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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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Primary splinting

Implant supported overdentures are an evidence-based treatment option for edentulous patients leading to a significantly increased quality of life.
There are various retention elements available which connect the implants directly...

CAD/CAM
Prosthetic materials
Implant prosthetics
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Treatment guidelines

Edentulous

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Secondary splinting

Implant overdentures are an excellent treatment option for edentulous patients and lead to significant improvement of quality of life. There are various options for their retention mechanism...

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Prosthetic materials
Implant prosthetics
Removable prosthetics
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Treatment guidelines

Edentulous

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Number of implants maxilla and mandible

The tradition to insert 6 implants, and eventually more, in an arch-wide pattern dates back to the early days of osseointegration when implants with a machined surface were used and risk for early...

Implant prosthetics
Biomechanics and occlusion
Success & failure
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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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Healed vs fresh extraction socket

The treatment of the edentulous jaw can be a mixture of placing implants in healed and fresh extraction sockets. Unequal hard and soft tissue levels around the implants (Fig. 1&2), especially in the interforaminal region, can be adjusted by leveling the bone...

Immediate implant placement
Success & failure
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Treatment guidelines

Edentulous

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Hard tissue management - mandible

The scientific literature shows that short implants with a length of ≥ 6 mm are able to support prosthetics in the edentulous mandible. After tooth removal the mandible displays different degrees of atrophy (Fig 1&2). Regarding hard tissue management...

Radiology
Bone grafting and regeneration
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Treatment guidelines

Edentulous

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Need for grafting

There are three main indications for grafting from an anatomical perspective...

Radiology
Bone grafting and regeneration
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Treatment guidelines

Edentulous

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Hard tissue management - maxilla

3-D imaging seems the best option unless clinical examination reveals an ample bone volume. The bone quality can be derived from density measurements if CT scan images are available or approximately from the trabecular pattern of 2-D images. Pano....

Radiology
Bone grafting and regeneration
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Treatment guidelines

Edentulous

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Grafting, maxilla

In the edentulous upper jaw implant insertion can be limited due to the adjacent anatomical structures (nasal floor, maxillary sinus). Less than 5-6 mm in height and 6 mm in width requires augmentation before implant placement....

Bone grafting and regeneration
Sinus augmentation
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Treatment guidelines

Edentulous

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Biologic complications

This is the reversible inflammatory process in the soft tissues around functioning implants. Peri-implant mucositis occurs in almost 60% of subjects (± 30% of sites), restored with implants. Diagnosis is stated by clinical examination: redness, ...

Peri-implantitis
Peri-implant therapy
Local factors
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Treatment guidelines

Edentulous

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Post operative soft tissue management

After treatment of edentulous patients, there is no need to schedule specific recalls for soft tissue control. Traditional post-operative controls at day 1 - 3, day 7 - 14 and week 4 - 6 after surgery involve soft tissue control and...

Aftercare / follow up
Success & failure
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Treatment guidelines

Edentulous

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Bleeding

Damage of sublingual arteries can lead to intense hemorrhage. Subsequent elevation of floor of the mouth can lead to (fatal) airway obstruction ! An early symptom of sublingual swelling may be a muffled speech. In such situation ensure free airways (intubation, tracheotomy),...

Aftercare / follow up
Success & failure
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Treatment guidelines

Edentulous

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Overdenture retention devices, overview

Attachment selection

The relative merits of different prosthodontic treatment objectives - resilient versus rigid attachments - are controversial and empirical. A resilient retention mechanism is recommended on the assumption that this will protect implants from overload; while in...

Prosthetic materials
Implant prosthetics
Biomechanics and occlusion
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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