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- 1.
- 2. Introduction • Long-term successin implant dentistry requires certain important criteria. There are more than 50 criteria that are required in treatment planning • one of the prosthodontic needs of the patient have been determined, the most important criteria is the available bone • Describe the external architecture or quantity of bone present in edentulous area considered for implant
- 3. Literature review • inthe mandibular symphysis, females present higher total reduction and more rapid bone loss during the first 2 years.9 More recent studies in complete denture wearers have confirmed the higher rate of resorption in the first year of edentulous. The anterior maxilla resorbs in height slower than the anterior mandible. However, the original height of the available bone in the anterior mandible is twice as much as the anterior maxilla. Therefore the resultant maxillary atrophy, although slower, affects the potential available bone for an implant patient with equal frequency
- 4. • 1.5-2mm-Surgical error. •Root form implants-width Mesiodistal length of available bone Diameter and •length of implant Height of bone available
- 5. Implant width (Diameter) •S=F/A • 0.25mm increase in diameter ,5-8% surface area increases . • Increase in dia-less stress at crestal bone-implant interface.
- 6. Implant Height • Implantheight also affects total surface area. • 3mm longer implant 20-30% increase in surface area. • Initial stability of implant
- 7. Measurement of availablebone • Its measured in • Width • Height • Length • Angulation • Crown height space
- 8. Available bone height •Radiographic Evaluation OPG • Anterior regions of jaws greatest height • Maximum height-Maxilla and mandible-sites • The minimum bone height for a predictable long-term endosteal implant survival is 12 mm.
- 9. Available bone height •Skeletal relationships-Class 2 and class 3 • Posterior jaws -more limiting for implant height • suggested bone height -12mm • Dense bone may accommodate shorter implant but a porous bone may require longer implant. • More imp.as affects implant length and crown height. • Once the minimum bone height is established width is more important than additional height.
- 10. Available bone width •Measured between the facial and lingual plates at the crest. • The crest is supported by a wider base. • Osteoplasty Exception-ant maxilla
- 12. Available bone length •The mesiodistal length of the bone in an edentulous area is limited by adjacent teeth or implants. • Implant - 1.5mm adjacent tooth and 3mm from the adjacent implant • For a bone width of 5mm the minimum length is 8 mm
- 13. Available bone angulation •It represents the root trajectory in relation to occlusal plane. Acceptable bone-angulation depends on the width of the ridge. For narrower ridges acceptable angulation is 20 degrees For wider ridges, bone angulation can be as much as 25 degrees.
- 14. Bone angulation • Ideally,angulation is 1. Perpendicular to occlusal forces. 2. Aligned with forces of occlusion 3. Parallel to long axis of prosthodontic restoration.
- 16. Crown-Height space • Verticaldistance from the crest of the ridge to the occlusal plane.• Considered as a vertical cantilever. Affects: • appearance • amount of moment of force on the implant and surrounding crestal bone. • Considered as a vertical cantilever • Greater the CHS ,greater the moment of force, or lever arm • Ideally,CHS should be =, < 15Mm.
- 17. LEKHOM AND ZARB(1985) Type 1 Type 2 Type 3 Type 4
- 18.
- 19. Division A bone(Abundant bone)
- 20. Division A bone Treatmentoptions • Division A root forms or wider implants. • All prosthetic options. • Limited interarch space. (High profile O-ring) • Osteoplasty.
- 21.
- 22. FP-3 restoration indivision A bone Removable prosthesis
- 23. Division B (Barelysufficient Bone)
- 24.
- 26.
- 27.
- 28. Division C (CompromisedBone) • Deficient in one or more dimensions • Resorption first occurs in width.The bone is called C-w • Then in height. The bone is called C-h • Posterior maxilla VS Anterior maxilla • Posterior mandible VS anterior mandible.
- 30.
- 32. Division C-w implantplacement
- 33. Division D (Deficient Bone) • Characterized by severe atrophy of alveolar process as well as basal bone • • Basal bone loss: Flat maxilla Pencil-thin mandible • CHS>20mm
- 34. Treatment options • Ridgeaugmentation is the treatment of choice. • Fixed restorations X • RP-5 not suggested. • Complete implant-supported dentures indicated