GSTP Session 1

5/2/14

1

GRADUATE SYNERGY TRAINING PROGRAM® www.eas&nprosthodon.cs.com

!GSTP Session 1 Handout!

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Steven LoCascio Knoxville!!!

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GSTP Session 1 Handout!!

Password: GSTPSession1loc21!

Goals and Objectives

➡ Continuation of the Synergy Training Program®

➡ To increase proficiency in identifying dental implant patients

➡ To increase proficiency in treatment planning dental implant patients

Goals and Objectives

➡ To learn to transition patients from teeth to dental implants

➡ To understand the “New Mixed Dentition” ➡ To keep up to date with new technologies

and techniques

Eligibility

➡ Surgeon must have successfully sponsored a Synergy Training Program® in the past.

➡ Restorative dentist must have successfully completed a Synergy Training Program.

Program Outline ��Session 1

 Course Introduction

– Review of GSTP course schedule

– Patient requirements for the course

 Treatment planning the patient transitioning from teeth to dental implants


 Treatment planning for complex situations in the anterior aesthetic zone

– Single tooth edentulous space -- single implants

– Multiple missing teeth -- multiple implants

– The influence of gingival biotype on treatment planning

– Delayed provisionalization

– Immediate non-occlusal loading -- immediate provisionalization


 Treatment planning session

– Presentation of completed cases from the previous STP

– Trouble shooting treatment plans from the previous STP

– Presentation of new cases for the GSTP®

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 New technologies for implant dentistry

– CAD/CAM procedures and techniques   Encode® Complete   CAM StructSURE® bars

– CT Guidance   Navigator™



– Presentation of completed cases from previous sessions

– Trouble shooting treatment plans from the previous session



 Transitioning the full arch dental implant patient from teeth to dental implants

– Temporization options

– Immediate Occlusal Loading of full arch dental implants

  Mandible

  Maxilla


 Transitioning the full arch dental implant patient from teeth to dental implants

– Case design considerations   Number and placement positions of implants

  Choice of restorative material

  Attachment techniques







 Occlusion

 The re-restoration of the existing dental implant patient

– Diagnosis and planning

– Long term considerations and complications

– Maintenance

– Managing complications






Patient Requirements

 NEW treatment plans presented by each participant at all Sessions

 At least one case presented by the participant with treatment to commence and follow throughout the course

– Participants are encouraged to bring more than one case to the session.

3 to 5 Cases Each!

Handouts

 Cases are to be written up in the following format – Chief complaint – Dental history – Medical history – Charting (dental and periodontal) – Problem List / Assessment / Diagnosis – Treatment recommendations – Prognosis

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Patient Selection Criteria

 Patient in good health – ASA class 1 or 2

 Patient requires at least one tooth replaced

 Patient needs to consent to be a part of the course and be willing to allow photographs of their dentition

 Grafting acceptable – May delay treatment

Treatment planning the patient transitioning from teeth to dental

implants

The Transition from Teeth to Dental Implants

Challenges: ➡ Management of patient expectations

✦ Design Considerations •  Fixed prosthesis vs. removable prosthesis

-  No flange vs. flange


It is imperative to plan for long term prosthetics. As a general rule, if a fixed restoration is fabricated for a partially edentulous clinical situation, then the patient is committing to additional fixed implant restorations with similar prosthetic designs when additional teeth are lost in the future. The reverse treatment scenario may also apply.


If you plan for a fixed crown and bridge restoration now, then you will most likely be providing the patient with additional fixed restorations in the future. If you plan for a removable restoration now, then you will most likely transition the patient into a larger removable prosthesis in the future.

  Overdentures •  15 – 17 mm

  Hybrid Dentures •  13 – 15 mm

  Ceramo-Metal •  9 – 13 mm

Vertical Space Requirements

LoCascio S, / Salinas, T PPAD 1997; Vol. 9, No.3: 357-370


Fixed with no flange

✦ Step By Step “Phased” Treatment Plan: 1) Extraction of all teeth with poor prognosis with initial provisionalization 2) Impressions and diagnostic wax up to full contour of all missing teeth 3) Fabrication of implant radiographic guides or surgical guides 4) Placement of all endosseous implants 5) Integration and uncovery as needed 6) Diagnostic wax-up to full contour and complete provisionalization 7) Final transfer impressions and fabrication of definitive prostheses 8) Insertion of definitive prostheses 9) Maintenance / recall


Fixed vs. Removable

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Removable with flange


Pink aesthetics vs. natural aesthetics


Porcelain vs. acrylic

Clinical Case #1 Clinical Case #2

Treatment Planning��The Edentulous Patient

Where do we begin?

Clinical Scenarios��(Edentulous Mandible)

4.  Hybrid Denture

3.  Implant Supported Overdenture

2.  Implant Retained Overdenture

1.  Conventional Denture

5.  DIEM






5.  DIEM

Clinical Scenarios��(Edentulous Maxilla)

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5.  DIEM Х


4.  Fixed (C & B)




5.  DIEM

Classification ��of ��

Implant Overdentures



Implant Retained / Tissue Supported “Implant Assisted”




Implant Retained / Implant Supported

“Implant Supported”




Implant Retained / Implant Supported

“Implant Supported”





5.  DIEM

Х



➡ Challenges: ✦ Management of patient expectations

•  Functional Expectations

•  Functional Realities

•  Comfort



•  Functional Expectations -  As a general rule, patients expect to function as

well as or better than they did before they lost their natural teeth

-  These expectations may not be a reality due to many factors: ‣  Case design/implant number ‣  Occlusal material ‣  Prosthesis design considerations: Fixed vs.

Removable

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•  Functional Realities -  Implant Assisted Overdentures ‣  2 implant assisted mandibular overdenture

functions like a denture with added retention ‣  4 implant assisted maxillary overdenture functions

like a denture with added retention ‣  Food trapping probable -- PAIN



•  Functional Realities -  Implant Supported Overdentures

‣  No tissue support -- functional support may resemble fixed designs

✓ Locking bar attachments most retentive design -- most like fixed design

‣  Prosthesis remains removable -- psychological limitations

‣  Food trapping possible -- NO PAIN



•  Comfort -  As a general rule, patients expect their level of

comfort to be as good as or better than it was before they lost their natural teeth.

Treatment Planning the Patient Transitioning from Teeth to

Dental Implants

Treatment planning for complex situations in the anterior

aesthetic zone

Biologic Width &

Platform Switching

Diameter Driven Treatment Planning: Maxilla TOOTH IMPLANT INTERFACE TOOTH

DIAMETER*

  Central Incisor 5mm 7mm

  Lateral Incisor 3.4 or 4.1mm 5mm

  Canine 5mm 5.5mm

  Premolars 4mm 5mm

  Molar 6mm 9mm

Platform chosen based on the dimension of the tooth 3mm apical to the CEJ.

*The tooth diameter measurement is at the CEJ.

The Rule of 3’s:

3mm from the labial surface to the center of the implant

1.5mm from the adjacent tooth to the implant

1.5mm 1.5mm

3mm

The Rule of 3’s:

3mm from the labial surface to the center of the implant

1.5mm from the adjacent tooth to the implant

3mm apical to the crest of labial sulcus

3mm

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Implants with smaller than “ideal” diameter restorative platforms may need to be countersunk deeper for proper emergence through the soft tissue.

Implants with smaller than “ideal” diameter restorative platforms may need to be countersunk deeper for proper emergence through the soft tissue.

Mapping

 How much space should be treatment planned between dental implants?

 How much space should be treatment planned between dental implants and teeth?

 Why is this important?

 3mm between dental implants

 1.5mm between dental implants and teeth

 For blood supply and biologic width

Becomes The Driver Of Crestal Bone Remodeling And The Resulting

Support Scaffolding For The Soft Tissues

Biologic Width…

Evidence Based Research

 Epithelial attachment and connective tissue form the physiologic attachment apparatus around teeth

• Gargiulo AW, J Perio 1961; 32:261-267

• Vacek JS, I J Perio Rest Dent 1994; 14:155-165

Conclusion: There appears to be a minimum of 3mm tissue

thickness separating the bone from the oral environment with 2mm being the area of

attachment tissue (Biologic Width).

The 3mm of Required Tissue Depth and 2mm of Biologic Width Around Natural Teeth

1mm Sulcus

1mm Epithelial Attachment

1mm Connective Tissue Attachment

What Impact Does The Biologic Width And Other Dynamics Have On Crestal Bone Remodeling?

Evidenced Based Research

Bone Level Is Determined By:

  Soft tissue thickness of approximately 3mm ��(1mm sulcus, 2mm biologic width)

  Exposure to the oral environment, combined with the location of the Implant-Abutment Junction (IAJ) and of the Inflammatory Connective Tissue (ICT) Infiltrate

  Surface Topography

Biologic Width Surrounding Implants

 The implant-abutment junction (IAJ) being exposed to the oral environment, triggers a cascade of tissue reactions:

– The 1mm of connective tissue moves apically to protect the bone from potential irritants

– The connective tissue will always cover itself with about 1mm of epithelium

– Therefore, the 2mm biologic width forms below the ��micro-gap

– The bone will remodel to allow for this more apical formation of the biologic width.

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Biologic Width Established

Tissue Levels At Placement

1mm Sulcus

1mm Epithelial Attachment

1mm Connective Tissue Attachment

Bone Resorption Begins At The IAJ When Exposed To The Outside Environment

1.3mm Buccal Bone

Loss

abut. ICT 1.1mm

0.55mm

0.55mm

0.55 mm of inflammatory cell Infiltrate is vertically located on

each side of the “flush” implant-abutment interface

0.8mm of healthy connective tissue between the abutment ICT and the

bone crest

Bone loss was observed to allow for healthy connective tissue to seal

off the bone

The abutment ICT has a longer vertical dimension, than lateral

Buccal

Ericsson I, et al. Clin Oral Impl Res 1996;7:20-26.

Abutment and Implant Junction Inflammatory Cell Tissue (ICT) Infiltrate

Summary of Biologic Evidence  When open to the oral cavity, the bone needs approximately

3mm of tissue for protection, this is the first prerequisite.

 The presence of either an implant/abutment interface or a rough smooth interface may establish an inflammatory zone with a vertical dimension of 0.5mm to 1.1mm and a lateral dimension of .20mm to .40mm.

 There is a biologic need to maintain an inflammation-free connective tissue zone of about 1mm apical to the inflammatory zone above the bone.

 The combination of these two numbers approximates the classic 2.0mm number reported in the literature as the vertical distance from the platform to the bony crest and appears to explain the “angular” crestal remodeling configuration. ��

Numbers May Vary By Nature Of Study: Animal Vs Human, Radiographic, Histologic, And Clinical

Clinical Significance Of The Formation

Of The Biologic Width:

Mid Facial Recession And Inter-proximal Space

Between Two Implants

Tarnow DP, Cho SC, Wallace SS. J Periodontol 2000;71:546-549

When Implants Were More Than 3mm Apart, Crestal Bone Loss From The Implant Shoulder Was 0.45mm

Vertical Bone Loss To The First Thread

When Implants Were More Than 3mm Apart, Crestal Bone Loss From The

Implant Shoulder Was 0.45mm


Tarnow DP, Cho SC, Wallace SS. J Periodontol 2000;71:546-549

When Implants Were Closer Than 3mm, Crestal Bone Loss From The

Implant Shoulder Was 1.04mm



When Implants Were Closer Than 3mm, Crestal Bone Loss From The

Implant Shoulder Was 1.04mm Vertical Distance From The Crest Of Bone To The Height Of The Interproximal Papilla Between

Adjacent Implants Tarnow D. et al, J Perio 74:12 1785-1788 Dec. 2004

The findings indicate 2-4mm (3.4mm average) of soft tissue height can be expected to cover the inter-implant crest of

bone.

This represents a deficiency of 1 to 2mm of what is needed to duplicate the interproximal papillae of the adjacent teeth.

Platform Switching™

 The placement of one size smaller prosthetic component on an implant seating surface

 The objective is to move the implant-abutment connection in from the implant shoulder

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4-year bone levels

Expanded Platform With Platform

Switch

Without Platform Switch

4-Year Bone Levels

Grunder, U. et al, I J Perio Rest Dent 2005:25:113-119

Influence Of The 3-D Bone-to-Implant Relationship On Esthetics

4mm Diameter Abutment Placed On 5mm Diameter Implant Distances Contaminated

Interface From Bone

Thus, Degree Of Bone Resorption Is Limited.

Even If 2 Implants Are Positioned Close To Each Other, Thanks To Platform Switching Concept,

Interproximal Bone Height Is Not Reduced After 1 Year.

The Certain® ��Prevail™ Implant  The Prevail Implant moves

the implant-abutment interface in from the shoulder of the implant and away from the bone

4.8 mm

4.1 mm

4.8 mm

4.1 mm

“Medial Factor” Amount of lateralization

0.35mm

With The Certain® Prevail™ Implant, By Moving The Micro- Gap In From The Implant Shoulder, The

Bone Is Shielded From The ICT And Confined To The Top Of The Implant

Platform.

Clinical Case Will soft tissue follow the bone around the implant or the adjacent teeth?

Are there any benefits to platform switching with single tooth implants if we

can maintain at least 1.5mm of space between the implant platform and the

adjacent teeth?

Clinical Case #1

Problem List

• Violation of the Map

–  Poor implant diameter

–  Poor implant angulation

–  Poor implant position

–  Not platform switched

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Clinical Case #2


aesthetic zone

The Single tooth edentulous space

#6

#3

#5

#4

#2

#7 #8 X

#11

#14

#12

#13

#15

#10 #9

1.5mm 1.5mm I


#3

#5

#4

#2

#14

#12

#13

#15

TOTAL = 7mm

#11

4

#6

#10

1.5mm

#7 #8

1.5mm



aesthetic zone

Multiple Missing teeth

#6

#3

#5

#4

#2

#7 #8 X X

#11

#14

#12

#13

#15

#10 #9

3mm 1.5m

m 1.5mm I I

Two Missing Teeth

#3

#5

#4

#2

#14

#12

#13

#15

3mm

TOTAL = 16mm

5 5

#11 #6

#10

1.5mm

#7

1.5mm

Two Missing Teeth

#3

#5

#4

#2

#14

#12

#13

#15

3mm

TOTAL = 14mm

#11

4 4

#6

#10

1.5mm

#7

1.5mm

Two Missing Teeth

#3

#5

#4

#2

#14

#12

#13

#15

3mm

TOTAL = 12.5mm

#11

3.25 3.25

#6

#10

1.5mm

#7

1.5mm

Two Missing Teeth

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X X

Two Missing Teeth

#6

#3

#5

#4

#2

#7 #8 X X

#11

#14

#12

#13

#15

#10 #9

1.5mm 3mm

1.5mm

I I

Two Missing Teeth

#3

#5

#4

#2

#14

#12

#13

#15

TOTAL = 15mm

5 4 3mm

#11 #6

1.5mm

#10 #9

1.5mm

Two Missing Teeth

#3

#5

#4

#2

#14

#12

#13

#15

TOTAL = 14mm

3mm

#11

4 4

#6

1.5mm

#10 #9

1.5mm

Two Missing Teeth

#3

#5

#4

#2

#14

#12

#13

#15

TOTAL = 12.5mm

3mm

#11

3.25 3.25

#6

1.5mm

#10 #9

1.5mm

Two Missing Teeth

X X

Two Missing Teeth

Clinical Case #1 Clinical Case #2 Clinical Case #3

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Clinical Case #4

#6

#3

#5

#4

#2

#7 #8 X X X

#11

#14

#12

#13

#15

#10 #9

3mm 3mm 1.5mm

1.5mm

I I I

Three Missing Teeth

#3

#5

#4

#2

#14

#12

#13

#15

3mm

TOTAL = 23mm

5 5 4 3mm

#11 #6

1.5mm

#10

1.5mm

Three Missing Teeth

#3

#5

#4

#2

#14

#12

#13

#15

3mm

TOTAL = 21mm

3mm

#11

4 4 4

#6

1.5mm

#10

1.5mm

Three Missing Teeth

#3

#5

#4

#2

#14

#12

#13

#15

3mm

TOTAL = 18.75mm

3mm

#11

3.25 3.25 3.25

#6

1.5mm

#10

1.5mm

Three Missing Teeth

X X X

Three Missing Teeth

X X X

Three Missing Teeth

#6

#3

#5

#4

#2

#7 #8 X X X X

#11

#14

#12

#13

#15

#10 #9

3mm 3mm 3mm

1.5mm

I I I I 1.5m

m

Four Missing Teeth

#3

#5

#4

#2

#14

#12

#13

#15

3mm 3mm

TOTAL = 30mm

5 5 4 4 3mm

#11

1.5mm

#6

1.5mm

Four Missing Teeth

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#3

#5

#4

#2

#14

#12

#13

#15

3mm 3mm

TOTAL = 28mm

3mm

#11

1.5mm

4 4 4 4

#6

1.5mm

Four Missing Teeth

#3

#5

#4

#2

#14

#12

#13

#15

3mm 3mm

TOTAL = 25mm

3mm

#11

1.5mm

3.25 3.25 3.25

3.25

#6

1.5mm

Four Missing Teeth

X X X X

Four Missing Teeth

X X X X

Four Missing Teeth

X X X X

Four Missing Teeth

Clinical Case #1

Clinical Case #2 Clinical Case #3

#6

#3

#5

#4

#2

#7 #8 X X X X

X #11

#14

#12

#13

#15

#10 #9

3mm 3mm 3mm

3mm

1.5m

m I

I I I I 1.5m

m

Five Missing Teeth

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#3

#5

#4

#2

#14

#12

#13

#15

3mm 3mm

1.5m

m

TOTAL = 38mm

5

5 5 4 4 3m

m

3mm

#11

1.5mm

Five Missing Teeth

#3

#5

#4

#2

#14

#12

#13

#15

3mm 3mm

1.5m

m

TOTAL = 35mm

3mm

3mm

#11

1.5mm

4

4 4 4 4

Five Missing Teeth

#3

#5

#4

#2

#14

#12

#13

#15

3mm 3mm

1.5m

m

TOTAL = 31.25mm

3mm

3mm

#11

1.5mm

3.25

3.25 3.25 3.25

3.25

Five Missing Teeth

X X X X X

Five Missing Teeth

X X X X X

Five Missing Teeth

#6

#3

#5

#4

#2

#7 #8 X X X X

X X #11

#14

#12

#13

#15

#10 #9

3mm 3mm 3mm

3mm 3m

m

1.5mm 1.

5mm I

I I I

I

I

Six Missing Teeth

#3

#5

#4

#2

#14

#12

#13

#15

3mm 3mm

1.5mm 1.

5mm

TOTAL = 46mm

5

5 5

5

4 4 3m

m 3m

m

3mm

Six Missing Teeth

#3

#5

#4

#2

#14

#12

#13

#15

3mm 3mm

1.5mm 1.

5mm

TOTAL = 44mm

5

4 4

5

4 4 3m

m 3m

m

3mm

Six Missing Teeth

#3

#5

#4

#2

#14

#12

#13

#15

3mm 3mm 3mm

3mm 3m

m

1.5mm 1.

5mm

TOTAL = 42mm

4

4

4 4 4

4

Six Missing Teeth

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#3

#5

#4

#2

#14

#12

#13

#15

3mm 3mm

1.5mm 1.

5mm

TOTAL = 40.5mm

4

3.25 4 4 3.25

4

3mm 3m

m

3mm

Six Missing Teeth

#3

#5

#4

#2

#14

#12

#13

#15

3mm 3mm

1.5mm 1.

5mm

TOTAL = 37.5mm

3.25

3.25 3.25 3.25

3.25

3.25

3mm 3m

m

3mm

Six Missing Teeth

X X X X X X

Six Missing Teeth

Will the aesthetics of the case be guaranteed if mapping principles are

followed and not violated?

X X X X Tooth mass equals 34mm

27mm total space needed

This line must be greater than 27mm

This line must be greater than 34mm ➡ Mapping is definite ➡ Violation of the map leads to poor aesthetics ➡ Adherance to the map does not guarantee aesthetics ➡ Biotype, smileline, & the aesthetics of the adjacent teeth also influence final results


aesthetic zone

The influence of Gingival biotype on treatment planning

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Biotypes

Thick vs Thin

Biotype Thick / Flat

Biotype Thin / Scalloped

Thick Flat Biotype

Thin Scalloped Biotype

BIOTYPES Thin / Scalloped Biotype

• Distance from peak of papilla to facial gingival margin is large

• Short contact area towards the middle to incisal third

• Tooth form is tall and tapered with large CL/CW ratio

• Thin band of attached mucosa

• Probably relates to initial tooth eruption through thin band of attached tissue

• Thin facial bone

Thick / Flat Biotype

• Distance from papilla height to facial gingival margin is small • Long broad contact areas from incisal to cervical third • Tooth form is short and square with small CL/CW ratio • Thick band of attached mucosa

• Probably relates to initial tooth eruption through a thick band of attached tissue • Thicker facial bone

Thin Biotype

➡ Gingival recession common with bone level changes

➡ Tissue tears easily and does not heal well

➡ Thin tissue shows underlying metal ➡ CT grafts better than hard tissue for

final augmentation to thicken tissue for better color.....converts thin to thick (Kan et al)

“Facial gingival recession of thin periodontal biotype seems to be more pronounced than that of thick biotype. Biotype conversion around both

natural teeth and implants with subepithelial connective tissue graft has been advocated, and the resulting tissues appear to be more resistant

to recession.”

Kan JY, Rungcharassaeng K, Lozada JL. Bilaminar Subepithelial Connective Tissue Grafts for Immediate Implant Placement and Provisionalization in the Esthetic Zone. J Calif Dent Assoc. 2005 Nov;33(11):865-71

Thick Biotype

➡ Bone levels change with less recession ➡ Scars are easier to hide ➡ Hard tissue augmentation for flat ridges

works well at time of implant placement


aesthetic zone

Delayed Provisionalization

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➡ Techniques:

✦ Laboratory fabrication ✦ Chairside fabrication


➡ Techniques: ✦ Laboratory fabrication 1) Place implant 2) Fabricate surgical index or index impression 3) Laboratory fabricates a working cast from the surgical index or index impression 4) Wax-up to full contour and duplicate 5) Fabricate provisional restoration 6) Implant uncovery 7) Insertion of completed abutment and provisional


➡ Techniques: ✦ Laboratory fabrication

Surgical Index Fabrication


➡ Techniques: ✦ Laboratory fabrication

Index Impression


➡ Techniques: ✦ Chairside fabrication


➡ Techniques: ✦ Chairside fabrication 1) Fabricate provisional shell 2) Implant uncovery 3) Place provisional abutment and “mark facial” 4) Place abutment on lab holder and prepare 5) Place abutment on implant and refine prep 6) Pack cotton and wax in screw channel 7) Line provisional shell with material of choice 8) Place abutment on lab holder with lined provisional and finish shaping the provisional 9) Insertion of completed abutment and provisional


Conversion of Interim RPD

➡ Techniques: ✦ Chairside fabrication


aesthetic zone

Immediate Non-Occlusal Loading:

Immediate Provisionalization

Immediate Placement: Non-occlusal Loading

➡  Partially Edentulous Patients ✦  93 implants in 38 partially edentulous patients ✦  All were immediately provisionalized with prefabricated

abutments and acrylic provisional restorations ✦  Implants were restored at 8 to 12 weeks and followed for

18 months minimum ✦  97.4% success rate with only .76mm of bone loss noted

Drago and Lazarra. JOMI, 2004

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Immediate Placement: Non-occlusal Loading

➡  Partially Edentulous Patients ✦  35 implants in 35 partially edentulous patients ✦  All were immediately provisionalized with

prefabricated abutments and acrylic provisional restorations

✦  Implants were restored at 6 months and followed for 12 months

✦  100% success rate with only .55mm of papilla loss noted and .26mm of bone loss

Kan, et. al., JOMI. 2003

INOL Provisionalization ➡ Techniques: ✦ Chairside fabrication 1) Fabricate provisional shell 2) Implant placement 3) Place provisional abutment and “mark facial” 4) Place abutment on lab holder and prepare 5) Place abutment on implant and refine prep 6) Pack cotton and wax in screw channel 7) Line provisional shell with material of choice 8) Place abutment on lab holder with lined provisional and finish shaping the provisional --NO CONTACTS OR OCCLUSION-- 9) Insertion of completed abutment and provisional -- consider venting prior to cementation

  For Cement-Retained Restorations

  Straight and 15º PreAngled

  PEEK Material

  180-Day Use

  Flat Side for Antirotation

  4mm and 6mm Collar Heights

  Aesthetic Color

  Strong Titanium Alloy Insert

  QuickSeat® Connection or External Hex

  Color-Coded for Certain® Implants

  Carbide Bur, E Cutter Lab Bur, 180 Grit Diamond Bur

PreFormance™ Post��

PreFormance™ ��Temporary Cylinder

  For Screw-Retained Restorations

  PEEK Material

  180-Day Use

  Knurled Surface For Mechanical Retention

  QuickSeat® Connection or External Hex

  Titanium Alloy Interface With QuickSeat® Connection

  Color-Coded for Certain® Implants

  Non-Hexed Also Available

INOL Requirements ➡ The soft tissue profile must be pleasing to

the patient preoperatively ➡ The patient must be a candidate for

immediate non-occlusal loading ✦ Implants torque in at 30NCM or greater ✦ The patient has a suitable occlusion for

non-occlusal function ✦ The patient is a healthy non-smoker ✦ The patient understands the functional

restrictions

INOL: Immediate Non-occlusal Loading Tooth present and hopeless

Tooth is aesthetic: Favorable Biotype

Meets Criteria

INOL

Does Not Meet Criteria

Tooth is un-aesthetic: Unfavorable Biotype

Site Development

Grafting Restorative Dentistry

Implant Placement

Implant Placement

Index impression vs. Surgical Index

Alternative Provisional: Ovate Flipper / AEFPD / IR Tissue Training

& Integration

Keep or Change Abutment (Stock or Custom) Complete Case

2nd Stage Uncovery & Delayed Provisionalization Tissue Training

& Integration

INOL: Immediate Non-occlusal Loading Tooth missing

Favorable Edentulous Site

Meets Criteria

INOL

Does Not Meet Criteria

Index impression vs. Surgical Index

Alternative Provisional: Ovate Flipper / AEFPD / IR Tissue Training

& Integration

Keep or Change Abutment (Stock or Custom)

Unfavorable Edentulous Site

Site Development

Grafting Restorative Dentistry

Implant Placement

Implant Placement

Complete Case

2nd Stage Uncovery & Delayed Provisionalization Tissue Training

& Integration

Homework For Session 2  Complete, update & document “in progress”

cases  Select and work-up NEW PATIENTS  Documentation

– Chief complaint – Case history, dental and periodontal charting – Mounted casts – Clinical photographic images – Radiographs

• FMX, panoramic, tomograms

 Prepare handouts for the group  Review and abstract literature


!!

For Doctors!!

Teaching!!

Presentations!!

STP Session 1 Handout!!

Password: GSTPSession1loc21!

5/2/14

19

Steven J. LoCascio, D.D.S. 306 Prosperity Drive Suite 201 Knoxville, Tennessee 37923

steven@eas&nprosthodon.cs.com

Thank You!


GSTP Session 1

Documents

Transcript of GSTP Session 1