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Dental implant biomechanics, treatment planing, and prosthetic considerations
- 1. BIOMECHANICS, TREATMENT PLANING, ANDPROSTHETIC CONSIDERATIONS Chapter 76
- 2. Biomechanical considerations • Osseointegratedimplant provide predictable means of replacing missing teeth • Load-bearing capacity of implants > anticipated loads during function • If applied loads > load-bearing capacity Failure : Mechanical, Biologic
- 3. • Implant failure •Mechanical failure : screw loosening, bend, fracture of the implants • Biologic failure : resorption- remodeling response of bone around implants Progressive bone loss Biomechanical considerations
- 4. • Teeth aresuspended within the supporting alveolar bone by periodontal ligament Physiologic movement Teeth movement: orthodontic Implant- VS Tooth-retained restoration Excessive forces
- 5. • Osseointegrated dentalimplants : direct contact with alveolar bone No periodontal ligament Destructive alveolar bone Implant- VS Tooth-retained restoration Excessive forces
- 6. Load-bearing capacity • Thebone appositional index : percentage of bone-to-implant contact • Several factors influence load-bearing capacity • Number and size of implant • Angulations of implant position • Quality of the bone-to-implant interface
- 7. Load-bearing capacity • Posteriormaxilla : less dense trabecular, thin cortical plate layer poor bone quality • Anterior mandible : dense trabecular, thick cortical plate layer
- 8. • Surface modification: altered microtopography achieve higher bone apposition index • Lack of bone height ≠ long implant -> reduce bone-to-implant contact Use of short, wide implants Increase load-bearing capacity Load-bearing capacity
- 9. Angulation and arrangement •Angulation of implants in relation to the plane of occlusion and the direction of the occlusal load • Axial loads are well-tolerated • Implant at an angle of 20 degrees or more - >resorptive remodeling response of bone
- 10. • Nonaxial loadsconcentrated stresses around the neck of the implant Angulation and arrangement
- 11. Mechanism of implantfailure • Excessive occlusal loads • Load resulting in microdamage: fracture, cracks, and delaminations • Resorption-remodeling response of bone • Loss of bone at the bone-to-implant interface as a result of remodeling • Vicious cycle of continues loading, additional microdamage, and bone loss progressing to implant failure
- 12. • Distal cantiliveredpontics were used to replaced missing maxillary posterior teeth Nonaxial occlusal forces Angulation and arrangement
- 13. • Distal angulationand the curve of Spee Nonaxial loads Angulation and arrangement
- 14. Treatment planing withdental implants • Anterior-posterior (A-P) implant spread • Distance from the middle of the most anterior implant to the distal edge of the most posterior implant
- 15. Edentulous maxilla • Implant-supportedprosthesis : provide stability comfort and restore confidence • Poor ridge form with a marginally stable conventional maxillary denture : 2 or 4 implants provide greater stability and security of a maxillary denture in function
- 16. Edentulous maxilla • Implant-supportedprosthesis : provide stability comfort and restore confidence • Lack of posterior support with an intact mandibular anterior dentition : Combination syndrome “Hammer and anvi”
- 17. • Implant-supported prosthesis: provide stability comfort and restore confidence • Palatal coverage is not tolerated Minimum of four implants with adequate A-P spread Edentulous maxilla
- 18. • Implant-assisted maxillaryoverdenture is preferred over an implant-supported fixed prosthesis -> labial flange can provide lip support Edentulous maxilla
- 19. Edentulous mandible • Mandibularcomplete denture is more problematic especially for pt with severely atrophic mandibular ridge • Two-implant-assisted overdenture -> treatment of choice
- 20. • Implant-supported fixedprosthesis • 4,5, or 6 implants arranged in an appropriate arc of curvature with at least 1 cm of A-P spread • distal extension cantilevers up to twice the A-P spread Edentulous mandible
- 21. Partially edentulous patients •Multiple tooth sites • The number of implants used will influence the load-bearing capacity • Posterior maxilla : one implant for every missing tooth • Posterior mandible : three-unit bridge supported by two implants is widely accepted
- 22. • Single toothsites Partially edentulous patients
- 23. • Implant: Adequatenumber, size and position to sustain the occlusal loads • Residual ridge and site permits : wide diameter implants should be used for molar replacement Strategies to avoid implant overload
- 24. Strategies to avoidimplant overload • Place implants perpendicular to the occlusal plane • Place implants in tooth positions • Use an implant for each unit being replaced • Avoid the use of cantilevers in linear configurations • Avoid connecting implants to teeth
- 25. Strategies to avoidimplant overload • If connecting implants to teeth, use a rigid attachment • Control occlusal factors such as cusp angles and width of occlusal table • Restore anterior guidance if possible
- 26. • Occlusal design •Limit the width of occlusal table • Flattening the cusp angles • Avoid Cantilevered restoration Strategies to avoid implant overload
- 27. • Connecting implantto teeth • Keep implant-supported restorations separate from natural teeth • Implants and teeth function differently • Connect with the rigid system Strategies to avoid implant overload
- 28. Conclusions • The biomechanicsmust be factored into the planning at the beginning of any implant treatment • To achieve long-term, predictable success
Editor's Notes
- #17 การใส่ implant จะช่วยลด Destructive บริเวณ Anterior maxilla