Fundamentals of Implant Dentistry

Cover
Title page
Copyright page
Contents
Acknowledgments
About the Companion Website
1: Introduction to Dental Implants
	1.1 Introduction
	1.2 Tooth loss
		Consequences of tooth loss on alveolar bone
		Demographics of tooth loss
		Reasons why implant treatment is increasing
	1.3 Early dental implants
		Implant classification
		Contemporary endosseous root-form implants
		Implant treatment
	1.4 Pioneering implant research
		Brånemark group
		Schroeder/ITI, Schulte, and Kirsch groups
	1.5 Commercial implant history
		Nobel Biocare (Nobel Bofors/Nobelpharma)
		Straumann (ITI/Bonefit®)
		Tübingen (Frialit/Friadent-Dentsply)
		IMZ (Interpore/Dentsply)
		Core-Vent (Paragon/Dentsply/Sulzer/Centerpulse/Zimmer/Implant-Direct-Sybron)
		Calcitek (Integral/Omniloc/Sulzer)
		Steri-Oss (Nobel Biocare)
		Implant Innovations International (3i/Biomet-3i)
		Astra Tech (Astra-Zeneca/Dentsply Implants)
		Bicon
		Endopore (Sybron)
	1.6 Notable implant “milestones”
		NIH Harvard Conference, 1978
		Toronto Conference on Osseointegration, 1982
		NIH Conference, 1988
	1.7 Criteria for implant success
		Implant success and survival
		Implant and prosthetic success
	1.8 Clinical studies, implant validation
	1.9 Implant regulation
	1.10 Research and development
	1.11 Summary
	References
2: Implant–Tissue Interface Biology
	2.1 Concept of osseointegration
	2.2 Implant surface chemistry
	2.3 Biology of osseointegration
	2.4 Bone healing biology
		Implant immobilization
		Osteogenesis and the implant surface
		Description of the three phases of bone healing
		Bone loss after abutment connection
		Platform-switching and bone preservation
		Implant failure or loss of osseointegration
	2.5 Soft tissue–implant interface
		Peri-implant soft tissue cuff
		Junctional epithelium (JE)
		Connective tissue
		The implant–abutment junction (IAJ)
		The implant collar
	2.6 Peri-implant infection
		Factors that facilitate peri-implant bone loss
		Clinical signs and symptoms of peri-implant disease
		Ligature induced peri-implantitis model
		Progression of peri-implant infections (mucositis and peri-implantitis)
	2.7 Implant surface modifications
	References
3: Implant Biomechanics
	3.1 Introduction
		Biomechanics
		Implant proprioception and nocioception
		Functional bone remodeling
		Peri-implant bone loss related to overload
		Peri-implant infection and bone loss
		Mechanical failure
	3.2 Natural tooth: functional response
	3.3 Implant: functional response
		Osseointegration
		Implant–bone interface
		Bone response to load: remodeling or loss
		Loading sequelae
		The implant–abutment connection
	3.4 Functional and nonfunctional forces
		Functional occlusal force
		Nonfunctional (secondary) force
	3.5 Dissipation functional forces
		Bone–implant contact
		Implant body surface configuration
		Implant collar configuration
		Implant length (crown-to-implant length ratio)
	3.6 Bite force mechanics and implant prostheses
		Stress and strain
		Moment forces
		Clinical cantilevers or moment forces
		Impact forces
		Fatigue failure
		Lack of implant proprioception
	3.7 Quality of osseointegration
		Strain testing (Periotest and Osstell)
		Photoelastic and finite element analysis (FEA)
	3.8 Clinical force management
		Force on an implant restoration is mitigated by:
		Theoretical means of mitigating force include:
		Prevention of screw loosening by preloading the abutment connection
	3.9 Biomechanical treatment planning
		Recommendations for implant diameter, number, and length
		Some general guiding principles
		Clinical scenarios
	3.10 Adjusting occlusion
	References
4: Implant Systems
	4.1 Introduction
	4.2 Implant materials
	4.3 Evolution of implant systems
		Evolution of systems
		Modern implant systems
		Research
		Implant shape, surface, and connection
		Implant-level impression coping and implant-level restoration (UCLA abutment)
		Prefabricated customizable abutments
		Computer-aided design (CAD) and computer-aided manufacturing (CAM) of Ti and ceramic abutments
		Interactive software, and instrumentation for computer-guided surgery and prosthetics
	4.4 Surgical instrumentation
	4.5 Features of endosseous implants
		Thread design
		Implant length
		Implant body and platform diameter
		Implant collar
		Prosthetic connection and anti-rotation feature
		One-piece implant
		Implant platform
		Platform-switching design
		Surface finish/texture
		Cover screw, healing abutment
	4.6 Prosthetic components
		Healing abutment/transmucosal abutment, tissue-shaping abutment
		Impression coping or abutment, implant analog or replica
		Provisional restoration abutments
		Stock/prefabricated abutments
		Custom restorative abutments
		Multi-unit abutments
		Standard abutments
		Overdenture abutments
	4.7 Screws, screwdrivers, and torque drivers
		Screwdrivers
		Abutment screws and prosthetic screws
	4.8 Implant marketplace and system selection
	References
5: Assessment, Diagnosis, and Treatment Planning
	5.1 Introduction
		A multidisciplinary approach
	5.2 Patient interview
	5.3 Medical history
		General factors
		Medications of significance
		Major medical conditions
		Physician consultation
		Relative contraindications for implants
		Absolute contraindications for implants
		Patient age guideline
	5.4 Dental history and clinical examination
		Dental history
		Dental examination
	5.5 Special diagnostic tests
		Photographs
		Study impressions and models/casts
		Radiographs
		Consultations and referrals
	5.6 Examination of edentulous space or potential implant site
		Aesthetic zone
		Residual ridge (aided by using study models and radiographs)
		Mesio-distal crown and root spacing
		Vertical space for implant prosthesis
		Opposing arch and force factors
		Identification of contiguous anatomic structures
	5.7 Surgical consultation
	5.8 Synthesis of data and treatment planning
		Reevaluation
		Treatment selection
		Patient responsibilities
	5.9 Evidence-based implant dentistry
	5.10 Case selection and risk assessment
	5.11 Treatment modifiers, complicating or risk factors
	5.12 Patient education, expectations, and consent
		Informed consent
		Legal issues
	5.13 Summary of assessment and treatment planning
	References
6: Essentials for Implant Treatment
	6.1 Brånemark osseointegration protocol
		First-stage surgery
		Atrophic maxillae
		Second-stage surgery
		Prosthetic rehabilitation
	6.2 Other surgical protocols
		One-stage surgery with transmucosal healing
		Other surgical protocols and shortened loading protocols
	6.3 Different treatment presentations and arch configurations
		The single-implant crown
		Multiple missing teeth
		One edentulous arch opposing a natural arch or partial arch with or without significant restoration
		Complete edentulism
	6.4 Prosthetic options: Screw fixation, cementation, and retentive anchors
	6.5 Implant treatment outcomes
		Implant success
		Implant survival or cumulative survival rate (CSR)
		Prosthesis survival
	6.6 Criteria for patient outcomes
		Positive outcomes from a patient perspective
	6.7 Implant maintenance
		Recall schedule
		Prosthetic stability
	6.8 Peri-implant health assessment and treatment
		Implant surfaces and biofilms
		Peri-implant probing
		Keratinized (attached), nonkeratinized peri-implant cuff/mucosa
		Treatment of soft tissue problems and peri-implant infection
	References
7: Surgical Planning and Procedures
	7.1 Introduction
	7.2 Patient education and expectations
	7.3 Medical assessment and management
		Medical management
	7.4 Implications of medical conditions and medications
		Diabetes mellitus
		Immunodeficiency
		Antiresorptive therapy for bone dysplasias, cancer, and osteoporosis
		Irradiation of jawbones
		Smoking
		Contraindications to implant surgery
	7.5 Surgical site assessment (see Chapter 5)
		Overview of dental status
		Applied anatomy
		Radiographs
		Bone volume (height, width, and shape)
		Bone density or quality
		Spatial factors
		Implant position: Aesthetic and safety guidelines
		Gingival biotype and the band of attached gingiva
	7.6 Implant surgery
		Patient preparation and informed consent
		Surgical operating field
		The surgical guide
		Flap management
		Implant osteotomy site, placing the implant
		Screw tapping, osteotomes, final drill size, and insertion
		Final position and suturing
	7.7 Implant surgical protocols
		One-stage surgery
		Two-stage surgery
		Implant placement variations
		Immediate placement
		Aesthetic soft tissue management
		Ridge preservation (socket augmentation) following extraction
		Implant placement with simultaneous ridge augmentation or sinus lift
	7.8 Solutions for insufficient bone volume at the implant site
		Solutions for inadequate bone volume
		Types of ridge grafting/augmentation
		Types of graft materials and membranes
	7.9 Implant selection
		Implant platform, diameter
		Implant length
		Implant number
		Implant configuration
	7.10 Provisional restorative options
		Immediate/early loading
	7.11 Postoperative management and surgical review
	7.12 Second-stage surgery
		Clinical indicators of osseointegration
		Implant stability testing
	7.13 Complications
		Complications related to surgery and healing
	References
8: Single-Implant Crowns
	8.1 Introduction
	8.2 Treatment options for single tooth absence
	8.3 Advantages and disadvantages of various treatments
	8.4 The implant site
		Residual bone volume
		Evaluating the aesthetic zone
		Gingival biotype and the width of the band of attached mucosa (gingiva)
		Vertical and mesio-distal space for a crown
	8.5 Implant surgery
		The surgical guide
	8.6 Provisional restoration
		Immediate provisional crowns
	8.7 Implant crown fabrication
		Indicators of implant health
		Tissue shaping
		Implant level impression taking
		Laboratory steps (master cast, implant analogs)
		Restorative abutments for laboratory fabrication
	8.8 Crown adjustment and delivery
		Cement-retained crown (abutment and separate crown)
		Screw-retained crown
		Crown try-in and proximal adjustment
		Occlusal adjustment
		Torquing and cementation
		Postdelivery checks and advice
	8.9 Clinical notes on single-implant crowns
		Use the correct size and shape impression coping
		Proximal contacts
		Occlusal contact
		Aesthetic deficit
		Soft tissue distension
	8.10 Complications
	References
9: Multi-Unit Implant Fixed Prostheses
	9.1 Introduction
	9.2 Treatment options for multiple tooth loss
	9.3 Advantages and disadvantages of various treatments
	9.4 Clinical assessment
	9.5 Examination of the implant site and surgical consultation
		General factors
		Mesio-distal spacing
		Vertical space/alignment with opposing teeth
		Opposing arch and force factors (see Chapter3)
		Surgical consultation
	9.6 Diagnosis and treatment planning
		Key treatment planning factors
		Nonaesthetic zone
		Aesthetic zone
		Number, diameter, and position of implants
		Financial constraints
	9.7 Patient education, expectations, and consent
	9.8 Implant surgery
		The surgical guide and radiographic guide
		Solutions for insufficient bone volume at the implant site
	9.9 Provisional restorations
		Summary of provisional options
		Tissue shaping
	9.10 Implant multi-unit FDP design
		Designs for implant FDPs
		One-stage screw-retained FDP
		Two-stage FDP using abutments and a cemented prosthesis
		Two-stage FDP multi-unit abutments and a screw-retained prosthesis
		Advantages and disadvantages of screw-retained and cemented FDPs
	9.11 Biomechanical factors
		Individual units versus joined units
		Cantilevers
		Implants combined with natural teeth
	9.12 FDP procedures, provisionals, adjustment, and delivery
		Impression and master cast
		FDP try-in-fit, proximal contact, occlusion
		Torquing screws and cementation
		Postdelivery checks/advice (See Chapters 6, 8)
		Protective orthotic occlusal devices
	9.13 Clinical notes on implant FDPs
	9.14 Maintenance and complications
	References
10: Mandibular Implant Overdentures
	10.1 Introduction
	10.2 Patient education, expectations, and consent
	10.3 Medical assessment
	10.4 Clinical assessment and surgical consultation
		Volume of bone available for implants
		Intermaxillary space
		Width of the band of attached mucosa
		Skeletal jaw relationships
		Quality of existing complete dentures
		Radiographs
	10.5 Treatment options for the edentulous patient
		Conventional complete dentures
		Mandibular implant overdenture opposing maxillary complete denture
		Fixed full-arch prostheses
	10.6 Treatment planning factors
		The need to fabricate new complete dentures
		Adapting to complete dentures
		Transitioning to full dentures
		Immediate implant placement
		Immediate and early loading
		Severely atrophic mandible
		Referrals
	10.7 Mandibular overdenture protocols
		Mandibular overdenture with two independent implants
		Mandibular overdenture with two implants joined by a bar
		Mandibular overdenture with three or more implants with or without joining bars
		Mandibular overdenture with a single implant
		Mandibular and maxillary implant supported overdentures or combinations with fixed implant prostheses
	10.8 Planning phase and case preparation
	10.9 The surgical guide
	10.10 Implant surgery
		One- or two-stage surgery
		Implant position
		Implant diameter and length
		Ridge modification
		Immediate implant placement
		Implant loading and osseointegration
		Surgical summary
	10.11 Prosthetic phase
		Choice of anchor or attachment system
		Selecting implant abutments chairside
		Selecting abutments at the laboratory
		Selecting bar abutments
		Seating anchor abutments
	10.12 Overdenture protocol 1: retrofit implant attachments to the definitive mandibular complete denture
		Indirect technique
		Direct technique
	10.13 Overdenture protocol 2: fabricate a new mandibular denture over implants
	10.14 Overdenture delivery
	10.15 Clinical notes
		Locator matrices/direct technique
		Locator retentive nylon inserts
		Nobel Biocare ball attachments and the indirect technique
		Altering retention of ball matrices
	10.16 Maintenance considerations
		Peri-implant health (see Chapter 6)
		Prosthetic stability
		Maintenance problems
		Overdenture complications
	References
11: Advanced Topics: Surgery
	11.1 Introduction
	11.2 Surgical complexity
	11.3 Immediate and early implant placement
		Placement protocols
		Immediate placement
	11.4 Graft materials, osteogenic materials, and scaffolds/matrices
		Graft materials
		Tissue engineering and osteoconduction
	11.5 Ridge augmentation and guided bone regeneration (GBR)
	11.6 Block autografts
	11.7 Sinus-lift/sinus augmentation
		Indirect sinus lift/internal bone core sinus elevation/transcrestal
		Direct sinus lift (Caldwell–Luc access)
	11.8 Other surgical techniques
		Ridge splitting
		Distraction osteogenesis
		Onlay horseshoe grafting
	11.9 Virtual treatment planning and guided surgery
		Rationale for guided surgery
		Background of computer-guided surgery planning
		NobelGuide™ system
		Computer technology and surgery
		Custom surgical guide
		Guided surgery problems
		Guided surgery summary
	References
12: Advanced Topics: Prosthetics
	12.1 Introduction
	12.2 Prosthetic cases with high aesthetic risk
	12.3 Mandibular full-arch implant prostheses
	12.4 Maxillary full-arch implant prostheses
		Maxillary full arch options
		Maxillary overdentures
		Maxillary implant FDP
	12.5 Full-arch fixed rehabilitation approaches
	12.6 Cases with a natural arch opposing an overdenture arch
	12.7 Implant-supported removable partial dentures
	12.8 Shortened loading protocols
		Loading protocols
		Stability-dip
		Micro-motion
		Full-arch immediate loading
	12.9 CAD/CAM prosthetics
	References
13: Complications
	13.1 Introduction
	13.2 Implant treatment outcomes and complications
	13.3 Complications during the surgical and healing phases, early failure
		General complications related to surgery and healing
		Etiology of complications
		Patient risk factors
		Operator risk factors
	13.4 Implant fracture
	13.5 Implant malposition and problems with treatment planning
	13.6 Complications during function
	13.7 Aesthetic complications
		Notes on implant placement in the aesthetic zone
		Common placement problems with aesthetic implications
		Avoidance of implant malposition
		Soft tissue management for aesthetics
	13.8 Mechanical complications
	13.9 Peri-implant soft tissue complications
	13.10 Peri-implant bone loss
		Functional bone loss around an implant may occur for several reasons
		Peri-Implantitis
		Avoidance of peri-implantitis
	13.11 Avoidance of implant complications
		Immediate postsurgical assessment
		Stage-two surgery and preprosthetic assessment
		Routine maintenance and implant assessment
	13.12 Diagnosing and treating other clinicians’ implant cases
	References
Appendix A
Appendix B
Index