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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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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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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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Radiological Control

At the beginning of the recall control it is necessary to define the intention of a radiograhical control and if it is needed. Radiological controls are only justified in the presence of certain symptoms, anamnesis and/or clinical examination...

Radiology
Aftercare / follow up
Peri-implant therapy
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Treatment guidelines

Edentulous

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Inflammation and infection

Inflammation can be limited to the soft tissue around the implant (mucositis) or involve the underlying bone tissue as well (peri-implantitis). Infection can be caused by various risk factors, such as inadequate hygiene and patient compliance...

Peri-implantitis
Aftercare / follow up
Peri-implant therapy
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Treatment guidelines

Edentulous

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Infection - microbiological diagnostics

Presence/number of implants influences aerobe and anaerobe species in saliva and on tongue in edentulism. Subgingival microbiota in periimplantitis vary according to studies. Less periodontal pathogens than in partial edentulism. Prevotella nigrescens,...

Peri-implantitis
Aftercare / follow up
Peri-implant therapy
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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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Provisionals

Conceptually, a provisional prosthesis for an edentulous patient is a convenient tool that offers the patient a satisfactory level of function and esthetic appearance while definitive treatment is undertaken...

Guided Surgery
Immediate loading / provisionalization
Diagnosis and treatment planning
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Treatment guidelines

Edentulous

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Probing

Radiographical check-ups to evaluate bone levels cannot be repeated too often to avoid unnecessary radiation. Monitoring the overlying soft tissues may help to identify eventual problems of the underlying bone, although the correlation...

Aftercare / follow up
Peri-implant therapy
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Treatment guidelines

Edentulous

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Smoking

Smoking and nicotine consumption have a constrictive effect on blood vessels thereby reducing blood supply. It increases the susceptibility to periodontal inflammatory diseases, dry extraction sockets and wound healing...

Peri-implantitis
Systemic factors
Patient assessment