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Treatment guidelines

Edentulous

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Skeletal consequences of edentulism

Teeth loss in the maxilla initiates residual ridge/alveolar resorption, especially in the anterior region, which is flared labially. The consequences of this resorption is a gradual medial or palatal shift of the crest of the maxilla. This...

Patient assessment
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Treatment guidelines

Edentulous

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Overarching considerations

The primary goal is a proper oral function. This implies not only chewing but also speaking, smiling. Patients’ adaptability varies enormously. Some are satisfied with removable dentures, others object to the esthetics of...

Local factors
Patient assessment
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Treatment guidelines

Edentulous

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Cement-retained restorations, overview

Cement-retained restorations are a traditional design to attach a restoration (crown, bridge) to an implant-retained abutment, similar to cementing a crown or bridge restoration on a natural tooth. With the traditional, relatively...

CAD/CAM
Prosthetic materials
Implant prosthetics
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Treatment guidelines

Edentulous

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Direct to implant vs. abutment

Advantages of abutment-supported prostheses are 1) When implants are not parallel to each other, the use of angulated abutments can "correct" for the non-parallelism 2) Angulated abutments are available for a screw-retained prosthesis and 3) Custom abutments can be...

Prosthetic strategies
Prosthetic materials
Implant prosthetics
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Treatment guidelines

Edentulous

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Anesthesia

The choice of anesthesia depends on many variables including the complexity of treatment, duration of treatment, need for patient awareness and the response during treatment, only to name a few. In general, the clinician and patient should discuss the...

Patient assessment
Preoperative procedures
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Treatment guidelines

Edentulous

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Alveolar atrophy and insufficiency

Teeth extractions are followed by a reduction of the bucco-lingual as well as the vertical dimension of the residual alveolar ridge. The ensuing resorption is progressive and even the basal jaw may become involved. In the lower jaw, the....

Radiology
Systemic factors
Patient assessment
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Treatment guidelines

Edentulous

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Soft tissue and hard tissue

Removable prostheses should always be removed over night. Since the acrylic denture base is tightly covering the keratinised mucosa, it often leads to fungal/candida infections of the ginigiva under the prosthesis....

Aftercare / follow up
Fixed prosthetics
Removable prosthetics
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Treatment guidelines

Edentulous

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Post-placement

At this appointment, a careful evaluation of the patient's oral hygiene and soft tissue response is performed and adjustments made as needed. A daily home-care program must be customized to the individual's ability to clean the...

Aftercare / follow up
Fixed prosthetics
Oral hygiene instructions
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Treatment guidelines

Edentulous

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Oral hygiene instructions

All tissue surfaces, prosthesis surfaces and implant surfaces should be accessible by oral hygiene aids like toothbrushes, interdental brushes and dental floss or dental tape. It is paramount that, during treatment planning...

Aftercare / follow up
Fixed prosthetics
Oral hygiene instructions
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Treatment guidelines

Edentulous

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Professional oral hygiene

The regular recall control appointment, at least every 6 months, should comprise a hygiene check by the dental/oral hygienist or other auxiliary, and include professional cleaning of the restoration, prosthetic components, sulcus and any...

Aftercare / follow up
Fixed prosthetics
Oral hygiene instructions
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Treatment guidelines

Edentulous

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Peri-operative care

As described in Patient Assessment, a thorough evaluation of patient factors influencing whether to proceed with surgical therapy is relevant.
Depending on the tpe of surgery prescribe pre-operative medication (for example antibiotic coverage), if...

Patient assessment
Preoperative procedures
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Treatment guidelines

Edentulous

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Fixed implant prostheses, introduction

A fixed prosthesis offers benefits from both a functional and esthetic point of view and may be regarded as quite similar to a patient's own natural dentition when compared to alternative treatment options such as complete dentures....

CAD/CAM
Prosthetic materials
Implant prosthetics
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Treatment guidelines

Edentulous

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Salivary output

Physiological salivary output is 0.75 to 1.5 liters per day, with most originating from the submandibular glands. Saliva is a lubricant and has a complex set of protective and healing functions for the oral cavity. It adheres instantly to...

Local factors
Patient assessment
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Treatment guidelines

Edentulous

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Microbiology

Epithelial desquamation in the oropharynx limits bacterial accumulation, except on the tongue dorsum and in the tonsillar crypts. Loss of teeth dramatically reduces the load of periodontal pathogens except for Aggregatibacter actinomycetemcomitans and to a...

Implants in compromised sites
Local factors
Patient assessment
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Treatment guidelines

Edentulous

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Occlusion

A universally accepted definition of ideal occlusion has been elusive. This is because an ideal occlusion can only be defined in broad terms of a physiological range of form and function. Functional aspects of occlusion, rather than specific anatomical...

Biomechanics and occlusion
Patient assessment