treatment planning pt.1-2
TRANSCRIPT
![Page 1: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/1.jpg)
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.
![Page 2: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/2.jpg)
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.
![Page 3: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/3.jpg)
My vision of the UCSF graduate– a good decision maker: an example
Decision making
![Page 4: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/4.jpg)
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
![Page 5: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/5.jpg)
• Caries process/ RCT• Weakened tooth perio, structurally• Root proximity• Difficult maintenance• Crown lengthening
![Page 6: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/6.jpg)
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.
![Page 7: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/7.jpg)
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
![Page 8: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/8.jpg)
Shortened Dental Arch
• Article by Armellini et. al.
• Function and stability of bicuspid occlusion
• Evaluated over time
![Page 9: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/9.jpg)
![Page 10: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/10.jpg)
![Page 11: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/11.jpg)
What would you do here?
![Page 12: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/12.jpg)
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.
![Page 13: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/13.jpg)
Issues with an implant?
![Page 14: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/14.jpg)
What would you do here?
![Page 15: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/15.jpg)
What would you do here?
Please read: Curtis et al. Treatment planning in the 21st century.
![Page 16: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/16.jpg)
![Page 17: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/17.jpg)
Implants are not always the best treatment
![Page 18: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/18.jpg)
![Page 19: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/19.jpg)
![Page 20: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/20.jpg)
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
![Page 21: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/21.jpg)
• 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.
![Page 22: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/22.jpg)
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
![Page 23: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/23.jpg)
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
![Page 24: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/24.jpg)
Optional essay
• Any topic related to implants
• Previous national awards
![Page 25: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/25.jpg)
Assessments
• Some MC, some essay, some slide identification
• The only make up and/or remedial exams will be essay exams
![Page 26: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/26.jpg)
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
![Page 27: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/27.jpg)
Nomenclature: please also see DVD
• Healing abutment
• Fits into implant
• Maintains access through tissue
![Page 28: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/28.jpg)
Nomenclature
• Transfer assembly
![Page 29: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/29.jpg)
Nomenclature
• Transfer assembly that is used to transfer the position of the implant in the patient to the cast
![Page 30: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/30.jpg)
Nomenclature
• Transfer assembly with implant analogue attached so the impression can be poured up in stone
![Page 31: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/31.jpg)
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.
![Page 32: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/32.jpg)
Traditional protocol
![Page 33: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/33.jpg)
4 to 6 implants
added between foramen
4 to 6 implants
added between foramen
Traditional protocol
for implant prosthesis
![Page 34: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/34.jpg)
![Page 35: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/35.jpg)
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
![Page 36: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/36.jpg)
Overdenture option45% increase in
chewing efficiency.
Adaptations to the traditional protocol
![Page 37: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/37.jpg)
Adapted for single tooth implants
![Page 38: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/38.jpg)
![Page 39: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/39.jpg)
Steps for a single tooth implant
![Page 40: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/40.jpg)
![Page 41: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/41.jpg)
3
![Page 42: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/42.jpg)
Nomenclature
• Implant (sometimes called a fixture)
![Page 43: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/43.jpg)
Nomenclature • Implant abutment
(solid)
• Implant abutment (to be waxed up
![Page 44: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/44.jpg)
Nomenclature • Healing abutment
• Transfer assembly
![Page 45: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/45.jpg)
Nomenclature
• Implant analogue
![Page 46: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/46.jpg)
Nomenclature
• Implant screws
![Page 47: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/47.jpg)
• 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.
![Page 48: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/48.jpg)
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
![Page 49: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/49.jpg)
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.
![Page 50: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/50.jpg)
• 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.
![Page 51: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/51.jpg)
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.
![Page 52: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/52.jpg)
![Page 53: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/53.jpg)
• Space
![Page 54: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/54.jpg)
Treatment Planning with dental implants: what is possible and what is best?
5 patient examples
![Page 55: Treatment Planning pt.1-2](https://reader038.vdocuments.us/reader038/viewer/2022110118/554b4043b4c9054b5e8b486e/html5/thumbnails/55.jpg)