Presentation is loading. Please wait.

Presentation is loading. Please wait.

In partnership with Nobel Biocare Diagnosis and treatment planning for the replacement of missing teeth Module 1 | Session 2 Treatment planning and restoring.

Similar presentations


Presentation on theme: "In partnership with Nobel Biocare Diagnosis and treatment planning for the replacement of missing teeth Module 1 | Session 2 Treatment planning and restoring."— Presentation transcript:

1 in partnership with Nobel Biocare Diagnosis and treatment planning for the replacement of missing teeth Module 1 | Session 2 Treatment planning and restoring the single posterior implant Disclaimer: Some products may not be regulatory cleared/released for sales in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability Please note: It is encouraged that the presentation at hand is adapted and enhanced by clinical cases of the lecturer. Please feel free to adjust the slides according to your preferences.

2 Treatment planning and restoring the single posterior dental implant 2 Gain proficiency in diagnosis and treatment planning Master the restorative steps for a posterior dental implant Transform restorative decision-making and execution into a simple and easy process Learn how to avoid or manage complications Learn how to gain patient acceptance for dental implant treatment Module 1: Course objectives Treatment planning and restoring the single posterior dental implant

3 3 Dental implants – the standard of care Indications and contraindications for dental implants Cement vs. screw-retained restorations Options for replacing a missing tooth Diagnosis and treatment planning Clinical examples How to find patients and gain treatment acceptance Session 1 Session 2 Review of restorative options Surgical templates Biomechanics and occlusion in implant dentistry Case presentation from participants Treatment plan and case work-up with faculty Introduction for surgical preparation Time: 3 hours Time: 3 hours Module 1: Session overview

4 Treatment planning and restoring the single posterior dental implant 4 Impression techniques Cement vs. screw-retained restorations Provisionalization NobelProcera Restorative workshop and hands-on Patient treatment status Basic patient communication concepts Session 3 Session 4 Avoiding or managing complications Dental implant maintenance Final case presentations Time: 3 hours Time: 3 hours Module 1: Session overview

5 in partnership with Nobel Biocare Diagnosis and treatment planning for the replacement of missing teeth Module 1 | Session 2 Agenda Review restorative options Surgical templates Biomechanics and occlusion in implant dentistry

6 Treatment planning and restoring the single posterior dental implant 6 Restorative solutions for dental implants Implant supported solutions from single tooth to full arch restorations Single posterior implant Full arch implants Multiple implants Single anterior implant

7 Treatment planning and restoring the single posterior dental implant 7 Restorative solutions for dental implants Implant supported solutions from single tooth to full arch restorations Single posterior implant

8 Treatment planning and restoring the single posterior dental implant 8 Single missing tooth Restorative options for a single posterior implant: Clinical cases courtesy of Dr. Baldwin Marchack, Pasadena, USA

9 in partnership with Nobel Biocare Diagnosis and treatment planning for the replacement of missing teeth Single missing tooth Single posterior implant Clinical case courtesy of Dr. Sebastian Horvath, Jestetten, Germany

10 Treatment planning and restoring the single posterior dental implant 10 Single missing tooth Restorative options for a single posterior implant: Pre-fabricated abutment, cement-retained crown Individualized abutment, cement-retained crown Screw-retained crown (one piece)

11 Treatment planning and restoring the single posterior dental implant 11 Single missing tooth Screw-retained restoration Cement-retained restoration Single posterior implant Photographs courtesy of MDT Claus-Peter Schulz, Baden-Baden, Germany

12 Treatment planning and restoring the single posterior dental implant 12 Single missing tooth Individualized (CAD/CAM) abutment Pre-fabricated abutment Cement-retained restoration Photographs courtesy of Dr. Baldwin Marchack, Pasadena, USA Photographs courtesy of MDT Claus-Peter Schulz, Baden-Baden, Germany

13 Treatment planning and restoring the single posterior dental implant 13 Guidelines for abutment selection Issues to be considered: Implant-abutment connection Distance from the implant platform to bone crest Interocclusal distance Depth of peri-implant soft tissues Biotype of the tissue Emergence profile Shape and contour of the tissue Screw-retained/cement-retained

14 Treatment planning and restoring the single posterior dental implant 14 Ideal gingival height – 1 to 3mm, flat shape Ideal interarch dimension – 5 to 10mm Guidelines for abutment selection

15 Treatment planning and restoring the single posterior dental implant 15 Guidelines for abutment selection Too deep, not flat – use another solution.

16 Treatment planning and restoring the single posterior dental implant 16 Guidelines for abutment selection A case study: “Resistance to dislodgement of zirconia copings cemented onto titanium abutments of different heights.” Abbo B, Razzoog M, Vivas J, Sierraalta M. J Prosthet Dent 2008; 99: Purpose: Authors measured the force it takes to dislodge a cemented crown on abutments of various heights Results: The taller the abutment height the greater the force required to dislodge a cemented crown. Study recommends that abutments should be no less than 4mm in height when using a cemented crown. Abutment height:6.5mm5.5mm Average dislodgement force:198.09N N

17 Treatment planning and restoring the single posterior dental implant 17 Guidelines for abutment selection 2-3mm gingival height 5mm interarch dimension

18 Treatment planning and restoring the single posterior dental implant 18 Posterior abutment decision tree – single implant crown Posterior Abutment Decision Tree © Copyright 2010 Baldwin Marchack, DDS. Used by permission. Interarch distance > 5mm Interarch distance < 5mm Screw-retained crown Individualized one-piece restoration NobelProcera Screw-retained crown (Ti or Zr) Single posterior implant restoration

19 Treatment planning and restoring the single posterior dental implant 19 Guidelines for abutment selection Limited interarch dimension Photographs courtesy of Dr. Baldwin Marchack, Pasadena, USA

20 Treatment planning and restoring the single posterior dental implant 20 Guidelines for abutment selection Use a screw-retained crown: 1.Limited interarch dimension 2.Patient is a bruxer 3.Retrievability is desired 4.Cement-free solution wanted Screw-retained crown: 1.NobelProcera screw-retained crown 2.GoldAdapt abutment

21 Treatment planning and restoring the single posterior dental implant 21 Guidelines for abutment selection Photographs courtesy of MDT Claus-Peter Schulz, Baden-Baden, Germany

22 Treatment planning and restoring the single posterior dental implant 22 Guidelines for abutment selection Clinical case courtesy of Dr. Sebastian Horvath, Jestetten, Germany

23 Treatment planning and restoring the single posterior dental implant 23 Posterior abutment decision tree – single implant crown Posterior Abutment Decision Tree © Copyright 2010 Baldwin Marchack, DDS. Used by permission. Interarch distance > 5mm Interarch distance < 5mm Cement-retained crown Screw-retained crown Flat tissue < 3mm ID 5–10mm Pre-fabricated abutment Snappy Abutment Individualized one-piece restoration NobelProcera Screw-retained crown (Ti or Zr) Retrievability is desired Single posterior implant restoration

24 Treatment planning and restoring the single posterior dental implant 24 Guidelines for abutment selection Ideal gingival height (1–3mm) Ideal interarch dimension (5-10mm) Flat tissue architecture Clinical case courtesy of Dr. Sebastian Horvath, Jestetten, Germany

25 Treatment planning and restoring the single posterior dental implant 25 Snappy ™ Abutment Ideal gingival height (1–3mm) Ideal interarch dimension (5-10mm) Flat tissue architecture Clinical case courtesy of Dr. Sebastian Horvath, Jestetten, Germany

26 Treatment planning and restoring the single posterior dental implant 26 Clinical case courtesy of Dr. Sebastian Horvath, Jestetten, Germany Snappy ™ Abutment

27 Treatment planning and restoring the single posterior dental implant 27 Posterior abutment decision tree – single implant crown Posterior Abutment Decision Tree © Copyright 2010 Baldwin Marchack, DDS. Used by permission. Interarch distance > 5mm Interarch distance < 5mm Cement-retained crown Screw-retained crown Flat tissue < 3mm ID 5–10mm Pre-fabricated abutment Snappy Abutment Individualized one-piece restoration NobelProcera Screw-retained crown (Ti or Zr) Scalloped < 4mm ID 5–10mm Pre-fabricated abutment Esthetic Abutment (Ti) Procera Esthetic Abutment (Zr) Single posterior implant restoration

28 Treatment planning and restoring the single posterior dental implant 28 Pre-fabricated Esthetic Abutment Pre-fabricated, customizable Titanium abutment: Comprehensive selection of different margin designs and angulations minimize chair-side adjustments Scalloped margin designed to profile natural soft tissue contours Optional temporary coping available for temporization Indications: Single- and multiple-unit implant restorations Cement-retained Esthetic Abutment (Titanium)

29 Treatment planning and restoring the single posterior dental implant 29 Esthetic Abutment Clinical case courtesy of Dr. Christopher Marchack, Pasadena, USA

30 Treatment planning and restoring the single posterior dental implant 30 Esthetic Abutment Clinical case courtesy of Dr. Christopher Marchack, Pasadena, USA Milled titanium Can be adjusted by the lab Corrects minor angulation problems Fixture level impression Easy to cement

31 Treatment planning and restoring the single posterior dental implant 31 Posterior abutment decision tree – single implant crown Posterior Abutment Decision Tree © Copyright 2010 Baldwin Marchack, DDS. Used by permission. Interarch distance > 5mm Interarch distance < 5mm Cement-retained crown Screw-retained crown Flat tissue < 3mm ID 5–10mm Pre-fabricated abutment Snappy Abutment Individualized one-piece restoration NobelProcera Screw-retained crown (Ti or Zr) Scalloped < 4mm ID 5–10mm Pre-fabricated abutment Esthetic Abutment (Ti) Procera Esthetic Abutment (Zr) Scalloped or flat tissue > 4mm ID > 5 mm Individualized abutment NobelProcera Abutment (Ti or Zr) Single posterior implant restoration Depending on clinical situation and preference, the GoldAdapt Abutment can be a flexible solution for both cement- and screw-retained restorations and for various gingiva heights.

32 Treatment planning and restoring the single posterior dental implant 32 Guidelines for abutment selection Individualized abutment Scalloped tissue architecture Thick soft tissue Angled implant placement Excessive interarch dimension Excessive interproximal dimension Fabrication options: 1.NobelProcera abutment in Titanium or Zirconia 2.GoldAdapt abutment

33 Treatment planning and restoring the single posterior dental implant 33 NobelProcera ® abutment NobelProcera Angulated Screw Channel abutment Easy access due to tilted access hole Clinical case courtesy of Dr. Sebastian Horvath, Jestetten, Germany Photographs courtesy of MDT Claus-Peter Schulz, Baden-Baden, Germany

34 Treatment planning and restoring the single posterior dental implant 34 NobelProcera ® abutment Clinical case courtesy of Dr. Sebastian Horvath, Jestetten, Germany Photographs courtesy of MDT Claus-Peter Schulz, Baden-Baden, Germany

35 Treatment planning and restoring the single posterior dental implant 35 Posterior implant restoration Clinical case courtesy of Dr. Sebastian Horvath, Jestetten, Germany

36 Treatment planning and restoring the single posterior dental implant 36 Posterior abutment decision tree – single implant crown Interarch distance > 5mm Interarch distance < 5mm Cement-retained crown Screw-retained crown Flat tissue < 3mm ID 5–10mm Pre-fabricated abutment Snappy Abutment Individualized one-piece restoration NobelProcera Screw-retained crown (Ti or Zr) Retrievability is desired Scalloped < 4mm ID 5–10mm Pre-fabricated abutment Esthetic Abutment (Ti) Procera Esthetic Abutment (Zr) Scalloped or flat tissue > 4mm ID > 5 mm Individualized abutment NobelProcera Abutment (Ti or Zr) Posterior Abutment Decision Tree © Copyright 2010 Baldwin Marchack, DDS. Used by permission. Single posterior implant restoration Depending on clinical situation and preference, the GoldAdapt Abutment can be a flexible solution for both cement- and screw-retained restorations and for various gingiva heights.

37 in partnership with Nobel Biocare Diagnosis and treatment planning for the replacement of missing teeth Diagnosis and prosthetic treatment planning Four important tools 1.Diagnostic models 2.Radiographs 3.(CB)CT scans 4.NobelClinician Software

38 Treatment planning and restoring the single posterior dental implant Diagnostic Models Evaluate: Centric relation position Edentulous ridge relationship to adjacent teeth, opposing ridge, opposing dentition Inclination, rotation, extrusion, alignment of the remaining dentition Soft tissue, gingival heights, and other esthetic parameters Interarch space Determine: Options for occlusal schemes Ideal number and location of implants Direction of forces to which future implants would be subjected 38

39 Treatment planning and restoring the single posterior dental implant Please bear in mind that radiographs are not completely accurate Radiographs Evaluate: Amount of bone available (2D only) Angulation of adjacent teeth Location of anatomical structures Sinus, mandibular canal, mental foramen 39 Clinical case courtesy of Dr. Richard Sullivan, Pasadena, USA

40 Treatment planning and restoring the single posterior dental implant (CB)CT scans 40 Clinical case courtesy of Dr. Christopher Marchack, Pasadena, USA Since radiographs are not completely accurate, a (CB)CT scan can improve the diagnosis

41 Treatment planning and restoring the single posterior dental implant NobelClinician ® Software 41 Visualize the patient’s (CB)CT data together with the intra-oral situation and the diagnostic setup thanks to NobelClinician’s SmartFusion™ technology Clinical case courtesy of Dr. Christopher Marchack, Pasadena, USA

42 Treatment planning and restoring the single posterior dental implant Surgical templates Models, radiographs and (CB)CT scans are essential in fabricating surgical templates for various types of surgery: –Flapless –Mini flap –Flap All options are covered with the NobelClinician Software and NobelGuide 42

43 Treatment planning and restoring the single posterior dental implant Surgical templates Benefits of surgical templates: More precise placement of implants Preservation of anatomic structures Shorter treatment times, surgery times Less invasive, flapless surgery and therefore less chance of swelling Less post-operative strain on dentist and patient 43 Manikandan R et al. Implant surgical guides: From the past to the present. J Pharm Bioallied Sci 2013;5(Suppl 1):S98-S102

44 Treatment planning and restoring the single posterior dental implant One integrated treatment workflow, countless benefits 44 1.Clinical diagnostics and treatment acceptance 2.Capturing both the current and desired situation 3.Treatment planning and patient communication Production of surgical template 4.Implant placement either freehand or using pilot drill template or fully guided template 5.Prosthetic design Production of prosthesis 6.Restoration placement NobelConnect ® Clinical diagnostics & treatment acceptance Capturing both the current & desired situation Treatment planning & patient communication Production of surgical template Implant placementDesign of final restoration Production of prosthesis Restoration placement

45 Treatment planning and restoring the single posterior dental implant 45 Treatment planning What is the minimum space needed between teeth for a single-tooth implant? ø 3.5mmø 4.3mmø 5.0mm ~1.5mm on each side of implant, 2mm is better for soft tissue Ø 4.3mm 1.5-2mm Illustrations refer to Nobel Biocare implants with Conical Connection 1 Gastaldo JF et al. Effect of the Vertical and Horizontal Distances Between Adjacent Implants and Between a Tooth and an Implant on the Incidence of Interproximal Papilla. J Periodontol 2004;75(9):

46 Treatment planning and restoring the single posterior dental implant 46 Occlusion and biomechanics The picture shows which force occurs during a situation of malocclusion The resulting force is perpendicular to the plane of contact If the resulting force is too strong for the crown, the restoration may break or may result in crestal bone loss The principles are the same for both natural teeth and implants →how can breakage and crestal bone loss be avoided? Forces acting during a condition of malocclusion Illustrations obtained through internet research:

47 Treatment planning and restoring the single posterior dental implant 47 Occlusion and biomechanics Uneven loading Overloading may occur because of incorrect placement of the implant and critical restoration geometries This can result in uneven force distribution on the implant's surface Dental implants should ideally be placed so that the biting forces are directed straight downward onto the dental implant

48 Treatment planning and restoring the single posterior dental implant 48 Occlusion and biomechanics FBite  FN1 FNx1 FBite  FN2 FNx2 The steeper the line of contact, the stronger the resulting force The force necessary to equalize the vertical bite force is higher, when the line of contact is steeper In the dental environment, the occlusion should be shallow or flat in order to reduce the lateral forces impacting on the occlusion →it is recommended to create shallow or flat occlusion lines to reduce the overload risk

49 Treatment planning and restoring the single posterior dental implant Possible consequences of overload Crestal bone loss Dislodged restorations Screw loosening Screw fracturing Restoration or ceramic fracture Peri-implantitis Implant failure 49 Occlusion and biomechanics Clinical case courtesy of Dr. Baldwin Marchack, Pasadena, USA * This list makes not claim to be complete.

50 Treatment planning and restoring the single posterior dental implant Possible consequences of overload 50 Occlusion and biomechanics Clinical case courtesy of Dr. Baldwin Marchack, Pasadena, USA

51 Treatment planning and restoring the single posterior dental implant Summary Keep cusp inclines flat or shallow to minimize lateral forces No premature contacts Light occlusal contacts Avoid supra-occlusal axial and lateral loading Keep contacts in the same line as the long axis of the implant, i.e., as close to the center as possible Avoid cantilevers, whether mesial, distal, buccal, or lingual 51 Occlusion and biomechanics Chia-Chun Yuan J, Sukotjo C. Occlusion for implant-supported fixed dental prostheses in partially edentulous patients: a literature review and current concepts. J Periodontal Implant Sci 2013;43:51-57 Rani G, Gambhir A. Occlusion In Implants - A Review. Indian J Dental Sci 2012;3(4):95-98

52 Treatment planning and restoring the single posterior dental implant 52 Refer your patient to your surgical specialist for implant treatment Ensure a complete patient documentation for later case presentation You may invite your dental laboratory technician to participate in session 3 of the Esthetic Alliance Program Your next steps for session 3 Treatment planning and restoring the single posterior dental implant

53 53 Thank you! Disclaimer: Some products may not be regulatory cleared/released for sales in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability © Nobel Biocare Services AG. All rights reserved.


Download ppt "In partnership with Nobel Biocare Diagnosis and treatment planning for the replacement of missing teeth Module 1 | Session 2 Treatment planning and restoring."

Similar presentations


Ads by Google