In the edentulous upper jaw the placement of implants can be challenging due to limited bone quantity and the presence of the maxillary sinus. Pterygoid implants present an alternative option to use residual bone for implant anchorage and to overcome the need for...
Zygomatic implants have been documented as a an alternative for the rehabilitation of the atrophic posterior maxilla with both the classical two stage and immediate loading protocols. Zygomatic implants avoid grafting and sinus lift procedures and therefore contribut
Less than 4-6 mm of vertical residual bone height in the posterior segment of the maxilla is an indication for a sinus augmentation procedure [Esposito]. The external access to the maxillary sinus is carried out at a lateral buccal alveolar...
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...
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...
Hand-made templates are duplicates obtained from the denture/tooth arrangement with access holes or titanium tubes. These are located in the correct positions and axes of the planned prosthetic teeth according to the CBCT a...
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...
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...
In the edentulous lower jaw implant insertion can be limited due to bone resorption processes and the resulting superficial alveolar nerve topography. In the anterior region less than 5-6 mm in height and 6 mm in width requires bone grafting before implant placement...
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...
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
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...
With appropriate pre-drilling based on their shape upon insertion into the bone, tapered implants will achieve a gradually increasing contact pressure with the surrounding bone and thus provide a high primary stability. This primary...
Accurate implant planning is the first step to achieve an optimum prosthetic result. Well-fitting, well-designed dentures can directly be used for planning and pre-surgical analysis or a new tooth arrangement and mock-up have to be considered...
Emerging techniques in dental implant surgery are trending towards one-stage procedures and immediate function and therefore require a high level of primary stability of the implant. In order to implement the most appropriate drilling protocol based on bone...