Good Occlusal Practice in the Provision of Implant Borne Prostheses

Go Top of Page S. J. Davies,1 R. J. M. Gray2 and M. P. J. Young3 The increased use of endosseous dental implants means that many dentists will encounter patients with dental implants in their everyday practice. Dental practitioners might be actively involved in the provision of implant borne prostheses at both the surgical and restorative phases, or only at the restorative stage. This section is written for all dentists and aims to e amine the sub!ect of occlusion within implantology. It aims to provide guidelines of good occlusal practice to be used in the design of the prosthesis that is supported or retained by one or more implants. "s implantology is a #new$ discipline of dentistry, there are fewer standard te ts and this section, therefore, is much more e tensively referenced than the sub!ects that have been considered to date. This is the last section of this series. 1*GDP, 73 Buxton Rd, ig! "ane, Sto#$%ort S&' (DR) P*+ "e#turer in Denta, Pra#ti#e, -niversity Denta, os%ita, o. Man#!ester, ig!er /a01ridge St.,Man#!ester M12 '3 ) 2 onorary 3e,,o4, -niversity Denta, os%ita, o. Man#!ester, ig!er /a01ridge St., Man#!ester M12 '3 3 Senior "e#turer and onorary /onsu,tantin Restorative Dentistry, -niversity Denta, os%ita, o. Man#!ester, ig!er /a01ridge St., Man#!ester M12 '3 */orres%onden#e to 5 Ste%!en Davies, 73 Buxton Rd, ig! "ane, Sto#$%ort S&' (DR Email: stephen.j.davies@man.ac.uk 6ven t!ose genera, denta, %ra#titioners 4!o are not i0%,ant %roviders are ,i$e,y in t!e .uture to 1e responsible for the maintenance o. i0%,ants

Osseointegration
3or osseointegration to o##ur %redi#ta1,y #,ini#a, guide,ines !ave 1een deve,o%ed to o%ti0ise su##ess rates51
• • • •

+!e i0%,ant 0ust #onsist o. a suita1,e 1io0ateria, 4it! a%%ro%riate sur.a#e %ro%erties 7de8uate vita, 1one 0ust 1e %resent to su%%ort t!e i0%,ant 7 %re#ise surgi#a, .it 0ust 1e a#!ieved 1et4een t!e 1one and t!e i0%,ant +!e i0%,ant 0ust 1e inserted 4it! a ,o49trau0a te#!ni8ue to avoid over!eating o. t!e 1one during %re%aration o. t!e re#e%tor site

+!e i0%,ant s!ou,d not 1e su1:e#t to .un#tiona, ,oads during a !ea,ing %eriod o. 3;' 0ont!s <+!is traditiona, %roto#o, is no4 1eing 8uestioned=.

7,t!oug! t!ese guide,ines do not 0ention >o##,usion?, on#e integrated, denta, i0%,ants 0ust 1e restored sympathetically 4it! due regard to o##,usion sin#e un.avoura1,e ,oading !as 1een #ited as a 0a:or #ause o. .ai,ure. +!is %art o. t!e series 4i,, %resent t!e .a#tors t!at in.,uen#e t!e o##,usa, s#!e0es used .or %rost!eses su%%orted or retained 1y endosseous denta, i0%,ants. Sin#e re,ative,y .e4 studies !ave 1een designed 4it! t!e so,e ai0 o. #o0%aring di..erent o##,usa, s#!e0es, it is di..i#u,t to 1e #ertain 4!at is t!e 1est o##,usion .or a given #,ini#a, situation. /urrent te#!ni8ues and 0ateria,s tend to 1e 1ased on 4!at !as evo,ved over years o. #,ini#a, %ra#ti#e and ,a1oratory resear#!. +!ey are 1ased on 4!at is 1e,ieved, rat!er t!an 4!at is $no4n, to 1e good o##,usa, %ra#ti#e in i0%,anto,ogy. >@sseointegration? is t!e 1io,ogi#a, %ro#ess t!at resu,ts in a #,ose stru#tura, re,ations!i% 1et4een vita, 1one and a denta, i0%,ant. Su##ess.u,,y integrated and #are.u,,y ,oaded i0%,ants !ave 1een s!o4n to 1e #a%a1,e o. 1eing retained 1y t!e !ost tissues .or 0any years. @sseointegration 4as .irst de.ined as >t!e dire#t stru#tura, and .un#tiona, #onne#tion 1et4een ordered ,iving 1one and t!e sur.a#e o. a ,oad #arrying i0%,ant?.2 More re#ent,y t!is !as 1een de.ined as >a %ro#ess 4!ere1y a #,ini#a,,y asy0%to0ati# rigid .ixation o. a,,o%,asti# 0ateria,s is a#!ieved and 0aintained in 1one during .un#tiona, ,oading?.3 @1vious,y, t!e signi.i#ant di..eren#e 1et4een >osseointegration? and t!e atta#!0ent o. teet! to t!e a,veo,us is t!e a1sen#e o. a %eriodonta, ,iga0ent. 7,t!oug! axons !ave 1een identi.ied in %eri9i0%,ant regions, t!eir .un#tiona, signi.i#an#e is not #,ear,y understood.A 7t %resent, t!e %ro%rio#e%tive #a%a1i,ity o. restored i0%,ants is usua,,y attri1uted to 1one de.or0ation o. t!e %eriostea, 0e#!anore#e%tors on i0%,ant ,oading.2 Regard,ess o. t!e %re#ise 0e#!anis0 .or su#! %ro%rio#e%tion, it !as 1een s!o4n t!at t!e 1B 6ven t!ose genera, denta, %ra#titioners 4!o are not i0%,ant %roviders are ,i$e,y in t!e .uture to 1e res%onsi1,e .or t!e 0aintenan#e o. i0%,ants 70end0ent5 +!is %a%er is an u%dated version .ro0 t!e origina, %rinted version. Part o. t!e .ina, senten#e at t!e 1ase o. %age (' 4as o0itted and is no4 s!o4n !ere in .u,,. t!res!o,d o. ta#ti,e sensitivity is a%%roxi0ate,y eig!t ti0es ,ess t!an t!at o. natura, teet!.' Cn addition, t!e range o. >.ood9 !o,ding? .or#es .or %atients 4it! i0%,ants is signi.i#ant,y !ig!er t!an t!ose .or %atients 4it! natura, teet!.7 D!en %res#ri1ing or 0odi.ying o##,usa, #onta#ts .or i0%,ant %rost!eses, it s!ou,d 1e 1orne in 0ind t!at t!e %atient?s %er#e%tion o. o##,usa, irregu,arities and o##,usa, ,oads is 0u#! redu#ed and, t!ere.ore, s!ou,d not 1e so,e,y re,ied u%on. Implantology is based upon osseointegration

%urrent "pplication of Oral Implants
+!e #urrent a%%,i#ation o. i0%,ants is 0u#! 0ore extensive t!an 4!en i0%,ants 4ere .irst uti,ised. Cn star$ #ontrast to t!eir initia, a%%,i#ations E4!en %redo0inant,y on,y edentu,ous %atients 4ere treated 4it! .ixed denturesF, i0%,ants are no4 inserted into5

Partia,,y dentate %atients 4it! a !ea,t!y or #o0%ro0ised %eriodontiu0.

ants in 0ore de0anding #ir#u0stan#es. a #riti#a. resear#! t!at uses t!is ter0 #annot 1e #onsidered to 1e as 0eaning. 0ust 1e 0ade. is a #rude 0easure o. or t!e use o. 0ore re#ent.ined a1ove.ant su##ess !ave 1een out.4ays #.5 • • • • • Mo1i.ear.ore. HBI. a%%raisa.ter.ant !ea.ini#a.uating #. .1( /riteria .e Sites in 4!i#! t!e 1one !as 1een aug0ented.oading G B.ined and 0ig!t 1e >syste0 s%e#i.1H +!is 0ig!t 1e ex%.u#en#y Pain Cn. an i0%.ant surviva. +!ere.e dentures Re0ova1.• • Posterior regions o. as t!at 4!i#! de. Des%ite nu0erous ear. 4!en eva.oss G 1.e overdentures <0u#osa and i0%. Implant &uccess 's Implant &urvival Cn re#ent years..ity 7sso#iated radio.? <i0%. Cn addition.(917 +!is ter0 0ig!t 1e 0ista$en.or i0%. Sin#e i0%.ant su##ess.e#tion or iatrogeni# neuro%at!ies.o4er su##ess rates !ave 1een re%orted.y inter%reted as 1eing synony0ous 4it! implant success as de.ines and 0easures i0%.ant9su%%orted5 • • • • • 3ixed #ro4ns 3ixed 1ridges 3ixed dentures Pre#ision re0ova1.ant syste0 .t!.ant surviva. t!e study= a%%ears to 1e in#reasing. %rost!eses 0ay no4 1e i0%.y used 4!en re%orting treat0ent out#o0es.B 00 in t!e .ant retention at t!e end9%oint o.or su##ess are not a. +!ere s!ou.u. Peri9i0%.y .y studies t!at re%orted su##ess rates in ex#ess o.ant verti#a.a and 0andi1. 1one . %oor o%erator te#!ni8ue.ained 1y t!e use o. >i0%.2 00 %er annu0 t!erea.i#?.ant su%%orted= The absence of a periodontal ligament between an implant and the bone significantly reduces the patient$s sensory perception of the occlusal load Implant &uccess /riteria .erent ty%es o.y de. 0any di. i0%.irst year o. resear#! studies. t!e 0axi. i0%.ined so0e years ago..d 1e an a1sen#e o.

oss <#.usa. i0%.ten %resents as a #!roni# t!en ter0ina. i0%. Progressive 1one .or a.a1.ant .ini#a.a#tor 0ig!t 1e t!e . %o#$ets A.a#tors .antitis? i0%.ies a##o0%anying 1one .eve. in.ant ex.o.y to de.ant? in..ined as one in 4!i#! t!e #riteria .ant radio..e.ant o. 0i#ro.ing? i0%.ti0ate. treat0ents.ai.oss '. o.ure are5 • • • • Redu#ed !ost resistan#e P.eature. i0%. stress Syste0i# .so to exa0ine !o4 it 0ig!t 1e %revented.assi.e .eading to i0%.a00ation <%eri9i0%. in. /!ange in 0i#ro1ia. 4it! 1one .i..a#tors eg dia1etes and s0o$ing . Progressive dee%ening o.or exa0%..ess t!an t!eir %roven e. >Perii0%.ant syste0 to su%%ort t!eir e.2B Implant survival does not e(ual implant success The )ailing Implant D!i.e#tiveness o.ant #an 1e de.a00ation 2..ants to 1e . 7 . . 1ut a.st >%eri0%.o. t!e surgeons t!at %rovide i0%.ant ex..e? studies 4!ere.ation @##. . Progressive atta#!0ent .4it! an un%roven tra#$ re#ord.or #ertain syste0s.ogi#a.ine i0%.e4er studies are avai.ures=.or su##ess are not 0et.oss as a $ey ..t tissue in.e#tiveness in >rea.22922 +!e >. !y%ertro%!y 3.21 7s . +!e stages o.or i0%.or so.ant treat0ent. Gingiva.a00ation.ant .i#ation and revie4 o.ant .ure !ave 1een suggested to 1e <a.e#tion #riteria 0ig!t 1e 0ore re.ai.i#a#y.st t!e e. 7gainst t!is 1a#$ground.i#a#y o. and denta.antitis= %resents a si0i. C0%.y de0onstrated .iation +!e suggested aetio. i0%.ar #. 7 .ai. #ondition u.ant . >@sseo9disintegration? 4it! 0o1i.a8ue a##u0u.ity and %erii0%.or any i0%. %i#ture to %eriodonta.ter Je40an=52' 1.. Gingiva.y . . .iation.axed.. >Peri0u#ositis?. 4!i.ai.ants !as 1een a0%. 4e #an ex%e#t t!e %roven e. se.ora 7.ing i0%.ant. ex%erien#e o.ai.e#tion around an i0%. !as 1een reserved .oss 2. 0edi#a.urt!er .ure.ai. it is i0%ortant not on.u#en#y (.

ivered as a >tea0? <at one or 0ore sites= t!e 8uestion o. >sau#erisation or .ity . over.ar.ant ..d not su.7. and t!e #auses o.ant t!era%y is de. .oad <3ig.y i0%ortant sin#e t!e #urrent eviden#e to su%%ort t!e e. restorative dentist and denta. 1ut t!e %rin#i%.. +!e >tea0 .ure are not #o0%. t!e sa0e #. t!e restorative dentist 0ust a%%re#iate t!e anato0i#a. #o00uni#ation 1et4een t!e #.ants #an and do .e t!at a %atient?s treat0ent s!ou.ai. +!e team leader 0ust ensure t!at t!e :oint treat0ent %.ure 1e#o0es 0ore #o0%. 3irst. +!e surgeon 0ust as$ .ant 1orne restoration is o.t!oug! a 4ide range o.or ensuring t!at t!e a%%ro%riate #o00uni#ation exists to satis. 3ai.27 %ase *esponsibility +!e deter0ination o. te#!ni#ian is essentia. and restorative %!ases.y understood. D!en i0%.ogi#a. it is suggested t!at t!e 0ost ex%erien#ed 0e01er o.ogy o.t in a de1ate 4!i#! does t!e %ro. t!e i0%.y.or0.ai.ai. o4ever.ete..ten a tea0 e. +!is is %arti#u.22.usa.a#$ o. te#!ni8ues !as 1een e0%.at. an i0%. vary a##ording to t!e ex%erien#e o. toget!er 4it! an a%%ro%riate 0aintenan#e %rogra00e is une8uivo#a.ession no #redit. t!e #ase.ai.ant te#!ni#ian 0ust !ave so0e #on#e%t o.an 0ini0ises t!e ris$ o.is!ed t!at trau0a .ant treat0ent is de.. 1=. #onta#ts are to 1e in#or%orated into t!e i0%.y. %osition 4it! regards to t!e %ro%osed o##.oyed to sta1i.ity 4i..or design and exe#ution o. #onstraints 4!en giving so0e guidan#e on t!e idea..urro4ing? is asso#iated 4it! o##. 4!en i0%.ai. res%onsi1i. Cn su#! situations.ivered 1y a >tea0?. t!e treat0ent.ro0 o##. Occlusal Overload as a %ause of Implant )ailure Ct !as 1een esta1.o#ation.ant tea0 1e#o0es t!e >tea09. a%%earan#e o. t!e tea0 0e01ers. Se#ond.ved is %ara0ount. i0%.ants.e . t!e res%onsi1i. 4!et!er t!ey 1e surgeon or restorative dentist.ure. i0%.ini#ian #arries out 1ot! surgi#a.er t!roug! a .ure. it is re#ognised t!at t!e eviden#e to su%%ort t!ese interventions a%%ears %oor at %resent.ity is an i0%ortant #onsideration .ant su%%orted %rost!esis.eader?. t!e %rovision o.2H .ant . a%%ro%riate o##.erred o##.ing i0%.or t4o reasons.usa. %re.ort. +!e degree o.y.ant .ai.eader? is res%onsi1.ant9res#ue te#!ni8ues is 4ea$.y t!e needs o.ure under t!is regi0e 0ay resu.. i0%. restorative i0%.usa.a#tor in t!e aetio. %. #ase res%onsi1i.i#a#y o.ose #o.usa. #.a1oration 1et4een t!e surgeon.or guidan#e as to t!e o%ti0a. res%onsi1i. C.ise . i0%. 68ua.ity .. s#!e0es i.or i0%.ex and indeed 0ore #ontentious. +!e i0%.usion 0ay 1e a .ant .ini#ians invo.2( Ct !as 1een suggested t!at a radio.

o##. 1ut ..oads? either way .ai.eren#es <as o%%osed to 1a.y ex.u.ingua. ta1. "e.ants are 0ore easi.y over.ude5 • • • • • Cnade8uate nu01er o.iga0ent 0eans t!at denta.oaded i0%. a#tion 0ust 1e s%eedi.ead to i0%.unne.o. 0asti#atory . #onta#ts in #entri# o##. ex#ess . an over.e sign o.t untreated. o##.ant 4i.oad5 >. 1 7 %ossi1.ed under nor0a.ai.y integrated.e .ed 1e#ause o.ants to su%%ort t!e %rost!esis .eren#es 6x#essive 1u##a.ai.ing? or >sau#erisation?. .oads? or The *estorative Dentist$s Tale >+!e i0%.y underta$en to redress t!e un.e o.ti0ate.an#ed #onta#ts= Jon94or$ing side inter.ever <t!e o##.ogi#a.oaded and t!is #an to . D!ereas t!e natura.avoura1.usion Dor$ing9side inter.oading #onditions. over. a %eriodonta. u.y integrated and so . i0%. i0%.ant dia0eter= The &urgeon$s Tale >+!e i0%.ants 4ere su##ess.. %!ysio.usa.usa.ants 4ere %oor. t!e a1sen#e o. stress are nu0erous and in#. +!e #auses o.ant ..itted eavy o##. dentition is #a%a1.e too 4ide .ure. #anti.usa.. or .usa. Re0edia.iate.or t!e i0%.3ig.usions.y ada%ting to trau0ati# o##.

sing.inted.e9 #onstru#tion? te#!ni8ues.y atta#!ed and 4i.iga0ent= 0eans t!at %ro%rio#e%tive and a%ta%tive %otentia.ant #annot undergo ort!odonti# 0ove0ent 7n idea.an.t!oug! #onne#tions to t!e #entra.e i0%. .ant su##ess rates.inting. 0ove or intrude 0u#! .ti%.ant #ase?.ess t!an 4it! natura. is a re#ent deve.e.o%0ent and t!e eviden#e 1ase is #orres%onding.o. anterior guidan#e5 t!at is #anineguidan#e or grou%9. in re#ent years t!is %rin#i%.ig!t.usion in >an i0%.ant su%%orted %rost!esis.or0ative a%%roa#! t!is is t!e sa.ixed91ea0 stru#tures.ant is rigid.e i0%.tii0%.usion or re9organising t!e o##.ti%. o4ever. !o4ever.ai.oading o. s#!e0e . teet!5 • • • +!e i0%.? o##. +!e de#ision to %rovide an o##. .+!e Patient?s +a. 1e 0ade in exa#t.ant #ases are no4 1eing restored as 0u.ieved to exist.ity.or an i0%.. The absence of a periodontal membrane is believed to be the reason why endosseous implants appear to tolerate non+a ial loads poorly To %onform or to *e+Organise.ed K? Techni(ue *ecommendations for Occlusal &chema for Implant &upported Prostheses Ct is t!e nature o.ants istori#a.usion. 7s it is 4ide.eatures o. 1ars or .y .ant su%%orted %rost!eses !as 1een re#o00ended53B • • • 7 #entri# o##.e >My i0%.ig!t 7n idea. it is a##e%ted t!at %ro%rio#e%tion is redu#ed 7n i0%.ure.ants restored 4it! .ants.usion . nervous syste0 are 1e.un#tion) no %osterior inter. t!e i0%. . and >dou1. . /are.ants !ave .ines are %ara0ount5 • C.usa.e to .d 1e dissi%ated 1y t!e use o..ossa? #onta#t 4!i#! is .usion >#us% to #entra. osseointegration <no %eriodonta.y. is . an >idea. +!is de#ision90a$ing %ro#ess is des#ri1ed ear..e teet! i0%.ai. nature o.or .est route ..ixed %rost!eses in t!is region is #onsidered to #arry a greater ris$ o. +4o guide.o4 t!e #on. .oading in t!e %osterior regions see0s es%e#ia. +!e .unda0enta. nons%.ess 7. osseointegration t!at deter0ine t!e . +!is a%%roa#!.or0ing to t!e %reexisting o##..edged t!at t!e 1one o.ixed i0%. t!e %osterior 0axi.inted. o##. it is %ossi1. 0u.eren#es 7xia.ier. . t!e use o. non9s%.oads s!ou.y i0%ortant to sustain a##e%ta1. 1y 0eans o. inter9i0%.y t!e sa0e 0anner as in any ot!er restoration treat0ent %. it !as 1een re#o00ended t!at non9axia.a is %oor in 8ua.u.ant s%..y a#$no4. eit!er #on. 4i.e !as 1een 8uestioned31 and 0u.

irst ste%. esta1. >4ide9dia0eter? i0%.ants.o.y to in#rease t!e ris$ o. ..9ar#!. +!e o##.3293A 7 %oor o##.e9toot! i0%. CC.i#ation5 • • • • • Sing.. . anterior toot! i0%.usion is to 1e re9organised.usa. an o##.e i0%. +!e di. i0%. .ant "ig!t or no o##.ant9retained overdenture C0%. i0%.ixed9%rost!esis .e or sing. .assi.earan#e o.ure in t!e %osterior region.ant su%%orted %rost!esis 3ree9standing. %hec/ 0.i$e.erent ty%es o. i0%.ant 0o.amine D .oad <in.earan#e is i0%ortant sin#e t!e natura. re#ent. -nti. in %art de%end u%on t!e ty%e o. Cn #entri# o##. CL C0%.ant is no4 an a##e%ted and a !ig!.y ex#eed t!ose in t!e anterior region.or dou1. 0o. 1e #onsidered under t!e . &' 1. %lassification of Osseointegrated Prostheses +!e $ey .. %rost!esis.e. . %rost!eses 4i.is!ing and re#ording /entri# Re.ant 3u.usion 1y 3B N0= under !eavy #.a#e0ent is si0i. i0%.a#e0ent.or#es in t!is region great.ant retained %rost!esis .ra9o##. Design . t!e i0%..eatures o. Discussion of Requirements of ‘Ideal’ cclusion for !in"le #ooth Implant $%i".ar toot! re%.en#!ing @##. &ingle Tooth *eplacement by Implant *etained %rown +!e sing. an a%%ro%riate o##. dentition. 3B N0.. to t!e natura. Ideal Occlusion for &ingle Tooth Implant • • • "ig!t ..or t!e sing.or#e dire#ted do4n t!e .usa.ong axis o.usa.• C.ant 4as #onsidered #ontra9indi#ated.y %redi#ta1. s#!e0e is .ant M toot!9retained.a#e0ents.e 0eans o.ecute % .a#e0ent 1y an endosseous denta. toot! re%.oads 4!ereas t!e i0%.y. Prior to t!e deve. 0o.ation is t!e essentia.ars 4ere restored using t4o narro4 i0%. teet! #an 1e intruded in t!eir so#$ets under !eavy .ant .ant su%%orted #ro4n s!ou. sin#e t!e #!e4ing .o%0ent o. Re#ent studies indi#ate t!at si0i.d !ave a #.ants. +!is #.usion.ai.ar.ixed9%rost!esis &ennedy #. .o4ing #.asses C. CCC.ity is %oorer..ar su##ess rates #an 1e ex%e#ted . #onta#t during ex#entri# ex#ursions.usion re8uired . 1ut not identi#a.ar re%.e toot! re%.. and 1e#ause 1one 8ua.usion 4i.

o##.earan#e. t!e treat0ent.ong axis o.ants are 1est a1.earan#e 4ou. 0e01rane 0eans t!at t!ere is . 6ndosseous i0%.i0ited %ro%rio#e%tion in t!e i0%. 1 Predictability of success for a single tooth implant Cdeal %ase • • +oot! a1sent -R1 7etio. . re#ognise t!at 3B N0 is a signi.usa.usion Predicted &uccess is 'ery 2igh Guide.veo.ar 1one syste0.usion • • Protrusive #onta#t s!ou. 3.ant su%%orted #ro4n is >!ig!? 1e#ause t!e a1sen#e o. .or0ative 7%%roa#!= 3on+Ideal %ase • +oot! a1sent -R1 .usa.. t!e a1sen#e o. #ro4n and 1ridge4or$ using s!i0sto#$ < t!i#$ness (N0 = 4i. #.oss O a#ute trau0a • • • • Lerti#a. not intrude.or0 to existing o##.ixed%rost!esis to ex#essive . re8uire0ent to avoid non9axia. an i0%.ini#ian 4!o is used to ad:usting #onventiona.e to 4it!stand .ass1in#isor re.ied u%on to re%ort t!at an i0%. t!e %eriodonta.a#ing o. +!is re8uire0ent is not %ure. %re0aturities in /R • /anine9guided dis#.e ta$e a##ount o.y distri1uted on t!e in#isors /.or#es under heavy loadin" conditions.d 1e even. 1e#ause o.ant9a.ure to 1ui.ant.earan#e 3B P0 in #entri# o##.4i.ine5 /on. 3ai. a %eriodonta.d 4!erever %ossi1.iga0ent s.ations!i% anterior #.oss O ni.y a #onsideration in t!e restorative %!ase o.ogy o.ant9retained .usion 71sen#e o. 7ny #.i#ant #. -n. "ig!t ex#entri# #onta#ts are a vita.d ex%ose t!e i0%. t!e i0%. t!e %atient #annot 1e re. 7de8uate 1one 4idt! 7de8uate %osterior o##. toot! . .y.oading. t!e eventua.oading.or#es t!at are dire#ted do4n t!e .ortunate..ant s!ou. 1one . )ig. 2.d in t!is a%%ro%riate o##.usion 4!i#! is atrau0ati# <+!e /on.ing. t!e %.

y 1e %rote#ted . so t!e sing. +!e a. attrition o. 7d:a#ent natura.ant treat0ent is #ontra9indi#ated unti. .ant su%%orted.y i. over.ro0 ex#ess .ter 0a$ing t!e %atient a4are t!at t!e i0%. 7de8uate 1one 4idt!.e and 0ay !ave #ontri1uted to t!e .ogy o.usa. #onta#ts • 6dge to edge in#isor re. /ertain. ex#ursion • Jo %osterior dis#.atera.avoura1. t!e i0%.oads.usion is un.usion is #!anged to 1eing a 0ore idea.ra9o##.ant #an easi.ti%.d 1e >re#ruited? to %rovide %ro%rio#e%tive %rote#tion . o##. "ingua.u.usion. di0ensions • Posterior o##. 1e#o0e !ig!. Implant &upported Prosthesis +4o o##. Ct is %ossi1. • Severe #us%a.e toot! i0%..oss O ni.usion <"@= .y !osti. 1..y %rote#ted o##.a#ed into a #o0%arative.oss5 root .ro0 0e#!ani#a.usion ex!i1its very 4ide 1ased o##. Mutua.usion in %rotrusive ex#ursions Predicted &uccess is 4uestionable (uideline: 6xisting o##. )ull+"rch.or t!e restoration o.• 7etio. teet! s!ou.ations!i% • Grou% .9 ar#! i0%. so i0%.y %ost9retained #ro4n= • • Lerti#a.ternative is to %ro#eed 4it! i0%.e to over.a#e . a. toot! .iQed o##. t!e natura...usa.e to >!ide? t!e i0%..y sus#e%ti1.ant treat0ent a. . 1one .usion 1y s.ixed9 %rost!eses532 1.oad. toot! sur.oad.e environ0ent. s#!e0es !ave 1een des#ri1ed and re#o00ended .ant 4it!in t!e natura. one <ie t!e re9organised a%%roa#! =.ant 4i. o##.usion <MP@= 2.ra#ture <%revious..ig!t in.ant 4i. .oss #ontinues.un#tion ex!i1ited in ..oss o. 1e %. t!is toot!.a#eting • Redu#ed verti#a.our #anines • Mu.e teet! 4it! 0irror9.

.is!ed and 0aintained...e#t? natura.ed >palatalised? o##.= #onta#t.u. anterior teet! %ositive.d it !ave 1een #a. s#!e0es !ave 1een %ro%osed.ude 4it! t!eir o%%osing o##. #us%s and 0andi1u.ini#a. ..a1ri#ation ti0e is redu#ed and t!is s#!e0e re%resents a %osterior o##..ternative o##.ossae. aest!eti# a%%earan#e.oads axia. +!is ty%e o.0. environ0ents t!ere1y ena1.ata.usion re8uires #onsidera1.ossae.usionR= o##.y #onsidered very di.usa. o##.ro0 !ar0.it and 0aintain./ and &/ mm.ary #us%s 4!i#! 0ig!t resu. !hallo. us #an des#ri1e t!is ty%e o..y regarded to 1e t!e o%ti0a. and its a1i.a1oratory and #. .or#es.e o##.a1ri#ate.9ar#! denta.usion) or s!ou.ude 4it! shallo. #he presence of rid"e*lappin" should -e minimised . +!us.or t!e restoration o.ation t!ere is on.usion t!at #an 1e 0ore readi. 5utually Protected Occlusion6 5PO7 +!is #on#e%t re#o00ends t!at in #entri# re.ing any un.usion. +!e #onta#ts 1et4een t!e 1a#$ teet! s!ou. 7na.eature is t!e arrange0ent o. 0utua.ingua.usa. .i#a.4ays 1e ne#essary...y o1served in 1ot! t!e . i0%..a1oratory and te#!ni#a.t in .arge nu01er o. MP@ re8uires t!at a . o##.i1riation 4i.ants.d 1e tri%oda.ysing and 0odi. .ieved to #..u.ined <non9axia.ity to dire#t 0asti#atory .ude t!e %osterior teet! in a.usion !as 1een re%orted to 1e t!e 0ost e. 0andi1u.s and a0%.i#ient in ter0s o. #.e .y t!e ma+illary palatal #us%s <!en#e5 >. 0ore recently1 it has -een su""ested that the optimal distal cantilever is in the re"ion of just 2 mm. e8ui. %rote#ting t!e %osterior teet! <or i0%.ar 1u##a.ary %a.y %rote#ted o##.henever possi-le and the distal len"th of a cantilever has -een empirically recommended -et.i#u.ingua. #o01ined 4it! 4!at is 4ide.ants= . #onta#ts to 1e identi. 0axi.i#u.ini#a.ied and #orre#ted 0ore easi. .d o##ur si0u.taneous. S%e#i. to .y.ossae. t!e %osterior teet! so t!at on. a.. #us%s s!ou. s$i. +!e $ey .d o##.. +!is >gnat!o. 3hen e+ceedin" this len"th1 clinicians should carefully consider the num-er1 location and precise arran"ement supportin" implants. +!e 0axi.ar 1u##a.ith tripodal cuspal contacts should -e attained.its o.? s#!e0e is 1e.y %osterior toot! #onta#t.ex #onta#ts is genera.y re%resent t!e >%er.ar #entra. su1stantia.t in a in#.0ost a.ying su#! #o0%. +!ere is no #onta#t 1et4een t!e 0andi1u.u.i#ity 4it! 4!i#! it #an 1e esta1.t and ti0e9#onsu0ing to .usa.een .usa. .y onto t!e su%%orting denta..edged t!at MP@ is di.y dis#.y.e #!air9side ti0e.ogi#a.usion? !as 1een re#o00ended .. a.usion. 0asti#ation. central fossae . . ex%ertise.ata. 8inguali9ed Occlusion 68O7 Sin#e it is a#$no4.henever possi-le. +!e ai0s are t!e sa0e 1ut t!e 0a:or 1ene. #us%to9 . ex#entri# ex#ursions. i0%.avoura1.atera.iQed? o##.ose. /!airside o##.a1ri#ate. D!ereas 0ost o. (uideline: )void non*a+ial loadin" .ant su%%orted %rost!eses.ants.45 1.. s#!e0e are t!e #o0%arative si0%.9ar#! i0%. .it and 0onitor su#! an o##.usa.iQed o##. #onta#ts 1et4een t!e %osterior teet! s!ou. #us% and %a. "a1oratory . t!is o##. >.y.

t!e 0andi1u. 1. )ree+standing.ith ma+illary palatal cuspal contacts should -e attained.ar teet! and t!eir 0axi.7 very 0inor disadvantage o. :.ennedy %lasses I +I' Inclusive7 1.ill carefully monitor the situation. #he -est treatment outcome is likely to -e provided -y those clinicians . )i ed+Bridges 6 ..ill allo.ennedy %lass II (uideline: #his clinical situation $unilateral free end saddle' can -e re"arded as a very favoura-le application for a fi+ed prosthesis -ecause the natural teeth . It is not unusual for clinicians to have such issues to reconcile. 1y de.ill provide the occlusion7 .ill -e provided -y the natural dentition as lon" as the implant supported -rid"es are desi"ned to allo.ith osseointe"rated -rid"es. adequate posterior disclusion. .ary #ounter%arts.ennedy %lass I' (uideline: #his is an anterior -ounded saddle. n the other hand1 $"iven that there is "eneral a"reement that it is more ideal that the -ack teeth contact harder than the front teeth' this . mandi-ular central fossae . #us%s o. .henever possi-le.. .ith implant supported -rid"e. .usion is t!e #reation.ill not -e possi-le if the posterior occlusion is e+clusively provided -y the implant supported -rid"es. 3hen there is as a lar"e span $for e+ample 8R9 $. <.ith the 4/ 6m clearance7 and the anterior teeth . t!e ar#!es.ith a fi+ed -rid"e .9' to 8:9$&9' it is very difficult to restore .ho realise that there is a dan"er of trauma from occlusion and so .henever possi-le and the len"th of a cantilever should not e+tend further than 2 mm -eyond the most distal implant $!ee later for an e+planation of rid"e lappin"'. o. . #he presence of rid"e*lappin" should -e minimised . the construction of the restorations .hich is impossi-le to resolve.hilst the contralateral unilateral free end saddle can -e restored . (uideline: )void non*a+ial loadin" . :.ork that has 4/ 6m clearance. #here is a conflict in the desi"n of these -rid"es1 . sin#e t!is s%a#ing o##urs in t!e %osterior region o. t!e aest!eti# i0%.i#ations are 0ini0a. a s.iQed o##. !hallo.ill provide the ideal anterior "uidance.ingua.inition.ennedy %lass III (uideline: 3here there are -ounded posterior saddles the use of implants is a"ain ideal -ecause the adjacent natural teeth that -ound the edentulous space .ig!t 1u##a. n the one hand there is an indication to make the occlusal stops on the posterior -rid"es li"hter -y a-out 4/ 6m than those in the remainin" natural teeth. s%a#e 1et4een t!e 1u##a. o4ever.ennedy %lass I (uideline: In these -ilateral free end saddle cases -oth posterior sections of the arch are restored . #he anterior "uidance .

y a##e%ted t!at t!is situation is .e#t on t!e atta#!0ents and*or t!e %rost!esis.-ecause of the e+cessive torque that is a result of the cantilever. Implant and Tooth+*etained.e0s o. Pra#ti#e in Re0ova1.y di. teet! to i0%. . 7s a #onse8uen#e. .ends itse. an o##.i0ited at %resent.usion 1et4een a 0u#osa su%%orted u%%er #o0%. it is 4ide. >o.oad is de%endant u%on t!e . Man!ei0.or#e to t!e su%%orting i0%.d 1e a rigid .ess t!an idea. su%%orting toot! !as 1een re%orted 4!en CMST i0%.or0 o. t!e se#tion on Good @##.ixed 1ridge t!at is su%%orted in t!is 4ay is t!at t!e 1ridge 4ou.ants s!ou.y di.ant syste0 <3RC7D6J+ 7G. o4ever. Ger0any= %ossesses a #o0%ressi1.erent atta#!0ents to 1one..e Prost!odonti#s=.i# eviden#e . In addition1 is advisa-le to prescri-e sli"htly "reater freedom in centric occlusion than for natural anterior teeth... Sin#e t!e atta#!0ents o.ete denture are dis#ussed under >Je4 #o01ination syndro0e? <Se#tion 3/<iii= o.ants to su%%ort a .37 Ct !as 1een suggested t!at t!is >stress91rea$ing? .erent.ative.ixed 1ridges. designing an o##.ants.3( 7.ixed %rost!eses su%%orted 1y teet! and i0%. teet! are used to su%%ort .usa.ant<s= to 1e :oined to a re.ated #onsidera1.in$ 1et4een t4o tota. o##.ar %ro1.t to design an idea. )i edprosthesis +!e #on#e%t o. sin#e it re8uires rigid 1one9an#!ored i0%.in$ing teet! to i0%.in$ing natura.ever1 in vie.or t!is is .e de1ate and resear#!.d 1e avoided 4!enever %ossi1.ete denture and an i0%. teet! and i0%.ant retained .ennedy <lass I= -rid"e must provide an appropriate anterior "uidance . intrusion o. Rea#tion to o##. of the "enerally softer -one in the ma+illa than in the mandi-le1 si+ implants .e.ants are so di.eature .ant.ould -e prefera-le1 in order to reduce the functional load on each implant. to . #he occlusion recommended in either denture is fully -alanced lin"uali?ed occlusion.ants in #o01ination 4it! natura. . %onsiderations of %ase Planning .hich achieves posterior disclusion1 and a shallo.in$age 4it! natura. <..ixed 1ridge !as sti0u. t!e natura. teet!.usa. . =.edged t!at t!e s#ienti. (uideline: In the upper arch it is usual to use a minimum of four implants for denture retention and full palatal covera"e is employed for additional support and retention. +!e reason 4!y it is extre0e..e #o0%onent t!at redu#es t!e i0%a#t o.e0 o. anterior "uidance is recommended. Ct is 4ide. toot!.t!oug! t!is syste0 see0s to over#o0e t!e in!erent %ro1. Overdentures verdentures may -e used for -oth ma+illary and mandi-ular edentulous cases. In the mandi-le1 t.o4er #o0%. t!e atta#!0ent to 1one. the reaction to occlusal load is -ound to differ) and t!is #an !ave an adverse e. #he implant*supported .o implants may -e sufficient.y 0o1i. +!e CMST i0%.e natura.i#u.. In contrast1 the insertion of four to si+ anterior implants can easily and predicta-ly treat this situation.usa. .usion . +!e %arti#u.or a .y a#$no4.

or0 o.e.a1oratory te#!ni#ian and 0ay1e !ygienist and * or genera. di0ensions are .t . su%%ort it is extre0e.ations!i% 1et4een i0%. ridge9.. avai.ess t!e 0any di. 3=.y des#ri1ed 6D6/ %rin#i%.ant*1one t!at 4i.a%%ed .ations!i% to o##.erent ty%es and designs o.ata. Bot! are a sour#e o.ants are . ta1.usa. Presented 1e.es and t!eir re.oading <3ig.y in t!e .oading is to 1e avoided i. +!ese variations are not.oading and.ure.o4s t!e %revious. varia1.o. . 1ut a. o.3B9AB Jon9axia.es t!at exists 4it!in t!ese design o%tions e0%!asise t!e need .ant syste0s and t!e %ossi1i.u. %ra#titioner=. 1one aug0entation o. ridge .enge.+!e re. 1e #onstraints i0%osed 1y t!e %atient?s #ondition.e i0%. restorative dentist. t!e i0%. at a. 1one resor%tion is not on. #hese choices can only -e enjoyed -y patients of those dentists .or ea#! and every #ase. non9axia.y a%i#a. %ossi1.ations!i% 1et4een t!e o##..ity o. Ridge "a%%ing +!e %attern o.. treat0ent %.y. to t!e %osition Cdea. t!e o##.or t!e i0%.o4 are so0e o.. . %rost!eses. t!e re. Restoration 1y t!e %rovision o.ant is . siQe and orientation o.y ris$ i0%.ro0 extending t!e %rost!eses 1eyond 4!ere t!e i0%.y t!e 8uantity and ar#!ite#ture o.usa. +!e %ro#ess .evered .usion and t!e i0%.arge nu01er o.ixed %rost!eses <3ig.ear.y to 1e %a.ant su%%orted %rost!esis %resents a #!a. . 4it!out .i$e.ho plan ahead.in$ed to non9axia. t!e 1one.er #onsidera1.anning and #o00uni#ation 4it!in t!e treat0ent tea0 <surgeon.. i0%.a1. %osition. Jevert!e. t!e #onsidera1. %otentia. *elationship Between Occlusal Table and Implant Diameter /anti.ingua.ini#ian !as t!e o%%ortunity to5 • • • De#ide t!e siQe and s!a%e o.ant . So an i0%..usion.. 1e#ause t!e #.ants Modi.1=. t!e varia1.e /!oose t!e nu01er. 0. #ourse.ai. t!ere.y i0%ortant.ant dia0eter and o##.ant to su%%ort aest!eti# #ro4n .i0it and t!ere 4i.or #are.. /.e #!oi#e . A and 2a..o#ated or arise 0ore su1t.or0 .e.. +!is .e nu01er o.or#es 0ay resu.so . .ore. denta.

4!i#! 4ou. t!e ridge.ting in ex#essive ridge . +!ere is a tenden#y.or aest!eti# reasons= .d a. t!ere.a%%ingU +!e danger o. t!e 0issing toot!. Resor1ed ridge .ore.ant in a %osition t!at is .a%%ing <. over.a1ia. #anti. a .ant. en#e Uridge .a1ia.ever on t!e i0%.or0 resu. to t!e i0%.a#e0ent o.ant 4i.ant ie t!e i0%.a%%ing is t!at it is... in e.a% t!e .. ridge . to %.o4 t!e 0ost aest!eti# re%.a1ia.e#t. 1order o.a#e t!e #ro4n onto t!e i0%.

to t!e %osition o. gingivae. t!e 0ost aest!eti# %..ant and 0ay a.or#e on t!e i0%.ata. to t!e i0%.us in a %a.Cn t!is exa0%.ure.a#e0ent o. t!e 0argina.usa. 4!i#! !as 1een restri#ted 1y t!e resor%tion o.a00ation o. /ro4n Bone C0%. +!is 0ay 1e detri0enta.a1ia.ant.veo. dire#tion.ts in a #anti.ant . t!e #ro4n is . t!e a.so 1e asso#iated 4it! in.e. +!is resu. i0%.evered o##. .ant and #ause .ai.

t <see 3ig. t!e i0%.ant to 1e inserted.ai.ini#a.y .ution 0ay 1e5 o o Jot on.an#ed o##. 4as su%%orting an o##.ant t!at su%%orting #ro4n 4it! ex#essive 1u##a. t!e ridge is narro4..usion 4it! . Aa9# C.es and . a nor0a. ang.ant is inserted 1e. Ideal Occlusal 5orphology Provide an Occlusion >hich is? o Ba. 21 Dista.e 4it! a #anti. #anti. . ta1. vie4 o.so a narro4 #ro4n Bone aug0entation or 1one 0ani%u.ant. 1ut a.o4 #us%a. #ro4n . resor%tion. vie4 o..ore verti#a.3ig. resu. 1..o4 a 4ider i0%. C.usa.usion o . 1one . t!e so.y t!is i0%.ig!t dista.i0entary to t!e existing o##.ever.engt! 4i. 'a= 3ig.ai. -nsur%rising.ever dra0ati#a.oss !as o##urred. #. 1e#ause o. 2a Bu##a.y a narro4 i0%.ant s.ation.usionA1 /o0%.ant 3ig. to a.reedo0 in #entri# o##.ed i0%.ed. t!e sa0e i0%.

#ro4n*i0%.d 1e #onsidered.ant and t!e o##..ant o%tion needs to 1e #onsidered 1e.i#ations 4!i#! are .ant ratio.ine is t!e 1one .y .hen anatomically possi-le. 3ig.o o 7#!ieva1. @n#e t!e i0%...oading i0%. 1one . 1one .ant %.ess ..ined #onta#ts and %osterior inter.e#t i0%. ear. 1e#o0e %rogressive.usion 0ay 1e easiest= 3ree o.ter extra#tion in t!e a1sen#e o.oss.y i0%.ant to #ro4n ratio 1e#o0es %rogressive.oss t!e i0%.ustration o. a toot!.ayed i0%.i$e.oading 1ut a.y 4orse <. 152 is idea.ant insertion <at ' to 12 4ee$s a. <Ye.ost is re#o00ended. :.ore t!e extra#tion o.usa. t!ere are no %u1. a #ro4n . not :ust in ter0s o. !o4 t!e i0%..engt! to i0%.. %.e ter0s.e %rost!esis s!ou.engt! ratio o.ant su##ess rates.t!oug! t!e re.ant#ro4n ratio 4i.ant9#ro4n ratio a%%roa#!es 151 a re0ova1. 1one !eig!t !as 1een . 3ith si"nificant vertical -one loss1 a fi+ed prosthesis may not -e feasi-le unless pre* . Dit! in#reasing verti#a.ts and !ygiene 0aintenan#e. 0argin= (uideline: 0a+imise the implant to cro.e <. 7.e <3ig. t!is 0eans t!at t!e i0%.or#es <ie no in#.ogy= usua.a#e0ent 1e. aest!eti# resu. The &ignificance of Implant 8ength+%rown 8ength *atio Cn si0%.ingua.oading and aest!eti#s= 4it! in#reasing verti#a.y .so in ter0s o. t!e i0%.eve. and t!e red .ane !as o1vious . C00ediate. . .is!ed studies in t!is area. any non9axia.o4 . 1one %at!o.ised o##.y to a.itates t!e o%ti0a. Cn %ra#ti#e. 'a9#=.ore verti#a.avoura1. 'a9# C.n ratio . or de.eren#es=.a#i.ations!i% 1et4een t!e !ead o.ine is t!e gingiva.ant . +o a#!ieve t!is.

.a%%ing to avoid nonaxia. +!is e.ity o.usa..d 1e designed not to over. %hec/ /. an i0%. .e s!ou.e#t 0ig!t 1e %er0anent or te0%orary.ants %.ant treat0ent +!e o##.y.ant Provide a verti#a. 1one 0ust 1e %resent to su%%ort and integrate 4it! t!e i0%..y to 4it!stand o##.e#t t!e 4idest dia0eter i0%.oads at t!e 1a#$ o. a suita1.e autogenous 1one 4it! no aug0entation is t!e >go..y in#reases to4ards t!e 1a#$= Vua.ant . <.. (uideline: #he a-ility of the implant -ed to support occlusal load is dependant upon: o o Site <o##. .a #an 1e ex%e#ted to s!o4 .oad t!e 1one9 i0%.usa.or osseointegration to o##ur %redi#ta1.ant inter.1H. or a1andoning i0%.ess o. Design .oad %otentia..oading Cn narro4 ridges #onsider a re0ova1.e 4it! no ridge .it 0ust 1e a#!ieved 1et4een t!e 1one and t!e i0%. . The &ite and 3ature of the Implant Bed Ct is $no4n t!at .y !ig!er o##.a#e   o 7 %re#ise surgi#a. de%ending u%on t!e 0ateria.a#ed into t!e %osterior 0axi. 4it! a%%ro%riate sur.amine D .y #ertain #onditions 0ust 1e 0et5 o o +!e i0%. studies and ex%erien#e !ave s!o4n t!at i0%. e0ergen#e %ro.usa.ant 0ust #onsist o. . .usa.oad. 68ua.e 1io0ateria.i. .a#ed 1y vita.ant site t!at !as 1een aug0ented <regard. or te#!ni8ue used= #an 1e ex%e#ted to %ossess a redu#ed a1i. .ant &ummary of Occlusal Guidelines?   Se. t!e 0out!.e %rost!esis.a#e %ro%erties 7de8uate vita.. ta1.d standard?=.implant -one "raftin" is accepta-le to re*esta-lish favoura-le inter*arch vertical relationships. .ity o. t!e 0ateria. to 1ond 4it! or 1e#o0e re%.A2 t!is 0ay 1e #aused 1y t!e %otentia. su%%orting 1one <sta1.o4er su##ess rates. ridge aug0entation.ity initia.ecute % . 1one. t!at 0ateria. used and t!e a1i.ini#a..

t!e stages . #he provision of any treatment that has the potential to chan"e the occlusion any. The Importance of 5onitoring of Occlusal 8oad Sin#e osseointegrated i0%.ants is 4e.aid out 1e.e i. in#. 7=.atory syste0 <+MJ. t!e nature o. A3 3ig.usion= is needed to diagnose any %re9existing +MD. E+amination 7 s!ort exa0ination o.usa. Six years o.. . 71= 4!i#! 4as 0ade at t!e sa0e ti0e. a note 4ou.ants re8uire . (uideline: Re"ularly evaluate the occlusal relationships of the implant supported prosthesis $at short intervals1 typically 4@5 months'..ude any signs o. 0any . o.ar.ations!i%s #an #!ange as a resu. teet! or i0%.usion %rovided 1y a %rost!esis su%%orted 1y i0%. #ases 4i..ines to ensure t!at t!e o##. 0us#.o%ing and #!ee$ ridging=. #onta#ts and re.erated 1y t!e %atient. o4ever.ants.ants #annot 0ove 1y nature o. )ccurate occlusal records of the startin" point are e+tremely helpful. 7 Prost!esis 4ear. t!eir re. an a#tive %ara. . Pre+Treatment . and 0u#osa.d 1e 0ade o. t!ere is a #onsidera1.ant su%%orted denture.t o.=.e te0%tation to #onsider t!at restored i0%.. Cn %arti#u.es. need a.un#tion <tongue s#a. any 0onitoring. /o0%are t!e 4orn denture <3ig.a#tors in#.ations!i% 4it! 1one.uding toot! and %rost!esis 4ear <3ig.oss o. +!ese stages are %resented as guide. use !ave severe. atro%!y. t!e %atient?s arti#u.here in the mouth should -e the tri""er to check the occlusion of an implant supported prosthesis.y 4orn t!is i0%.itt.amination and %ase #>or/ @p$ Jot a... +!is 4i. o##. to. 7a= against t!e s%are denture <3ig. o##.o4.

7 8ua. "o#a. 0a$e it 0u#! si0%.ina.ator a.an t!e eventua. +!res!o. t!e %rost!esis and t!e o##. '. t!e i0%. R.usa. s#!e0e ) dia"nostic .y .er B. a. t!e edentu.antsu%%orted %rost!eses and teet! regarding %assive t!res!o. axons in t!e %erii0%. Be.ter . Ro#$.ant region 1y i00uno!isto#!e0istry. o1:e#tives o.ised ridge aug0entation using guided 1one regeneration 1.y a surgi#a. . 2. o1:e#tives o..u. Int A ral 0a+illofac Implants 1HH3) (5 2AH9 22A. in.et a. .int. endosseous i0%.ant treat0ent is 1eing #onsidered.ants in t!e treat0ent o.% t!e restorative #. Int A ral !ur" 1H(1) 1B5 3(79A1'. Cnt A Beriod C Rest Dent 1HH3) 135 2H9A2 2. %ro#edure in t!e 0axi.i#ation o. /o0%arison 1et4een i0%. Du..itative and 8uantitative assess0ent o.usa. treat0ent. it e01odies t!e %rin#i%.an is %ara0ount.a &.so 1e an aid in t!e #onstru#tion o.a#i.a+*up or %re9i0%.any eviden#e t!at o##.er to exa0ine t!e existing o##. t!e %otentia.. Deiner S. <lin ral Implants Res 1HH2) '5 (39HB. surgi#a. A.e / . Ja#o1s R.ore t!e surgi#a..es t!e idea.. great. 7de. Buser D.ants and natura.. t!e a.uen#e t!e ty%e o. Cdenti.ar 1ed= 1e deter0ined 1y t!e aest!eti# and o##.e sensitivity %er#eived 4it! denta.e t!at it #an %rovide. a00er. Dagner D.e J ".a#tors #ontri1uted to t!e .ter t!e treat0ent %.. a%%oint0ent and 1y .. <ase ‘3ork 8p$ !tudy models 0ounted on a se0i9ad:usta1. Cts use is 0ore t!an si0%.veo. Doy. Bragger . 7 129year study o.d a. 1.eve. Int A ral 0a+illofac Implants 1HH2) 1B5 '(H9 'H2.0 -. Brane0ar$ P C. restorations.e t!at t!e %osition o.or t!e %eriodonta.ser -. %!ase o.d <4it!in t!e %!ysi#a. osseointegrated i0%. @sseointegration5 a re8uie0 .. Bert!o. Brunner M. %osition o.itate t!e #onstru#tion o.. Pra#ti#e in 7dvan#ed Restorative Dentistry= 4i. irt P. i0%.. teet! . Surgi#a.usa.oss o. 3.ised at t!e surgi#a.ein M. teet!.ini#ian and t!e . t!e .uding t!e aest!eti# and o##. t!e i0%.ants to 1e visua.a#tors in#. aid. "e$!o.ant diagnosti# %rost!esis 4i. #onstraints o. !e. ta1. &.d o. van Steen1erg!e D.ant 1ed 4i. .usion and to design an a%%ro%riate o##. any te0%orary or %rovisiona.usa. ) sur"ical stent is a devi#e t!at ena1.usa. t!e treat0ent %.y.e t!at t!e %osition o. 7 diagnosti# 4ax u% <see se#tion on Good @##.d .iga0entR Int A Beriod C Rest Dent 1HH1) 115 ((9H1.ants 4i.or 4!i#! i0%. 1e deter0ined 1e.a1oratory te#!ni#ian %.e arti#u. Ct 4i. s%. %rost!esis.a#e1o4 re#ord 4i. +!e %rin#i%.d . a use.a. t!e i0%.usa. +!is #ou.ants s!ou.an #onsidera1. Sar1 G.ous :a4. restorations. ta#ti.

ous :a4s5 a 1B9year %ros%e#tive 0u. 3ood9!o.inger G J. i0%. "i. H. enry P.ar .a5 a 129year retros%e#tive study. "e$!o.ants5 a revie4 and %ro%osed #riteria o.i#a#y o. Gronda!.o /. 11.. / J. A ral 0a+illofac !ur" 1HH() 2'5 13B39 1311. o. 7 #o0%arison o. Meri#s$e9Stern R.ysis and #. 17.ixed %rost!esis an#!orage.or t!eir use...0 -. su##ess. &e.e ana.ogi#. Do. dentures su%%orted 1y 7stra +e#! denta.ti#enter retros%e#tive re%ort o. 12.ding and 1iting 1e!avior in !u0an su1:e#ts .. 3a!raeus J. Sinus .e ta1.erent sur. Cn. &. Rund#rantQ +.ary antra. Bergstro0 /. @. A Dent Res 1HH() 775 27A92(2. +ru. 1(.ants.ini#a. Int A ral 0a+illofac Implants 1HHH) 1A5 17391(B. t!e Brane0ar$ i0%. Cvano.ants in edentu. re%ort. Se#ond 7na.ing a1ut0ents in. Int A Beriodontics Restorative Dent 1HH() 1(5 22(9 2A3. A ral 0a+illofac Implants 1HHH) 1A5 '3H9 'A2. Bergstro0 /. variations in i0%. Sar1 G 7.uation o. Gunne J. Rave! J. Int A ral 0a+illofac Implants 1HHH) 1A5 (239(2(.ado J R et a. in.ants su%%orting %rost!eses a.ants5 a #ase . van Steen1erg!e D Cnt Surviva.ary i0%.ti#enter study.uen#e o. "it!ner B. Rosen P S.ti#enter study.y used denta.ay autogenous 1one gra... ora. Int A ral 0a+illofac Implants 1HHH) 1A5 '739'(B. .ixed %artia.a#e textures. Do !ea.ysis.y treated %atients. Dort!ington P. !isto. Part 2 o.. i0%.ous ar#!es .. +arno4 D P.evation using anorgani# 1ovine 1one 0atrix <@steoGra. Su00ers R.sson -. #onse#utive.. #o0%ro0ised 0axi. Morris 3. 1A.. Ba.ants 4it! di. +o. Da.ini#a..s!i S 3. A Brosthet Dent 1HH() (B5 1H391H(. Int A ral 0a+illofac Implants 1HHH) 1A5 3H(9AB' 13. Int A ral 0a+illofac !ur" 1H(') 15 11922..0an D 6.ant treat0entR 7 t!ree9year 0u.s!i + J.ant in %artia.ini#a.ignant tu0ors. /!o S /. Marine.er 6 6.ary and 0andi1u.0an @. @#!i S ydroxya%atite#oated i0%.or .. 0a. Maxi. Got.. and !isto0or%!o0etri# ana. 6ri$sson 7 R.ysis o.ter rese#tion o.oor e. i0%.1re$tsson +.t re#onstru#tion o.9nasa. &ar...evation te#!ni8ue5 0u. Gunne S. 6#$ert S 6.*J= 4it! and 4it!out autogenous 1one5 a #. 1B. 1'. &:e. Ro!rer M D. Perren R.ant dia0eters5 a 39 to 29year retros%e#tive #. "inden -. +!e .. #urrent. i0%. (. an ongoing %ros%e#tive study.sson / 7 29 year re%ort on 0axi.ong9ter0 e..sson M.. Int A ral 0a+illofac Implants 1HHH) 1A5 7B79721. 7. radiogra%!i#. Me. 32' %terygo0axi. re#e%tors. Ba. +!e 1one9added osteoto0e sinus .0 -. <lin ral Implants Res 1HH() H5 23292A2. eva. Senner1y ".a#e S S. 3rou0 S J.y edentu. 2 i0%. "e$!o.7.uen#e t!e out#o0e o.oor e. igu#!i &..redsen &. Datson R.a#$ing %eriodonta. 12.

Pa. +so. Csidor 3.a# C0%.1H.Jorton Denta. Ba!at @. +!o0sen P. Pa.ation.. Cn +rot0an / 7.ants5 . sing. 33.ants 1HH') 115 37H9 3('. Cnt J @ra.ai. 6s%osito M.ants.a%atite #oated endosseous denta.ai. A Ir Dent )ssoc 1HHH) A25 AA921.ants5 a revie4 o. Sur. 32.ants in t!e %osterior :a45 a #. 6s%osito M. Je40an 1H(( Je40an M J. 2H. 7nn 7r1or5 -niversity o. /!a%0an R J. e. Mu. PrysQ. 23.ant asso#iated 0i#ro1iota. +ins. +reat0ent out#o0es in i0%.1HH2. +!o0sen P. A Diomed 0ater Res 1HHH) A(5 22H92'(.uen#e o. Russe.ts o. one i0%.ures.ay S.e toot! !ydroxy.ant versus t4o re%. S%en#er P.e i0%.usa. Implant Dent 1HHH) (5 17391(2. 2A. 3.Dr Dent A 1HHH5 1(75 '239'2(.a#e ana. isto. Denta. 22. Re%. a %ros%e#tive study. diagnosis and treat0ent strategies .s!i + J.ants and dou1.erentia.e00ig 3 +. i0%.ures.0 -. 2(.ini#a. 1st ed.. Int A ral 0a+illofac Implants 1HHH) 1A 5 A739AHB.ert R M. i0%.ants and i0%. 6s%osito M.ing ora..ogi#a.ysis o.our9 year %rost!odonti# resu. In M.or #. 31. @gden 7 R.ant 1one at i0%. re%ort. i0%. 6ri#son " 6.ant .y ora.s0an M. t!e . Di.. 27. registries. 22. "ondon5 Vuintessen#e Pu1.ini#a.a#ing a sing. surgi#a. Int A ral 0a+illofac Implants 1HHH) 1A5 7H(9(1B. Int A Brosthodont 1HH2) (5 273927H.oad or %. o4e ".a$ M /.o. "e$!o.ai. Dr Dent A 1HHH) 1(75 HB9HA. irs#! J M.ai.tu 7.ar.i#ations and 0aintenan#e. irs#! J.ogi# #o0%. Maxi..a8ue a##u0u. and %rost!odonti# ex%erien#e. Mi#!igan. +!o0sen P.ant .is!ing /o "td.ants. Preis$e.0er R. ande. Implants: a "uide for the "eneral practitioner. -se o.e 0o. Rangert B 7 #o0%arative study o. /o0%. D. i0%.ogi# o1servations on ear.ed ora. implants failE Bart I.itation. Ba.uation o. titaniu0 i0%. @sseointegrated i0%.0 -. Me. 4ide i0%. Gri.0er P.i#ations and . #onsiderations o.in + D!y do denta. 7s$ary 7 S.a#ing %osterior teet! 4it! . +!e #ase . Deyant R J.ants su1:e#ted to o##. %erii0%.iterature. Davison 6 M. 3B. "e$!o.or 1io. @?Ma!ony 7. 2B. .reestanding i0%. Periodonta. 27. eva. 2'.$a P. A )m Dent )ssoc 1HH() 12H 5 1BH7911B2. i0%. 21.ey D. A Dent Educ 1H(() 225 737. Int A ral 0a+illofac Implants 1HH') 115 372937(. 7 39 to A9 year study o. <lin ral Implants Res 1HH7) (5 19H.. M#Ja0ara J 7. "aus0aa J. Datson / J. . M Jorton.ant t!era%y5 t!e in. %% (191BA. <eds= rthodontic treatment: outcome and effectiveness.ants5 Part 1B. over. ernandeQ R 6. Mu. J ". 3ixed 1ridge re!a1i. 1st ed %% 31H93A3. isto%at!o.

&ruger B.y an into.e toot! re%.ant . Sout!ard + 6.uen#e o.e nu01er o. "ingua. 3'. Ber0an / ".usa.or#es trans. Int A Brosthodont 1HH() 115 229'H.ant s!o#$ a1sor1er. Int A ral 0a+illofac Implants 1HHB) 25 3'H937A.erred to i0%.usion o. "und P S.ant %rost!esis during #anti.ants in ty%e CL 1one5 a 29year ana. i0%.iQed o##. &au$inen J 7. a1ut0ent site o.or#es #!ange in i0%. t!e %atient invo. anato0y. o##. o4 o##. ti0es to %ara.ingua. 2. 3.oading using a 0odi..or#es 4it! a resi. A Brosthodont 1HH3 ) 25 H391B2.e.ant*%rost!esis 4it! staggered 1u##a.in R 7. . t4o di0ensiona.ixed 0andi1u. resear#! re%ort.ino S 7. '.un#tion on it. A )m Dent )ssoc 1HH2) 12'5 113B91133.ore any treat0ent is started. @ester. 7 si0%. ReitQ J L.y 1ad o##. +!e ex#essive .y !ar0.usa. . re#ording t!e %atientUs o##.ever . S#!4artQ97rad D.atory syste0. /!a%0an R J. AB. +!e %atient?s o##. A.ants5 a survey. Dein1erg " 7. tor8ue <0o0ent= on i0%.usa. 3(. Jatura.usion s!ou.u. a . %ra#ti#e. a restoration does not !ave %otentia.. &irs#! 7 Lariations in o##.ient interna. #onta#t. on.. Fuintessence Int 1HHA) 225 17791(B. A3. 3H.oss o. 37.ated 0asti#atory . .. 7( i0%. Ja.est 4ay o. A1.3A. 0eans o. A2. strain at t!e ter0ina.e " J. o. design on si0u. +!e exa0ination o. ensuring t!at t!e o##.ar i0%. RodrigueQ 7 M. and . Int A Beriodont Restor Dent 1HH') 1'5 2229 2'2.usa. tissues and arti#u.ied #entri# o##.usion against t!e 1en#!0ar$ o. %eriodonta. 7n eva. Ryt!er J S. 6dge M J. i0%.uation o. +!e in. during and a.usion in i0%.ant dentistry. #onse8uen#es. Sa0et J. Int A ral 0a+illofac Implants 1HH() 135 2279231. idea. A Beriodontol 1HHH) 7B5 AAH9A2A.usa. Dario " J.era1. Dein1erg " 7 Redu#tion o.ves t!e teet!. 1e.ant %atients5 a #. 78ui.ter treat0ent is an aid to good o##.set. The %ompleted 8ist of Guidelines of Good Occlusal Practice 1. +!e #on. toot! intrusion %!eno0enon 4it! i0%.oading. "ang B R.ysis. Brane0ar$ i0%. A Beriodontol 1HH1) '25 29A. Gar#ia " +. 6va. +!ere is no su#! t!ing as an intrinsi#a.usion 1e. /o0%are t!e %atient?s o##. Sing.ants.usa.ini#a.uation o.ars5 a retros%e#tive study o. 32.usion.ant9retained %rost!eses and su%%orting 1one..a#e0ent o. 0issing 0o. A Brosthet Dent 1HH') 7'5 2B922.ore.or0ative a%%roa#! is t!e sa. 2.d 1e re#orded. o##.

Britis! Denta. exe#ution and #!e#$ing <6D6/= (.d not 1e an out#o0e o. ort!odonti# treat0ent is not #.? o##. 7n >idea.ude5 t!e dyna0i# o##.ities o.ore i0%. +!e >reorganised a%%roa#!? invo. Journa. exa0ination.d in#.d 1e %.usion o.o%ing o##. osseointegration 17.or0s <to t!e %atient?s %re9treat0ent state= is a %rodu#t o..ations!i% in 4!i#! t!e %atient !as #entri# o##. +!e o##. t!e deve.a#e . DateWWWWWWW .a#e . Dento9a.usion in t!e %atient?s %retreat0ent teet! or %rovisiona.ant su%%orted restoration needs to ta$e a##ount o.e %rost!odonti#s is one 4!i#! redu#ed de9 sta1i.usion and #entri# re.usa.usion #on.or0ative a%%roa#!? H. t!e da0aged %eriodontia 13.u0eWW. 6nsuring t!at t!e o##. Jo. %res#ri%tion o.y #o0%ro0ised teet! s!ou. 1A.anned 1e.a#ed Re%rinted 4it! %er0ission. t!e . #onse8uentia. t!e >#on.arge dis#re%an#y 1et4een #entri# o##.y t!e esta1.ear.ants are %. 1ut e. t!e o##. 1ut a ... 12. +!e o##.dren is deter0ined 1y t!e needs o.usa. a >0ore idea.or#es to 1e 4it!in t!e ada%tive #a%a1i. toot! sur. Jot a.e#tive 0onitoring is essentia.veo.ising .usion..usion? in re0ova1. Good o##.d 1e designed to redu#e t!e . #osts? 0ay not 1e t!e 1est %o.ves . 7n >ort!odonti#? exa0ination o.usion s!ou. design.y >restoration at a.oss. treat0ent 11.i#y. +!e o##. o##. %ra#ti#e in #!i.usion) and t!e :a4 re. Lo. %eriodonta.usion 12.usa. restorations) and t!en ad!ering to t!at design using t!e te#!ni8ues o. o1:e#tive o.eatures o. +!e o##. 1'.is!0ent o.ten o##ured in %atients exi1iting 0ar$ed toot! sur.ar #o0%ensation !as o.7.oss needs treat0ent..WWW.or#es 1B.irst. an i0%.ation s!ou.usion s!ou.