introducing dental implants 1st edition by John Hobkirk,Roger Watson,Lloyd Searson 9780702059339 0702059331

1 Using this book

INTRODUCTION

IMPLANT TREATMENT

GENERAL TREATMENT DECISIONS

GATHERING INFORMATION AND TREATMENT PLANNING

IMPLANT SURGERY

THE EDENTULOUS CASE

THE PARTIALLY DENTATE CASE

THE SINGLE-TOOTH SCENARIO

OTHER APPLICATIONS

PROBLEMS

2 Implants: an introduction

MANAGEMENT OF MISSING TEETH

OSSEOINTEGRATION

3 General treatment decisions

INTRODUCTION

Treatment alternatives to dental implants for the partially dentate case

NO REPLACEMENT

4 Gathering information and treatment planning

WHAT ARE THE OBJECTIVES OF GATHERING INFORMATION AND PLANNING IMPLANT TREATMENT?

Box 4.1 Patient assessment leading to planned treatment

In which circumstances are dental implants most needed?

The edentulous patient

Box 4.2 Essential information

The partially dentate patient

What specific information should be sought in the medical, dental and social history of the patient?

5 Basic implant surgery

INTRODUCTION

INFORMATION REQUIRED AT THE SURGICAL STAGE

INFORMED CONSENT

MANAGEMENT

 

POST-OPERATIVE CARE

Wound management

Fig. 5.19 Using bone collected from the bone trap the implant site is augmented to provide better soft tissue support and cover any exposed implant threads.

Box 5.5 Grafting material

Postoperative haemorrhage

Postoperative analgesia

One-week review

SINUS LIFT/ELEVATION PROCEDURES

Contraindications

GRAFT MATERIALS

 

Problems seating the implant

Failure to place a cover screw or healing abutment over the implant

Failure to close the flap

Excess bleeding

Paraesthesia

Fig. 5.30 Wound breakdown around these three recently inserted implants has led to their exposure. They are associated with necrotic bone, and all three have failed.

Wound breakdown

Exposure of cover screws

Postoperative pain

FURTHER READING

6 The edentulous patient

INTRODUCTION: WHEN IS IMPLANT TREATMENT CONSIDERED APPROPRIATE?

IN WHICH CIRCUMSTANCES IS THIS TREATMENT LIKELY TO BE PROVIDED?

HOW MAY THE EDENTULOUS OR POTENTIALLY EDENTULOUS JAW BE TREATED?

Box 6.1 Complete dentures -influencing factors

Box 6.2 Complete implant-stabilized overdentures(s) -influencing factors

Box 6.3 Complete implant-stabilized fixed prosthesis(es) -influencing factors

Box 6.4 Problems associated with conventional complete dentures

HOW MAY THE EDENTULOUS JAW BE TREATED WITH IMPLANTS?

 

JAW RELATION

OCCLUSAL RELATION

POSITION OF RIDGE V. PROPOSED DENTAL ARCH

WELL-DESIGNED EXISTING COMPLETE DENTURES

Fig. 6.31 The OPT identifies the alignment of the bar with the condylar hinge axis.

Insertion of the prosthesis

Table 6.2 Complete over-denture anchorage to dental implants

Alternative procedure: relining/ adapting a denture

Preparation of fixed implant prostheses

Box 6.9 Choices in superstructure construction for fixed complete implant prostheses

Fig. 6.32 The wax pattern prepared for the cast alloy superstructure.

Fig. 6.33 A cast alloy superstructure showing the cantilever extensions and the enclosed gold alloy cylinders.

Fig. 6.34 A superstructure can be constructed by the ProceraTM technique of milling.

Fig. 6.35 Masking is applied to the titanium beam.

Fig. 6.36 Intra-oral radiographs of the ProceraTM prosthesis sited on the implants.

Fig. 6.37 Implants placed for the provision of fixed prostheses.

Fig. 6.38 Healing abutments will be removed and replaced by standard or multi-unit components.

Fig. 6.39 Healing caps have been placed on standard abutments and the patient’s denture modified to clear them.

Fig. 6.40 Access holes enable placement of the gold screws, which secure the prosthesis to the abutments.

Fig. 6.41 Radiograph showing a fixed mandibular prosthesis.

Fig. 6.42 A functioning maxillary prosthesis after 5 years.

Box 6.10 Patient complaints of new implant prostheses

LOOSENESS/INSTABILITY OF REMOVABLE PROSTHESIS

DIFFICULTY WITH ORAL HYGIENE

FOOD ACCUMULATION

SPEECH IMPAIRMENT

MONITORING AND MAINTENANCE

FURTHER READING

7 The partially dentate patient

INTRODUCTION

The partially dentate patient

Case assessment

SYSTEMIC FACTORS

Patients’ desires and needs

The patient’s expectations

Commitment

Resources

Residual life expectancy

Ability to cooperate

Ability to undergo surgery

LOCAL FACTORS

Treatment alternatives

Orthodontic treatment

Removable partial dentures

Resin retained bridges

Conventional bridges

Implant-based treatment

Missing posterior teeth

8 Single-tooth implants

INTRODUCTION

CAUSES OF THE MISSING SINGLE TOOTH

THE DECISION TO REPLACE A MISSING ANTERIOR TOOTH

 

Fig. 8.28 When designing an implant crown opposing a natural dentition, light contact in the intercuspal position is preferred while maintaining heavy contact between the adjacent natural dentition.

Fig. 8.29 If implant crowns oppose implant crowns, it is preferred that there is little or no contact of these crowns when the patient is in the intercuspal position.

Fig. 8.30 Initial blanching of the soft tissues upon insertion of the porcelain-fused-to-metal crown on 12.

Fig. 8.31 One-week review of 12 showing healthy soft tissue.

Two-week review

Fig. 8.32 Manufactured ‘CeraOne’ abutment replacing 46.

Fig. 8.33 Final crown cemented on ‘CeraOne’ abutment replacing 46.

Box 8.5 A final radiograph is taken to:

Danger signs at a review appointment

Fig. 8.34 Baseline radiograph after cementation of a crown on 11.

Fig. 8.35 Porcelain crown replacing 23 cemented on a single-tooth implant.

Fig. 8.36 Radiograph showing excess cement in the soft tissues.

Fig. 8.37 Radiograph showing loosening of an abutment screw due to failure to tighten it correctly.

Evaluation of marginal bone levels

Oral hygiene

FURTHER READING

9 Other applications

INTRODUCTION

INTRA-ORAL APPLICATIONS

Box 9.1 Other applications for osseointegrated implants

INTRA-ORAL

INTRA-ORAL AND FACIAL SKELETON

EXTRA-ORAL/FACIAL

Immediate loading

Fig. 9.1 Diagram showing a zygomatic implant engaging the palate and zygomatic bones of the skull lateral to the maxillary antrum and the orbit.

Orthodontic applications

How may implants assist restoration of the resected mandible?

Fig. 9.2 A resected mandible has been reconstructed with corticocancellous bone grafts.

Fig. 9.3 A computer image reconstructed from a CT scan, showing malocclusion arising from the graft of excessive length and inadequate height.

Box 9.2 Siting of dental implants in resected mandibles

Fig. 9.4 The mandible has been enhanced sufficiently by shortening and the use of cancellous iliac bone enclosed by a preformed titanium mesh tray. Dental implants now support a fixed prosthesis.

Box 9.3 Assessment of resected/reconstructed mandibles

Choice of prosthesis

Maxillary defects

Treatment stages

Problems

Treatment planning

Failure of osseointegration

Cleaning

Zygomatic implants

Introduction

Indications

Patient assessment

Surgical stage

Fig. 9.5 Partial restoration of the maxillary arch has been achieved with dental implants. The posterior sites in the premolar and first molar areas are restored with zygomatic implants.

Restoration

Fig. 9.6 The fixed maxillary prosthesis has been constructed with a cast alloy framework enclosing gold cylinders supporting a resin-based dental arch.

Box 9.4 Zygomatic implants

WHAT ARE THEY?

WHEN MIGHT THEY BE USED?

PATIENT ASSESSMENT

WHAT PROBLEMS MAY BE ENCOUNTERED WHEN USING THEM?

Problems

Fig. 9.7 A flanged implant body manufactured for use in the skull.

REHABILITATION OF EXTRA-ORAL DEFECTS

Facial prostheses

Fig. 9.8 Percutaneous abutments support cylinders linked by a bar.

The design and construction of facial prostheses

Fig. 9.9 The ear prosthesis is retained by clips on the bar.

Box 9.5 Treatment planning for facial prostheses

CLINICAL APPRAISAL OF DEFECTIVE TISSUE AREA

RADIOGRAPHIC EXAMINATION

LABORATORY ASSESSMENT

SURGICAL PREPARATION

PROSTHESIS DESIGN

Fig. 9.10 Reconstruction from the CT scan identifies, in an axial slice, the limited thickness of the mastoid bone on the defect side of the skull, where the ear is affected by hemifacial micosomia.

Surgical placement of skull implants

Fig. 9.11 Inserting a skull implant into the prepared site.

Prosthesis construction

Fig. 9.12 The patient has been born with hemifacial microsomia including a missing external ear (anotia).

Fig. 9.13 A computer image from an MRI scan may be manipulated to include a mirror image of the normal ear in a planned position on the defective side of the face.

Fig. 9.14 This image from the computer shows a slice file prepared for rapid proces modelling.

Fig. 9.15 Rapid process models can be prepared of the prosthesis fitted to the face and of the defect side for a precisely fitting wax replica.

Fig. 9.16 Rehabilitation achieved with the implant-retained silicone prosthesis.

Key issues

Fig. 9.17 Skull implants positioned in the orbital rim, support a bar carrying magnets for retention of a facial prosthesis.

Fig. 9.18 The orbital facial prosthesis is retained by keepers. The spectacles mask the perimeter.

Bone anchored hearing aids

Fig. 9.19 The skin has been penetrated by four abutments. The thick, hair-bearing skin has been replaced by a free graft to create thin, tightly bound tissue around the abutment, which is to be used for a bone-anchored hearing aid (BAHA).

Fig. 9.20 The ear prosthesis and BAHA are slightly separated.

12. Discuss the range of radiographic techniques which may be used in the planning of implant treatment.