Treatment Planning pt.1-2
Transcript of Treatment Planning pt.1-2
Implant Dentistry
Course goals
Students will improve their clinical decision making skills when treatment planning patients
requiring prosthodontic care.
Students will understand how dental implantscan be used to improve masticatory function
and quality of life issues.
Instructional Objectives
• Students will be familiar with implant component identification and the steps involved in completing an implant crown for a patient requiring a single tooth implant.
• Students will understand how to treatment plan using implants being aware of patient assessment, biomechanical issues, and risk factors with implants.
• In the partially and completely edentulous patient, students will understand the options for treatment using dental implants as opposed to traditional prosthodontic treatment.
My vision of the UCSF graduate– a good decision maker: an example
Decision making
Decision Making Gather appropriate information for assessment
of what went wrong and why. Next, determine the treatment options.
If Implants:• The type, position, diameter and length of
implants• The number of implants• Internal or external connection• Splinting?• Treatment sequence
• Caries process/ RCT• Weakened tooth perio, structurally• Root proximity• Difficult maintenance• Crown lengthening
FPD Success Rates
• 87% 10 yr success rate,69% at 15 years
• Failure by recurrent caries (18%),loose retainer (7%), porcelain fracture 6.1%, Endo 5%, Perio 4%.
• Please read Goodacre et al.
Removable partial denture
• RPD is often a good option; especially if there is support from teeth
• Less expensive than FPD, Implants
• Increased plaque accumulation 25%.
• Psychological
Shortened Dental Arch
• Article by Armellini et. al.
• Function and stability of bicuspid occlusion
• Evaluated over time
What would you do here?
To restore:
• Root canal, post build-up, crown• Would you do crown lengthening; no, why
not? Crown lengthening would compromise soft tissue esthetics and compromise a future implant site because you are removing bone.
• How would you develop sufficient ferrule if you were to try to save this tooth? This could be done by orthodontic extrusion.
Issues with an implant?
What would you do here?
What would you do here?
Please read: Curtis et al. Treatment planning in the 21st century.
Implants are not always the best treatment
Treatment planning
• Treatment plan based on functional need rather than anatomic loss– Some patients may have a substantial
anatomic loss but QOL may be satisfactory
• Today’s lecture: 1/7/09• What do the implant components look like
and how do the parts work together. Nomenclature
• Reasons dental implants should be considered when providing prosthodontic care.
• What are the success rates of dental implants and what factors influence success?
• Treatment planning dental implants using efficacy and benefit/risk as outcome assessments.
Articles for this week and next week
• Curtis et al. Occlusal considerations for Implant restorations… Please read entire article carefully.
• Curtis et al. Treatment planning in the 21st Centruy; What’s new. Please read introduction and section on prosthodontics on page 505.
• Curtis et al. The use of dental implants to improve quality of life…. Please read entire article carefully.
• Goodacre et al. Clinical complications with implants and implant prostheses
Supplements for this week
Implant DVD; please look over the treatment planning section and single tooth implant section
Course goals for 2009 handout; outlines goals for this course
Short answer essay questions; outlines most of the major concepts I hope you will learn
Optional essay
• Any topic related to implants
• Previous national awards
Assessments
• Some MC, some essay, some slide identification
• The only make up and/or remedial exams will be essay exams
What are dental implants??
Materials: (Ti-99) or (ti-6Al-4V)
Threaded or not threadedTi or HA
Smooth or acid etchedDiameter
Tapered or parallelLength
Distribution
Nomenclature: please also see DVD
• Healing abutment
• Fits into implant
• Maintains access through tissue
Nomenclature
• Transfer assembly
Nomenclature
• Transfer assembly that is used to transfer the position of the implant in the patient to the cast
Nomenclature
• Transfer assembly with implant analogue attached so the impression can be poured up in stone
Nomenclature
• Implant analogue; this has the same geometry as the top of the implant
• The implant analogue is in the same position on the cast as the implant is in the mouth.
Traditional protocol
4 to 6 implants
added between foramen
4 to 6 implants
added between foramen
Traditional protocol
for implant prosthesis
A 15 year study of osseointegrated implants in
the edentulous jaws
A 15 year study of osseointegrated implants in
the edentulous jaws
ADELL, R. et al. 1981
91%81%96% 100%
0%
50%
100%
150%
MAXILA MANDÍBULA
CIRURGIA
PROTESESurgery
prosthesis
maxilla mandible
Overdenture option45% increase in
chewing efficiency.
Adaptations to the traditional protocol
Adapted for single tooth implants
Steps for a single tooth implant
3
Nomenclature
• Implant (sometimes called a fixture)
Nomenclature • Implant abutment
(solid)
• Implant abutment (to be waxed up
Nomenclature • Healing abutment
• Transfer assembly
Nomenclature
• Implant analogue
Nomenclature
• Implant screws
• Today’s lecture: 1/7/09• What do the implant components look like and
how do the parts work together. Nomenclature• Reasons dental implants should be
considered when providing prosthodontic care.
• What are the success rates of dental implants and what factors influence success?
• Treatment planning dental implants using efficacy and benefit/risk as outcome assessments.
Why implants should be considered
• Over 40 million• 65% affects quality of
life- Curtis article• 50% of patients are
limited in food choices• 150 million on denture
adhesives• Psychosocial
implications
Why consider implants?
• About 60%, or over 21 million Americans that use a prosthesis report at least one major problem with their prosthesis that limits their ability to masticate the foods they would like to eat.
• 29% of edentulous patients are able to eat only soft or mashed foods.
• 50% of edentulous patients state they avoid many foods.
• Today’s lecture: 1/7/09• What do the implant components look like and
how do the parts work together. Nomenclature• Reasons dental implants should be considered
when providing prosthodontic care.• What are the success rates of dental
implants and what factors influence success?
• Treatment planning dental implants using efficacy and benefit/risk as outcome assessments.
Success rates
• Integration above 95%
• Some compromises (esthetics, function, timing) when treatment is not coordinated
• Success is if the patients expectations are met; be careful to outline limitations of functional improvement and/or esthetic issues.
• Space
Treatment Planning with dental implants: what is possible and what is best?
5 patient examples