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IMPLANT OCCLUSION

This document discusses occlusal schemes for implants, known as implant protective occlusion (IPO). IPO aims to reduce stress at the implant-bone interface through 14 considerations including eliminating premature contacts, positioning occlusal contacts over implant bodies, reducing cantilever lengths, and decreasing crown heights. The goals of IPO are to reduce force magnification, improve force direction, and increase the implant support area to promote implant longevity and success.

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Dr. Shari S.R introduces the concept of occlusion in implants and outlines key topics to be discussed.

Introduction to osseointegrated prosthesis; difference between natural teeth and implants; importance of Implant Protective Occlusion (IPO).Discusses 14 considerations for implant protective occlusion, focusing on stress reduction and occlusal contact management. Importance of eliminating premature contacts for harmonizing occlusion and load distribution.

Guidelines for ideal occlusal contact and monitoring occlusal performance over time.

Discusses factors impacting force magnification in occlusion, promoting reduction of stress and optimized load direction.

Details regarding the design and stress considerations for cantilever prostheses related to IPO.

Relationship between crown height, cantilever dynamics, and stress magnification in implants.

Discusses the influence of crown contour on loading and occlusal function in implants.

Focus on choosing implants favoring weaker arches, with recommendations for restoration.

Importance of occlusal material choice which affects overall performance and longevity of implant prostheses.

Discussion on the impact of angled loads on implants, solutions to manage shear forces and prevent bone loss.

Overview of design specifications to ensure effective load distribution and functional performance.

Emphasizes the significance of the occlusal table width in minimizing stress and maximizing function.

Details immediate vs. delayed loading strategies and the importance of surface area in stress distribution.

Summarizes findings and future considerations of occlusal impact on implant success and patient outcomes.

Highlights key conclusions on the significance of occlusion in implants, with references for further reading.

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Dr. Shari.S.R, Junior resident; Dept of Prosthodontics | GDC Trivandrum Occlusal Schemes in Implants
Occlusion In Implants 1. Introduction 2. Diff between natural tooth and implants 3. Development of IPO 4. 14 considerations for IPO 5. Occlusal guidelines for different clinical situations 6. Review of literature. 7. Conclusion
Introduction Occlusion in osseointegrated prosthesis A prosthesis that is retained, or retained and supported by implants.
7 Table 1. Comparison between tooth and implant Tooth Implant Connection PDL Osseointegration Proprioception Periodontal mechano receptors Osseoperception Tactile sensitivity High Low Axial mobility 25-100ևm 3-5ևm Movement phases Two phases Primary: nonlinear and complex Secondary: Linear and elastic One phase Linear and elastic Movement patterns Primary : Immediate movement Secondary: Gradual movement Gradual movement Fulcrum to lateral forces Apical third of root Crestal bone Load bearing charcteristics Shock absorbing function Stress distribution Stress concentration at crestal bone Signs of overloading PDL thickening,mobility,wear facets,fremitus,pain Screw loosening,or fracture, abutment or prosthesis fracture,bone loss,implant fracture.
8 Tooth and Implant compared Kim Y, Oh T-J, Misch CE, Wang
Tooth Movement vs Implant movement. Lateral Movement 50-108µm no movement Vertical movement 8 to 28µm size shape no of roots
Understanding difference between natural teeth and implants Will help in developing occlusal harmony with the implants NATURALTEETH Protected by Periodontal receptors or tactilereceptors (Shock absorbers) IMPLANTS No such receptors Occlusal scheme of natural teeth Occlusal scheme of implants (Modifications has to be done)
Multitude of difference between natural teeth and implant IPO also called MEDIALLY POSITIONED LINGUALIZED OCCLUSION Misch and Bidez
LONGEVITY AND SUCCESS IMPLANT PROTECTIVE OCCLUSION. DECREASE STRESS AT IMPLANT BONE INTERFACE IPO
1. Elimination Of Premature Contact 2. Occlusal Contact Position 3. Parafunction 4. Cantilevers 5. Crown height 6. Crown Contour 7. Favoring Weak Arch 8. Occlusal Material 9. Implant Body And Load Direction 10. Cuspal Angle 11. Controlling Occlusal Table Width 12. Mutually Protected Occlusion 13. Loading Time 14. Provide Adequate Surface Area Considerations for following implant protected occlusion scheme
Implant protective occlusion 1. Implant Angle 2. Cusp Angle 3. Mutually Protected Occlusion 4. Occlusal Table Width 1. Loading Time 2. Adequate Surface Area (implant number, width & length) 1. Premature Contact Elimination 2. Occlusal Contact Position 3. Cantilever Prosthesis 4. Crown Height 5. Crown Contour 6. Parafunction 7. Favouring weak arch 8. Occlusal material REDUCE FORCE MAGNIFICATION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA Mnemonics: POP is the C³FO
Premature contact Ipo and premature contact DIVERTS MANDIBLE INTERFERES HARMONIOUS GLIDING MOVEMENT OF DEFLECTS POSITION OF CONDYLE, TEETH OR PROSTHESIS MANDIBLE
REMOVE PREMATURE CONTACT PRIOR TO INSERTION OF IMPLANT PROSTHESIS ALL OCCLUSAL PREMATURITIES MUST BE ELIMINATED IN MAXIMUM INTERCUSPATION
IPO WITH PREMATURE CONTACT ELIMINATION OF PMC WITH IMPLANT PROSTHESIS USE 25 µm ARTICULATING PAPER In occlusion light contacts withLight tapping force
Following elimination of premature contacts under light contact(harmonization under light loads) Premature contacts are eliminated under heavy contact(harmonization under heavy loads) O Elimination This ensures equal sharing of the load between the implant and the natural teeth under heavy loads.
Following premature contact adjustment Centric occlusion Anterior implant prosthesis - No initial contact Surrounding natural teeth - Greater initial contact. Posterior Implant prosthesis - Minimum initial contact
Regular evaluation of occlusal contacts at regularly scheduled hygiene appointments so that minor variations occurring during long-term functioning can be monitored An important philosophy behind ipo
IMPLANT PROTECTIVE OCCLUSION REDUCE FORCE MAGNIFICATION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA 1.Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length)
IPO AND OCCLUSAL CONTACT
PRIMARY CONTACT SECONDARY CONTACT Ideal occlusal contact for implant prosthesis is over the implant body WITH IN THE IMPLANT DIAMETER,WITH IN CENTRAL FOSSA WITHIN 1 mm OF PERIPHERY OF IMPLANT POSTERIORTOOTH
Influence of Occlusal Contacts
26 REDUCE FORCE MAGNIFICATION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA 1.Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length) Implant protective Occlusion
IPO AND CANTILEVER PROSTHESIS GOAL SHOULD BE TO REDUCE THE LENGTH OF CANTILEVER CANTILEVERS ARE CLASS I LEVER WHICH INCREASES THE AMOUNT OF STRESS ON THE IMPLANT
28 Cantilever
ACTS AS IPO and CANTILEVER COMPRESSIVE LOAD ON CANTILEVER TENSILE LOAD ON FARTHEST ABUTMENT y X LOAD ON THE NEAREST ABUTMENT ISA COMBINATION X+Y SEVERE LOSS OF CRESTAL BONE
IPO and CANTILEVER LENGTH OF THE CANTILEVER FORCE ON THE IMPLANT DIRECTLY PROPORTIONAL Maxillary anteriors Maxillary posteriors -10 mm -15 mm Mandibular posteriors -20mm MAXIMUM LENGTH OF CANTILEVER FOR SYSTEMS WITH 4-6 IMPLANTS NO LATERAL LOADS TO CANTILEVER PORTION Gradient of force type load that gradually decreases the occlusal contact force along the cantilever.
31 IMPLANT PROTECTIVE OCCLUSION REDUCE FORCE MAGNIFICATION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA 1.Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length)
IPO AND CROWN HEIGHT CROWN HEIGHT IS DETERMINED ATTHE TIME OF DIAGNOSIS REDUCE CROWN TO IMPLANT RATIO TO REDUCE CANTILEVER
• Increased crown height acts as Vertical cantilever - (magnifies stress) • During lateral load,angled force,cantilever load and results in greater force component. IPO AND CROWN HEIGHT
34 REDUCE FORCE MAGNIFICATION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA 1.Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length) IMPLANT PROTECTIVE OCCLUSION OCCLUSION
36 IPO AND CROWN CONTOUR
35 DUE TO RRR IPO AND CROWN CONTOUR OCCLUSION NARROW OCCLUSAL TABLE with reduced buccal contour, IMPROVING AXIAL LOADING Buccal contour the same as the original, natural tooth will lead to buccal offset load Remaining ridge shifts lingually Implant body under the lingual cusp of a natural tooth( not under the natural buccal cusp tip)
37 IPO and Crown Contour Central fossa of Implant crown broadened 2-3 mm to receive functional cusp contact from natural teeth DIVISION A BONE
38 IPO and Crown Contour DIVISION A BONE Axial loading in both arches not possible so favour the weaker maxilla
39 IPO and Crown Contour Division C and D bone, bone augmentation procedure and create a condition as close as possible to Division B bone. Mandibular posterior implants require angulated abutment DIVISION B ,C & D BONE Maxillary posterior implants require restoration in crossbite The implant position lingual to the position of the natural tooth.
40 REDUCE FORCE MAGNIFICATION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA 1.Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length) IMPLANT PROTECTIVE OCCLUSION
IPO AND PARAFUNCTION POOR OCCLUSAL DESIGN BRUXISM PARAFUNCTION CLENCHING Marginal bone loss and implant failure
By using maximum fixture length Shorter cantilevers Proper location of fixtures along the arch Ridge augmentation Reduction in height of crown By increasing soft tissue support Night guard protection IPO and Parafunction In patients with parafunctional habits, The overload canbe greatly reduced:-
43 REDUCE FORCE MAGNIFICATION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA 1.Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length) IMPLANT PROTECTIVE OCCLUSION
DESIGN OF PROSTHESIS WEAKESTARCH SHOULD ALWAYS FAVOUR MAXILLA IPO AND WEAK ARCH FAVOURING COMPROMISED ANATOMICAL CONDITIONS 1. NARROW IMPLANTS 2. NARROW RIDGES 3. REDUCED BONE DENSITY 4. INCREASED BONE RESORPTION 5. FACIAL CANTILEVER
IPO and Arch Strength PREMAXILLA SO CHOOSE ANGLED ABUTMENT IN PREMAXILLA STRAIN IS HIGHER STRAIN IS LESSER
IPO and Arch Strength RECOMMENDATIONS USE OF MORE NUMBER OF IMPLANTS WITH SPLINTING USE OF LARGER DIAMETER IMPLANTS WITH RIDGE AUGMENTATION
Favouring weak arch MAXILLARY POSTERIOR CANTILEVERS ARE LESS INDICATED IF THE IMPLANTS OF THE BOTH ARCHES CANNOT BE LOADED TOGETHER ,MAXILLARY IMPLANTS ARE PROTECTED WITH AXIAL LOAD
47 REDUCE FORCE MAGNIFICATION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA 1.Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length) IMPLANT PROTECTIVE OCCLUSION
IPO AND OCCLUSAL MATERIAL DEPENDS ON CHOICE OF OCCLUSAL MATERIAL FOR IMPLANT PROSTHESIS QUADRANT RESTORED
1. ALL CERAMIC 2. ZIRCONIA 3. METALCERAMIC RESTORATIONS 4. ALL METAL 5. RESIN BASED 6. ACRYLIC u OCCLUSAL MATERIAL EVALUATED BY OCCLUSAL MATERIAL Occlusal material fracture is one of the most common of implant restoration 1. ESTHETIC 2. IMPACT FORCE 3. STATIC LOAD 4. CHEWING EFFICIENCY 5. FRACTURE 6. WEAR 7. INTERARCH SPACE REQUIREMENT 8. ACCURACY OF CASTING
50 REDUCE FORCE MAGNIFICATION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA 1.Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length) IMPLANT PROTECTIVE OCCLUSION
IPO AND IMPLANT ANGLE / LOAD DIRECTION CONDITIONS OF ANGLED LOAD DIRECTION ANGLED IMPLANT BODIES ANGLED ABUTMENTS PREMATURE OCCLUSAL CONTACT
Angled load---Angled implant 15° angled implant---30% offset load to facial bone. 30° angled implant—50% increase of stress at crestal bone.
ANGLED LOAD APPLIED CAUSES SHEAR COMPONENT OF LOAD CRESTAL BONE LOSS AND INTERFERES WITH SUCCESSFUL BONE REGROWTH IMPLANT BODY
ANISOTROPY refers to CHARACTER OF BONE MECHANICAL PROPERTIES DEPEND ON THE DIRECTION IN WHICH THE BONE IS LOADED ANGLE OFLOAD SHEAR COMPONENT OF LOAD
CORTICALBONE WITHSTAND Angled load SHEAR(65%LESS) AND TENSILE(30%LESS) FORCE COMPRESSIVE FORCE
TO PREVENT CAUSES O Angled loads WHENEVR ANGLED LOADS CANNOT BE ELIMINATED BONE LOSS OR IMPLANT LOSS REDUCE MAGNITUDE OF FORCE INCREASE SURFACE AREA
Solution to Angled loads INCREASING DIAMETER OF ANGLED IMPLANT USING MORE NUMBER OF IMPLANTS SELECTING A DESIGN WITH GREATER SURFACE AREA ADDITIONAL IMPLANT NEXT TO THE MOST ANGLED IMPLANT SPLINTING THESE CAN BE ACHIEVED BY
57 IMPLANT PROTECTIVE OCCLUSION REDUCE FORCE MAGNIFICATION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA 1.Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length)
ANGLED LOAD ON IMPLANTS ANGLED LOAD CRESTAL BONE LOSS IPO AND CUSPAL ANGLE CUSPAL ANGLE
GREATER CUSPAL ANGLE EFFICIENT INCISION OF FOOD BUT PREMATURE OCCLUSAL CONTACT ALONG CUSP ANGLE COULD RESULT IN ANGLEDLOAD ON THE CRESTAL BONE KAUKINEN etal CUSPAL ANGLE
For every 10° increase in cusp inclination----30% increase in torque Cusp inclination produce a high level of torque. IMPLANT RETAINED PROSTHESIS SHOULD HAVE SHALLOW OCCLUSALANATOMY Solution no:1
Occlusal contact on implant crown should be on flat surface perpendicular to implant body • Increasing width of central groove in posterior implant crown(2-3mm) • Recontouring opposing tooth to occlude in central fossa over Implant body SOLUTION.2 Accomplished by
62 IMPLANT PROTECTIVE OCCLUSION REDUCE FORCE MAGNIFICATION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA 1.Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length)
Rationale of MPO The forces are distributed to segments of the jaws Decrease in force magnitudes IPO AND MUTUALLY PROTECTED OCCLUSION CANINE PROTECTIVE OR ORGANIC OCCLUSION.
64 OR MAY HAVE LIGHT CONTACT FIXED IMPLANT PROSTHESIS Posteriors contact and anteriors disocclude CENTRIC
Protrusive excursions Incisors contact, posteriors and canine disocclude
Lateral Excursions Canine contact, incisors and posteriors disocclude
Anterior guidance of implant prosthesis with anterior implants SHOULD Anterior guidance of implant prosthesis with anterior implants AS SHALLOWAS POSSIBLE STEEPER THE ANTERIOR GUIDANCE GREATER THE FORCE ON ANTERIOR IMPLANTS • In most patients ,an incisal guidance of atleast 23-25° is suggested in IPO. • Vertical overbite reduced to less than 4mm
IF CANINE IS REPLACED BY IMPLANT Occlusal contact over this must be avoided during excursion IFANTERIOR IMPLANTS MUST DISOCCLUDE THE POSTERIOR TEETH Implants maybe splinted together to reduce lateral force MPO on Lateral incisor
69 IMPLANT PROTECTIVE OCCLUSION REDUCE FORCE MAGNIFICATION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA 1.Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length)
70 • Wider the occlusal table, the greater the force developed. • Occlusal anatomy of natural teeth often results in offset load IPO AND OCCLUSAL TABLE WIDTH Width of the occlusal table Width of the implant body Width of the occlusal table must be reduced in comparison to a natural tooth in non aesthetic regions
THE NARROW OCCLUSAL TABLE THE OFFSET LOAD HENCE TEETH RESTORED IN NON- ESTHETIC REGION OF THE MOUTH PREFERABLY HAVEA NARROW OCCLUSAL TABLE REDUCES DECREASES RISK OF CERAMIC FRACTURE REDUCED OCCLUSAL LOAD HELPS TO MAINTAIN THE NARROW OCCLUSAL TABLE NARROW OCCLUSAL TABLE GREATER HYGIENE
72 IMPLANT PROTECTIVE OCCLUSION REDUCE FORCE MAGNIFICATION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA 1.Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length)
IPO AND LOADING TIME IMPLANT LOADING PROGRESSIVE DELAYED IMMEDIATE DENSITY OF BONE DETERMINES TIME OF LOADING
IMMEDIATE LOADING ESTHETIC ZONE OFTEN DONE BECAUSE OF DAMPING EFFECT CHOICE OF MATERIAL RESIN BASED
WOLFF'S LAW BASED ON WHERE THE MASS OF BONE INCREASES IN RESPONSE TO CONTROLLED STRESSES WHEN LOAD APPLIED TO IMPLANTS IN POOR QUALITY BONE INCREASED GRADUALLY FUNCTION MASS AND DENSITY OF BONE 1. TIME INTERVAL(3-6 MO) 2. DIET(SOFT TO HARD) 3. OCCLUSAL MATERIAL(R-M-P) 4. OCCLUSAL CONTACT(GRADUA L INCREASE) 5. DESIGN OF PROSTHESIS 6. LESS DENSE BONE PROGRESSIVE LOADING PROGRESSIVE LOADING FACTORS
When Implants Are Placed And It Has Been Decided To Place The Restoration Osseoinegration Following A 2nd After Stage Surgery, The Loading Is Defined As Delayed Loading DELAYED LOADING DELAYED LOADING Grafted situation Can be well done in non-esthetic zone Where The Quality Of Bone Needs To Be Improved where the implant stability is less than 45Ncm
77 REDUCE FORCE MAGNIFICATION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA 1.Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length) IMPLANT PROTECTIVE OCCLUSION
IPO AND SURFACE AREA Compensates for increased load INCREASE WIDTH OF THE IMPLANT INCREASE NUMBER OF THE IMPLANT SPLINTING THE IMPLANTS
• Wider diameter implants- preferred. • Since they have a greater area of bone contact at the crest than a narrow implants, For a given occlusal load - stress at the crestal region is lesser when compared to narrow implants • Larger the S.A wider the distribution of force. • Lesser the concentration of force on the crest. Surface area
• . Multiple implants must be staggered not placed in straight line
•If a 3 unit fixed prosthesis supported by 2 implants is cantilevered, stress is doubled. 2000) •If a 3 unit F.P.D is supported by 3 implants stress is reduced to 1/3rd . Splinted larger diameter of implants decrease crestal load more Effectively(Sato Y ,et.al, Surface area
8 4 Kim Y, Oh T-J, Misch CE, Wang
OPPOSING ARCH TYPE OF OCCLUSION EXTRA CARE COMPLETE DENTURE BALANCED OCCLUSION NATURAL DENTITION MUTUALLY PROTECTIVE/GROUP FN OCCLUSION SHALLOW ANTERIOR GUIDANCE FIXED MUTUALLY PROTECTIVE/GROUP FN OCCLUSION IN CANTILEVERS  NO WORKING AND BALANCING CONTACTS.  INFRA OCCLUDE BY 100UM  FREEDOM IN CENTRIC 1-1.5MM FULL ARCH FIXED IMPLANT PROSTHESIS
86 OVER DENTURE Bilateral balanced occlusion using lingualized occlusion Monoplane occlusion on a severely resorbed ridge
POSTERIOR IMPLANT SUPPORTED FIXED PROSTHESIS OCCLUSAL TABLE NARROW FLAT CUSPS MINIMUM OR NO CANTILEVER 1. Anterior guidance with natural dentition. 2. Group function occlusion with compromised canines. Contacts should be centered over the implant body
88 SINGLE IMPLANT PROSTHESIS 1.Anterior Or Lateral Guidance With Natural Dentition 2.Light Contact At Heavy Bite And No Contact At Light Bite INCREASED PROXIMAL CONTACT NO OFFSET CONTACTS CENTERED CONTACTS (1–1.5MM FLATAREA)
REVIEW OF LITERATURE
Review of literature Taylor ,Weins,Carr.Evidence based considerations for removable prosthodontic and dental implant occlusion:A Literature review.The journal of prosthetic dentistry.Dec 2005.Vol.94(6) • The effect of non- axial load on implant function and survival. Two studies: One in a primate model with cyclic occlusal loading Sheep with static loading Conclusion: They were unable to demonstrate a negative effect on bone to implant anchorage after extended periods of non-axial loading. • Progressive loading and occlusal overload of dental implants. The evidence available doesnot support the need for progressive loading. The effect of placing restorations on a previously unloaded implants in heavier than normal occlusion. The occlusal overload was tolerated by implants without any deleterious effects.
Review of literature Proprioception and Dental implants: • The patients with extensive implant supported prosthesis clinically function well without the benefit of periodontal proprioceptive nerve endings. • The presence of proprioceptive nerve endings in periosteum ,muscles of mastication ,oral mucosa,TMJ compensate for those lost from the missing periodontal ligament. osseoperception
PREDOMINANTLY A PROSTHETIC DISCIPLINE IMPLANT TREATMENT COMPLETE AWARENESS OF THE FINAL OUTCOME OF THE PROSTHESIS MUST BE PRESENT PRIOR TO IMPLANT PLACEMENT CONCLUSION
• Occlusion has been an important variable in the success or failure of most prosthodontic reconstructions. • With natural teeth, a certain degree of flexibility permits compensation for any occlusal irregularities. • Implant dentistry is not as forgiving. • The status of the occlusion must be diagnosed, corrected or compensated and properly integrated into the design of the definitive restoration.
1.Dental Implant Prosthetics – Carl.E.Misch 2.Principles Of Occlusion In Implant Dentistry Mahesh Verma, Aditi Nanda, Abhinav Sood 2015 Journal Of The International Clinical Dental Research Organization | Published By Wolters Kluwer – Medknow 3.Implant Protected Occlusion Yogeshwari Swaminathan¹, Gururaj Rao²iosr Journal Of Dental And Medical Sciences (Iosr-jdms)volume 11, Issue 3 (Nov.- Dec. 2013), Pp 20-25 4.Occlusal Considerations In Implant Therapy: Clinical Guidelines With Biomechanical Rationale Kim Y, Oh T-j, Misch Ce, Wang H-l. Occlusal Considerations In Implant Therapy: Clinical Guidelines With Biomechanical Rationale. Clin. Oral Impl. Res. 16, 2005; 26–35 5.Implant Occlusion: Biomechanical Considerations Forimplant-supported Prostheses Yu-ying Chen1,2 Chung-ling Kuan1 Yi-bing Wang1,2 J Dent Sci 2008‧vol 3‧no 2 REFERENCES
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IMPLANT OCCLUSION

  • 1.
    Dr. Shari.S.R, Juniorresident; Dept of Prosthodontics | GDC Trivandrum Occlusal Schemes in Implants
  • 2.
    Occlusion In Implants 1.Introduction 2. Diff between natural tooth and implants 3. Development of IPO 4. 14 considerations for IPO 5. Occlusal guidelines for different clinical situations 6. Review of literature. 7. Conclusion
  • 3.
    Introduction Occlusion in osseointegratedprosthesis A prosthesis that is retained, or retained and supported by implants.
  • 4.
    7 Table 1. Comparisonbetween tooth and implant Tooth Implant Connection PDL Osseointegration Proprioception Periodontal mechano receptors Osseoperception Tactile sensitivity High Low Axial mobility 25-100ևm 3-5ևm Movement phases Two phases Primary: nonlinear and complex Secondary: Linear and elastic One phase Linear and elastic Movement patterns Primary : Immediate movement Secondary: Gradual movement Gradual movement Fulcrum to lateral forces Apical third of root Crestal bone Load bearing charcteristics Shock absorbing function Stress distribution Stress concentration at crestal bone Signs of overloading PDL thickening,mobility,wear facets,fremitus,pain Screw loosening,or fracture, abutment or prosthesis fracture,bone loss,implant fracture.
  • 5.
    8 Tooth and Implantcompared Kim Y, Oh T-J, Misch CE, Wang
  • 6.
    Tooth Movement vsImplant movement. Lateral Movement 50-108µm no movement Vertical movement 8 to 28µm size shape no of roots
  • 7.
    Understanding difference betweennatural teeth and implants Will help in developing occlusal harmony with the implants NATURALTEETH Protected by Periodontal receptors or tactilereceptors (Shock absorbers) IMPLANTS No such receptors Occlusal scheme of natural teeth Occlusal scheme of implants (Modifications has to be done)
  • 8.
    Multitude of differencebetween natural teeth and implant IPO also called MEDIALLY POSITIONED LINGUALIZED OCCLUSION Misch and Bidez
  • 9.
    LONGEVITY AND SUCCESS IMPLANTPROTECTIVE OCCLUSION. DECREASE STRESS AT IMPLANT BONE INTERFACE IPO
  • 10.
    1. Elimination OfPremature Contact 2. Occlusal Contact Position 3. Parafunction 4. Cantilevers 5. Crown height 6. Crown Contour 7. Favoring Weak Arch 8. Occlusal Material 9. Implant Body And Load Direction 10. Cuspal Angle 11. Controlling Occlusal Table Width 12. Mutually Protected Occlusion 13. Loading Time 14. Provide Adequate Surface Area Considerations for following implant protected occlusion scheme
  • 11.
    Implant protective occlusion 1.Implant Angle 2. Cusp Angle 3. Mutually Protected Occlusion 4. Occlusal Table Width 1. Loading Time 2. Adequate Surface Area (implant number, width & length) 1. Premature Contact Elimination 2. Occlusal Contact Position 3. Cantilever Prosthesis 4. Crown Height 5. Crown Contour 6. Parafunction 7. Favouring weak arch 8. Occlusal material REDUCE FORCE MAGNIFICATION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA Mnemonics: POP is the C³FO
  • 12.
    Premature contact Ipo andpremature contact DIVERTS MANDIBLE INTERFERES HARMONIOUS GLIDING MOVEMENT OF DEFLECTS POSITION OF CONDYLE, TEETH OR PROSTHESIS MANDIBLE
  • 13.
    REMOVE PREMATURE CONTACT PRIOR TOINSERTION OF IMPLANT PROSTHESIS ALL OCCLUSAL PREMATURITIES MUST BE ELIMINATED IN MAXIMUM INTERCUSPATION
  • 14.
    IPO WITH PREMATURECONTACT ELIMINATION OF PMC WITH IMPLANT PROSTHESIS USE 25 µm ARTICULATING PAPER In occlusion light contacts withLight tapping force
  • 15.
    Following elimination ofpremature contacts under light contact(harmonization under light loads) Premature contacts are eliminated under heavy contact(harmonization under heavy loads) O Elimination This ensures equal sharing of the load between the implant and the natural teeth under heavy loads.
  • 16.
    Following premature contactadjustment Centric occlusion Anterior implant prosthesis - No initial contact Surrounding natural teeth - Greater initial contact. Posterior Implant prosthesis - Minimum initial contact
  • 17.
    Regular evaluation ofocclusal contacts at regularly scheduled hygiene appointments so that minor variations occurring during long-term functioning can be monitored An important philosophy behind ipo
  • 18.
    IMPLANT PROTECTIVE OCCLUSION REDUCEFORCE MAGNIFICATION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA 1.Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length)
  • 19.
  • 20.
    PRIMARY CONTACT SECONDARY CONTACT Ideal occlusal contactfor implant prosthesis is over the implant body WITH IN THE IMPLANT DIAMETER,WITH IN CENTRAL FOSSA WITHIN 1 mm OF PERIPHERY OF IMPLANT POSTERIORTOOTH
  • 21.
  • 22.
    26 REDUCE FORCE MAGNIFICATION IMPROVE FORCE DIRECTION INCREASESUPPORT AREA 1.Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length) Implant protective Occlusion
  • 23.
    IPO AND CANTILEVERPROSTHESIS GOAL SHOULD BE TO REDUCE THE LENGTH OF CANTILEVER CANTILEVERS ARE CLASS I LEVER WHICH INCREASES THE AMOUNT OF STRESS ON THE IMPLANT
  • 24.
  • 25.
    ACTS AS IPO andCANTILEVER COMPRESSIVE LOAD ON CANTILEVER TENSILE LOAD ON FARTHEST ABUTMENT y X LOAD ON THE NEAREST ABUTMENT ISA COMBINATION X+Y SEVERE LOSS OF CRESTAL BONE
  • 26.
    IPO and CANTILEVER LENGTHOF THE CANTILEVER FORCE ON THE IMPLANT DIRECTLY PROPORTIONAL Maxillary anteriors Maxillary posteriors -10 mm -15 mm Mandibular posteriors -20mm MAXIMUM LENGTH OF CANTILEVER FOR SYSTEMS WITH 4-6 IMPLANTS NO LATERAL LOADS TO CANTILEVER PORTION Gradient of force type load that gradually decreases the occlusal contact force along the cantilever.
  • 27.
    31 IMPLANT PROTECTIVE OCCLUSION REDUCEFORCE MAGNIFICATION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA 1.Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length)
  • 28.
    IPO AND CROWNHEIGHT CROWN HEIGHT IS DETERMINED ATTHE TIME OF DIAGNOSIS REDUCE CROWN TO IMPLANT RATIO TO REDUCE CANTILEVER
  • 29.
    • Increased crownheight acts as Vertical cantilever - (magnifies stress) • During lateral load,angled force,cantilever load and results in greater force component. IPO AND CROWN HEIGHT
  • 30.
    34 REDUCE FORCE MAGNIFICATION IMPROVE FORCE DIRECTION INCREASESUPPORT AREA 1.Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length) IMPLANT PROTECTIVE OCCLUSION OCCLUSION
  • 31.
  • 32.
    35 DUE TO RRR IPOAND CROWN CONTOUR OCCLUSION NARROW OCCLUSAL TABLE with reduced buccal contour, IMPROVING AXIAL LOADING Buccal contour the same as the original, natural tooth will lead to buccal offset load Remaining ridge shifts lingually Implant body under the lingual cusp of a natural tooth( not under the natural buccal cusp tip)
  • 33.
    37 IPO and CrownContour Central fossa of Implant crown broadened 2-3 mm to receive functional cusp contact from natural teeth DIVISION A BONE
  • 34.
    38 IPO and CrownContour DIVISION A BONE Axial loading in both arches not possible so favour the weaker maxilla
  • 35.
    39 IPO and CrownContour Division C and D bone, bone augmentation procedure and create a condition as close as possible to Division B bone. Mandibular posterior implants require angulated abutment DIVISION B ,C & D BONE Maxillary posterior implants require restoration in crossbite The implant position lingual to the position of the natural tooth.
  • 36.
    40 REDUCE FORCE MAGNIFICATION IMPROVE FORCE DIRECTION INCREASESUPPORT AREA 1.Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length) IMPLANT PROTECTIVE OCCLUSION
  • 37.
    IPO AND PARAFUNCTION POOROCCLUSAL DESIGN BRUXISM PARAFUNCTION CLENCHING Marginal bone loss and implant failure
  • 38.
    By using maximumfixture length Shorter cantilevers Proper location of fixtures along the arch Ridge augmentation Reduction in height of crown By increasing soft tissue support Night guard protection IPO and Parafunction In patients with parafunctional habits, The overload canbe greatly reduced:-
  • 39.
    43 REDUCE FORCE MAGNIFICATION IMPROVE FORCE DIRECTION INCREASESUPPORT AREA 1.Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length) IMPLANT PROTECTIVE OCCLUSION
  • 40.
    DESIGN OF PROSTHESIS WEAKESTARCH SHOULD ALWAYSFAVOUR MAXILLA IPO AND WEAK ARCH FAVOURING COMPROMISED ANATOMICAL CONDITIONS 1. NARROW IMPLANTS 2. NARROW RIDGES 3. REDUCED BONE DENSITY 4. INCREASED BONE RESORPTION 5. FACIAL CANTILEVER
  • 41.
    IPO and ArchStrength PREMAXILLA SO CHOOSE ANGLED ABUTMENT IN PREMAXILLA STRAIN IS HIGHER STRAIN IS LESSER
  • 42.
    IPO and ArchStrength RECOMMENDATIONS USE OF MORE NUMBER OF IMPLANTS WITH SPLINTING USE OF LARGER DIAMETER IMPLANTS WITH RIDGE AUGMENTATION
  • 43.
    Favouring weak arch MAXILLARYPOSTERIOR CANTILEVERS ARE LESS INDICATED IF THE IMPLANTS OF THE BOTH ARCHES CANNOT BE LOADED TOGETHER ,MAXILLARY IMPLANTS ARE PROTECTED WITH AXIAL LOAD
  • 44.
    47 REDUCE FORCE MAGNIFICATION IMPROVE FORCE DIRECTION INCREASESUPPORT AREA 1.Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length) IMPLANT PROTECTIVE OCCLUSION
  • 45.
    IPO AND OCCLUSALMATERIAL DEPENDS ON CHOICE OF OCCLUSAL MATERIAL FOR IMPLANT PROSTHESIS QUADRANT RESTORED
  • 46.
    1. ALL CERAMIC 2.ZIRCONIA 3. METALCERAMIC RESTORATIONS 4. ALL METAL 5. RESIN BASED 6. ACRYLIC u OCCLUSAL MATERIAL EVALUATED BY OCCLUSAL MATERIAL Occlusal material fracture is one of the most common of implant restoration 1. ESTHETIC 2. IMPACT FORCE 3. STATIC LOAD 4. CHEWING EFFICIENCY 5. FRACTURE 6. WEAR 7. INTERARCH SPACE REQUIREMENT 8. ACCURACY OF CASTING
  • 47.
    50 REDUCE FORCE MAGNIFICATION IMPROVE FORCE DIRECTION INCREASESUPPORT AREA 1.Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length) IMPLANT PROTECTIVE OCCLUSION
  • 48.
    IPO AND IMPLANTANGLE / LOAD DIRECTION CONDITIONS OF ANGLED LOAD DIRECTION ANGLED IMPLANT BODIES ANGLED ABUTMENTS PREMATURE OCCLUSAL CONTACT
  • 49.
    Angled load---Angled implant 15°angled implant---30% offset load to facial bone. 30° angled implant—50% increase of stress at crestal bone.
  • 50.
    ANGLED LOAD APPLIED CAUSES SHEAR COMPONENTOF LOAD CRESTAL BONE LOSS AND INTERFERES WITH SUCCESSFUL BONE REGROWTH IMPLANT BODY
  • 51.
    ANISOTROPY refers toCHARACTER OF BONE MECHANICAL PROPERTIES DEPEND ON THE DIRECTION IN WHICH THE BONE IS LOADED ANGLE OFLOAD SHEAR COMPONENT OF LOAD
  • 52.
  • 53.
    TO PREVENT CAUSES O Angled loads WHENEVR ANGLEDLOADS CANNOT BE ELIMINATED BONE LOSS OR IMPLANT LOSS REDUCE MAGNITUDE OF FORCE INCREASE SURFACE AREA
  • 54.
    Solution to Angledloads INCREASING DIAMETER OF ANGLED IMPLANT USING MORE NUMBER OF IMPLANTS SELECTING A DESIGN WITH GREATER SURFACE AREA ADDITIONAL IMPLANT NEXT TO THE MOST ANGLED IMPLANT SPLINTING THESE CAN BE ACHIEVED BY
  • 55.
    57 IMPLANT PROTECTIVE OCCLUSION REDUCEFORCE MAGNIFICATION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA 1.Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length)
  • 56.
  • 57.
    GREATER CUSPAL ANGLE EFFICIENT INCISION OF FOOD BUTPREMATURE OCCLUSAL CONTACT ALONG CUSP ANGLE COULD RESULT IN ANGLEDLOAD ON THE CRESTAL BONE KAUKINEN etal CUSPAL ANGLE
  • 58.
    For every 10°increase in cusp inclination----30% increase in torque Cusp inclination produce a high level of torque. IMPLANT RETAINED PROSTHESIS SHOULD HAVE SHALLOW OCCLUSALANATOMY Solution no:1
  • 59.
    Occlusal contact onimplant crown should be on flat surface perpendicular to implant body • Increasing width of central groove in posterior implant crown(2-3mm) • Recontouring opposing tooth to occlude in central fossa over Implant body SOLUTION.2 Accomplished by
  • 60.
    62 IMPLANT PROTECTIVE OCCLUSION REDUCEFORCE MAGNIFICATION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA 1.Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length)
  • 61.
    Rationale of MPO Theforces are distributed to segments of the jaws Decrease in force magnitudes IPO AND MUTUALLY PROTECTED OCCLUSION CANINE PROTECTIVE OR ORGANIC OCCLUSION.
  • 62.
    64 OR MAY HAVE LIGHTCONTACT FIXED IMPLANT PROSTHESIS Posteriors contact and anteriors disocclude CENTRIC
  • 63.
  • 64.
  • 65.
    Anterior guidance ofimplant prosthesis with anterior implants SHOULD Anterior guidance of implant prosthesis with anterior implants AS SHALLOWAS POSSIBLE STEEPER THE ANTERIOR GUIDANCE GREATER THE FORCE ON ANTERIOR IMPLANTS • In most patients ,an incisal guidance of atleast 23-25° is suggested in IPO. • Vertical overbite reduced to less than 4mm
  • 66.
    IF CANINE IS REPLACEDBY IMPLANT Occlusal contact over this must be avoided during excursion IFANTERIOR IMPLANTS MUST DISOCCLUDE THE POSTERIOR TEETH Implants maybe splinted together to reduce lateral force MPO on Lateral incisor
  • 67.
    69 IMPLANT PROTECTIVE OCCLUSION REDUCEFORCE MAGNIFICATION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA 1.Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length)
  • 68.
    70 • Wider theocclusal table, the greater the force developed. • Occlusal anatomy of natural teeth often results in offset load IPO AND OCCLUSAL TABLE WIDTH Width of the occlusal table Width of the implant body Width of the occlusal table must be reduced in comparison to a natural tooth in non aesthetic regions
  • 69.
    THE NARROW OCCLUSALTABLE THE OFFSET LOAD HENCE TEETH RESTORED IN NON- ESTHETIC REGION OF THE MOUTH PREFERABLY HAVEA NARROW OCCLUSAL TABLE REDUCES DECREASES RISK OF CERAMIC FRACTURE REDUCED OCCLUSAL LOAD HELPS TO MAINTAIN THE NARROW OCCLUSAL TABLE NARROW OCCLUSAL TABLE GREATER HYGIENE
  • 70.
    72 IMPLANT PROTECTIVE OCCLUSION REDUCEFORCE MAGNIFICATION IMPROVE FORCE DIRECTION INCREASE SUPPORT AREA 1.Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length)
  • 71.
    IPO AND LOADINGTIME IMPLANT LOADING PROGRESSIVE DELAYED IMMEDIATE DENSITY OF BONE DETERMINES TIME OF LOADING
  • 72.
    IMMEDIATE LOADING ESTHETIC ZONE OFTEN DONE BECAUSEOF DAMPING EFFECT CHOICE OF MATERIAL RESIN BASED
  • 73.
    WOLFF'S LAW BASED ONWHERE THE MASS OF BONE INCREASES IN RESPONSE TO CONTROLLED STRESSES WHEN LOAD APPLIED TO IMPLANTS IN POOR QUALITY BONE INCREASED GRADUALLY FUNCTION MASS AND DENSITY OF BONE 1. TIME INTERVAL(3-6 MO) 2. DIET(SOFT TO HARD) 3. OCCLUSAL MATERIAL(R-M-P) 4. OCCLUSAL CONTACT(GRADUA L INCREASE) 5. DESIGN OF PROSTHESIS 6. LESS DENSE BONE PROGRESSIVE LOADING PROGRESSIVE LOADING FACTORS
  • 74.
    When Implants ArePlaced And It Has Been Decided To Place The Restoration Osseoinegration Following A 2nd After Stage Surgery, The Loading Is Defined As Delayed Loading DELAYED LOADING DELAYED LOADING Grafted situation Can be well done in non-esthetic zone Where The Quality Of Bone Needs To Be Improved where the implant stability is less than 45Ncm
  • 75.
    77 REDUCE FORCE MAGNIFICATION IMPROVE FORCE DIRECTION INCREASESUPPORT AREA 1.Premature Contact Elimination 2.Occlusal Contact Position 3.Cantilever Prosthesis 4.Crown Height 5.Crown Contour 6.Parafunction 7.Favouring weak arch 8.Occlusal material 1.Implant Angle 2.Cusp Angle 3.Mutually Protected Occlusion 4.Occlusal Table Width 1.Loading Time 2.Adequate Surface Area (implant number, width & length) IMPLANT PROTECTIVE OCCLUSION
  • 76.
    IPO AND SURFACEAREA Compensates for increased load INCREASE WIDTH OF THE IMPLANT INCREASE NUMBER OF THE IMPLANT SPLINTING THE IMPLANTS
  • 77.
    • Wider diameterimplants- preferred. • Since they have a greater area of bone contact at the crest than a narrow implants, For a given occlusal load - stress at the crestal region is lesser when compared to narrow implants • Larger the S.A wider the distribution of force. • Lesser the concentration of force on the crest. Surface area
  • 78.
    • . Multiple implantsmust be staggered not placed in straight line
  • 79.
    •If a 3unit fixed prosthesis supported by 2 implants is cantilevered, stress is doubled. 2000) •If a 3 unit F.P.D is supported by 3 implants stress is reduced to 1/3rd . Splinted larger diameter of implants decrease crestal load more Effectively(Sato Y ,et.al, Surface area
  • 81.
    8 4 Kim Y, OhT-J, Misch CE, Wang
  • 82.
    OPPOSING ARCH TYPEOF OCCLUSION EXTRA CARE COMPLETE DENTURE BALANCED OCCLUSION NATURAL DENTITION MUTUALLY PROTECTIVE/GROUP FN OCCLUSION SHALLOW ANTERIOR GUIDANCE FIXED MUTUALLY PROTECTIVE/GROUP FN OCCLUSION IN CANTILEVERS  NO WORKING AND BALANCING CONTACTS.  INFRA OCCLUDE BY 100UM  FREEDOM IN CENTRIC 1-1.5MM FULL ARCH FIXED IMPLANT PROSTHESIS
  • 83.
    86 OVER DENTURE Bilateral balancedocclusion using lingualized occlusion Monoplane occlusion on a severely resorbed ridge
  • 84.
    POSTERIOR IMPLANT SUPPORTEDFIXED PROSTHESIS OCCLUSAL TABLE NARROW FLAT CUSPS MINIMUM OR NO CANTILEVER 1. Anterior guidance with natural dentition. 2. Group function occlusion with compromised canines. Contacts should be centered over the implant body
  • 85.
    88 SINGLE IMPLANT PROSTHESIS 1.AnteriorOr Lateral Guidance With Natural Dentition 2.Light Contact At Heavy Bite And No Contact At Light Bite INCREASED PROXIMAL CONTACT NO OFFSET CONTACTS CENTERED CONTACTS (1–1.5MM FLATAREA)
  • 86.
  • 87.
    Review of literature Taylor,Weins,Carr.Evidence based considerations for removable prosthodontic and dental implant occlusion:A Literature review.The journal of prosthetic dentistry.Dec 2005.Vol.94(6) • The effect of non- axial load on implant function and survival. Two studies: One in a primate model with cyclic occlusal loading Sheep with static loading Conclusion: They were unable to demonstrate a negative effect on bone to implant anchorage after extended periods of non-axial loading. • Progressive loading and occlusal overload of dental implants. The evidence available doesnot support the need for progressive loading. The effect of placing restorations on a previously unloaded implants in heavier than normal occlusion. The occlusal overload was tolerated by implants without any deleterious effects.
  • 88.
    Review of literature Proprioceptionand Dental implants: • The patients with extensive implant supported prosthesis clinically function well without the benefit of periodontal proprioceptive nerve endings. • The presence of proprioceptive nerve endings in periosteum ,muscles of mastication ,oral mucosa,TMJ compensate for those lost from the missing periodontal ligament. osseoperception
  • 89.
    PREDOMINANTLY A PROSTHETIC DISCIPLINE IMPLANT TREATMENT COMPLETE AWARENESSOF THE FINAL OUTCOME OF THE PROSTHESIS MUST BE PRESENT PRIOR TO IMPLANT PLACEMENT CONCLUSION
  • 90.
    • Occlusion hasbeen an important variable in the success or failure of most prosthodontic reconstructions. • With natural teeth, a certain degree of flexibility permits compensation for any occlusal irregularities. • Implant dentistry is not as forgiving. • The status of the occlusion must be diagnosed, corrected or compensated and properly integrated into the design of the definitive restoration.
  • 91.
    1.Dental Implant Prosthetics– Carl.E.Misch 2.Principles Of Occlusion In Implant Dentistry Mahesh Verma, Aditi Nanda, Abhinav Sood 2015 Journal Of The International Clinical Dental Research Organization | Published By Wolters Kluwer – Medknow 3.Implant Protected Occlusion Yogeshwari Swaminathan¹, Gururaj Rao²iosr Journal Of Dental And Medical Sciences (Iosr-jdms)volume 11, Issue 3 (Nov.- Dec. 2013), Pp 20-25 4.Occlusal Considerations In Implant Therapy: Clinical Guidelines With Biomechanical Rationale Kim Y, Oh T-j, Misch Ce, Wang H-l. Occlusal Considerations In Implant Therapy: Clinical Guidelines With Biomechanical Rationale. Clin. Oral Impl. Res. 16, 2005; 26–35 5.Implant Occlusion: Biomechanical Considerations Forimplant-supported Prostheses Yu-ying Chen1,2 Chung-ling Kuan1 Yi-bing Wang1,2 J Dent Sci 2008‧vol 3‧no 2 REFERENCES
  • 92.