in partnership with Nobel Biocare Diagnosis and treatment
planning for the replacement of missing teeth Module 1 | Session 2
Treatment planning and restoring the single posterior implant
Disclaimer: Some products may not be regulatory cleared/released
for sales in all markets. Please contact the local Nobel Biocare
sales office for current product assortment and availability Please
note: It is encouraged that the presentation at hand is adapted and
enhanced by clinical cases of the lecturer. Please feel free to
adjust the slides according to your preferences. Slide 2 Treatment
planning and restoring the single posterior dental implant 2 Gain
proficiency in diagnosis and treatment planning Master the
restorative steps for a posterior dental implant Transform
restorative decision-making and execution into a simple and easy
process Learn how to avoid or manage complications Learn how to
gain patient acceptance for dental implant treatment Module 1:
Course objectives Treatment planning and restoring the single
posterior dental implant Slide 3 3 Dental implants the standard of
care Indications and contraindications for dental implants Cement
vs. screw-retained restorations Options for replacing a missing
tooth Diagnosis and treatment planning Clinical examples How to
find patients and gain treatment acceptance Session 1 Session 2
Review of restorative options Surgical templates Biomechanics and
occlusion in implant dentistry Case presentation from participants
Treatment plan and case work-up with faculty Introduction for
surgical preparation Time: 3 hours Time: 3 hours Module 1: Session
overview Slide 4 Treatment planning and restoring the single
posterior dental implant 4 Impression techniques Cement vs.
screw-retained restorations Provisionalization NobelProcera
Restorative workshop and hands-on Patient treatment status Basic
patient communication concepts Session 3 Session 4 Avoiding or
managing complications Dental implant maintenance Final case
presentations Time: 3 hours Time: 3 hours Module 1: Session
overview Slide 5 in partnership with Nobel Biocare Diagnosis and
treatment planning for the replacement of missing teeth Module 1 |
Session 2 Agenda Review restorative options Surgical templates
Biomechanics and occlusion in implant dentistry Slide 6 Treatment
planning and restoring the single posterior dental implant 6
Restorative solutions for dental implants Implant supported
solutions from single tooth to full arch restorations Single
posterior implant Full arch implants Multiple implants Single
anterior implant Slide 7 Treatment planning and restoring the
single posterior dental implant 7 Restorative solutions for dental
implants Implant supported solutions from single tooth to full arch
restorations Single posterior implant Slide 8 Treatment planning
and restoring the single posterior dental implant 8 Single missing
tooth Restorative options for a single posterior implant: Clinical
cases courtesy of Dr. Baldwin Marchack, Pasadena, USA Slide 9 in
partnership with Nobel Biocare Diagnosis and treatment planning for
the replacement of missing teeth Single missing tooth Single
posterior implant Clinical case courtesy of Dr. Sebastian Horvath,
Jestetten, Germany Slide 10 Treatment planning and restoring the
single posterior dental implant 10 Single missing tooth Restorative
options for a single posterior implant: Pre-fabricated abutment,
cement-retained crown Individualized abutment, cement-retained
crown Screw-retained crown (one piece) Slide 11 Treatment planning
and restoring the single posterior dental implant 11 Single missing
tooth Screw-retained restoration Cement-retained restoration Single
posterior implant Photographs courtesy of MDT Claus-Peter Schulz,
Baden-Baden, Germany Slide 12 Treatment planning and restoring the
single posterior dental implant 12 Single missing tooth
Individualized (CAD/CAM) abutment Pre-fabricated abutment
Cement-retained restoration Photographs courtesy of Dr. Baldwin
Marchack, Pasadena, USA Photographs courtesy of MDT Claus-Peter
Schulz, Baden-Baden, Germany Slide 13 Treatment planning and
restoring the single posterior dental implant 13 Guidelines for
abutment selection Issues to be considered: Implant-abutment
connection Distance from the implant platform to bone crest
Interocclusal distance Depth of peri-implant soft tissues Biotype
of the tissue Emergence profile Shape and contour of the tissue
Screw-retained/cement-retained Slide 14 Treatment planning and
restoring the single posterior dental implant 14 Ideal gingival
height 1 to 3mm, flat shape Ideal interarch dimension 5 to 10mm
Guidelines for abutment selection Slide 15 Treatment planning and
restoring the single posterior dental implant 15 Guidelines for
abutment selection Too deep, not flat use another solution. Slide
16 Treatment planning and restoring the single posterior dental
implant 16 Guidelines for abutment selection A case study:
Resistance to dislodgement of zirconia copings cemented onto
titanium abutments of different heights. Abbo B, Razzoog M, Vivas
J, Sierraalta M. J Prosthet Dent 2008; 99: 25-29 Purpose: Authors
measured the force it takes to dislodge a cemented crown on
abutments of various heights Results: The taller the abutment
height the greater the force required to dislodge a cemented crown.
Study recommends that abutments should be no less than 4mm in
height when using a cemented crown. Abutment height:6.5mm5.5mm
Average dislodgement force:198.09N 124.89N Slide 17 Treatment
planning and restoring the single posterior dental implant 17
Guidelines for abutment selection 2-3mm gingival height 5mm
interarch dimension Slide 18 Treatment planning and restoring the
single posterior dental implant 18 Posterior abutment decision tree
single implant crown Posterior Abutment Decision Tree Copyright
2010 Baldwin Marchack, DDS. Used by permission. Interarch distance
> 5mm Interarch distance < 5mm Screw-retained crown
Individualized one-piece restoration NobelProcera Screw-retained
crown (Ti or Zr) Single posterior implant restoration Slide 19
Treatment planning and restoring the single posterior dental
implant 19 Guidelines for abutment selection Limited interarch
dimension Photographs courtesy of Dr. Baldwin Marchack, Pasadena,
USA Slide 20 Treatment planning and restoring the single posterior
dental implant 20 Guidelines for abutment selection Use a
screw-retained crown: 1.Limited interarch dimension 2.Patient is a
bruxer 3.Retrievability is desired 4.Cement-free solution wanted
Screw-retained crown: 1.NobelProcera screw-retained crown
2.GoldAdapt abutment Slide 21 Treatment planning and restoring the
single posterior dental implant 21 Guidelines for abutment
selection Photographs courtesy of MDT Claus-Peter Schulz,
Baden-Baden, Germany Slide 22 Treatment planning and restoring the
single posterior dental implant 22 Guidelines for abutment
selection Clinical case courtesy of Dr. Sebastian Horvath,
Jestetten, Germany Slide 23 Treatment planning and restoring the
single posterior dental implant 23 Posterior abutment decision tree
single implant crown Posterior Abutment Decision Tree Copyright
2010 Baldwin Marchack, DDS. Used by permission. Interarch distance
> 5mm Interarch distance < 5mm Cement-retained crown
Screw-retained crown Flat tissue < 3mm ID 510mm Pre-fabricated
abutment Snappy Abutment Individualized one-piece restoration
NobelProcera Screw-retained crown (Ti or Zr) Retrievability is
desired Single posterior implant restoration Slide 24 Treatment
planning and restoring the single posterior dental implant 24
Guidelines for abutment selection Ideal gingival height (13mm)
Ideal interarch dimension (5-10mm) Flat tissue architecture
Clinical case courtesy of Dr. Sebastian Horvath, Jestetten, Germany
Slide 25 Treatment planning and restoring the single posterior
dental implant 25 Snappy Abutment Ideal gingival height (13mm)
Ideal interarch dimension (5-10mm) Flat tissue architecture
Clinical case courtesy of Dr. Sebastian Horvath, Jestetten, Germany
Slide 26 Treatment planning and restoring the single posterior
dental implant 26 Clinical case courtesy of Dr. Sebastian Horvath,
Jestetten, Germany Snappy Abutment Slide 27 Treatment planning and
restoring the single posterior dental implant 27 Posterior abutment
decision tree single implant crown Posterior Abutment Decision Tree
Copyright 2010 Baldwin Marchack, DDS. Used by permission. Interarch
distance > 5mm Interarch distance < 5mm Cement-retained crown
Screw-retained crown Flat tissue < 3mm ID 510mm Pre-fabricated
abutment Snappy Abutment Individualized one-piece restoration
NobelProcera Screw-retained crown (Ti or Zr) Scalloped < 4mm ID
510mm Pre-fabricated abutment Esthetic Abutment (Ti) Procera
Esthetic Abutment (Zr) Single posterior implant restoration Slide
28 Treatment planning and restoring the single posterior dental
implant 28 Pre-fabricated Esthetic Abutment Pre-fabricated,
customizable Titanium abutment: Comprehensive selection of
different margin designs and angulations minimize chair-side
adjustments Scalloped margin designed to profile natural soft
tissue contours Optional temporary coping available for
temporization Indications: Single- and multiple-unit implant
restorations Cement-retained Esthetic Abutment (Titanium) Slide 29
Treatment planning and restoring the single posterior dental
implant 29 Esthetic Abutment Clinical case courtesy of Dr.
Christopher Marchack, Pasadena, USA Slide 30 Treatment planning and
restoring the single posterior dental implant 30 Esthetic Abutment
Clinical case courtesy of Dr. Christopher Marchack, Pasadena, USA
Milled titanium Can be adjusted by the lab Corrects minor
angulation problems Fixture level impression Easy to cement Slide
31 Treatment planning and restoring the single posterior dental
implant 31 Posterior abutment decision tree single implant crown
Posterior Abutment Decision Tree Copyright 2010 Baldwin Marchack,
DDS. Used by permission. Interarch distance > 5mm Interarch
distance < 5mm Cement-retained crown Screw-retained crown Flat
tissue < 3mm ID 510mm Pre-fabricated abutment Snappy Abutment
Individualized one-piece restoration NobelProcera Screw-retained
crown (Ti or Zr) Scalloped < 4mm ID 510mm Pre-fabricated
abutment Esthetic Abutment (Ti) Procera Esthetic Abutment (Zr)
Scalloped or flat tissue > 4mm ID > 5 mm Individualized
abutment NobelProcera Abutment (Ti or Zr) Single posterior implant
restoration Depending on clinical situation and preference, the
GoldAdapt Abutment can be a flexible solution for both cement- and
screw-retained restorations and for various gingiva heights. Slide
32 Treatment planning and restoring the single posterior dental
implant 32 Guidelines for abutment selection Individualized
abutment Scalloped tissue architecture Thick soft tissue Angled
implant placement Excessive interarch dimension Excessive
interproximal dimension Fabrication options: 1.NobelProcera
abutment in Titanium or Zirconia 2.GoldAdapt abutment Slide 33
Treatment planning and restoring the single posterior dental
implant 33 NobelProcera abutment NobelProcera Angulated Screw
Channel abutment Easy access due to tilted access hole Clinical
case courtesy of Dr. Sebastian Horvath, Jestetten, Germany
Photographs courtesy of MDT Claus-Peter Schulz, Baden-Baden,
Germany Slide 34 Treatment planning and restoring the single
posterior dental implant 34 NobelProcera abutment Clinical case
courtesy of Dr. Sebastian Horvath, Jestetten, Germany Photographs
courtesy of MDT Claus-Peter Schulz, Baden-Baden, Germany Slide 35
Treatment planning and restoring the single posterior dental
implant 35 Posterior implant restoration Clinical case courtesy of
Dr. Sebastian Horvath, Jestetten, Germany Slide 36 Treatment
planning and restoring the single posterior dental implant 36
Posterior abutment decision tree single implant crown Interarch
distance > 5mm Interarch distance < 5mm Cement-retained crown
Screw-retained crown Flat tissue < 3mm ID 510mm Pre-fabricated
abutment Snappy Abutment Individualized one-piece restoration
NobelProcera Screw-retained crown (Ti or Zr) Retrievability is
desired Scalloped < 4mm ID 510mm Pre-fabricated abutment
Esthetic Abutment (Ti) Procera Esthetic Abutment (Zr) Scalloped or
flat tissue > 4mm ID > 5 mm Individualized abutment
NobelProcera Abutment (Ti or Zr) Posterior Abutment Decision Tree
Copyright 2010 Baldwin Marchack, DDS. Used by permission. Single
posterior implant restoration Depending on clinical situation and
preference, the GoldAdapt Abutment can be a flexible solution for
both cement- and screw-retained restorations and for various
gingiva heights. Slide 37 in partnership with Nobel Biocare
Diagnosis and treatment planning for the replacement of missing
teeth Diagnosis and prosthetic treatment planning Four important
tools 1.Diagnostic models 2.Radiographs 3.(CB)CT scans
4.NobelClinician Software Slide 38 Treatment planning and restoring
the single posterior dental implant Diagnostic Models Evaluate:
Centric relation position Edentulous ridge relationship to adjacent
teeth, opposing ridge, opposing dentition Inclination, rotation,
extrusion, alignment of the remaining dentition Soft tissue,
gingival heights, and other esthetic parameters Interarch space
Determine: Options for occlusal schemes Ideal number and location
of implants Direction of forces to which future implants would be
subjected 38 Slide 39 Treatment planning and restoring the single
posterior dental implant Please bear in mind that radiographs are
not completely accurate Radiographs Evaluate: Amount of bone
available (2D only) Angulation of adjacent teeth Location of
anatomical structures Sinus, mandibular canal, mental foramen 39
Clinical case courtesy of Dr. Richard Sullivan, Pasadena, USA Slide
40 Treatment planning and restoring the single posterior dental
implant (CB)CT scans 40 Clinical case courtesy of Dr. Christopher
Marchack, Pasadena, USA Since radiographs are not completely
accurate, a (CB)CT scan can improve the diagnosis Slide 41
Treatment planning and restoring the single posterior dental
implant NobelClinician Software 41 Visualize the patients (CB)CT
data together with the intra-oral situation and the diagnostic
setup thanks to NobelClinicians SmartFusion technology Clinical
case courtesy of Dr. Christopher Marchack, Pasadena, USA Slide 42
Treatment planning and restoring the single posterior dental
implant Surgical templates Models, radiographs and (CB)CT scans are
essential in fabricating surgical templates for various types of
surgery: Flapless Mini flap Flap All options are covered with the
NobelClinician Software and NobelGuide 42 Slide 43 Treatment
planning and restoring the single posterior dental implant Surgical
templates Benefits of surgical templates: More precise placement of
implants Preservation of anatomic structures Shorter treatment
times, surgery times Less invasive, flapless surgery and therefore
less chance of swelling Less post-operative strain on dentist and
patient 43 Manikandan R et al. Implant surgical guides: From the
past to the present. J Pharm Bioallied Sci 2013;5(Suppl 1):S98-S102
Slide 44 Treatment planning and restoring the single posterior
dental implant One integrated treatment workflow, countless
benefits 44 1.Clinical diagnostics and treatment acceptance
2.Capturing both the current and desired situation 3.Treatment
planning and patient communication Production of surgical template
4.Implant placement either freehand or using pilot drill template
or fully guided template 5.Prosthetic design Production of
prosthesis 6.Restoration placement NobelConnect Clinical
diagnostics & treatment acceptance Capturing both the current
& desired situation Treatment planning & patient
communication Production of surgical template Implant
placementDesign of final restoration Production of prosthesis
Restoration placement Slide 45 Treatment planning and restoring the
single posterior dental implant 45 Treatment planning What is the
minimum space needed between teeth for a single-tooth implant?
3.5mm 4.3mm 5.0mm ~1.5mm on each side of implant, 2mm is better for
soft tissue 4.3mm 1.5-2mm Illustrations refer to Nobel Biocare
implants with Conical Connection 1 Gastaldo JF et al. Effect of the
Vertical and Horizontal Distances Between Adjacent Implants and
Between a Tooth and an Implant on the Incidence of Interproximal
Papilla. J Periodontol 2004;75(9):1242-1246 Slide 46 Treatment
planning and restoring the single posterior dental implant 46
Occlusion and biomechanics The picture shows which force occurs
during a situation of malocclusion The resulting force is
perpendicular to the plane of contact If the resulting force is too
strong for the crown, the restoration may break or may result in
crestal bone loss The principles are the same for both natural
teeth and implants how can breakage and crestal bone loss be
avoided? Forces acting during a condition of malocclusion
Illustrations obtained through internet research:
http://www.scielo.br/img/revistas/bdj/v16n1/a08fig01.gif Slide 47
Treatment planning and restoring the single posterior dental
implant 47 Occlusion and biomechanics Uneven loading Overloading
may occur because of incorrect placement of the implant and
critical restoration geometries This can result in uneven force
distribution on the implant's surface Dental implants should
ideally be placed so that the biting forces are directed straight
downward onto the dental implant Slide 48 Treatment planning and
restoring the single posterior dental implant 48 Occlusion and
biomechanics FBite FN1 FNx1 FBite FN2 FNx2 The steeper the line of
contact, the stronger the resulting force The force necessary to
equalize the vertical bite force is higher, when the line of
contact is steeper In the dental environment, the occlusion should
be shallow or flat in order to reduce the lateral forces impacting
on the occlusion it is recommended to create shallow or flat
occlusion lines to reduce the overload risk Slide 49 Treatment
planning and restoring the single posterior dental implant Possible
consequences of overload Crestal bone loss Dislodged restorations
Screw loosening Screw fracturing Restoration or ceramic fracture
Peri-implantitis Implant failure 49 Occlusion and biomechanics
Clinical case courtesy of Dr. Baldwin Marchack, Pasadena, USA *
This list makes not claim to be complete. Slide 50 Treatment
planning and restoring the single posterior dental implant Possible
consequences of overload 50 Occlusion and biomechanics Clinical
case courtesy of Dr. Baldwin Marchack, Pasadena, USA Slide 51
Treatment planning and restoring the single posterior dental
implant Summary Keep cusp inclines flat or shallow to minimize
lateral forces No premature contacts Light occlusal contacts Avoid
supra-occlusal axial and lateral loading Keep contacts in the same
line as the long axis of the implant, i.e., as close to the center
as possible Avoid cantilevers, whether mesial, distal, buccal, or
lingual 51 Occlusion and biomechanics Chia-Chun Yuan J, Sukotjo C.
Occlusion for implant-supported fixed dental prostheses in
partially edentulous patients: a literature review and current
concepts. J Periodontal Implant Sci 2013;43:51-57 Rani G, Gambhir
A. Occlusion In Implants - A Review. Indian J Dental Sci
2012;3(4):95-98 Slide 52 Treatment planning and restoring the
single posterior dental implant 52 Refer your patient to your
surgical specialist for implant treatment Ensure a complete patient
documentation for later case presentation You may invite your
dental laboratory technician to participate in session 3 of the
Esthetic Alliance Program Your next steps for session 3 Treatment
planning and restoring the single posterior dental implant Slide 53
53 Thank you! Disclaimer: Some products may not be regulatory
cleared/released for sales in all markets. Please contact the local
Nobel Biocare sales office for current product assortment and
availability Nobel Biocare Services AG. All rights reserved.
