Transcript Carl Misch; Dental implant prosthetics; 2ed; 2014. Ch. 24 Treatment option 1, Branemark approach 4 or 6 implants betw. mental foraminae & distal cantilever.

Carl Misch; Dental implant prosthetics; 2ed; 2014. Ch. 24
Treatment option 1,
Branemark approach
4 or 6 implants betw.
mental foraminae &
distal cantilever off
each side to replace
posterior teeth (5)
Treatment option 1, Branemark
approach
The anterior arch form (square, oval, tapered) is
related to the anterior most implant position
The foraminae position affects the position of
distal most implants
A-P distance of greater than 8 mm
A-P distance of 6 to 8 mm
A-P distance of 2 to 5 mm
Mental foramenae may be located as far anterior
as just distal to the canine (more common in
white women) and as far distal as the mesial of
the first molar apex (more often in black men).
Cutright B, Quillopa N, Shupert W, et al. An anthropometric analysis of key foramina
for maxillofacial surgery. J Oral Maxillofac Surg. 2003;61:354–357.
Treatment option 1, Branemark approach
For
five anterior
implants in anterior
mandible, cantilever
should not exceed 2
times A-P spread,
with all other stress
factors being low
A cantilever rarely
indicated on 3
implants, even with
simillar A-P spread
as 5 implants
Narrow implants are not
designed to support cantilevers
Treatment option 1, Branemark approach
Reserve this option for patients with low force factors
(older female, wearing upper denture, abundant anterior
bone, CHS to 15 mm, tapered or ovoid mandibular arches, &
posterior segments of inadequate height for endosteal implant)
Treatment option 2
A slight variation of
Branemark protocol
to place additional
implants above
mental foraminae
Treatment option 2
 A prerequisite
available bone in height
and width over foraminae
 A minimum recommended implant height of 9
mm & a greater diameter of an enhanced
surface area recommended
Treatment option 2
No.
of implants may
be increased to as
many as 7
 A-P spread for
implant placement is
greatly increased
Length
of cantilever
is reduced
Key implant positions:
second premolars,
canines, centeral incisor
or midline position
Treatment option 3
One posterior segment
connected to anterior
segment
key implant positions
first molar (on one
side), bilateral 1st
premolars, bilateral
canines
Secondary positions
second premolar on
same side as molar
implant, central incisor
(midline)
Treatment option 3
Option 3 is
better than 1 & 2:
A-P spread 1.5 to
2 times greater
When force factors are greater, 6 or 7 implant
may be used (5 implant between foraminae & one
or two implant distal on one side)
Treatment option 3
One piece casting can
be fabricated & one
cantilever to opposite
side of molar implant
would replace those
posterior teeth
Requires available
bone in at least one
posterior region
Treatment option 4
Bilateral posterior
implants that they
are not splinted
together
Key implant positions:
First molars, first premolars,
canines
Secondary implant positions
second premolars and/or incisor
Treatment option 4
advantages:
1. Elimination of cantilever
2. Risk of uncemented
restorations & occlusal
overload reduced
3. Prostheses has two
segments rather than one
Disadvantages
1. Need for abundant bone in both posterior region
2. Additional cost
Treatment option 4 is selected :
1. When force factors are great or bone density is poor
2. When the body of mandible is division C-h &
subperiosteal or disc like implants are used for
posterior
Treatment option 5
Three independent
prostheses
Treatment option 5
Advantages:
• Smaller segments for individual restorations
• Most flexibility and torsion of mandible
Disadvantages:
• Greater number of
implants required
•Available bone
needs are greatest
Treatment option 5
•Most common scenario for
option 5 is when posterior
mandible is C-H bone
volume & a circumferential
subperiosteal or disc-design
implant is used as second
premolar & first molar

From 7 to 10, with at least 3 implants from canine to canine
 In the case of heavy stress factors, an additional anterior implant and bilateral second
molar positions (to increase the anteroposterior distance) may be of benefit
Carl Misch; Dental implant prosthetics; 2ed; 2014. Ch. 25
26
The dentist may use the following guidelines for implant locations in
a completely edentulous maxilla:
1. The bilateral canine position is a key implant position and is
planned for 4-mm-diameter implants.
2. The center of the first premolar is planned 7 to 8 mm distal from
the center of the canine implant (for a 4.0-mm-diameter
implant). This is an optional implant site when parafunction is
moderate to severe.
3. The center of the second premolar is 7 to 8 mm distal from the first
premolar site (14 mm from the midcanine position) on each side
for a 4.0-mm-diameter implant. This is a key implant position.
4. The distal half of the first molar is 8 to 10 mm distal from the mid
second premolar implant (this places the implant in the distal of
the first molar and increases the A-P distance). Ideally, the
implant should be 5 to 6 mm in diameter. This is a key implant
position. When a 4-mm diameter is used, the first implant is 7 to
8 mm from the mid second premolar site, and the second
implant is 7 to 8 mm more distal than the first implant.
5. The center of the second molar is 8 to 10 mm distal from the
center of the first molar implant. This position is most important for
the edentulous arch with a tapered dentate arch form, D4 bone
types, or severe force factors.
Carl Misch; Dental implant prosthetics; 2ed; 2014. Ch. 25
Square, ovoid, and tapering
Carl Misch; Dental implant prosthetics; 2ed; 2014. Ch. 25
Arch Form
Anterior
Cantilever
(mm)
Number of
Implants
Implant
Position
Square
<8
2
Canines
Ovoid
8-12
3
Tapering
>12
4
Carl Misch; Dental implant prosthetics; 2ed; 2014. Ch. 25
Two canines
and one
incisor
Two canines
and two
incisors
Carl Misch; Dental implant prosthetics; 2ed; 2014. Ch. 25
Treatment with mandibular IFCDPs yields high
implant and prosthodontic survival rates (more
than 96% after 10 years).
Rough surface implants exhibited cumulative
survival rates similar to the smooth surface ones
in the edentulous mandible.
Papaspyridakos et al. Implant and Prosthodontic Survival Rates with Implant Fixed Complete Dental Prostheses in the Edentulous Mandible after at
Least 5 Years: A Systematic Review Clinical Implant Dentistry and Related Research, Volume 16, Number 5, 2014
The
number of supporting implants and the
anteroposterior implant distribution had no
influence on the implant survival rate.
The prosthetic design, the veneering material,
and the retention type had no influence on the
prosthodontic survival rates.
The loading protocol also had no influence on
the prosthodontic survival rates.
Papaspyridakos et al. Implant and Prosthodontic Survival Rates with Implant Fixed Complete Dental Prostheses in the Edentulous Mandible after at
Least 5 Years: A Systematic Review Clinical Implant Dentistry and Related Research, Volume 16, Number 5, 2014
A
recent meta-analysis showed that technical
complications are frequently encountered with
IFCDPs during 5 to 10 years of clinical function.
 The 10-year cumulative rate of “prosthesis free
of complications” of 8.6% reported in that review
opitomizes the advantage of retrievability of
screw-retained IFCDPs vs cement-retained metalceramic IFCDPs.
Papaspyridakos P, Chen CJ, Chuang SK, Weber HP, Gallucci GO. A systematic review of biologic and technical complications with fixed implant rehabilitations
for edentulous patients. Int J Oral Maxillofac Implants 2012; 27: 102–110.
The insertion of four implants for a
fixed restoration in the edentulous
mandible reveals satisfying results.
However, it has to be noticed that
five or more implants showed a
slightly better outcome.
Kern et al. A systematic review and meta-analysis of removable and fixed implant supported
prostheses in edentulous jaws: post-loading implant loss. Clin. Oral Impl. Res. 00, 2015, 1–22
Implants
with rough surfaces showed a statistically
higher survival rate than machined implants at all intervals.
Implants placed in augmented bone had a statistically
lower survival rate, except for rough-surface implants, for
which no statistical difference between augmented and
non-augmented bone survival rates was found.
Machined implants showed a stable survival rate only
when placed in native bone.
When machined implants were placed in augmented bone,
the survival rate decreased significantly at each study
endpoint.
Lambert FE,Weber HP, Susarla SM, Belser UC, Gallucci GO. Descriptive analysis of implant and prosthodontic survival rates with fixed
implant-supported rehabilitations in the edentulous maxilla. J Periodontol 2009; 80:1220–1230.
The
prosthetic design, veneering material,
and the number of prostheses per arch had no
influence on the prosthodontic survival rate.
Implant
number and distribution along the
edentulous maxilla seemed to influence the
prosthodontic survival rate.
Lambert FE,Weber HP, Susarla SM, Belser UC, Gallucci GO. Descriptive analysis of implant and
prosthodontic survival rates with fixed implant-supported rehabilitations in the edentulous maxilla. J
Periodontol 2009; 80:1220–1230.
The insertion of six or more implants
for a fixed reconstruction in the
maxilla reveals favorable results.
Considering the “all-on-4” concept for the
maxilla, one study (Crespi et al. 2012) with an
acceptable level of evidence was found,
revealing a satisfactory outcome.
Kern et al. A systematic review and meta-analysis of removable and fixed implant supported
prostheses in edentulous jaws: post-loading implant loss. Clin. Oral Impl. Res. 00, 2015, 1–22
Implants
with fixed prostheses show
slightly but significantly better results
than removable prostheses regarding
both jaws.
Rough-surfaced implants
demonstrated favorable results
compared to machined implants.
Kern et al. A systematic review and meta-analysis of removable and fixed implant supported
prostheses in edentulous jaws: post-loading implant loss. Clin. Oral Impl. Res. 00, 2015, 1–22