Biomechanics, Treatment

Planning, and Prosthetic

Considerations
of implants
 OBJECTIVES

• To understand the importance of load bearing

capacity of implant and factors affecting it.

• To understand the treatment planning in implant

placement.
(implant-components-prosthesis) (bone-implant contact)

Is Problematic Is a Critical factor

Controlled by
BUT most of it can be resolved
• Control & distribution of stress
Controlled by
F.
Improvement of material & • The Q & Q of available bone.
design • Maintenance of bone apposition.
• Bone Support under functional
loading.
• Osseointegration successful implant

• IF Loading- bearing capacity of implant < anticipated

loads during function implant FAILURE.
-NATURAL TEETH are more adapted to forces ( y??)

Any movement of OSSEOINTEGRATED IMPLANT (direct bone

contact) loss of osseointegration fibrous encapsulation
failure(no adaptation to excessive forces)
 If applied loads exceed load-bearing
capacity
Mechanical failure Biologic failure
• Screws that secure the • ébone loss around the
restoration may bend, implant èloss of
loosen, or fracture osseointegration
• Fracture of the implant
 Load-Bearing Capacity
Is influenced by:
1.The quality of the bone-implant interface.
2.The no and size (Length & Width) of implants.
3.The arrangement & angulation of implant positions

•The bone appositional index :

vis the percentage of bone-to-implant contact
vIt is the most important factorè to consider when
evaluating the load-bearing capacity of implant.

ê bone density and êbone-implant contact (low bone

apposition index) ê support & resistance to occlusal loading
 1-Quality of bone
D1 [Ant. mand.] (homogeneous cortical bone)
D2 [Ant. & Post. Mand.] (dense porous with dense trabecular)
D3 [ant. Max. & post. of both jaws]
D4- [Post. Max.] (little or no cortical plate+ fine trabecular)

Ant. Mand. Index=65-90%

Post. Max. index=30-60%
 Implant Surface with altered microtopography
(surface modification)

Higher bone appositional index than machined

surfaces + facilitate biologic process of bone formation.

Enhance bone apposition in poor Q & Q bone.

 2.a. Number of implants
One implant for every missing tooth
BUT In mand : use fewer implants, y??

2.b.Size of implant (Width &Length)

• Lack of bone height limits placement of Long Implant
Infe
r
ner ior alv
ve& e o la ê bone-implant contact
Ma vesse r
x. s
inus ls ê Bone apposition index

This can be solved by

Ø Use of short wide implant to increase load bearing capacity
Ø Elevation of sinus floor/bone augmentation/nerve
repositioning)
 3.a.Implant Arrangement
v When implants are arranged In linear fashion
bone response are unfavorable
v In nonlinear configuration (curvilinear or
staggered) more stable & resists torqueing
forces( created by off-center contacts & lateral
loads).

Linear implant configurations (FPD) → more bone loss when

loads are non axial. esp. post. area à load magnification

• Implant- with a cantilevered ponticà transfer

nonaxial f. to implantà creating a torqueing
forces à load magnification àBONE LOSS.
 3.b.Implant Angulation
If loads are applied at ≥200 to the long axis of the
implant (Non-axial loads )

LOAD MAGNIFICATION stress conc. around the

neck of the implant

Resorptive remodeling of bone

dec. bone density in the coronal aspect

• Excessive distal angulations created non-axial

loading and bone loss.
N.B Short implant +improperly positioned and angulation in poor
quality bone=OVERLOAD=FAILURE
Treatment plan for implant placement
Dental Implants For Edentulous Mandible

Partially Edentulous Patients

Multiple Teeth Sites

Partially Edentulous Patients

single Tooth Site
Complete denture -Implant Overlay Implant-supported
Adv: denture fixed prosthesis
The max. sinus limits Only 4 implant • 6 or more implants
the height of bone 1.Lower cost arranged in arc of
available for implant. curvature
2.Hygiene accessibility
Disadvantages. • Long crowns dt êST
3. Improve speech,
•Poor ridge form palatless. height+ lack of lip
•Hammer and anvil support.
4.The labial flange
destruction [combination support lip (if lost )
syndrome when placed
with intact mandibular ant.
teeth
•Patient cannot tolerate
.
palatal coverage???.
(psychologically- taste and
texture sensation-avoid gag
reflex-presence of torus )
 Treatment Planning with Dental Implants
Edentulous Mandible
• The 2 implant–assisted overdenture is the treatment of choice
for patients with an atrophic edentulous mandible
Adv.
• Provide stability, retention and bears minimal stress from
occ. Loads

Fixed implant supported prosthesis vs implant over denture

•4-6 implants arranged in arc of curvature
•Gives psychological advantage to patients
•Masticatory efficiency similar to removable ones
•It tends to stop resorption of the post. Mand.
 Partially Edentulous Patients
Multiple Tooth Sites

The same rule(one implant for every missing tooth)

The number of implants affect the load-bearing capacity

Post. Maxilla: one implant for every missing tooth,
Post. Mand.:3 units bridge supported by 2 implants is accepted.

Post. implant placement in max and mand. Limits height of implant.

Single implants èhigh success è in the ant. &
premolar areas.
• In post region ,
The most common problem
With external hex-headed implant

Tipping of restoration during functionè causing

stretching & loosening of the screw.

because the diameter of the implant head is much

smaller the size of the occlusal surface

§ The B Li width of the crown can be controlled by

narrowing the dimension of the restoration BUT
not the MD dimension because of the contacts.
Ø Solution→ is use of wide diameter implants
How to Avoid
Implant
Overload???
§ Multiunit implant restorations …..splinted to share the loads.
§ Open embrasure spaces…… facilitate OHI (avoid tipping F.)
§ Wider diameter implants …..esp. for Molar Replacement.[when
adequate bone and space exist]
§ Standard diameter (4 mm implants)… best for premolar
replacement.

1. Limiting the width of the occlusal table

2. Flattening the cusp angles
3. Avoiding cantilevered restorations
4. Restoring the anterior guidance
 Not advisable because:
1. Implants & teeth function differently.
2. It may cause screw loosening and intrusion of natural
teeth.
3. It may create a cantilever effect on the implant.
 If implant is to be connected
to teeth authors say:
1. A rigid connection should be done.
2. Tooth preparation should allow good retention.
3. Teeth should be periodontally healthy & stable.
4. The occlusal scheme should be good.
Revision
 to Avoid Implant Overload
Place implants perpendicular to the occ.
Plane.(not flat)(curve of Spee & Wilson )

Use 1 implant for each tooth being

replaced.

Avoid the use of cantilevers in

linear manner.

Avoid connecting implants to

teeth. If needed, use a rigid
attachment.
Control occ. factors such as cusp
angles & width of occ. table.

Avoid use of short implants(less

than 10mm) and distal
angulation

Restore ant. guidance

 Summary

Ø Biomechanical consideration
Ø Load bearing capacity
vTreatment planning for implant placement
Ø Maxillary edentulous
Ø Mandibular edentulous
Ø Partially edentulous
ü Multiple sites
ü Single tooth site
vHow to avoid implants overload
vConnecting implants to teeth
Thank You