Technical Complications in implant dentistry46.pptx

Technical Complications in implant dentistry chapter 46 misch 2020

1. Technical Complications in Implant Dentistry Chapter 46

2. Implant fractures Implant complications Abutment and abutment screw complications Residual cement as a technical problem Prosthesis attrition and fracture Prevention of technical complications

3. Implant fractures: increased implant length Maxilla high insertion torque implant-abutment connection designs ( Imp design)

4. clinical signs of vertical implant fractures repeated and frequent abutment loosening vertical bone loss adjacent to the implant fracture Circumferentially around the implant Radiographic image of bone loss associated with vertical implant fracture (not observed radiographically)

5. solutions for vertical/horizontal implant fractures implant may be buried or remove altering the prosthesis to connect with the residual portion of the implant multi-implant cases Alternative prosthesis : overdenture

6. Implant complications Iatrogenic damage to an implant : remove overtightened cover screws or abutments remove broken abutment screws : hand instrumentation Iatrogenic damage upon implant insertion: Improper engagement of implant drivers non-axial forces to internal connection implants High torque upon insertion

7. Iatrogenic implant placement Too facially/ lingually Too shallow/deep too close to an adjacent tooth two implants are too closely approximated

8. Abutment and abutment screw complications

9. Conus vs external hex : mechanical advantages : reducing or eliminating micromotion favorable distribution of forces along the implant and to bone potential complication ‘settling’ of the abutment and related screw loosening implant itself is deformed, permitting conus interfaces to seat deeper within the implant

10. internal vs external hex : Several studies have shown that internal connection (particularly internal conus/more taper interfaces)demonstrate less abutment screw loosening than external hex implants the load on the screw is reduced in internal implant‐abutment connections higher strength and resistance to bending of internal abutment Externally connected abutments : technical problems internally connected abutment: biologic problems

11. Abutment material: superior abutment survival for metal versus ceramic abutments zirconia abutments provide for high success when used for single tooth, anterior implant restorations esthetic crown : gold or gold hue abutment with a zirconia coping Peri-implant soft tissue coloration : zirconia abutments zirconia has minimal effect on mucosal color difference when placed beneath 1.5 mm of mucosa (pig model)

12. Single versus multiunit reconstruction higher for : full arch and multi‐implant prostheses Recurrent screw loosening of a multi‐implant prosthesis : check passive fit single tooth implants : crown to implant ratio crown‐to‐implant ratios of 1–2 did not demonstrate significant technical complications

13. Fixture level/abutment level restoration Construction of the prosthesis at the abutment level : force transmission from the prosthesis to the implant abutment interface (abutment screw) places the restorative margin at a distance from the implant/bone interface ( reduce inflammation ) Construction at the implant level : forces are directed to the abutment screw (deformation/loosening/ fractue ) Micromotion and bacterial leakage ( inflammation)

14. Residual cement as a technical problem Proper cementation : shallow crown margin locations circumferentially (<1.0 mm) Cementation techniques : venting of crowns, monolayer application with brush Where peri‐implant mucositis is observed : cause must be the presence of residual cement Type of cement zinc oxide eugenol vs resin cements

15. Prosthesis attrition and fracture implant‐retained metal acrylic prostheses (hybrid) high level of occlusal function lack of proprioception low strength denture tooth wear often occurs on the posterior aspect leading to anterior tooth fracture Time dependent increase in the incidence of prosthesis complications Predominant risk factor: frame work design

16. Prosthesis attrition and fracture porcelain-fused-to-metal prosthsesis : high porcelain chipping complication increased risk of chipping was greater for (× 4.6) for ceramic versus metalacrylic type prosthesis Increased ceramic chipping Bruxism Absence of nightguard use higher rates of mechanical (and biologic) complications were observed for cement-retained prostheses

17. Prosthesis attrition and fracture monolithic zirconia restorations for full arch: veneered zirconia prostheses vs monolithic zirconia higher incidence of technical complications chipping in the veneered zirconia prostheses zirconia failures dimensional requirements for full arch zirconia implant prostheses 10 mm of vertical Larg and tall connectors Thickness : greater than 3 mm