Advantages of Implant Supported Prosthesis:
1. Maintenance of esthetics
2. Maintenance of bone
3. Maintenance of occlusal vertical dimension
4. Proper occlusion
5. Improved psychological health
6. Tooth positioned for esthetics Read more…
In reconstruction procedures in Dental Implant Cases, autogenous grafts are preferred to allogenic materials. It has been accepted by several implantologists that the main handicap with autogenous grafts is the secondary wound site. There’s an increase in infection risk in the donor site from which the graft is taken.
There also an alternative method of creating sufficient bone volume to allow reliable implant placement. The procedure is basically to sandwich bone grafts between the buccal and palatal cortices after carefully splitting the alveolar ridge.
Surgical Methods to Create Bone Volume for Dental Implants
1. Autogenous bone grafts
2. Guided bone regeneration
3. Allogenic demineralized bone powder and hydroxyapatite
4. Titanium mesh with bone grafts technique
5. Distraction osteogenesis
6. Interpositional bone grafts
Most bone augmentation procedures involve the use of bone grafts. The best material for a bone graft is the patient’s own bone, which most likely will come from chin or ramus. If the dentist can not get enough bone from these areas, he or she may need to get bone from the patient hip or shin bone (tibia) instead. The hip is considered to be a better source because the hip bone has a lot of marrow (soft tissue within the bone), which contains bone-forming cells.
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The jawbone must have enough bone to support dental implants. There may be no enough bone because of tooth loss from periodontal (gum) disease, injury or trauma, or a developmental defect. If the jaw is too short (up and down), too narrow (side to side), or both, a procedure is needed to add bone to the jaw before dental implants can be placed.
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Classification of Overdentures for Implants are:
1. Bar overdenture
2. O-ring overdenture
Common complication for bar overdenture is clip fracture. While in O-ring overdenture is rubber ring damage.
A bulky denture can develop from the bar and clip in Bar overdenture. It is not indicated for insufficient occlusal clearance.
O-ring has simple clinical and manufacturing procedure. It is not indicated if the insertion angle between the implants is completely out of the line.
In most dental implant cases a permanent bond is used such as resin cement and polycarboxylate cement. A temp-bond have sufficient strength if splinting more than 3 abutments with a height of more than 6 mm. Problem is temp-bond has limited durability and it should be replaced with a permanent adhesive. Rough surface abutment and resin cement are used if the abutment length is as short as 4mm.
An overdenture using a single dental implant is sometimes placed as treatment. This is if a conventional complete denture is not possible or sufficient number of implants can not be placed because of financial reasons. Successful cases have been reported although there is still insufficient scientific research. The relationship to the antagonist tooth should be fully considered.
In full mouth reconstruction with dental implants, one-piece splint is no longer necessary. The dispersal of stress during mastication is effectively enabled by improvement of implant designs such as development of progressive power threading, tapered body and internal connections. FPD is fabricated in 2 to 4 pieces depending on the length, diameter, number and path of placement of dental implant, thus, passive and more accurate fit can be obtained.
Flapless surgery is only recommended in limited cases with excellent bone quality and bone mass because it is a blind technique. Fenestration can occur in regions with bony concavities such as the anterior or premolar teeth of the maxilla. In these cases, extra attention is needed to avoid fenestration in placement of dental implants. Flapless surgery should also be avoided in patients with periodontal problems.
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