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Treatment guidelines

Single tooth

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Dentogingival complex and biologic width

The peri-implant mucosa consists of an externally located keratinized oral epithelium, which is connected to the peri-implant junctional epithelium facing the abutment. The latter extends approximately 2 mm apical to the...

Soft tissue management
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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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All-on-4® treatment concept

Patients wearing complete dentures often suffer from esthetic and functional discomfort and compromised denture retention and chewing function. Denture adhesives are often applied. Many patients perceive this...

Edentulous treatments
Implants in compromised sites
Immediate loading / provisionalization
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Treatment guidelines

Edentulous

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Implant placement with open flap procedure - mandible

The surgeon should be standing or be seated behind the supine patient. Bilateral truncular anesthesia is needed. The incision can be crestal or at a distance in the labial fold. Presence of keratinized tissue both labially and palatally should...

Edentulous treatments
Soft tissue management
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Treatment guidelines

Edentulous

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Implant placement - maxilla

Incision can be made either on top of the crest or at some distance in the labial fold. The outcome for both approaches seems comparable. A sagittal release incision at the midline eases the reflection of the labial mucoperiosteum. It is logical to try to achieve...

Edentulous treatments
Soft tissue management
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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Crestal/paracrestal Incision

Any intra-oral surgical intervention begins with the incision and finishes with a suture or gluing. Indications for a crestal incision include one-stage surgeries where the implant or abutment is non-submerged and is piercing into the oral...

Edentulous treatments
Soft tissue management
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Treatment guidelines

Edentulous

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Time to function

Traditional endosseous oral implant treatment protocols ad modum Brånemark required a variable healing period (usually 3-6 months) before prosthesis placement. The healing period was considered necessary to achieve osseointegration and establish a load-bearing interface...

Immediate loading / provisionalization
Success & failure
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Treatment guidelines

Edentulous

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Soft tissue management

The aims of peri-implant soft tissue management in the edentulous mandible are the eventual reconstruction of attached gingiva or immobilizing the soft tissue at the implant-soft tissue interface. Vestibuloplasty means deepening of the...

Soft tissue management
Peri-implant therapy
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Treatment guidelines

Edentulous

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Guided surgery with drill guides

Surgery using a drill guide fabricated on the basis of CT scan images transformed by a planning software offers several clinical advantages...

Radiology
Digital workflow
Guided Surgery
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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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Provisionals/temporary prosthesis

Whenever possible, provisional restorations should be fabricated to simulate the desired definitive prosthesis in form, albeit with different and less durable materials. The lessened durability and functional capacity of a provisional restoration...

Immediate loading / provisionalization
Aftercare / follow up
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Treatment guidelines

Edentulous

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Immediate dentures

The patient with a terminal dentition and who faces total teeth extractions can choose from a number of treatment options from immediate complete denture to one of the implant supported protocols.
Immediate dentures are chosen by patients who are unwilling...

Biomechanics and occlusion
Immediate loading / provisionalization
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Treatment guidelines

Edentulous

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Wound closure

Wound closure ensures and accelerates wound healing by protecting the site and influencing migration of keratinocytes over the granulation tissue. Some wound eversion maximizes epidermal approximation. Square knots, with two ties in one direction and a reverse...

Soft tissue management