained prosthesis Reduce risk of porcelain fractures associated with the screw access channel Screw retained prosthesis Cement retained prostheses Disadvantages and Concerns Prosthesis is not easily retrieved Incomplete seating of the crown Impaction of Residual cement Recurrent loss of retention NEWGIZA UNIVERSITY Screw retention Advantages Retrievability Less risk of peri-implantitis Extend the porcelain margins deeper sub-gingivally Provide good retention in cases with Insufficient interocclusal space NEWGIZA UNIVERSITY NEWGIZA UNIVERSITY I. Fixed Cemented retained Implant Prosthesis Fixed Cement retained Implant Prosthesis NEWGIZA UNIVERSITY minimum of 6-8 widely distributed implants are needed to support a fixed full arch restoration. NEWGIZA UNIVERSITY Fixed Cement retained Implant Prosthesis Fixed Cement retained Implant Prosthesis N E W G I Z A UNIVERSITY Advantages Disadvantages: Meet the patient desire Complications may be more difficult to Less food entrapment relative to removable manage overdentures Less regular maintenance and less prosthetic complications Fixed mandibular implant restoration may stop or decrease the atrophy of the posterior edentulous segment The prosthesis can`t be removed at night Lack of labial flange Hygiene may be more difficult Fixed screw retained Prosthesis NEWGIZA UNIVERSITY Screw retained Crown Hybrid Restoration Restoration NEWGIZA UNIVERSITY Fixed screw retained Prosthesis Hybrid Fixed screw retained Prosthesis Hybrid This type of prosthesis consists of denture teeth connected to a metal framework with acrylic resin. The prosthesis is retained by screws. The mandibular prosthesis requires the placement of four to five rigidly splinted implants interforaminaly NEWGIZA UNIVERSITY Fixed screw retained Prosthesis Hybrid NEWGIZA UNIVERSITY Fixed screw retained Prosthesis Indications Patients with moderate to advanced bone NEWGIZA UNIVERSITY Complications Alteration in speech resorption, where it replaces lost bone and soft Compromised hygiene with the flanges tissues extending over the abutments The presence of acrylic flange solve the problem of facial esthetics in cases lacking adequate lip support due to advanced bone resorption Esthetic problems with a high smile line in cases of maxillary Removable Prosthesis NEWGIZA (overdentures) An overdenture is defined as a removable partial or complete denture that covers and rests on one or more implant UNIVERSITY Removable Prosthesis (overdentures) NEWGIZA UNIVERSITY NEWGIZA UNIVERSITY Removable Prosthesis (overdentures): Indications: a geriatric treatment modality, especially in medically debilitated patients patients, who could not withstand prolonged oral surgeries to place the large number of implants required for full arch fixed prostheses. Cases with unfavorable arch relationships financial considerations Removable Prosthesis (overdentures) Advantages over conventional dentures Teeth could be positioned to enhance esthetics and phonetics The tongue and perioral musculature may resume a more normal position NEWGIZA UNIVERSITY Advantages of implant overdenture over fixed prosthesis Fewer implants are required Prosthodontic appointments are less complicated, and treatment is less expensive. Implant position and angulations are not that critical Reduction of the prosthesis flanges Esthetics is enhanced Convertibility Prosthesis can be removed at night Better Chewing efficiency bone preservation reducing the stress on the implants by using resilient attachment NEWGIZA UNIVERSITY Removable Prosthesis (overdentures) Disadvantages of overdentures Routine maintenance Bone in the maxillary region continues to be lost and eventually the patient may complain of loss of retention and instability of the maxillary denture Continued bone loss in the posterior region The overdenture need more crown height space than fixed prosthesis Types of Overdentures NEWGIZA UNIVERSITY Implant Retained Overdentures This type of prosthesis is combining implant and soft tissue support. The overdenture may be supported by two or more implants independent of each other with O ring attachments or splinted by a bar in the canine region. The main advantage of this option is the reduced cost and we can covert the patient original denture into implant overdenture NEWGIZA UNIVERSITY NEWGIZA UNIVERSITY Implant Retained Bar Overdentures There is an agreement that the placement of two implants and the fabrication of an implant retained overdenture should be the first treatment option to consider when treating edentulous mandible. The main advantage of this option is the reduced cost and we can covert the patient original denture into implant overdenture Implant Supported Overdentures This type of overdenture is independent of soft tissue support, as it is totally supported by implants. It requires the placement of five to six implants in mandible and six to eight in the maxilla rigidly connected with a Suprastructure or bar. Implant-supported overdentures in the mandible are highly predictable and effective in increasing the masticatory forces generated by the edentulous patients NEWGIZA UNIVERSITY Implant supported Overdentures Implant-supported overdenture is indicated for patients with: Sharp mylohyoid projections and high muscle attachment, Sensitive mucosa that is easily irritated by the pressure of the denture Patients where ridge resorption had resulted in superficial placement of the mental foramen on the crest of the ridge NEWGIZA UNIVERSITY NEWGIZA UNIVERSITY Reading material: Students are advised to read details at: Fundamentals of implant dentistry, prosthetic principles, John Beumer III, Robert F. Faulkner, Kumar C. Shah, Peter K. Moy. (Chapters 4, 5, 6, 7 and section III) Contemporary Implant Dentistry, by Carl E. Misch NEWGIZA UNIVERSITY NEWGIZA UNIVERSITY