1

Ed McGlumphy, DDS, MS

Confidence with Implant Dentistry: Accelerated Loading and Digital Technology

mcglumphy.1@osu.edu mcglumphy.1@osu.edu

College of Dentistry

Columbus, Ohio, USA

2

Special thanks to :

Rafael Tames, Tamer El Gendy,

OSU OMFS, Peter Larsen

Guillermo Chacon, Miguel

Alfaro, Nancy Clelland, Mauricio

Hervas, Lisa Knobloch, Tam

Issa-Abbas and Namrata Nayyar

for contributions to this lecture.

Disclaimer:

I will receive no honorarium for this

presentation. I have served as a

paid consultant and/or received

lecture honorarium and/or received

research support from Zimmer,

BioMet 3i, Dentsply/ Astratech,

Nobelbiocare, Straumann and

Global Dental Science.

Special thanks to :

Louie Salaita, Nakul Rathi, Andy

Gilbert, Greg Michaels, Marilyn

Miller, Robin Messner, Kent

Howell, Nate Farley, Luiz Daroz,

Burak Yilmaz,Jairo Saenz and

Demetrious Sarantopoulos

for contributions to this lecture. If (we) have seen further, it is only by standing on the shoulders of giants. - Isaac Newton

6 Major Implant Systems

Over 27,000 implants placed and restored

Now 32 Years Ohio State Implant Systems 1985 - IMZ

1987 - BRANEMARK

1987 - CV/PARAGON

1988 - CALCITEK

1989 - STERI-OSS

1992 – BIOMET 3i

1997 – STRAUMANN ITI

1999 – ASTRA TECH/DENTSPLY

...”

NobleBiocare

Zimmer

3

Desirable Implant Features

THE OHIO STATE EXPERIENCE

Strong Implants

Alternative Rough Surface

Alternative Anti-Rotation

1991

“... What We Have Learned About Early and Immediate Loading...”

Implant Research

Desires

Better

Faster

Cheaper

Then… Now Now Then…

4

Then… Now

?

Then… Now ?

“..

HIO STATE IMPLANT

CLINICAL TRIALS

… what we have learned about …

Everyday treatment planning

“.... posterior implant restorations”

BASIC IMPLANT

RESTORATIVE

QUESTIONS

How Many?

Open or closed tray or scan?

Stock, Custom or After-

market abutments? Screw or Cement?

Computer Generated Guide? Which Implant?

How soon to load?

Splinted or Single?

Torque? Screw access fill?

5

”

How would we

do it today?

Fixed vs. Removable?

Resin vs. Porcelain?

How Many ? On-4, 5, 6 or 8?

Bars vs. Locators?

How soon to load?

CBCT and/or Computer

Generated Guide?

Temporary or Final?

Single vs. Dual Scan?

“... What We Have Learned About Early and Immediate Loading...”

HIO STATE IMPLANT

CLINICAL TRIALS

HOW SOON WE CAN LOAD?

… what we have learned about …

Drive Thru Implant

Dentistry

EARLY LOADING

Less than 3 months

IMMEDIATE LOADING

First Week

“... What We Have Learned Early and Immediate Loading...”

IMMEDIATE PROVISIONAL

No Load

Accelerated Implant Loading Protocols

Immediate Provisional – No Load

Branemark principles

theoretically not broken

EARLY LOADING IMMEDIATE LOADING

HIO STATE IMPLANT

CLINICAL TRIALS

WHERE WE HAVE BEEN?

what we have learned about …

6

EDENTULOUS MAXILLA?

EDENTULOUS MANDIBLE?

X X

...”

1985 OSU

Implant

Patient

#2

Ken

“

2010 OSU

Implant

Patient

#2

Ken

25 years 2010

OSU

Implant

Patient

#2

Ken

25 years 1 Denture Set Remake

7 Sets of IME Changes (Ti placed ‘92)

7 Upper, 5 Lower Relines

11 Clip Changes

7

Edentulous Mandible Options Today

Maintenance

INT J ORAL MAXILLOFAC IMPLANTS 2008;23:847-857

...”

1988 First

OSU Sinus

Graft

Judy

8

1998 First

OSU Sinus

Graft

Judy 10 YEARS

...”

2009 First

OSU Sinus

Graft

Judy 21 YEARS

...”

2009 First

OSU Sinus

Graft

Judy 21 YEARS

...”

2014 First

OSU Sinus

Graft

Judy 26 YEARS

...”

2014 First

OSU Sinus

Graft

Judy 26 YEARS

9

Michael Scherer, DMD, MS

Michael Scherer, DMD, MS

10

Five Year

Follow-up

2013

Six Year

Follow-up

2014

HIO STATE IMPLANT

CLINICAL TRIALS

FUNDAMENTALS FIRST

… what we have learned about …

11

12

13

Hybrid Prosthesis

14

8-9 mm

8-9 mm Minimum15-18mm

The Ohio State University College of Dentistry

...”

1991 First

OSU All-

PFM

Implant

Rehab

Mark

...”

1996 First

OSU All-

PFM

Implant

Rehab

Mark

...”

2009 First

OSU All-

PFM

Implant

Rehab

Mark

18 YEARS 18 YEARS

15

...”

2009 First

OSU All-

PFM

Implant

Rehab

Mark

18 YEARS 18 YEARS

”

Is the chair analogy valid?

How Many ? On-4, 5, 6 or 8?

• Benefits of Tilted Implant Protocols

– Avoid anatomical structures such as the sinus, nerve, etc.

• May be possible to avoid grafting (avoid sinus lifts)

– Longer implants which increases the Bone-to-Implant Contact (BIC)

– Increase the A/P Spread and reduce cantilevers in the prosthesis

Tilted Implant Protocols

Part# 6288, Rev 2/2012 283

Part# 6288, Rev 2/2012

284

5mm 5mm Significant time and money

Immediate Restoration of Edentulous Maxilla with a Metal-Resin Implant-Fixed Complete

Denture with 4 Implants Placed with Flapless Surgery: All-on-4 concept.

CT Scanning Appliance

16

• 55-year-old

• Male

• No history of systemic problems

CT-Guided Surgical Stent for Flapless Surgery

17

Immediate Log CONVERSION PROSTHESIS New?V TJ Balshil The Biotes Conversion

Prosthesis: a provisional fixed prosthesis

supported by osseointegrated implants

for the restoration of the edentulous jaw.

QUINTESSENCE INTL 16 (10):667-77

OCT 1985

18

Malo Technique

19

20

21

457 Part# 6288, Rev 2/2012

22

•

23

24

25

26

27

28

29

30

31

HIO STATE IMPLANT

CLINICAL TRIALS

Implant Positioning Technology

… what we have learned about …

How do we

position the

implants?

Better ?

Faster ?

Cheaper ?

SURGICAL TEMPLATES

COMPLETELY EDENTULOUS

• •DELINEATE ARCH FORM

• •ALLOW HANDPIECE ACCESS

• •ALLOW SURGEON TO VISUALIZE BONE

32

Surgical Template Fabrication Surgical Template Fabrication

33

The Ohio State University College of Dentistry

Edentulous Patients

Cone Bean CT Scan

The Ohio State University College of Dentistry

Edentulous Patients

Teeth30%Ba

Base10%Ba

34

35

EDITH CT EDITH CT

36

EDITH CT EDITH CT

”

CBCT GUIDED

SURGERY

QUESTIONS Scan Guide? Virtual Teeth?

Different for Single vs Multiple vs Edentulous?

Surgical Guide? Benefit? Risk?

Scan warranted?

Single vs. Dual Scan Protocol

CBCT Generated

Guides

Better ?

Faster ?

Cheaper ?

Clin. Oral Impl. Res. 20 (Suppl. 4), 2009 / 73–86

A systematic review on the accuracy

and the clinical outcome of computer guided

template-based implant dentistry

Schneider, Marquardt, Zwahlen and Jung

In four studies with 101 patients, 37/537

implants (6.9%) failed during the follow-up

period. The implant failure rate in these studies

ranged from 4.2% to 9%.

Single vs. Dual

scan protocol

Single Scan Protocol Issue Segmentation Process

37

Simplant Academy Website

Dual Scan Protocol Confirmation

http://www.simplantacademy.org/dmdocuments/Procedure_Step_2.pdf

Single Scan less suitable with Conebeam 3D CT

Dual Scan ideally suited for Conebeam 3D CT

For the partially

edentulous patient,

do you need a scan

guide at all?

38

METHOD OF FABRICATION OF SCAN TEMPLATE FOR DUAL SCANNING

Fiduciary

markers on

Existing

prosthesis

Same

denture

s

scanne

d with

patient

INTEROCCLUSAL RECORDS FABRICATED FOR CBCT SCANNING

12 SAMPLES

Aluwax

Ramitec Take 1 Memosil Bluebite CT Lab putty Reprosilil

Jet bite Futar D Blu-moussee Memoreg 2 Modelling wax

RESULTS- VISUAL

Aluwax Jet bite Futar D Blu-mousse Memoreg 2 Modelling wax

39

Ramitec Take 1 Memosil Bluebite CT Lab putty Reprosil

15mm

40

41

42

43

“Fixed” is better than “Removable”,

“Final” is better than “Temporary”,

Four may be as good as 5,6 or 8 in both

arches.

Tilted Implant protocols are a more

affordable option for many edentulous

patients.

“Now” is usually better than

“Then”, but not always.

Use two implant locator

overdentures for cost benefit,

but remember the maintenance.

The risks of immediate loading

in the edentulous patient are

very manageable.

•

Technology is only as good as your

fundamentals .

Go Bucks!

Confidence with Implant Dentistry: Accelerated Loading Protocols and Digital Technology