IMPLANT OCCLUSION

IMPLANT OCCLUSION

1. Dr. Shari.S.R , Junior resident; Dept of P rosthodontics | GDC Trivandrum Occlusal Schemes in Implants

2. Occlusion In Implants Introduction Diff between natural tooth and implants Development of IP O 14 considerations for IPO Occlusal guidelines for different clinical situations Review of literature. Conclusion

3. Introduction Occlusion in osseointegrated prosthesis A prosthesis that is retained, or retained and supported by implants.

4. 7 Table 1. Comparison between tooth and implant Tooth Implant Connection PDL Osseointegration Proprioception Periodontal mechano receptors Osseoperception Tactile sensitivity High Low Axial mobility 25-100 և m 3-5 և m Movement phases Two phases Primary: nonlinear and complex Secondary: Linear and elastic One phase Linear and elastic Movement patterns Primary : Immediate movement Secondary: Gradual movement Gradual movement Fulcrum to lateral forces Apical third of root Crestal bone Load bearing charcteristics Shock absorbing function Stress distribution Stress concentration at crestal bone Signs of overloading PDL thickening,mobility,wear facets,fremitus,pain Screw loosening,or fracture, abutment or prosthesis fracture,bone loss,implant fracture.

5. 8 Tooth and Implant compared Kim Y, Oh T-J, Misch CE, Wang

6. Tooth Movement vs Implant movement. Lateral Movement 50-108µm no movement Vertical movement 8 to 28µm size shape no of roots

7. Understanding difference between natural teeth and implants Will help in developing occlusal harmony with the implants NATURAL TEETH Protected by Periodontal receptors or tactile receptors (Shock absorbers) IM PLANTS No such receptors Occlusal scheme of natural teeth Occlusal scheme of implants (Modifications has to be done)

8. Multitude of difference between natural teeth and implant IPO also called MEDIALLY POSITIONED LINGUALIZED OCCLUSION Misch and Bidez

9. LONGEVITY AND SUCCESS IMPLANT PROTECTIVE OCCLUSION. DECREASE STRESS AT IMPLANT BONE INTERFACE IPO

10. Elimination Of Premature Contact Occlusal Contact Position Parafunction Cantilevers Crown height Crown Contour Favoring Weak Arch Occlusal Material Implant Body And Load Direction Cuspal Angle Controlling Occlusal Table Width Mutually Protected Occlusion Loading Time Provide Adequate Surface Area Considerations for following implant protected occlusion scheme

11. Implant protective occlusion Implant Angle Cusp Angle Mutually Protected Occlusion Occlusal Table Width Loading Time Adequate Surface Area (implant number, width & length) P remature Contact Elimination O cclusal Contact Position C antilever Prosthesis C rown Height C rown Contour P arafunction F avouring weak arch O cclusal material REDUCE FORCE MAGNIFICATION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA Mnemonics : POP is the C ³ FO

12. Premature contact Ipo and premature contact DIVERTS M A N D IB L E INTERFERES HARMONIOUS GLIDING MOVEMENT OF DEFLECTS POSITION OF CONDYLE, TEETH OR PROSTHESIS M A N D IB L E

13. REMOVE PREMATURE CONTACT PRIOR TO INSERTION OF IMPLANT PROSTHESIS ALL OCCLUSAL PREMATURITIES MUST BE ELIMINATED IN MAXIMUM INTERCUSPATION

14. IPO WITH PREMATURE CONTACT ELIMINATION OF PMC WITH IMPLANT PROSTHESIS USE 25 µm A R TI C UL A T ING PAPER In occlusion light contacts withLight tapping force

15. Following elimination of premature contacts under light contact (harmonization under light loads) Premature contacts are eliminated under heavy contact (harmonization under heavy loads) O Elimination This ensures equal sharing of the load between the implant and the natural teeth under heavy loads .

16. Following premature contact adjustment Centric occl u sion Anterior implant prosthesis - No initial contact Surrounding natural teeth - Greater initial contact. Posterior Implant prosthesis - Minimum initial contact

17. Re gula r e v aluation o f oc c lu s al con t acts at regular l y scheduled hygiene appointments so that minor variations occurring during long-term functioning can be monitored An important philosophy behind ipo

18. IMPLANT PROTECTIVE OCCLUSION REDUCE FORCE MAGNIFIC A TION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA 1. Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length)

19. IPO AND OCCLUSAL CONTACT

20. PRIMARY CON T ACT SECONDA R Y CONTACT Ideal occlusal contact for implant prosthesis is over the implant body WITH IN THE IMPLANT DIAMETER , WITH IN CENTRAL FOSSA WITHIN 1 mm OF PERIPHERY OF IMPLANT POSTERIOR TOOTH

21. Influence of Occlusal Contacts

22. 26 REDUCE FORCE MAGNIFIC A TION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA 1.Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length) Implant protective Occlusion

23. IPO AND CANTILEVER PROSTHESIS GOAL SHOULD BE TO REDUCE THE LENGTH OF CANTILEVER CANTILEVERS ARE CLASS I LEVER WHICH INCREASES THE AMOUNT OF STRESS ON THE IMPLANT

24. 28 Cantilever

25. ACTS AS IPO and CANTILEVER COMPRESSIVE LOAD ON CANTILEVER TENSILE LOAD ON FARTHEST ABUTMENT y X LOAD ON THE NEAREST ABUTMENT IS A COMBINATION X+Y SEVERE LOSS OF C R ES T AL BONE

26. IPO and CANTILEVER LENGTH OF THE CANTILEVER FORCE ON THE IMPLANT DIRECTLY PROPORTIONAL Maxillary anteriors Maxillary posteriors -10 mm -15 mm Mandibular posteriors -20mm MAXIMUM LENGTH OF CANTILEVER FOR SYSTEMS WITH 4-6 IMPLANTS NO LATERAL LOADS TO CANTILEVER PORTION Gradient of force type load that gradually decreases the occlusal contact force along the cantilever.

27. 31 IMPLANT PROTECTIVE OCCLUSION REDUCE FORCE MAGNIFIC A TION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA 1. Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length)

28. IPO AND CROWN HEIGHT CROWN HEIGHT IS DETERMINED AT THE TIME OF DIAGNOSIS REDUCE CROWN TO IMPLANT RATIO TO REDUCE CANTILEVER

29. Increased crown height acts as Vertical cantilever - (magnifies stress) During lateral load,angled force,cantilever load and results in greater force component. IPO AND CROWN HEIGHT

30. 34 REDUCE FORCE MAGNIFIC A TION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA 1. Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length) IMPLANT PROTECTIVE OCCLUSION OCCLUSION

31. 36 IPO AND CROWN CONTOUR

32. 35 DUE TO RRR IPO AND CROWN CONTOUR OCCLUSION NARROW OCCLUSAL TABLE with reduced buccal contour, IMPROVING AXIAL LOADING Buccal contour the same as the original, natural tooth will lead to buccal offset load Remaining ridge shifts lingually Implant body under the lingual cusp of a natural tooth( not under the natural buccal cusp tip)

33. 37 IPO and Crown Contour Central fossa of Implant crown broadened 2-3 mm to receive functional cusp contact from natural teeth DIVISION A BONE

34. 38 IPO and Crown Contour DIVISION A BONE Axial loading in both arches not possible so favour the weaker maxilla

35. 39 IPO and Crown Contour Division C and D bone, bone augmentation procedure and create a condition as close as possible to Division B bone. Mand i bul a r posterior implants require angulated abutment DIVISION B ,C & D BONE Maxillary posterior implants require restoration in crossbite The implant position lingual to the position of the natural tooth.

36. 40 REDUCE FORCE MAGNIFIC A TION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA 1. Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length) IMPLANT PROTECTIVE OCCLUSION

37. IPO AND PARAFUNCTION POOR OCCLUSAL DESIGN BRUXISM PARAFUNCTION CLENCH I NG Marginal bone loss and implant failure

38. By using maximum fixture length Shorter cantilevers Proper location of fixtures along the arch Ridge augmentation Reduction in height of crown By increasing soft tissue support Night guard protection IPO and Parafunction In patients with parafunctional habits, The overload can be greatly reduced:-

39. 43 REDUCE FORCE MAGNIFIC A TION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA 1. Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length) IMPLANT PROTECTIVE OCCLUSION

40. DESIGN OF PROSTHESIS WEAKEST ARCH SHOULD ALWAYS FAVOUR MAXILLA IPO AND WEAK ARCH FAVOURING COMPROMISED ANATOMICAL CONDITIONS NARROW IMPLANTS NARROW RIDGES REDUCED BONE DENSITY INCREASED BONE RESORPTION FACIAL CANTILEVER

41. IPO and Arch Strength PREMAXILLA SO CHOOSE ANGLED ABUTMENT IN PREMAXILLA STRAIN IS HIGHER STRAIN IS LESSER

42. IPO and Arch Strength RECOMMENDATIONS USE OF MORE NUMBER OF IMPLANTS WITH SPLINTING USE OF LARGER DIAMETER IMPLANTS WITH RIDGE AUGMEN TA TION

43. Favouring weak arch MAXILLARY POSTERIOR CANTILEVERS ARE LESS INDICATED IF THE IMPLANTS OF THE BOTH ARCHES CANNOT BE LOADED TOGETHER ,MAXILLARY IMPLANTS ARE PROTECTED WITH AXIAL LOAD

44. 47 REDUCE FORCE MAGNIFIC A TION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA 1. Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length) IMPLANT PROTECTIVE OCCLUSION

45. IPO AND OCCLUSAL MATERIAL DEPENDS ON CHOICE OF OCCLUSAL MATERIAL FOR IMPLANT PROS T HESIS REMAINING DENTITION QUADRANT RESTORED OPPOSING DENTITION

46. ALL CERAMIC ZIRCONIA METAL CERAMIC RESTORATIONS ALL METAL RESIN BASED ACRYLIC u OCCLUSAL MATERIAL EVALUATED BY OCCLUSAL MATERIAL Occlusal material fracture is one of the most common of implant restoration ESTHETIC IMPACT FORCE STATIC LOAD CHEWING EFFICIENCY FRACTURE WEAR INTERARCH SPACE REQUIREMENT ACCURACY OF CASTING

47. 50 REDUCE FORCE MAGNIFIC A TION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA 1. Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length) IMPLANT PROTECTIVE OCCLUSION

48. IPO AND IMPLANT ANGLE / LOAD DIRECTION CONDITIONS OF ANGLED LOAD DIRECTION ANGLED IMPLANT BODIES ANGLED A B U T M E N T S PREM A TU R E OCCLUSAL CONTACT

49. Angled load---Angled implant 15° angled implant---30% offset load to facial bone. 30° angled implant—50% increase of stress at crestal bone.

50. ANGLED LOAD AP P LIED CAU S ES SHEAR COMPONENT OF LOAD CRESTAL BONE LOSS AND INTERFERES WITH SUCCESSFUL BONE REGROWTH IMPLANT BODY

51. ANISOTRO P Y refers to CHARACTER OF BONE MECHANICAL PROPERTIES DEPEND ON THE DIRECTION IN WHICH THE BONE IS LOADED ANGLE OF LOAD SHEAR COMPONENT OF LOAD

52. CORTICAL BONE WITHS T AND Angled load SHEAR(65%LESS) AND TENSILE(30%LE S S) FORCE COMPRE S SIVE FORCE

53. TO PREVENT CAUSES O Angled loads WHENEVR ANGLED LOADS CANNOT BE ELIMINATED BONE LOSS OR IMPLANT LOSS REDUCE MAGNITUDE OF FORCE INCREASE SURFACE AREA

54. Solution to Angled loads INCREASING DIAMETER OF ANGLED IMPLANT USING MORE NUMBER OF IMPLANTS SELECTING A DESIGN WITH GREATER SURFACE AREA ADDITIONAL IMPLANT NEXT TO THE MOST ANGLED IMPLANT SPLINT I NG THESE CAN BE ACHIEVED BY

55. 57 IMPLANT PROTECTIVE OCCLUSION REDUCE FORCE MAGNIFIC A TION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA 1. Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length)

56. ANGLED LOAD ON IMPL A NTS ANGLED LOAD CRES T AL BONE LOSS IPO AND CUSPAL ANGLE CUS P AL ANGLE

57. GREATER CUSPAL ANGLE EFFICIENT INCISION OF FOOD BUT PREMATURE OCCLUSAL CONTACT ALONG CUSP ANGLE COULD RESULT IN ANGLED LOAD ON THE CRESTAL BONE KAUKINEN etal CUSPAL ANGLE

58. For every 10° increase in cusp inclination----30% increase in torque Cusp inclination produce a high level of torque. IMPLANT RETAINED PROSTHESIS SHOULD HAVE SHALLOW OCCLUSAL ANATOMY Solution no:1

59. Occlusal contact on implant crown should be on flat surface perpendicular to implant body Increasing width of central groove in posterior implant crown(2-3mm) Recontouring opposing tooth to occlude in central fossa over Implant body SOLUTION.2 Accomplished by

60. 62 IMPLANT PROTECTIVE OCCLUSION REDUCE FORCE MAGNIFIC A TION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA 1. Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3 .Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length)

61. Rationale of MPO T he forces are distributed to segments of the jaws  D ecrease in force magnitudes IPO AND MUTUALLY PROTECTED OCCLUSION CANINE PROTECTIVE OR ORGANIC OCCLUSION .

62. 64 OR MAY HAVE LIGHT CONTACT FIXED IMPLANT PROSTHESIS Posteriors contact and anteriors disocclude CENTRIC

63. Protrusive excursions Incisors contact, posteriors and canine disocclude

64. Lateral Excursions Canine contact, incisors and posteriors disocclude

65. Anterior guidance of implant prosthesis with anterior implants SH O U L D Anterior guidance of implant prosthesis with anterior implants AS SHALLOW AS POSSIBLE STEEPER THE ANTERIOR GUIDANCE GREATER THE FORCE ON ANTERIOR IMPLANTS In most patients ,an incisal guidance of atleast 23-25° is suggested in IPO. Vertical overbite reduced to less than 4mm

66. IF CANINE IS REPLACED BY IMPLANT Occlusal contact over this must be avoided during excursion IF ANTERIOR IMPLANTS MUST DISOCCLUDE THE POSTERIOR TEETH Implants maybe splinted together to reduce lateral force MPO on Lateral incisor

67. 69 IMPLANT PROTECTIVE OCCLUSION REDUCE FORCE MAGNIFIC A TION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA 1. Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length)

68. 70 W ider the occlusal table, the greater the force developed . O cclusal anatomy of natural teeth often results in offset load IPO AND OCCLUSAL TABLE WIDTH Width of the occlusal table Width of the implant body Width of the occlusal table must be reduced in comparison to a natural tooth in non aesthetic regions

69. THE NARROW OCCLUSAL TABLE THE OFFSET LOAD HENCE TEETH RESTORED IN NON- ESTHETIC REGION OF THE MOUTH PREFERABLY HAVE A NARROW OCCLUSAL TABLE REDUCES D E CREASES RISK OF CERAMIC FRA CTURE REDUCED O C C L USAL LOAD HELPS TO MAIN T AIN THE NARROW OCCLUSAL TABLE NARROW O C C L USAL TABLE GRE A TER HYGIENE

70. 72 IMPLANT PROTECTIVE OCCLUSION REDUCE FORCE MAGNIFIC A TION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA 1. Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length)

71. IPO AND LOADING TIME IMPLANT LOADING PROGRESSIVE DELAYED IMMEDIATE DENSITY OF BONE DETERMINES TIME OF LOADING

72. IMMEDIATE LOADING ESTHETIC ZONE OFTEN DONE BECAUSE OF DAMPING EFFECT CHOICE OF M ATERIAL RESIN BASED

73. WOLFF ' S LAW BASED ON WHERE THE MASS OF BONE INCREASES IN RESPONSE TO CONTROLLED STRESSES WHEN LOAD APPLIED TO IMPLANTS IN POOR QUALITY BONE IN C REA S ED GRA D U A L L Y FUNCTION MASS AND DENSITY OF BONE TIME INTERVAL(3-6 MO) DIET(SOFT TO HARD) OCCLUSAL MATERIAL(R-M-P) OCCLUSAL CONTACT( GRADUA L INCREASE) DESIGN OF PROSTHESIS LESS DENSE BONE PROGRES S IVE LOADING PROGR E S S IVE LOADING FACTORS

74. When Implants Are Placed And It Has Been D e c i d ed T o Pla c e T h e R esto r at i o n Oss e o i n egr at ion F o l lo w ing A 2 nd Af ter S t age Surgery, The Loading Is Defined As Delayed Loading DELAYED L O ADING DELAYED LOADING Grafted situation Can be well done in non- esthetic zone Where The Quality Of Bone Needs To Be Improved where the implant stability is less than 45Ncm

75. 77 REDUCE FORCE MAGNIFIC A TION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA 1. Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length) IMPLANT PROTECTIVE OCCLUSION

76. IPO AND SURFACE AREA Compensates for increased load IN C REA S E WIDTH OF THE IMPLANT INCREASE NUMBER OF THE IMPLANT SPLIN T ING THE IMPLANTS

77. Wider diameter implants- preferred . Since they have a greater area of bone contact at the crest than a narrow implants , F or a given occlusal load - stress at the crestal region is lesser when compared to narrow implants Larger the S.A wider the distribution of force. Lesser the concentration of force on the crest. Surface area

78. . Multiple implants must be staggered not placed in straight line

79. If a 3 unit fixed prosthesis supported by 2 implants is cantilevered, stress is doubled. 2000) If a 3 unit F.P.D is supported by 3 implants stress is reduced to 1/3 rd . Splinted larger diameter of implants decrease crestal load more Effectively(Sato Y ,et.al, Surface area

80. 84 Kim Y, Oh T-J, Misch CE, Wang

81. OPPOSING ARCH TYPE OF OCCLUSION EXTRA CARE COMPLETE DENTURE BALANCED OCCLUSION NATURAL DENTITION MUTUALLY PROTECTIVE/GROUP FN OCCLUSION SHALLOW ANTERIOR GUIDANCE FIXED MUTUALLY PROTECTIVE/GROUP FN OCCLUSION IN CANTILEVERS NO WORKING AND BALANCING CONTACTS. INFRA OCCLUDE BY 100UM FREEDOM IN CENTRIC 1-1.5MM FULL ARCH FIXED IMPLANT PROSTHESIS

82. 86 OVER DENTURE Bilateral balanced occlusion using lingualized occlusion Monoplane occlusion on a severely resorbed ridge

83. POSTERIOR IMPLANT SUPPORTED FIXED PROSTHESIS OCCL U S A L TABLE NARROW FLAT CUS P S MINIMUM OR NO C A NTI L EVER Anterior guidance with natural dentition. Group function occlusion with compromised canines. Contacts should be centered over the implant body

84. 88 SINGLE IMPLANT PROSTHESIS Anterior Or Lateral Guidance With Natural Dentition Light Contact At Heavy Bite And No Contact At Light Bite INCREAS E D PROXIMAL CONTACT NO OFFSET CON T ACTS CENTERED CONTACTS (1–1.5MM FLAT AREA)

85. REVIEW OF LITERATURE

86. Review of literature Taylor , Weins,Carr.Evidence based considerations for removable prosthodontic and dental implant occlusion:A Literature review.The journal of prosthetic dentistry.Dec 2005.Vol.94(6) The effect of non- axial load on implant function and survival. Two studies : One in a primate model with cyclic occlusal loading Sheep with static loading Conclusion: They were unable to demonstrate a negative effect on bone to implant anchorage after extended periods of non-axial loading. Progressive loading and occlusal overload of dental implants. The evidence available doesnot support the need for progressive loading . The effect of placing restorations on a previously unloaded implants in heavier than normal occlusion. The occlusal overload was tolerated by implants without any deleterious effects .

87. Review of literature Proprioception and Dental implants: The patients with extensive implant supported prosthesis clinically function well without the benefit of periodontal proprioceptive nerve endings. The presence of proprioceptive nerve endings in periosteum ,muscles of mastication ,oral mucosa,TMJ compensate for those lost from the missing periodontal ligament. osseoperception

88. P RE D OM INA N T L Y A PROSTHETIC DISCIPLINE IMPLANT TRE A TMENT COMPLETE AWARENESS OF THE FINAL OUTCOME OF THE PROSTHESIS MUST BE PRESENT PRIOR TO IMPLANT PLACEMENT CONCLUSION

89. Occlu s ion h as b e en a n imp o r t a n t v ar i able in t h e suc c ess or failure of most prosthodontic reconstructions. W i th n atu r al t e et h , a c er t a i n d e g r ee of f le x i bil ity p er m i ts compensation for any occlusal irregularities. Implant dentistry is not as forgiving. The status of the occlusion must be diagnosed, corrected or compensated and properly integrated into the design of the definitive restoration.

90. Dental Implant Prosthetics – Carl.E.Misch Principles Of Occlusion In Implant Dentistry Mahesh Verma, Aditi Nanda, Abhinav Sood 2015 Journal Of The International Clinical Dental Research Organization | Published By Wolters Kluwer – Medknow Implant Protected Occlusion Yogeshwari Swaminathan¹, Gururaj Rao²iosr Journal Of Dental And Medical Sciences (Iosr-jdms)volume 11, Issue 3 (Nov.- Dec. 2013), Pp 20-25 Occlusal Considerations In Implant Therapy: Clinical Guidelines With Biomechanical Rationale Kim Y, Oh T-j, Misch Ce, Wang H-l. Occlusal Considerations In Implant Therapy: Clinical Guidelines With Biomechanical Rationale. Clin. Oral Impl. Res. 16, 2005; 26–35 Implant Occlusion: Biomechanical Considerations Forimplant-supported Prostheses Yu-ying Chen1,2 Chung-ling Kuan1 Yi-bing Wang1,2 J Dent Sci 2008 ‧ vol 3 ‧ no 2 REFERENCES

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