Transcript Prosthetic Options in Implant Dentistry Rola Shadid, BDS, MSc, AFAAID Seminar Outline  Description of implant prosthesis designs  Selection criteria.

Prosthetic Options in
Implant Dentistry
Rola Shadid, BDS, MSc, AFAAID
Seminar Outline
 Description of implant
prosthesis designs
 Selection criteria
Ideal goal of implant dentistry to
replace patient’s missing teeth to
normal contour, comfort, function,
esthetics, speech and health,
regardless of previous atrophy,
disease or injury of the
stomatognathic system
Final restoration – not implants
The end result should be
clearly identified before
the project begins
Ideal Treatment Plan Sequence
 The prothesis first is planned
 The key implant positions and implant
number are selected
 The patient force factors
 The bone density
 Implant size
 Implant design
 Available bone in the edentulous site
 Biologically-driven implant
placement
 Prosthetically-driven implant
placement
 Completely edentulous prosthesis
design
 Partially edentulous prosthesis
design
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ADVANTAGES OF FIXED IMPLANT RESTORATIONS
2. Removable implant overdentures require greater maintenance and
1.
Feeling
and
acting simillar
to natural
teeth
exhibit
more
complications
than
fixed restorations
3. Mandibular
overdenture
trapsbyfood
below its flanges
Problem
of IODs
review
ofoften
litrature
Goodacare:
4.Important
roleinfor
the presence
of complete
implant supported
Retention is
and
adjestement
problem(30%)
restoration
the
maintenance
and regeneration of posterior bone in
Clip or attachment fracture(17%)
mandible
Fracture of prosthesis (12%)
Reline(19%)
Prosthesis Designs
ln 1989, Misch proposed five prosthetic options for
implant dentistry:
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FP-1
 Replace only the anatomical crowns
 Minimal loss of hard and soft tissues
 The bone and soft tissue must be ideal in volume and
position to obtain an FP-1 for the final restoration
 Very similar in size and contour to most traditional fixed
prostheses
 Most often desired in the maxillary anterior region
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FP-1
FP-1 is difficult to achieve when more than
two adjacent teeth are missing
36% of patients presented bone
deficiencies that hindered
prosthetically ideal placement of
Implants
Bone & soft tissue augmentation is
often required
Andersson et al. 1995
FP-1 Material
Porcelain to noble-metal alloy
Zirconia-based restoraion
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FP-2
1. Restore the anatomical crown & a portion of the root
2. The volume and topography of the available bone is more apical
3. Incisal edge in correct position, but gingival third of crown is
overextended.
3. Are similar to teeth exhibiting periodontal bone loss and gingival
recession
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The patient and the clinician should be
aware from the onset
of treatment that the final prosthetic
teeth will appear longer than healthy
natural teeth without bone loss
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Esthetic zone vs FP-2
 The smile/lip line should be evaluated
 The selection of FP2 or FP3 is often based
on the evaluation of the lip line.
 An FP2 (in low lip line patients) is easier to
fabricate because of fewer porcelain bake
cycles.
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Smile Line Classification
 High: display all of the interdental papilla and
more than 2 mm of tissue above the cervices of
the teeth. Prevalence is 11%
 Average: 75% to 100% cervicoincisal length of
maxillary anterior teeth and interdental papilla
exposed. (69%)
 Low < 75% cervicoincisal length of maxillary
anterior teeth exposed. (20%)
Smile Line Classification
High
Average
Low
FP-2
If lip line during smiling does not display cervical
regions, longer teeth are usually of no esthetic
consequences, provided pt is informed
FP-2 Material
Porcelain to noble-metal alloy
 Easily be separated and soldered in case of a nonpassive
fit at the metal try-in
 Noble metals in contact with implants corrode less than
nonprecious alloys
Zirconia based restoraion
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FP-3
Replace the natural teeth crowns
and has pink-colored restorative
materials to replace a portion of
the soft tissue
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FP-3
Normal to high maxillary lip line
during smiling, or pt with high
esthetic demands
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Materials for Full Arch FP-3
 Porcelain-metal with pink porcelain
 Hybrid restoration of denture teeth and acrylic and metal
substructure
 Zirconia based restoration
The primary factor that determines the
restoration material is the amount of crown
height space
<15mm
PORCElAIN–METAL
≥15mm
HYBRID
CHS
Excessive CH & traditional porcelain-metal
restoration ???
 Porcelain thickness should not be greater than 2-mm thick
Base metals
large amount of metal
More shrinkage
porosities in the structure
increases the risk of porcelain fracture
Noble metals
weight and cost
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Fixed detachable hybrid prosthesis (fixed
complete denture) ( CHS ≥15mm)
A smaller metal framework and the acrylic resin polymerized
with the denture teeth on the framework.
Fixed detachable hybrid
prosthesis
The denture teeth in these
prostheses should not be
acrylic or composite, owing
to a high fracture rate.
Instead, porcelain denture
teeth are suggested.
Fixed detachable hybrid prosthesis
1.
2.
3.
4.
5.
6.
Smaller metal framework
Denture teeth and acrylic
Less expensive to fabricate
Highly esthetic
Acrylic pink soft tissue replacements
The impact force of dynamic occlusal loads is
reduced
7. Lightweight
8. Easier to repair
9. 15 to 20 mm
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Fixed detachable hybrid prosthesis
The fatigue of acrylic is greater than the
traditional prosthesis
REPAIR of the restoration is more commonly needed
CAD-CAM zirconia-based, screwretained, cross-arch restorations
Zirconia framework veneered with porcelain
Full-contour (monolithic) Zirconia
restorations
CAD-CAM zirconia-based, screwretained, cross-arch restorations
 lack of casting distortion due to the CAD/CAM
process;
 highly reduced chance of chipping compared to
acrylic or porcelain
 stronger and improved aesthetics of screw
access hole areas.
 monolithic zirconia bridge requires only 12 to
15 mm of prosthetic space, not 15mm-20mm
The success rate of implant supported
screw-retained zirconia prostheses have
been shown to be as high as 100% for a
period of 5 years
Vizcaya, 2011; Oliva, 2012
 High level of accuracy and rigidity of the
framework was obtained by CAD-CAM
method, and satisfactory esthetics was
featured by layering the porcelain on the
Zirconia framework.
Hong et al. 2014
Removable Prostheses
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Removable Prostheses
 Complete removable overdentures have often been
reported with predictability
 Two kinds of removable prostheses, based upon support
of the restoration:
1. RP-4
2. RP-5
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RP-4
 Completely supported by the implants
 The restoration is rigid when inserted
 A low-profile tissue bar or superstructure that splints the implant
abutments
 5 or 6 implants in the mandible
 6 to 8 implants in the maxilla
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RP-5
 Implant and soft tissue support
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RP-5
 The primary advantage of an RP-5 restoration is the reduced
cost
 Bone will continue to resorb in the soft tissue-borne regions
 Bone resorption with RP-5 restorations may occur two to
three times faster than the resorption found with full dentures
 Relines and occlusal adjustments every few years
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Selection Factors for Completely
Edentulous




Patient’s desire
Financial capabilities
Number of implants placed
The amount of vertical resorption
(Crown height space)
 Labial support requirements. (The
amount of Maxillary anterior/posterior
resorption)
The amount of vertical resorption
(Crown height space)
 CHS <15mm
(Fixed)
 CHS ≥15mm (Fixed hybrid or
Removable)
 If CHS < 12 mm, overdenture is
contraindicated without
osteoplasty
CHS for Removable
CHS for Fixed
Maxillary Anterior/Posterior Resorption
 If the anterior/posterior (A/P) resorption is 7 mm or
less, fixed prostheses are probably indicated
 If the A/P resorption is in the range of 8 to 10 mm,
fixed or removable prostheses may be indicated
 If the A/P resorption > 10 mm, removable or fixed
prostheses with removable labial veneers
Carl Drago, 2011
Maxillary Anterior/Posterior
Resorption
References
 Prosthetic options in implant dentistry
(chapter 5), Contemporary Implant
Dentistry, 3rd Edition, Carl Misch
 Drago C, Carpentieri J. Treatment of
maxillary jaws with dental implants:
guidelines for treatment. J Prosthodont.
2011 Jul;20(5):336-47.