2 Implant (Final): IMPLANT-SUPPORTED FIXED RESTORATIONS

• preservation of tooth structure on the teeth adjacent to the edentulous

area

• avoiding tooth hypersensitivity that can accompany tooth preparation

• avoiding the potential need for root canal treatment when teeth are

prepared for fixed partial denture (11% may require RCT)

• improved access for oral hygiene

• enhanced gingival response

• fewer complications with single dental implants compared with fixed

partial dentures

Reasons for selecting a single implant crown over a 3-unit FPD:

true

t/f: The survival of three-unit TFDPs and ISCs over 15 years was not statistically different when replacing posterior teeth, but ISCs survived significantly better when replacing anterior teeth.

true

t/f: the complication rates between TFDPs and ISCs were similar

false

t/f: the economic burden between TFDPs and ISCs were similar

TFDPs

Which has the higher economic burden, TFDPs and ISCs?

retaining teeth through periodontal care

Which is more cost effective, retaining teeth through

periodontal care and both initial root canal treatment and root canal retreatment OR tooth extraction and rehabilitation with a single implant?

external abutment connection interface

A implant w/ a coronal surface w/ an external hexagon:

internal abutment connection interface

A implant w/ a coronal surface of the implant has a core that

is threaded or tapered or has a polygonal design:

engaging

refers to presence of anti-rotational features of the implantabutment connection mechanism:

false

t/f: multiple unit (splinted) restorations are at more risk than single unit restorations

internal or external

Today anti-rotational features can be either:

single tooth restorations

What type of restorations always require ENGAGING

(antirotational) connections?

abutment supported, cement retained FPD

ID the type of implant fixed partial denture:

abutment supported, screw retained FPD

ID the type of implant fixed partial denture:

implant supported, screw retained FPD

ID the type of implant fixed partial denture:

healing abutment

Implant component placed at stage-two surgery to guide

periodontal soft tissue healing prior to definitive prosthetic restoration:

non-anatomical

ID the type of healing abutment:

anatomical

ID the type of healing abutment:

impression coping

in traditional implant impressions, the implant location is picked up via _______

scan body

in digital implant impressions, the implant location is picked up via _______

impression coping

• any device that registers the position of the dental

implant or dental implant abutment relative to adjacent

structures;

• most such devices are indexed to assure reproducible

three dimensional location

closed tray / transfer technique

ID the technique:

closed tray / transfer technique

ID the technique:

open tray/ pick-up technique

ID the technique:

open tray/ pick-up technique

ID the technique:

closed tray / transfer technique

ID the technique on the patient's left:

open tray/ pick-up technique

ID the technique on the patient's right:

implant replica

ID the part:

implant replica/analog

-replica of the implant that is embedded in

the working cast

• has same platform and connection

mechanism as the implant

• used during fabrication of the implant

prosthesis

open tray/ pick-up technique

ID which technique the following quality belongs to:

• reduces the effect of the implant angulation

open tray/ pick-up technique

ID which technique the following quality belongs to:

-removes the concern for replacing the coping back into its respective space in the impression

open tray/ pick-up technique

ID which technique the following quality belongs to:

-there are more parts to control when

fastening

open tray/ pick-up technique

ID which technique the following quality belongs to:

-there may be some rotational movement of the impression coping when securing the implant analog

closed tray / transfer technique

ID which technique the following quality belongs to:

- better for pts with limited mouth opening

closed tray / transfer technique

ID which technique the following quality belongs to:

- better for pts w/ gag reflexes

• limited mouth opening

• gag reflex

• if impression of natural teeth are to be

made at the same time with the implant(s)

• less number of implants

What are some indications for the closed tray / transfer technique?

- 4 or more implants

- angulation over 15 degrees

What are some indications for the open tray/ pick-up technique?

open tray/ pick-up technique

Which impression technique should be used here?

open tray/ pick-up technique

An _________ will reduce the effect of

the implant angulation

verification jig/index

what can you use to verify the accuracy of a multiunit implant bridge?

verification jig/index

ID the method:

scan body

ID the part:

scan body

• serves the same purpose in digital design that the

impression coping serves in the traditional impression and

model technique

• all are secured on the implant with screws

Standard Tessalation Language

digital scans are read and stored in ______ format

Digital Imaging and Communication In Medicine

CBCTs are read and stored in ______ format

• Complete arch scans (particularly for mandible) may not be

possible or accurate

• Scans for removable prosthesis may not be possible or

accurate

• High initial/ acquisition cost

• Learning curve

What are some disadvantages of digital implant scans:

• Real-time imaging

• Easy repeatability

• Step-by-step imaging of relevant segments

• No need to disinfect and clean impressions or

impression trays

• Chairside analysis

• Rapid communication and availability

• Archivability

• Material savings

• Chairside CAD/CAM option

• Color selection

• Shorter over all treatment time

• More comfortable for the patient

• Easy bite registration

What are some advantages of digital implant scans:

engaging temporary abutment

ID the part:

non-engaging temporary abutment

ID the part:

- cement

- screw

What are the 2 types of retention for an implants

• in situations of minimal interarch space

• to avoid a cement margin and the possibility of cement residue

• when retrievability is of importance

• in the esthetic zone, to facilitate tissue contouring and

conditioning in the transition zone (emergence profile)

What are some indications for a screw retained implant:

• For short-span prostheses with margins at or above tissue level to simplify

fabrication procedures

• To enhance esthetics when the screw access hole is visible or in cases of

malposition of the implant

• When an intact occlusal surface is desirable

• To reduce initial treatment costs

What are some indications for a cement retained implant:

prefabricated abutment

this type of abutment is:

- frequently titanium

- mostly engaging

- mostly used for cement type

- less expensive

- measured from platform to gingival margin

prefabricated abutment

ID the part:

prefabricated abutment

_________abutments do not alter emergence profile, since

their cross section is round and the resulting tissue profile is

round.

custom abutment

this type of abutment is:

• most frequently for cement type restorations

• can be made of cast gold alloy, titanium or ceramic

• all should be 'engaging' type for single unit restorations

• more expensive than prefabricated cement type abutments

• better esthetics (emergence profile)

hybrid abutment

this type of abutment is an individually milled ceramic (lithium disilicate or Zr abutment) which is luted to the Ti base

-shape, emergence profile and esthetic properties of this

abutment can be ideally adjusted with the design software

Angulated screw channel (ASC)

• by Nobelbiocare in 2016

• TUSDM predoctoral clinic started 2019

• Only for conical implant abutment connection mechanism

• Ceramic restorations or abutments on titanium inserts

• Screw access hole can be up to 25 degree off long-axis

• Uses special screw and screw driver

Angulated screw channel (ASC)

ID the part:

screw-retained single unit restorations

ID the type of restoration:

Always

– secured directly onto the implant (implant supported)

– involve

• a CAD/CAM (Zr, Alumina, Lithium disilicate) or cast custom

abutment (Porcelain does not bond very well to Titanium)

• an engaging abutment

UCLA abutment

-Prosthetic implant component developed as a

plastic castable pattern that can be modified

by adding wax for custom shape and

dimensions (lost wax technique)

• This is a foundation for creating a cast-tocustom

option

• The component is screw retained directly into

the implant, which circumvents the

attachment screw.

implant-supported ceramic crown *monolithic

• combines abutment and

monolithic crown in one piece

• an efficient two-in-one solution

made of lithium disilicate or

zirconia which is directly luted to

a Ti base

• Good for non-esthetic areas for

patients who do not exhibit

parafunctional activity

Multiunit abutments

Used for splinted crowns or FPDs:

implant

Use ____ support if implants are <3 mm subgingival and parallel to each other

abutment

Use ____ support if implants are placed very subgingival and/or not parallel to each other

abutment

cement-retained multiple unit restorations are ALWAYS ________ supported

Position

Angulation

Interocclusal Distance

Tissue depth/Contour

What does PAIT stand for?

1. Make implant-level soft tissue cast

2. Mount cast

3. Cover implant with aluminum foil

4. Set up missing tooth to ideal form and position

5. Duplicate a wax up cast

6. Fabricate a clear thermoplastic template

7. Attach guide pin(s) to the implant

8. Retrofit and make access hole to facilitate

seating of the clear template

9. Use PAIT to analyze proper abutment selection

"PAIT" analysis using traditional workflow:

guide pin

-Type of laboratory screw used in the

fabrication of a prosthetic restoration.

• Surgical or restorative adjunctive marker used

to indicate implant angulation or location when

preparing osteotomy sites.

position

the location of the implant in relation to the intended prosthesis:

angulation

- B M L D divergence from the intended path of insertion:

interocclusal space

measure of the distance between the implant platform and the opposing tooth:

tissue depth/contour

measure the distance (BLMD) between the implant platform and the gingival margin:

tissue depth/contour

this PAIT feature determines the collar height of the abutment:

articulating paper (2 types)

-accufilm (thick)

- shimstock (thin)

What two materials should be used to check occlusion for an implant?

framework has to be tried in for passive fit

The Framework try-in/insertion sequence for a cement retained multiple unit implant is similar to single units cement-retained EXCEPT:

one-screw test "Sheffield Test"

By inserting a screw in one end of the

prosthesis and then observing whether the

prosthesis lifts off of other implant or abutment

platforms, the clinician can determine the

presence or absence of movement when that

single screw is tightened, either by clinical or

radiographic visualization of the prosthesis

access holes

Opening in a replacement

tooth's occlusal or lingual

surface of an implant-retained

prosthesis that provides

entrance for abutment or

prosthesis screw placement or

removal.

retrievability, avoid excess (residual) cement

when choosing cementation always think about:

subgingivally

Residual cement increased as margins were located more

____

true

t/f: At 2 - 3mm sugingival, residual cement is 10x as much as at 0 - 1mm