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9781118513057

Implant Restorations A Step-by-Step Guide

by
  • ISBN13:

    9781118513057

  • ISBN10:

    1118513053

  • Edition: 3rd
  • Format: Hardcover
  • Copyright: 2014-05-05
  • Publisher: Wiley-Blackwell

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Summary

Implant Restorations: A Step-by-Step Guide, Third Edition offers clinicians a practical, step-by-step approach to treatment planning and restoring dental implants. This highly illustrated, case-based book demonstrates how to treat the most commonly encountered treatment scenarios, describing the procedures, techniques, and sequences required in clear, concise language and in an easy-to-use format. The book takes the theory of implant restoration, using as its basis 3i’s implant systems, and places it directly in the operatory, concentrating in detail on each stage of the actual clinical procedures involved in treating different patients. It integrates implant treatment with the realities of running a successful restorative practice. Building on the work of the 2nd edition, the 3rd edition of this successful text reflects the advances of implant prosthetics over the intervening years, providing all new cases, exploring new techniques and technology, and demonstrating updated system components and armamentarium.

Implant Restorations: A Step-by-Step Guide follows a logical structure of three sections. The first section introduces implant restorative dentistry, how to develop an implant restorative practice, the issues involved, the technical components of the 3i systems, diagnosis, and treatment planning. The central section of the book devotes separate chapters to in-depth descriptions of each of several types of patients that the restorative dentist may encounter, ranging from basic to more challenging cases. Every step of each procedure is described and illustrated with clinical photographs. Laboratory work orders are presented for use with commercial dental laboratories. The final section discusses record-keeping, patient compliance, hygiene regimes and follow-up, and provides the reader with an outline of best-practice procedural protocols.

An excellent and accessible guide on the most burgeoning subject in modern dental practice by one of its most experienced clinicians, Implant Restorations: A Step-by-Step Guide, Third Edition will appeal to prosthodontists, general dentists, implant surgeons, dental students, dental laboratory technicians and dental assistants.

Table of Contents

Chapter 1. Introduction to Implant Dentistry
                      

Introduction

Purpose of Textbook

Conventional Dentistry versus Implant Dentistry

Predictability of Fixed Prosthodontics

Predictability of Implant Prosthodontics

Economics associated with Implant Dentistry

Prognostic Indicators for Teeth

Periodontal disease

The heavily restored tooth

The furcation involved tooth

Dental exhaustion

Difficult aesthetic cases

Classification of ridge defects

Treatment Prognosis for the Dentition

Summary

 

Bibliography

 

 

Chapter 2. Implants and Implant Restorative Components
 
Introduction

Implants

Implant/Abutment Connections

Internal Implant/Abutment Connections

External Implant/Abutment Connections

Healing Abutments

Healing Abutments

CADCAM Healing Abutments

Impression Copings

Implant Impression Copings

Pick up (open tray)

Transfer (closed tray)

Abutment Impression Copings

Abutments

Standard Abutments

LOCATOR® Abutments

DIEM® Immediate Occlusal Loading (IOL®) Abutments

GingiHue® Posts

ZiReal® Posts

UCLA Abutments

CAD/CAM abutments (BellaTek™ Laboratory Designed Abutments)

Multi-Unit Abutments (Nobel Biocare)

Screws (Clinical)

Cylinders

Definitive Cylinders

Interim

DIEM® Immediate Occlusal Loading     Abutment Cylinders (Biomet 3i)

Temporary Coping Multi-unit Titanium Cylinders (Nobel Biocare)

Drivers and Placement Instruments

Large Hex Drivers

Large Hex Driver Tips

Square Drivers

Square Driver Tips

Abutment Drivers

Abutment Driver Tips

Laboratory Components

Implant Analogs

Abutment Analogs

Try In Screws

Abutment Holders

Polishing protectors

 

Bibliography
 

 

Chapter 3.  Diagnosis and Treatment Planning In Implant Restorative Dentistry

 

Patient selection

Medical history

Diagnostic procedures

Radiographs

CT scans

Scanning appliances

Diagnostic casts

 Physical examination

Extra-oral examination

Intra-oral examination

 Diagnostic Articulator Mounting

Diagnostic wax patterns

Surgical guides

Implant bone volume

Implant restorative volume

Treatment Planning

Edentulous Patients

Overdentures

Resilient attachments

Bar-retained overdentures

Fixed hybrid implant-retained prostheses-edentulous mandible

Fixed hybrid implant-retained prostheses-edentulous maxillae

Partially Edentulous Patients

Screw-retained restorations

Benefits

Limitations

Cement-retained restorations

Benefits

Limitations

Implant Loading Protocols

Unloaded, healing, two-stage surgical Protocol

Unloaded healing, single-stage surgical Protocol

Early loading

Immediate occlusal loading

Immediate non occlusal loading

Patient Consultation

Principles of Treatment Planning

Development of Fees

Informed consent

Implant treatment coordinators

Summary

 

Bibliography
 

 

Chapter 4.  Treatment of a Patient with an Edentulous Mandible-Implant Retained Bar Overdenture and Resilient Attachments

 

Literature Review

 

Clinical Case Presentation

 

Appt 1.  Initial examination

Radiographs
Physical examination
Diagnostic casts
Diagnosis
Appt 2.  Consultation Restorative Dentist/Patient

Treatment options
Appt 3.  Consultation Restorative Dentist/Surgeon

Prosthesis design
Type/Number/size of implants
Implant/abutment connection
Surgical guide
Surgical protocol
Healing abutment selection
Implant restorative wish list
Appt 4. Implant Placement

One/Two stage surgical protocol
Post operative instructions
Appts 5 and 6. Follow Up Appointments

Tissue conditioning
Appt 7. Implant Level Impression

Pick up Impression Copings
Definitive border molded impression
Laboratory work order/procedures
Appt 8. Jaw Relation Records

Clinical procedures
Laboratory procedures
                                                                                                        i.      Articulator mounting

Appt 9. Wax Try In

Evaluation of centric jaw relation records
Patient approval
Fabrication of CADCAM framework for mandibular bar-retained overdenture
                                                                                                     i. Work order form

Virtual design of framework
Milled framework
Laboratory evaluation of framework/master cast fit
Appt 10. Framework Try In

Clinical one screw test
Appt 11. Insertion

Insert bar
Torque abutment screws
Insert mandibular overdenture and maxillary complete denture
Occlusion
Post insertion instructions     
Appt 12. Follow Up Appointments
 
1-Year Recall Clinical and Radiographic Evaluations
 
 

Costs/Fees/Profitability

 

Bibliography
 

 

Chapter 5.  Treatment of a Patient with a Partially Edentulous Mandible Using Intra-Oral Scanning (IOS) of a CADCAM Healing Abutment

 

Literature Review

            Replacement of individual teeth

            Single unit implant restorations

Computer assisted design/computer assisted manufacturing     (CADCAM) healing abutments

Intra-oral scanning

Models from digital impressions

 

Clinical Case Presentation

 

Appt 1.  Initial examination

               a. Diagnostic casts

b. Diagnoses

Appt 2.  Consultation Restorative Dentist/Patient

                                       a. Treatment options

Appt 3.  Consultation Restorative Dentist/Surgeon

Type/Size of implant
Abutment/Prosthesis design
Implant/Abutment connection
Surgical Protocol
Healing Abutment Selection
Implant Restorative Wish List
Appt 4.  Extraction and Implant Placement

               a.  Extraction and immediate implant placement protocol

b.  CADCAM healing abutment placement

Appt 5.  Surgical Follow-up Appointments

10 days
4 weeks
8 weeks
Appt 6.  Re-evaluation and Determination of Impression Date

Appt 7.  CADCAM Healing Abutment Scan

Clinical Procedures
Laboratory Procedures
                                                                                                  i.      Abutment design/milling

                                                                                                ii.      Stereolithographic model

                                                                                              iii.      Crown fabrication

Appt 8.  CADCAM Abutment and All-Ceramic Crown Insertion

Abutment placement
Radiographic Verification And Crown Try-In
Torque
Cementation
Appt 9.  Follow Up Appointments

1 Week/6 Months
1-Year Recall Clinical and Radiographic Evaluations
 

 

Bibliography
 

 

Chapter 6.  Re-Treatment of A Patient With A Fractured Implant-Retained Fixed Partial Denture in the Posterior Maxilla-CAD/CAM Abutments and a New Fixed Partial Denture (Cement retained)

 

Literature Review

 

Clinical Case Presentation

 

Appt 1.  Initial examination

            a.         Diagnostic casts

b.         Diagnosis

Appt 2.  Consultation Restorative Dentist/Patient

Treatment options
Laboratory procedures
                                                                                                  i.      Custom impression tray

Appt 3.  Removal of existing prosthesis/abutments; implant impression

Implant level impression
Laboratory Procedures/Work Orders
Fabrication of master cast (implant analogs)
CAD/CAM protocol
Articulator mounting
CAD design of abutments
CAM milling of abutments
Fabrication of 3 unit fixed partial denture
 Appt 4. Bisque bake try-in

Removal of pre-existing prosthesis and abutments
Try-in CAD/CAM abutments
1. Verification radiograph (abutments)

c.         Try-in bisque bake FPD

1. Verification radiograph (FPD)

Appt 5. Insertion Appointment

Removal of pre-existing FPD and abutments
CAD/CAM Abutment placement
Torque
Fixed Partial Denture cementation
Appt 6.  Follow Up Appointments

2 weeks/6 months
1-Year Recall Clinical and Radiographic Evaluations
 

Costs/Fees/Profitability

 

Bibliography

 

 

Chapter 7.  Accelerated Treatment Protocol of a Patient with Edentulous Jaws and CAD/CAM Titanium Framework/Fixed Hybrid Prostheses

 

Literature Review

 

Original Treatment Protocol

 

Accelerated Treatment Protocol

 

Clinical Case Presentation Four Months Post Implant Placement and Immediate Occlusal Loading

 

Appt 1.  Evaluate Aesthetics, Jaw Relation Records, Clinical Verification of Osseointegration, Abutment Level Impressions. (3 hours)

            a.  Radiographic examination (CBCT)

            b.  Extra-oral physical evaluation

            c.  Intra-oral physical evaluation

            d.  Assessment

                                    e.  Jaw relation records

f.  Removal of interim prostheses/alginate impressions for      diagnostic casts

g.  Assess implant/abutment stability and clinical osseointegration

h.  Abutment level impressions

i.   Articulator mountings

j.   NobelProcera protocol for CADCAM titanium frameworks

k.   Biomet 3i protocol for CADCAM titanium frameworks

l.    CAD designs for the maxillary and mandibular frameworks

m.  Laboratory evaluation of CADCAM frameworks

n.   Denture set up on CADCAM frameworks

 

Appt 2.  CADCAM Framework, Wax Try-In, Verification of Jaw Relation Records and Aesthetics

 

            a.  Clinical one screw test

            b.  Verification of jaw relation records and aesthetics

            c.  Laboratory procedures

                        1.  Opaque frameworks

                        2.  Denture processing and finishing

 

Appt 3. Insertion of Definitive Hybrid, Screw-Retained Prostheses

 

  a.   Torque abutment screws

            b.   Occlusion

            c.   Oral hygiene instructions

 

  Appts 4 and 5. Follow up appointments

1 week/6 months
                                                                                                                          i.      Subjective patient evaluations

                                                                                                                        ii.      Clinical evaluations

Occlusion
Oral hygiene
 

                          Appt 6. One year recall with radiographs

                                                a.  Radiographic evaluation

                                                b.  Clinical examination

 

 

Bibliography

 

 

 

Chapter 8.  Treatment of a Patient with an Edentulous Mandible with an Immediate Occlusal Loading Protocol (DIEM®2)

 

 

Literature Review

                 a. Introduction

                 b. The Pre-Osseointegration Era

                 c. The Osseointegration Era

                 d. Immediate Occlusal Loading in the Edentulous Mandible

                 e. Immediate Occlusal Loading in Edentulous Maxillae

                 f.  DIEM Protocol

                 g. DIEM2 Protocol

 

Clinical Case Presentation

 

Appt 1.  Initial examination

a. Chief complaint

b. Radiographs

c. Physical examination

d. Diagnoses

e. Prognosis

Appt 2.  Consultation with Patient

Treatment options
Diagnostic impressions
Appt 3. Definitive maxillary impression and jaw relation records

a. Definitive maxillary complete denture impression

b. Jaw relation records

c. Articulator mounting

Appt 4.  Wax Try In

a.  Number/size of implants

b.  Prosthesis design

c.  Implant/abutment connection

                         d.  Laboratory procedures/work orders for processing             dentures

e.  Surgical work up and protocol

f.  Ball clasps

                        Appt 5.  Pre-Operative Surgical Review Office Visit

Appt 6.  Insert Maxillary Complete Denture, Mandibular Extractions, Alveolectomy, Implant Placement/Immediate Occlusal Loading for Mandibular Full Arch Prosthesis

a.   Surgical protocol
b.  Surgical guidelines for immediate occlusal loading

c.  Abutment selection

d.  Prosthetic guidelines for immediate occlusal loading

               1. Clinical procedures

2. Laboratory procedures

d.  Post-operative instructions

Appt 6.  Prosthetic Follow-Up Appointments

a.  24 hours

b.  1 week

c.   4 weeks

d.  12 weeks

Bibliography
 

Chapter 9.  Treatment of an Edentulous Patient with an Accelerated Treatment Protocol and Immediate Occlusal Loading Protocol (All on 4™)

 

 

Literature Review

 

Clinical Case Presentation

 

Appts 1 and 2.  Initial examination, articulator mounting and wax try-in

Chief complaint
History of the present illness
Radiographs (CT Scan)
Physical examination
Diagnostic casts, articulator mounting and diagnostic wax try-in
Diagnosis
Assessment
Treatment options
Prognosis
Appt 3.   Consultation Restorative Dentist/Patient

 

Appt 4.  Consultation Prosthodontist/Surgeon

                                     a. Number/size of implants

b. Prosthesis design

c. Implant/abutment connection

d. Surgical work up and protocol

e. Laboratory procedures for the maxillary and mandibular prostheses

Appt 5.  Implant/Prosthesis Placement

Maxillary surgical protocol
Maxillary prosthetic protocol
1. Laboratory procedures

c.       Mandibular surgical protocol

d.       Mandibular prosthetic protocol

                  1.  Laboratory procedures

e.       Post-operative instructions

                        Prosthetic Follow-up Appointments

                                    a.     One week

                                    b.     One month

 

 

          Bibliography
 

 

Chapter 10. Immediate Non-Occlusal Loading Provisional Restoration; Intra-Oral Scanning, CAD/CAM Abutment and Definitive Restoration Maxillary Central Incisor

 

Literature Review

 

Clinical Case Presentation

 

Appt 1.  Initial clinical visit

History of the present illness
Radiographs
Physical examination
Diagnostic casts
Surgical guide
  f.      Diagnoses

  g.     Prognosis

Appt 2.  Consultation Restorative Dentist/Patient

Diagnosis
Treatment options
Appt 3.  Consultation Restorative Dentist/Surgeon

Size and type of implant
Implant/abutment connection
Surgical protocol
Interim abutment
Implant restorative wish list
Appt 4.  Extraction, Implant and Interim Abutment Placement (Surgical office)

Extraction and implant placement
Insertion torque
Interim abutment placement
Appt 5.  Restorative Appointment-INOL Provisional Restoration (same day)

Abutment preparation
Immediate Non Occlusal Loading Provisional crown (INOL-No centric/eccentric contacts)
Dietary and oral hygiene instructions
Appt 6-8.   Re-evaluation Appointments

24 hours
                                                                                                  i.      History

                                                                                                ii.      Clinical examination

2 weeks
                                                                                                  i.      History

                                                                                                ii.      Clinical examination

10 weeks
                                                                                                  i.      History

                                                                                                ii.      Clinical examination

Appt 9.    CADCAM Healing Abutment Impression

            a.    History

            b.    Clinical examination

            c.    Abutment selection

d.    Remove INOL provisional restoration/interim abutment, place    CADCAM healing abutment

e.    Bella™Tek Encode® Healing Abutment intra-oral scan

Appt 10.  CADCAM Abutment and crown insertion

Interim abutment and crown removal
Definitive abutment placement
Radiographic verification
Torque
Crown try in
Cementation
Post operative instructions
Appts 11.  2 Week Follow Up Appointment

 

Bibliography
 

Chapter 11. Computed Tomography (CT) Guided Surgery/Immediate Occlusal Loading with a Full Arch Prosthesis in the Edentulous Mandible

 

Literature Review

a. Immediate occlusal loading

b Tilted implants

c. Diagnostic imaging

d. Computed tomography (CT)

e. Interactive computed tomography

f. Interactive computer software

g. Computer guided surgery

Overview of CT Guided Surgical and Prosthetic Protocols

a. Surgical guides

b. Master tubes

                    c. Prosthetic laboratory kit-implant analog mounts

d. Surgical kit components

e. Fabrication of master cast for immediate, fixed provisional prosthesis

f. Prosthetic laboratory kit-implant analog mounts

g. Abutment selection for fixed, screw-retained provisional prostheses

h. Fabrication of a screw-retained provisional prosthesis

 

Appointment 1.  Clinical Patient Presentation

a. Pre-operative Radiographs

b. Diagnosis

c. Assessment

d. Treatment plan

e. Construction of wax dentures

 

Appointment 2.  Clinical Try in of Wax Dentures

a. Fabrication of CT scanning appliance

 

                        Appointment 3. Intra-Oral CT Scan and Treatment Plan

a. Fabrication of master cast with implant analogs

                  b. Laboratory abutment selection and placement

c. Fabrication of metal framework for the provisional prosthesis

d. Fabrication of the provisional prosthesis

 

Appointment 4.  Surgical and Prosthetic Treatment

a. Surgical implant placement

b. Clinical abutment placement

c. Insertion of provisional prosthesis

 

Appointment 5. Post-operative visit

 

Bibliography

 

Chapter 12. Review of Concepts for Designing and Fabricating Metal Implant Frameworks for Hybrid Implant Prostheses

 

                  Introduction

                  Historical Perspective

                  Original Framework Designs for Fixed Hybrid Prostheses

                  Passively Fitting Frameworks

                  Prosthetic Complications Associated with Fixed Implant Frameworks

                  Physical Properties of Metals Used in Fixed Implant Frameworks

                              a. Cast noble alloys

                              b. Cast base metal alloys

                              c. Milled titanium frameworks

                              d. Milled zirconia frameworks

                  Design Considerations

                  The Rationale for Cantilever Length

                  A/P Spread and the All on Four™ Protocol

                  Guidelines for Implant-Retained Frameworks

                  Conclusions

 

                  Bibliography

Supplemental Materials

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