AVAILABLE BONE

CONTENTS

 INTRODUCTION
 AVAILABLE BONE
 BONE HEIGHT
 BONE WIDTH
 BONE LENGTH
 BONE ANGULATION
 CROWN HEIGHT SPACE
 DIVISION OF BONE
 SUMMARY
 Introduction

 Long term success in implant dentistry requires

certain important criteria .There are more than 50
criteria that are required in treatment planning.

 Once the prosthodontic needs of the patient have

been determined,the most important criteria is the
available bone.
 AVAILABLE BONE

 Describes the external

architecture or the
quantity of bone present
in edentulous area
considered for implants
 AVAILABLE BONE

 1.5-2mm-Surgical error.

 Root form implants-width Diameter and

Mesiodistal length of available bone

 length of implant Height of bone available

 Implant width
 S=F/A

 0.25mm increase in diameter,5-8% surface area

increases.
 Increase in dia-less stress at crestal bone implant
interface.

 Implant Height
 Also affects total surface area.

 3mm longer implant 20-30% increase in surface area.

 Initial stability of implant

 It is measured in terms
of
 Bone height
 Bone width
 Bone length
 Bone angulation
 Crown-height space
 Available bone height

 Radiographic Evaluation-
OPG
 Anterior regions of jaws-
greatest height

 Maximum height-Maxilla and

mandible-sites

 The minimum bone height for

a predictable long term
endosteal implant survival is
12 mm.
 Skeletal relationships-Class 2 and class 3

 Posterior jaws –more limiting for implant height

 Suggested bone height -12mm

 Available bone height

 Dense bone may accommodate shorter implant but a

porous bone may require longer implant.

 More imp.as affects implant length and crown height.

 Once the minimum bone height is established width is

more important than additional height.
 Available bone width

 Measured between the

facial and lingual plates at
the crest .

 The crest is supported by

a wider base.

 Osteoplasty
 Exception-ant maxilla
 Available bone width

 Minimum bone width for

a 4mm root form implant
is more than 6 mm.

 Reduced width -narrower

diameter implant.

 Initial width of available

bone is related to crestal
bone loss,after loading.
 Available bone length

 The mesiodistal length

of bone in an
edentulous area is
-For a bone width of 5mm
limited by adjacent
the minimum length is
teeth or implant.
8mm.
 Implant - 1.5 mm
adjacent tooth and
 3mm from adjacent
implant
 Ideal implant width for single tooth or multiple
implants.

 Natural tooth being replaced

 Available bone angulation

 It represents the root  For narrower ridges

trajectory in relation to acceptable angulation is
occlusal plane. 20 degrees

 Acceptable bone
angulation depends on the
width of the ridge.

 For wider ridges bone

angulation can be as much
as 25 degrees .
 Ideally,angulation is:

 1.Perpendicular to occlusal forces.

 2.Aligned with forces of occlusion

 3.Parallel to long axis of prosthodontic restoration.

 Rarely bone angulation remains ideal.

 Mandibular Teeth: lingually inclined in posterior

region and labial inclination in anterior region.

 Anterior region in both jaws is usually deficient in

bone
 Posterior mandible –submandibular fossa dictates
angulation
 Crown-Height space
 Vertical distance from
the crest of the ridge to
the occlusal plane.
 Affects
 appearance ,
 amount of moment of
force on the implant and
surrounding crestal bone.
 Considered as a vertical
cantilever.
 Greater the CHS,greater
the moment of force,or
lever arm.
 Ideally,CHS should be
=,< 15mm.
 LEKHOLM and ZARB (1985)

 TYPE 1
 TYPE2
 TYPE3
 TYPE4
 Classification of available bone

 DIVISION A
 DIVISION B
 DIVISION C
 DIVISION D

Misch and Judy in 1985

 DIVISION A BONE

Consists of abundant bone in all directions

Dimensions
Width>6mm

Height>12mm

Length>7mm

Angulations<25 degrees

CHS < or =15mm

 DIVISION A BONE

 Treatment options
 Division A root forms or wider implants .

 All prosthetic options.

 Limited inter arch space. (High profile O-ring)

 Osteoplasty .
 Fixed Prosthetic options
FP-2

FP-1
FP-3 restoration in Div A bone
Removable prosthesis
 DIVISION B BONE

 Barely sufficient bone.

 Ridge width is reduced.

 M-D width of bone is less…so 3mm implants.

 DIVISION B BONE

 Dimensions
 Width 2.5mm-6mm
 B+ :4-6mm
 B-w:2.5-4mm

 Height> 12mm
 Length> 6mm
 Angulations <20 degrees
 CHS <15mm
 Treatment options

 3 Rx:-

1) Modify the narrower

div B bone to div A by
osteoplasty
 However after osteoplasty
the ridge height should
not become <10 mm
 And place division A root
form
 2) Narrow diameter
division B root form
 angulation <20
 available bone length
atleast 12mm to ensure
adequate surface area for
narrow diameter implants
 The design of prosthesis
also changes with
osteoplasty procedures.
 3) Ridge
augmentation
 In cases where osteoplasty
will result in ridge height
less than 10mm, ridge
augmentation instead
should be done.
Bone spreader-an
alternative
 DIVISION C(COMPROMISED BONE)

 Deficient in one or more dimensions

 Resorption first occurs in width .The bone is called

C-w

 Then in height. The bone is called C-h

 Posterior maxilla VS Anterior maxilla

 Posterior mandible VS anterior mandible.

Inform patient about bone loss
 Dimensions
unfavorable in
 Width (c-w) :0 to 2.5mm

 Height(c-h)-<12mm

 Angulation (c-a)>30 degrees

 CHS > 15mm

 Uncommon sub category
 C-a
 Avbl bone adequate in
height and width
 Angulation greater than
30 degree
 Treatment options

1)C-w ridge

a) Osteoplasty which
converts it to C-h ridge
type with adequate width

b) Bone augmentation can

be done
 Treatment options

 2)C-h ridge can be treated with

 a) Greater no of endosteal implants of reduced height.
 b) Ridge augmentationton to upgrade div C to div A
 c) Subperiosteal –Circumfrential and unilateral.
 Disk design implants
 DIVISION D (DEFICIENT BONE)

 Characterized by severe
atrophy of alveolar
process as well as basal
bone
 Basal bone loss:
 Flat maxilla
 Pencil-thin mandible

 CHS>20mm
 Treatment options

 Ridge augmentation is
the treatment of choice.  Fixed restorations X

 RP-5 not suggested.

 Complete implant
supported dentures
indicated
 90 percent of autogenous
graft resorbs in 5 years-
so not intended for
denture support.
 Chances of dental
cripple.
 Subperiosteal implants-the myth.

 If adequate bone present in mandibular anteriors

with D bone in posteriors-
 Root form implants.
 Tripodal sub-periosteal implants.
 Mandibular staple implants
 Ramus frame implants
 Summary

In implant dentistry prosthesis is designed at

onset of treatment to satisfy patients needs and
desires.

Bone is THE most critical criteria in

determining the success.
 References

 Misch 3rd edition

 Babbush:art and science