implant diagnosis and treatment planning

A ppt on Implant diagnosis and treatment planning

1. DIAGNOSIS AND
TREATMENT
PLANNING
PRE PROSTHETIC
EVALUATION

2. Pre Prosthetic Evaluation
Intraoral examination
Analysis of mounted study casts
Bone mapping
Radiographic analysis
Force evaluation

3. Intraoral Examination
Existing occlusion
Existing occlusal plane, orientation
Interarch space
Existing vertical dimension of
occlusion
Maxillomandibular arch relations
Temporomandibular joint status
Existing prosthesis

4. Intraoral Examination
Arch form
Ideal implant permucosal position
Missing teeth location
Missing teeth number
Lip line at rest and during speech
Mandibular flexure
Soft tissue support

5. Arch form

6. Diagnostic Casts
Mounted diagnostic cast are
invaluableforOcclusalcentricrelation
positionincludingprematureocclusion
Edentulousridgerelationstoadjacent
teethandopposingarches
Position of potential natural
abutments including inclination
rotationextrusionspacingparallelism
andestheticconsiderations

7. Position of the replacement in
relation to the residual ridge

8. Diagnostic Casts
Directionofforcesinfutureimplant
sites
Presentocclusalschemeincludingthe
presenceofbalancingorworking
contacts
Edentuloussofttissueangulation,
length,width,locations,permucosal
estheticposition,muscleattachments
andtuberosities

9. Study Model Analysis –
Edentulous Patient
Patternofresorption-can
exhibitascrossbiteinposterior
regionandasprognathismin
anteriorregion.
Mountedstudymodelswillhelp
ascertainverticalandsagittal
relationships

10. Mounted study models indicating
minimum Interocclusal distance

11. Mounted Study models showing
large interarch space

12. Prognathic relationship

13. Angle class II

14. Study Model Analysis –
Partially Edentulous Patients

15. Interarch
Distances

16. Evaluation Of Available Bone
Evaluation of bone quantity
Evaluation of bone quality

17. Available bone is evaluated by
Digital Palpation
Radiographs
Study models
Bone sounding

18. Bone sounding

19. OSTEOMETER

20. MAINZ MEASURING GAUGE

21. EVALUATION OF BONE QUANTITY

22. ALVEOLAR PROCESS
FUNCTIONAL ADAPTATION

23. ATWOODS CLASSES OF RESORPTION
FOR MAXILLA

24. ATWOODS CLASSES OF RESORPTION
FOR MANDIBLE

25. Classification Of Degree Of Resorption Of
Edentulous Jaws By
Lekholm And Zarb(1985)

26. Pattern of resorption (Harle)
Maxillary arch buccal to lingual
Mandibular arch lingual to buccal

27. Available bone is studied under
Height of bone
Width of bone
Length of bone
Bone contour
Crown implant
ratio

28. Height of bone
Vertical extent bone available for
implantation
Distance between the crest of
alveolar bone to the opposing
anatomic structures

29. Width of bone
Distance between oral and vestibular
cortical plates
1mm diameter increase = 20-30%
increase in the total surface area
3mm increase in length provides
more than 10% increase in surface
area

30. Length of bone
Minimum distance between axis to
axis between two implants is 7mm
R1+R2+2mm=distance between two
implants

31. Bone contour (Angulation)
Favorable bone contour is one in
which the functional and esthetic
demands of the prosthesis to be
borne by the implant can be
fulfilled with axial loading of the
prosthesis

32. Divisions of
Available bone quantity
Division A (abundant)
Division B (barely sufficient)
Division C (Compromised)
Division D (Deficient)

33. Division A
Width > 5mm
Height >10-13mm
Length >7mm
C/I < 1

34. Division B
Width 2.5-5mm
Height >10-13mm
Length >12mm
C/I < 1

35. Options for Division B Bone
Modify the existing Div B ridge to
another division by Osteoplasty
Insert a narrow Div B root form
implant
Modify existing Div B bone into Div A
by augmentation

37. Disadvantages Division B
Stress at the crestal region around
the implant is twice
Lateral loads on the implant result in
almost 3 times greater stress than
Division A
Fatigue fractures in the abutment
are increased
Crown emergence profile is less
esthetic

38. Disadvantages Division B
Conditions around the cervical aspect
of the crown for daily care is poor
Angle of load must be reduced to
less than 20 degrees to compensate
for the small diameter
Two implants are required for proper
prosthetic support

39. Division C
Unfavorable Width (C-w)
Unfavorable Height (C-h)
Unfavorable Angulation (C-a)
Unfavorable C/I = 1

40. Treatment options for Division C
Ostoeplasty
Root form implants
Subperiosteal implants
Augmentation procedures
Ramus frame implants
Transosteal implants

41. EVALUATION OF BONE QUALITY

42. Bone Quality Is Evaluated By
Tactile
Radiographic
Biochemical

43. Bone density and success rates
Adell et al reported 10% greater
sucesss rate in the anterior mandible
compared to anterior maxilla
Schnitman et al reported highest
success rate of 75% in the posterior
maxilla
Friberg et al reported 66% of the
implant failures occurred in soft bone

44. CT determination of bone density
D1: > 1250 Hounsfield units
D2: 850 -1250 Hounsfield units
D3: 350 -850 Hounsfield units
D4: 150 -350 Hounsfield units
D5: < 150 Hounsfield units

45. Mechanostat theory of Frost
The structure of bone is maintained
by the micro strain environment
Bone reaction to different degrees of
micro strains
0-50 : acute disuse window
50-1500 : adapted window
1500-3000 : mild overload
Above 3000 : pathologic overload

46. Bone Classification Related To Implant
DentistryBy Linkow(1970)
Class I Bone structure:
ideal type of bone with evenly spaced
trabeculae with small cancellated spaces
Class II Bone structure:
bone has larger cancellated spaces with
less uniformity of the cancellous spaces
Class III Bone structure:
large marrow spaces between trabeculae

47. BONE DENSITY
CLASSIFICATION BY MISCH
Dense
cortical
Porous
cortical
Coarse
Trabecular
Fine
trabecular
D1 D2 D3 D4

48. Bone density location
D1 –6% in anterior mandible
3% in posterior mandible
D2 –most common in mandible
D3 –most common in maxilla
65% in anterior maxilla
50% in posterior maxilla
D4 –most common in posterior
maxilla

49. Influence Of Bone Density On Treatment
Planning
Surgical
–Soft bone protocol
–Selection of fixture size
–Selection of the drilling sequence
–Selection of the material of the implant
–Auxiliary procedures
Prosthetic
–Progressive loading

50. Evaluation of force
Parafunction
Position of abutment in the arch
Masticatory dynamics
Nature of the opposing arch
Direction of load forces
Crown-Implant ratio