Prosthetic oriented treatment planning

In its simplest form, prosthetic oriented treatment planning methodology refers to a protocol whereby the desired functional and esthetic result is considered first, leading to consideration of the ideal prosthetic emergence profile, loading condition and subsequent implant selection based on bone condition.

Prosthetic oriented treatment planning methodology will provide maximum biomechanical stability and allow for soft tissue flaring by utilizing an implant with a prosthetic platform slightly smaller in diameter than the emergence diameter of the tooth replaced. SLOCK®’s wide selection of implant fixtures allows clinicians to match the size of the prosthetic platform to the restoration it will eventually support, while allowing for different bone conditions and anatomical features at the implant site. Implant fixture and abutment selections are based upon the relationship of several key measurements:

•The emerging dimension of the crown in relation to the diameter of the prosthetic platform of abutment.
•The height and diameter of the intended restoration at the tissue exit point.
•The bone volume at the implant site in relation to the diameter of the fixture body.
 

Pre-surgical Implant Size Selection

Osseointegrated implants often fail because of excessive masticatory forces that cause extremely large stresses in bone tissue. A proper size of implant could be selected by comparing the masticatory forces and a wide range of anatomically available bone. It is determined by pre-surgical diagnosis and treatment planning for successful implant treatment, taking into consideration the biomechanical correlation between implant dimensions and stresses in supporting bone. For this purpose, clinical bone imaging procedures are used and patient occlusion is studied for estimate stresses in implant-bone interface areas to evaluate the influence of implant dimensions on stress concentration and on the value of an implant's ultimate masticatory load. Geometric images of a implant site were generated from computed tomography (CT) or panoramic images and were analyzed with CT software and implant overlay sheet. Critical point in the peri-implant area of bone was determined. The ultimate value of the masticatory load, which generates ultimate stresses at the critical point, was estimated for each implant. These pre-surgical findings provide correct selection of implant dimensions in clinical cases, because corresponding ultimate values of masticatory force were used as a criterion for assessment of their load-carrying capacity and applicability.


Pneumatization of the maxillary sinus limits the quantity of alveolar bone available for implant placement and may result in a lack of primary stability and difficulty in achieving osseointegration. The prevalence of sinus augmentation increased with decreased residual crestal bone height, more posterior implant locations, and complete or partial edentulism. Sinus augmentation was significantly associated with implant failure and wide implants.
The type and quality of bone available to support a dental implant are very important, so attention should be directed to all the factors responsible for the success or failure of a dental implant. In cases involving D4 bone, one must consider other treatment modalities for replacement of a missing tooth or use caution in the placement of the implants, especially in the high-load-bearing molar areas.
Implant therapy has become common practice and will continue to increase in popularity. This also implies that dental professionals will have to learn more how to deal with implant failure and related complications. Why an implant does not integrate could have a multifactorial etiology.



Intra-erative bone evaluation and Implant size selection


Post-surgical Evaluation of Implant position

A precise placement of dental implants is a crucial step to optimize both prosthetic aspects and functional constraints. Intraoperative bone evaluation allows precise implant placement and minimizes the risk of interferences with anatomical structures. Post-surgical evaluation of fixture position allows precise implant prostheses placement and minimizes the risk of interferences with function and esthetics. Especially the placement of dental implants in the anterior maxilla is a challenge for clinicians because of patients’ exacting esthetic demands and difficult pre-existing anatomy. Therefore the accuracy of implant position is assessed by radiographically and surgically. The postoperative cone beam CT and panoramic view is performed to calculate the difference between pre-surgical implant position in the preoperative planning and postoperative situation. The accuracy of implants is important to functional and esthetic results in implant dentistry.




Recommendations for Prosthetic oriented implant selection


Implant Size Recommendations:
The following chart contains recommendations only. Actual clinical conditions and the clinician’s assessment of the patient should be the main criteria for choosing the size of an implant for a particular area.

Recommendations for Prosthetic oriented Abutment selection

The SLOCK®'s abutment system has various diameters and heights for shaping the soft tissue to replicate the geometry and gingival contours of natural dentition. And the Post abutment, Hexed abutment, Screw abutment, Post cone abutment and Esthetica abutment system eliminates the need for an implant-level impression while delivering a restoration that has the appropriate margin height and natural emergence contour for function and esthetics. This easy and accuracy is achieved from various abutment system and fixture internal hex orientation. The SLOCK®'s abutment system communicates the post height, collar diameter, abutment height, fixture internal and external orientation. Because the tissue is healed at the time of impression, the margin should have the appropriate placement and contour. The result is a patient specific, anatomically designed, functional and esthetic prosthetic abutment.

omfskim11@gmail.com, 2014.05.31 오후 1:15:47 | 5848 hit(s) 0 comment(s)
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