BDS11114 Implant Treatment Planning PDF

I.Patient history: A. B. C. Patients presenting complaint Medical history Dental history II. Examination: A. Extra-oral examination B. Intra-oral examination III. Radiographic evaluation: IV. Articulator mounting and diagnostic wax-ups  A. Patients presenting complaint: in the patients own words...

I.Patient history: A. B. C. Patients presenting complaint Medical history Dental history II. Examination: A. Extra-oral examination B. Intra-oral examination III. Radiographic evaluation: IV. Articulator mounting and diagnostic wax-ups  A. Patients presenting complaint: in the patients own words. It is important to understand the initial expectations of the patient and to establish a patient-doctor connection, as well as possibly understand the patients current understanding of the different restorative options along with their expected timelines and clinical outcomes. B. Medical history: some patients are contraindicated (may be temporarily) for implant therapy while others are considered high risk for implant failure. Contraindications: systemic bisphosphonate medication, chemotherapy, unfinished facial growth, acute infectious disease, among others. High risk patients: osteoporosis, uncontrolled diabetes, heavy smoking, drug abuse, among others. C. Dental History: Patients with bad oral hygiene who are not committed to dental treatment may not be good candidates for dental implants  Extra-oral examination: TMJ and lymph nodes, facial and smile analysis, vertical dimension of occlusion  Intra-oral examination: oral hygiene, current restorations, periodontal condition, number of missing teeth, caries, occlusion, teeth that need extraction.  Peri-apical: evaluation of any pathosis around the planned implant site and evaluation of the condition of adjacent teeth and anatomic structures  Panoramic radiograph: may be used for easy identification of anatomic landmarks, initial assessment of vertical bone height, and gross evaluation of any pathological findings  Cone Beam Computed Tomography (CBCT): volumetric jaw bone imaging for determination of height and width of the bone in the proposed implant site Mounting study casts on a semi-adjustable articulator using facebow records  Waxing up of the proposed area to be restored: To help visualize the end result for the whole dental team and the patient. To provide an insight into the type of restoration that will be constructed Can be used with an index for temporization Can be used to construct a surgical guide How many implants? What is the interocclusal space? Do we need flanges? temporization Surgical guide  Smile analysis CBCT to determine the height and width of bone and the number of implants that may be used Mounting on a semi-adjustable articulator to determine the vertical dimension of occlusion, interocclusal space, wax-up and the type of restoration CBCT + Wax – up = surgical guide Diagnosis will determine the treatment plan (bone quality, bone quantity, number of implants, diameter and length of implants, type of prosthesis, the need for additional surgical procedures)  It is a correlation between the ideal prosthetic position and the bone architecture (multi-disciplinary implant treatment) The type and location of the prosthesis and artificial teeth is determined before locating the position of the implants I. II. III. IV. V. VI. Primary treatment phase Pre-implant surgical phase Biomechanical considerations Type and material of the restoration Determination of the time of loading Temporization method  Treatment of any pre-existing periodontal condition, caries, teeth requiring extraction, pathosis, restorations that need to be changed that may affect the outcome of the implant procedure  The need for surgical procedures prior to implant placement (bone augmentation, soft tissue augmentation, sinus lifting). This is achieved by proper radiographic imaging (CBCT) to determine the amount of available bone and determination of the number of implants required for the final restoration These procedures may be performed simultaneously with implant placement if indicated for a particular case A. Bone density B. Load bearing capacity C. Linear configurations and implant overload  Dense bone is better able to withstand the stresses resulting from the occlusal forces. If the occlusal loads are too high, this can result in pathological bone resorption and ultimately implant failure  Bone to implant contact (BIC): dense bone provides a larger surface area to contact with the implant surface, allowing for better stability and better distribution of forces in the bone.  the load bearing capacity of the implants supporting the restoration must be greater than the anticipated loads during function. If the applied loads exceed the load bearing capacity of the implants, the restoration or the bone, mechanical or biological failure may occur.  The load bearing capacity can be improved by increasing the number, length, diameter, arrangement and angulation of the dental implants Occlusal considerations for implant restorations must also be implemented to improve the load bearing capacity on the implants and supporting bone  Patients with parafunctional habits such as bruxism will exert excessive forces on the restoration – bone – implant complex.  Implant arrangement in a non-linear manner creates a more stable base capable of resisting lateral loads and off-center contacts  Implant overload can be caused by non-axial loading on the dental implant and by angulated abutments. This will result in bone resorption around the implant.  Type: Partially edentulous/completely edentulous Single missing tooth (anterior/posterior) Several teeth are missing (bounded/free end saddle) Esthetic zone/non-esthetic zone  Type:  Material: Will depend on the type of the restoration PFM/Zirconia/Acrylic/PEEK This will depend on several factors such as: bone density, primary stability, patients health, type and location of the implant site (esthetic zone/non-esthetic zone)  Provisional restorations enhance esthetics and function for a limited period of time until a definitive prosthesis can be constructed. May be constructed prior to implant loading (fixed/removable) May be constructed post implant placement (cement retained/screw retained) Students are advised to read details at: Carranza`s clinical periodontology, Newman, Takei, Klokkevold, Carranza (chapters 71 to 74) Fundamentals of implant dentistry, surgical principles, Peter K. Moy, Alessandro Pozzi, John Beumer III. Fundamentals of implant dentistry, prosthetic principles, John Beumer III, Robert F. Faulkner, Kumar C. Shah, Peter K. Moy.