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0
Patient Assessment
- 0.1 Patient demand
- 0.2 Overarching considerations
- 0.3 Local history
- 0.4 Anatomical location
- 0.5 General patient history
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0.6
Risk assessment & special high risk categories
- 5.1 Risk assessment & special high risk categories
- 5.2 age
- 5.3 Compliance
- 5.4 Smoking
- 5.5 Drug abuse
- 5.6 Recreational drugs and alcohol abuse
- 5.7 Parafunctions
- 5.8 Diabetes
- 5.9 Osteoporosis
- 5.10 Coagulation disorders and anticoagulant therapy
- 5.11 Steroids
- 5.12 Bisphosphonates
- 5.13 BRONJ / ARONJ
- 5.14 Radiotherapy
- 5.15 Risk factors
-
1
Diagnostics
-
1.1
Clinical Assessment
- 0.1 Lip line
- 0.2 Mouth opening
- 0.3 Vertical dimension
- 0.4 Maxillo-mandibular relationship
- 0.5 TMD
- 0.6 Existing prosthesis
- 0.7 Muco-gingival junction
- 0.8 Hyposalivation and Xerostomia
- 1.2 Clinical findings
-
1.3
Clinical diagnostic assessments
- 2.1 Microbiology
- 2.2 Salivary output
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1.4
Diagnostic imaging
- 3.1 Imaging overview
- 3.2 Intraoral radiographs
- 3.3 Panoramic
- 3.4 CBCT
- 3.5 CT
- 1.5 Diagnostic prosthodontic guides
-
1.1
Clinical Assessment
-
2
Treatment Options
- 2.1 Mucosally-supported
-
2.2
Implant-retained/supported, general
- 1.1 Prosthodontic options overview
- 1.2 Number of implants maxilla and mandible
- 1.3 Time to function
- 1.4 Submerged or non-submerged
- 1.5 Soft tissue management
- 1.6 Hard tissue management, mandible
- 1.7 Hard tissue management, maxilla
- 1.8 Need for grafting
- 1.9 Healed vs fresh extraction socket
- 1.10 Digital treatment planning protocols
- 2.3 Implant prosthetics - removable
-
2.4
Implant prosthetics - fixed
- 2.5 Comprehensive treatment concepts
-
3
Treatment Procedures
-
3.1
Surgical
-
3.2
Removable prosthetics
-
3.3
Fixed prosthetics
-
3.1
Surgical
- 4 Aftercare
Direct to implant vs. abutment
Key points
- A prosthesis directly supported by implants is indicated when inter-arch distance is limited
- A prosthesis supported by abutments is indicated when implant angulation needs to be corrected, especially for screw-retained prosthesis designs
- Abutments designed for cement-retained restorations are preferred in situations where an access screw hole is not desired
- For a prosthesis directly supported by implants, soft tissues around implants must be carefully manipulated during impression and trial placement appointments
Advantages of abutment-supported prostheses
- When implants are not parallel to each other, the use of angulated abutments can "correct" for the non-parallelism.
- Angulated abutments are available for a screw-retained prosthesis.
- Custom abutments can be fabricated for a cemented prosthesis.
- Placement of abutments permits the abutment-prosthesis interface to be placed crestally or supra-crestally making impression-taking and trial placement much easier and less invasive for the soft tissues.
Disadvantages of abutment-supported prostheses
- When there is limited interarch space, placing abutments reduces the size and hence the strength of the prosthesis framework.
- The typical implant to prosthesis system involves two retentive interfaces of implant-abutment and abutment-prosthesis meaning that in the case of cement-rertained prostheses, access to the abutment screw may be difficult.
- Cement excess is a major cause for peri-implant inflammation and peri-implant crestal bone loss.
Advantages of implant-supported prosthesis
- When there is limited interarch space, this type of prosthesis allows for the necessary size and strength of the prosthesis framework.
- With the typical implant-prosthesis-prosthetic screw system, retrievability is enhanced.
- There is only one retentive mechanism to manage.
Disadvantages of implant-supported prosthesis
- Cannot be used with a cement-retained prosthesis.
- Non-parallelism of implants may lead to compromised esthetics due to the position of the access holes for the prosthetic screws.
- Impressions and trial placement procedures may traumatize the peri-implant soft tissues.
- Connection and disconnection of the prosthesis may influence the periimplant tissue condition/crestal bone levels.
- Connection and disconnection of the restoration may be more uncomfortable for the patient in comparison to an abutment supported prosthesis.
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