0 Patient Assessment
- 0.1 Patient demand
- 0.2 Overarching considerations
- 0.3 Local history
- 0.4 Anatomical location
- 0.5 General patient history
- 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
  - 1.1 Occlusion
  - 1.2 Alveolar atrophy and insufficiency
  - 1.3 Skeletal consequences of edentulism
  - 1.4 Head-neck cancer
- 1.3 Clinical diagnostic assessments
  - 2.1 Microbiology
  - 2.2 Salivary output
- 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
  - 4.1 Prosthodontic guides overview
  - 4.2 Wax-up, arrangement, mock-up
  - 4.3 Splints and imaging for surgery
  - 4.4 Provisionals
2 Treatment Options
- 2.1 Mucosally-supported
  - 0.1 Mucosally supported - Overview and important considerations
  - 0.2 Complete denture
  - 0.3 Immediate denture
  - 0.4 Occlusal schemes
- 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
    
    9.1 Digital treatment planning protocols, introduction
    
    9.2 Digital treatment planning protocols, NobelClinician
- 2.3 Implant prosthetics - removable
  - 2.1 Implant overdenture, overview
    
    0.1 Implant overdenture, introduction
    
    0.2 Overdenture retention devices, overview
  - 2.2 Secondary splinting
  - 2.3 Primary splinting
- 2.4 Implant prosthetics - fixed
  - 3.1 Fixed implant prosthesis, introduction
  - 3.2 Screw-retained restorations
    
    1.1 Screw-retained
    
    1.2 Implant-supported vs abutment-supported
  - 3.3 Cement-retained restorations
    
    2.1 Cement-retained
    
    2.2 Abutment materials
  - 3.4 Framework materials
    
    3.1 Framework materials
    
    3.2 Veneering with ceramic
    
    3.3 Veneering with Acrylic
- 2.5 Comprehensive treatment concepts
3 Treatment Procedures
- 3.1 Surgical
  - 0.1 Surgical considerations
    
    0.1 Anesthesia
    
    0.2 Peri-operative care
    
    0.3 Post-operative care
    
    0.4 Flap-or flapless
    
    0.5 Wound closure
    
    0.6 Intra-operative complications
    
    0.7 Guided vs non-guided
    
    0.8 Semi-guided surgery with prosthetic template
    
    0.9 Guided surgery with drill guides
  - 0.2 Surgical protocols - general
    
    1.1 Crestal incision
    
    1.2 Choice of implant
    
    1.3 Parallel implant placement
    
    1.4 Tapered implant placement
    
    1.5 Insertion torque
    
    1.6 Insertion height
    
    1.7 Implant angulation
  - 0.3 Surgical protocols - mandible
    
    2.1 Implant placement with open flap procedure - mandible
    
    2.2 Grafting, mandible
  - 0.4 Surgical protocols - maxilla
    
    3.1 Implant placement - maxilla
    
    3.2 Grafting, maxilla
    
    3.3 Sinus lifting
    
    3.4 Zygomatic implants
    
    3.5 Pterygoid implants
    
    3.6 Problems and complications in maxillary implant surgery
- 3.2 Removable prosthetics
  - 1.1 Complete dentures
    
    0.1 Complete denture clinical protocol
    
    0.2 Complete denture impressions
    
    0.3 Complete denture - maxillo-mandibular relations
    
    0.4 Complete denture trial placement
    
    0.5 Complete denture placement
    
    0.6 Complete denture post-placement
  - 1.2 Implant overdentures
    
    1.1 Overdenture clinical protocol
    
    1.2 Implant overdenture impressions
    
    1.3 Implant overdenture maxillo-mandibular relations
    
    1.4 Implant overdenture trial placement
    
    1.5 Implant overdenture placement
    
    1.6 Implant overdenture post-placement
- 3.3 Fixed prosthetics
  - 2.1 Fixed implant prosthesis clinical protocol
  - 2.2 Impressions
    
    1.1 Impressions - overview
    
    1.2 Splinted vs unsplinted impression copings
    
    1.3 Open versus closed tray
    
    1.4 Parallel vs non-parallel
  - 2.3 Maxillo-mandibular relations
  - 2.4 Trial placement
  - 2.5 Framework trial placement
  - 2.6 Placement
  - 2.7 Post-placement
4 Aftercare
- 4.1 Surgical aftercare
  - 0.1 Medication
  - 0.2 Post-operative soft tissue management
  - 0.3 Suture removal
  - 0.4 Post-surgical recommendations
- 4.2 Prosthetic aftercare
  - 1.1 Esthetic and function check
  - 1.2 Provisionals / temporary prosthesis
  - 1.3 Oral hygiene instructions
  - 1.4 Occlusal guard
- 4.3 Post-treatment complications and management
  - 2.1 Bleeding
  - 2.2 Soft tissue and hard tissue
  - 2.3 Patient compliance / recall
  - 2.4 Biologic complications
  - 2.5 Esthetic complications
- 4.4 Recall visits and logistics
  - 3.1 Recall visits - overview
  - 3.2 Patient expectations
  - 3.3 General health check
  - 3.4 Professional oral hygiene
  - 3.5 Implant overdenture maintenance
  - 3.6 Occlusion check
  - 3.7 Probing
  - 3.8 Inflammation, infection
    
    7.1 Inflammation and infection - overview
    
    7.2 Infection, microbiological diagnostics
  - 3.9 Radiological control

治疗指南

上下颌位关系

Key points

对于上下颌位关系，咬合堤可建立垂直距离并描绘咬面、唇线、笑线和中间线
如果相对颌具有可拆卸修复体，则优先选择平衡咬合方案

重新建立横向和矢状颌关系

在全口缺齿患者的治疗过程中，一个目标是重新建立横向和矢状距离上的上下颌位关系，从而达到足够的面部高度。相应地定义义齿之间的咬合接触情况。为了对旧义齿进行评估，并创建体现最终修复结果的牙齿排列，初步诊断和规划阶段使用了多个修复参数。此插图是传输到最终固定修复体的信息的来源。如果相对颌用可拆卸修复体修复，则建议选择平衡咬合。

咬合堤技术

在最终模型上制作记录基托和咬合堤的技术仍被视为确定缺齿患者的上下颌位关系和咬面间记录的黄金标准。咬合堤可建立垂直距离并描绘咬面、唇线、笑线和中间线。记录基托通过粘膜支撑，或者使用现有种植体进行固定。如要获得准确的上下颌位关系记录，记录基托的稳定性必不可少。通常，下颌记录基托没有上颌记录基托稳定，因此，使用现有种植体来固定和稳定记录基托在下颌中的影响比较大。

使用各种技术和材料可以记录上下颌位关系。在理想情况下，所采用的技术能够获得无压迫感的病人口述的正中颌位关系。在某些临床情况下，可能需要就下颌接近正中颌位关系获得牙医指导。记录介质的理想特性包括，设置时间较短，设置牢固且能自由流动，对患者闭合的阻力可以忽略。

临床分类

种植体

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治疗指南

Edentulous

固定种植体修复体临床方案

固定种植体修复体完全由种植体固定和支撑。有许多不同的术语可以用来描述固定种植体修复体，例如固定全口义齿、固定可摘式修复体、混合修复体或 All-on-4 修复体。

要为这类修复体提供充分的生物力学支撑，通常需要 4 到 6 个种植体。需考虑通常与每个患者相关的特定生物力学因素，才能最终确定固定和支撑固定全口义齿所使用的种植体数量。这些因素包括所修复的牙颌、牙颌形态、骨量和骨质、相对颌的状态（有齿与缺齿）、患者产生的力以及解剖限制。

通常，由于解剖结构具有限制性，因此每一侧的后牙种植体为倾斜状态，以便以与前牙种植体保持较远距离

种植体

治疗指南

Edentulous

试验放置

试验放置就诊是对缺齿患者进行成功治疗的一次重要就诊。这是牙医和患者第一次看到技工室中制作的成果；然后决定接受、修改还是更改。在执行其他临床步骤（例如制作框架或处理修复体）之前，双方应就临时蜡塑成果的咬合情况、功能和美观效果达到相互满意。

牙齿排列提供牙齿相对于每个缺齿牙颌的空间位置的有形方向索引 - 这是设计框架和最终修复体的关键步骤。这种临床可视化解决了牙医和患者调解的美齿和技术顾虑。它在颌架上使用技工室准备的临时牙齿排列，从而模拟颌和牙齿接触面移动关系和移动情况。

最终修复体的框架试验

CAD/CAM

种植体

治疗计划

问题

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