1. Hana C. Hobbs DDS, MS 2900 Croasdaile Drive , Suite One Durham NC 27705
Diplomate of the Am.Board of Periodontology
Practice limited to Periodontology and Implants

2. Periodontal–Restorative Interactions
Key is Communication Pre-op To Achieve Good Results

3. The Keys To Success In Treatment
Clear and Timely Communication
Understanding The Goals of Each Treatment
a. Should Tooth Be in Provisional Before Soft Tissue
Grafting
b. Is there enough Clearance for Implant and Abutment
?counter-sink implant
c. Screw Retained vs Cemented Crown
d. How Long to Wait After Laser Therapy (LANAP) to
restore
e. How Long to Wait After Laser Therapy (LANAP) for
Orthodontic Treatment

4. Ideal Implant Placement
In the Anterior In the Cingulum Area
In the Highly Esthetic Area Implant Should be 3mm from Adjacent CEJ
(deeper a pocket will exist)
Ideal Implant to Tooth Distance
Anterior 1.5mm
Posterior 3mm
In Ant need Implant 2-3 mm From Buccal Plate
In Post need Implant 1mm From Buccal Plate

5. Implant in Cingulum area

6. Inter-Arch Distance Need 9mm’s in Anterior Need 7mm’s in Posterior
Need 12mm’s for Complete Denture
If there is less than 7mm’s use
Screw Retained Crown.

7. Immediate Implants Indications
Divergent Roots, Stability, No Infection,
Good Soft Tissue
Adjacent Teeth Sound
Minimize Surgical Procedure
Contraindications
Root Proximity, Mal-positioned Teeth, Large Infection, Soft Tissue Defect

8. Implant Failure “Rules”
Early Failure
Micromovement
Surgical Trauma
Impaired Healing
Pressure Necrosis
Type I Bone
Incision Line Opening
Infection
Late Failure
Residual Cement
Biomechanical
Prosthesis Design
Ex porcelain fx
Ex screw loosening
Trauma from Occlusion
Trauma from Occlusion can
Cause a previously
integrated implant to lose
integration

9. Pros and Cons of Fixed Provisionals
Immediate Fixed Provisional
Can be cumbersome to fabricate, may come loose and need to be tightened
Can damage the implant
Esthetics good , may think this is final restoration
Cost
Removable Provisional
Easy to fabricate
Annoyance factor
Motivate to finish
Implant Crown
Can achieve good
esthetics with it
Esthetics Based On
Implant Placement

10. Edentulous Patients have A Mouthful of Problems
Impaired Speech
Changed Appearance (sunken cheeks, Collapsed jawline)
Increased Health Risk (Increased Cardiovascular Disease)
Low Self –Esteem
Facial Aging
Eating Unhealthy Diet (less fruits and vegetables)

11. Implants in Edentulous Cases
Locator Case
Lower
Lower Two (minimum)
Four (Upper)

12. Overdenture Case Planning
Maxilla:
Minimum 4 implants
Mandible:
Minimum 2 implants

13. Select the appropriate Locator™ Abutment
Review the depth and the accompanying abutment

14. Multiple Implants
With Multiple Implants guided Implant Surgery Allows the advantage of Precise Implant Placement
Preoperative Implant Planning
Decision Making with the Restorative Doctor and the Periodontist and Patient (Win/win/win)
Simplant Software has been used in my practice since 2005

15. Abutment selection
Atlantis Custom Abutment emulates what a Lab Tech does in his or her head:
Fill the edentulous space with the “ideal” crown(s)
Analyze customer preferences that will affect abutment design
Design the abutment
“Inspect” virtual model against all preferences
When all parameters are met, the abutment is manufactured by computer-Warranty

16. Teeth Are Not Round
Atlantis™ Abutments are ideally designed from the final tooth shape

17. Comparison of Stock vs Atlantis
Stock Abutment
Atlantis Abutment

18. Ridge Augmentation/Preservation
After Tooth Extraction , proper placement of the correct bone grafting material with or without a membrane.
If the ridge is deficient, then ridge augmentation procedure with Block grafting or with particulate bone grafts and membrane.

19. Bone Loss After An Extraction
After An Extraction 60% of Bone in Socket is Resorbed within 2-3 years
The resorption is greater on the buccal aspect for both maxillary and mandibular arch
Schropp et al showed on average 3 to 5mm of bone loss at six month after tooth extraction and 50% width reduction of ridge at 12 month.
Preservation of the Ridge after Tooth extraction is vital.

20. Case Presentations