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Edentulous

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Treatment guidelines

Anatomical location

Oral implants are usually placed in the mandibular and maxillary bone and sometimes in additional bone structures such as the zygomatic, pterygoid or vomer bone. In order to identify relevant anatomical structures, diagnostic evaluation of the anatomy...

Edentulous

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Treatment guidelines

Overarching considerations

The primary goal is a proper oral function. This implies not only chewing but also speaking, smiling. Patients’ adaptability varies enormously. Some are satisfied with removable dentures, others object to the esthetics of...

Edentulous

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Treatment guidelines

Primary splinting

Implant supported overdentures are an evidence-based treatment option for edentulous patients leading to a significantly increased quality of life.
There are various retention elements available which connect the implants directly...

Edentulous

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Treatment guidelines

Secondary splinting

Implant overdentures are an excellent treatment option for edentulous patients and lead to significant improvement of quality of life. There are various options for their retention mechanism...

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Edentulous

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Treatment guidelines

Digital treatment planning protocols, introduction

Spiral or Cone Beam CT (CBCT) data sets of the patient jaw bones and of the scan template are transcoded by a specific software to produce three-dimensional (3-D) images of the jaw bones and thickness of the mucosa. Software planning... 

Edentulous

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Treatment guidelines

Implant placement with open flap procedure - mandible

The surgeon should be standing or be seated behind the supine patient. Bilateral truncular anesthesia is needed. The incision can be crestal or at a distance in the labial fold. Presence of keratinized tissue both labially and palatally should...

Edentulous

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Treatment guidelines

Implant placement - maxilla

Incision can be made either on top of the crest or at some distance in the labial fold. The outcome for both approaches seems comparable. A sagittal release incision at the midline eases the reflection of the labial mucoperiosteum. It is logical to try to achieve...

Edentulous

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Treatment guidelines

Number of implants maxilla and mandible

The tradition to insert 6 implants, and eventually more, in an arch-wide pattern dates back to the early days of osseointegration when implants with a machined surface were used and risk for early...

Edentulous

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Treatment guidelines

Direct to implant vs. abutment

Advantages of abutment-supported prostheses are 1) When implants are not parallel to each other, the use of angulated abutments can "correct" for the non-parallelism 2) Angulated abutments are available for a screw-retained prosthesis and 3) Custom abutments can be...

Edentulous

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Treatment guidelines

Placement of implants - Torque

Insertion torque represents the resistance of bone during implant placement. Since too low a torque corresponds to low initial mechanical implant stability and too high torque levels lead to avascular periimplant bone...

Edentulous

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Treatment guidelines

Choice of implant

The majority of commercially available implants are variations of Brånemark’s original design of a screw which he coined as 'fixtures'. This has been the starting point for numerous current market variations that incorporate convergent themes of implant material...

Edentulous

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Treatment guidelines

Crestal/paracrestal Incision

Any intra-oral surgical intervention begins with the incision and finishes with a suture or gluing. Indications for a crestal incision include one-stage surgeries where the implant or abutment is non-submerged and is piercing into the oral...

Edentulous

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Treatment guidelines

Anesthesia

The choice of anesthesia depends on many variables including the complexity of treatment, duration of treatment, need for patient awareness and the response during treatment, only to name a few. In general, the clinician and patient should discuss the...

Edentulous

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Treatment guidelines

Soft tissue and hard tissue

Removable prostheses should always be removed over night. Since the acrylic denture base is tightly covering the keratinised mucosa, it often leads to fungal/candida infections of the ginigiva under the prosthesis....

Edentulous

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Treatment guidelines

Biologic complications

This is the reversible inflammatory process in the soft tissues around functioning implants. Peri-implant mucositis occurs in almost 60% of subjects (± 30% of sites), restored with implants. Diagnosis is stated by clinical examination: redness, ...