Implant Restorations: A Step-by-Step Guide

List of Contributors xiii

Foreword xv

Preface xvii

Acknowledgments xix

1 Introduction to Implant Dentistry 1

Introduction 1

Purpose of Textbook 1

Conventional Dentistry Versus Implant Dentistry 2

Predictability of Fixed Prosthodontics 2

Predictability of Implant Prosthodontics 3

Economics of Implant Dentistry 4

Prognostic Indicators for Teeth 5

Periodontal Disease 5

The Heavily Restored Tooth 6

The Furcation-Involved Tooth 8

The Periodontal Prosthesis Patient 9

Difficult Aesthetic Cases 10

Classification of Ridge Defects 12

Treatment Prognosis for the Dentition 15

Summary 18

Bibliography 18

2 Implants and Implant Restorative Components 21

Introduction 21

Implants 21

Implant/Abutment Connections 25

External Implant/Abutment Connections 25

Internal Implant/Abutment Connections 27

Healing Abutments 30

Conventional, Stock Healing Abutments 30

CAD/CAM Healing Abutments 32

Custom Healing Abutments 34

Impression Copings 35

Implant Impression Copings 35

Pickup Impression Copings (Open Tray) 36

Transfer Impression Copings (Closed Tray) 37

Low-Profile Conical Abutment Impression Copings 38

Scan Bodies 38

Abutments 39

Low-Profile Conical Abutments (LPCA) 40

LOCATOR Overdenture Abutments 41

Stock Abutments 42

UCLA Abutments 44

CAD/CAM Abutments 47

Milled Titanium 47

Milled Zirconia 50

Multiunit Abutments 54

Screws (Clinical) 54

Abutment/Retaining Screws 55

Preload Screw Mechanics 56

Cylinders 57

Definitive Cylinders 57

Interim Cylinders 57

Drivers and Placement Instruments 58

Drivers/Driver Tips 58

Laboratory Components 60

Implant Analogs/Replicas 61

Abutment Analogs/Replicas 62

Try-In Screws 63

Abutment Holders 63

Polishing Protectors 64

Bibliography 65

3 Diagnosis and Treatment Planning in Implant Restorative Dentistry 69

Patient Selection 69

Medical History 69

Diagnostic Procedures 70

Radiographs 70

CBCT (Cone Beam Computed Tomography) Scans 72

Scanning Appliances/Surgical Guides 74

Diagnostic Casts 75

Laboratory-Generated Surgical Guides 75

Physical Examination 78

Extraoral Examination 78

Intraoral Examination 78

Diagnostic Articulator Mounting 79

Diagnostic Wax Patterns 79

Implant Bone Volume 80

Implant Restorative Volume 83

Treatment Planning 85

Edentulous Patients 86

Overdentures 87

Restorative Volume 87

Fixed Implant-Retained, Full-Arch Prostheses-Edentulous Jaws 89

Milled Titanium Frameworks 92

Milled Zirconia Frameworks 94

High-Performance Polymers (HPP) 95

Crown-and-Bridge Type Prostheses 95

Partially Edentulous Patients 96

Screw-Retained Restorations 96

Treatment Goals 96

Benefits 96

Limitations 97

Cement-Retained Restorations 98

Benefits 98

Limitations 99

Angled Screw Channel Abutments 99

Peri-Implant Disease 99

Implant Loading Protocols 101

Unloaded Healing, Two-Stage Surgical Protocol 101

Unloaded Healing, Single-Stage Surgical Protocol 102

Early Loading 102

Immediate Occlusal Loading 103

Immediate Non-Occlusal Loading 103

Patient Consultation 104

Principles of Treatment Planning 104

Informed Consent 104

Summary 105

Bibliography 105

4 Treatment of Edentulous Mandibular Patients: (1) Implant-Retained Framework Overdenture and Resilient Attachments; (2) Resilient Attachments and Two Interforaminal Implants 111

Literature Review 111

Clinical Case Presentation Mandibular Implant-Supported Overdenture with CAD/CAM Framework and Resilient Attachments 117

Clinical Case Presentation Implant-Supported Overdenture with Resilient Attachments and Two Interforaminal Implants 142

Bibliography 156

5 Replacement of Single Teeth with CAD/CAM Implant Restorations: Implant-Level Impressions, Intraoral Scanning, Cement and Screw-Retained Crowns 159

Literature Review 159

Replacement of Individual Teeth 159

Single-Unit Implant Restorations 161

Computer-Assisted Design/Computer-Assisted Machining (CAD/CAM) Healing Abutments/Scan Bodies 162

Intraoral Scanning 167

Models from Digital Impressions 169

Clinical Case Presentation Posterior, Cement-Retained Single-Implant Restoration 170

Clinical Case Presentation Anterior, Screw-Retained Single-Implant Restoration (Angled Screw Channel) 185

Bibliography 197

6 Fixed Dental Prostheses: Retreatment of a Patient with a Fractured Implant-Retained Fixed Dental Prosthesis; CAD/CAM Abutments and a Cement-Retained Fixed Dental Prosthesis; Intraoral Scanning and Screw-Retained Fixed Dental Prosthesis (Atlantis^™ Bridge Patient-Specific Suprastructures) 199

Literature Review 199

Clinical Case Presentation Implant-Level Impression/Screw-Retained Fixed Dental Prosthesis 204

Clinical Case Presentation Intraoral Scanning/Screw-Retained Fixed Dental Prosthesis (Atlantis^™ Bridge Patient-Specific Suprastructure) 219

Bibliography 235

7 Accelerated Treatment Protocol of a Patient with Edentulous Jaws and CAD/CAM Titanium Framework/Fixed Hybrid Prostheses 237

Literature Review 237

Original Treatment Protocol 239

Accelerated Treatment Protocol 242

Clinical Case Presentation Four Months Post Implant Placement and Immediate Occlusal Loading 243

Bibliography 275

8 Treatment of Edentulous Patients with Immediate Occlusal Loading: Conventional Surgical and Computer-Generated Surgical Guides 279

Literature Review 279

Introduction 279

The Preosseointegration Era 280

The Osseointegration Era 281

Immediate Occlusal Loading in the Edentulous Mandible 282

Immediate Occlusal Loading in Edentulous Maxillae 285

Clinical Case Presentation Mandibular Immediate Occlusal Loading with Clinical Conversion of Mandibular Immediate Denture 286

Clinical Case Presentation Maxillary Immediate Occlusal Loading Using Computer-Generated Surgical Guide with Clinical Conversion of Maxillary Immediate Denture 312

Bibliography 324

9 Treatment of Edentulous Patients with Immediate Occlusal Loading: Conventional Surgical/Prosthetic Protocols 327

Literature Review 327

Immediate Occlusal Loading 327

Computer-Guided Surgery 328

Clinical Case Presentation Conventional Surgical and Restorative Protocols 332

Bibliography 367

10 Treatment of Partially Edentulous Patients with Immediate Non-Occlusal Loading Protocols (Intraoral Scanning, CAD/CAM Abutment, and Definitive Maxillary Central Incisor Restoration; Co-Axis Implant and Restoration) 371

Literature Review 371

Clinical Case Presentation INOL Protocol and Intraoral Scanning 375

Clinical Case Presentation INOL Protocol with Co-Axis Implant 396

Bibliography 408

11 Computed Tomography (CT) Guided Surgery/Immediate Occlusal Loading with Full-Arch Prostheses in Edentulous Patients 411

Literature Review 411

Immediate Occlusal Loading 411

Tilted Implants 412

Diagnostic Imaging 413

Computed Tomography (CT) 415

Interactive Computed Tomography (ICT) 417

Interactive Computer Software 418

Computer-Guided Surgery 418

Overview of CT Guided Surgical and Prosthetic Protocols 419

Surgical Guides 419

Master Tubes 419

Prosthetic Laboratory Kit-Implant Analog Mounts 420

Surgical Kit Components 420

Fabrication of Master Cast for Immediate, Fixed Provisional Prosthesis 421

Abutment Selection for Fixed, Screw-Retained Provisional Prostheses 422

Fabrication of a Screw-Retained Provisional Prosthesis 424

Clinical Patient Presentation Ill-Fitting Maxillary Denture; Mandibular Implant-Supported Overdenture 425

Clinical Patient Presentation Maxillary and Mandibular Terminal Dentitions; Computer-Guided Surgery with Metal Surgical Guides 448

Bibliography 463

12 Guidelines and Maintenance Procedures for Fixed, Full-Arch, Implant-Retained Prostheses 465

Introduction 465

Full-Arch Hybrid Prostheses 465

Historical Perspectives 466

Original Protocol 466

Immediate Occlusal Loading for Full-Arch Prostheses 466

Clinical Complications 467

Mechanical 467

Biologic: Peri-Implant Mucositis/Peri-Implantitis 470

Treatment (Peri-Implant Mucositis) 472

Treatment (Peri-Implantitis) 473

Innovations in Full-Arch Designs 475

Prosthesis Design/Materials 476

Hygiene/Maintenance Protocol for Immediately Loaded Full-Arch Prostheses 477

Hygiene/Maintenance Protocol for Definitive Full-Arch Prostheses 478

At-Home Hygiene 478

Plaque Control–Dentifrice 478

Plaque Control–Mechanical 478

Recall Appointments 479

Recall Interval/Schedule 479

Examination 480

Radiographs 481

Professional Maintenance 485

Prosthesis Removal 487

Cleaning the Removed Prosthesis 488

Conclusions 488

Bibliography 488

Index 493