0 Patient Assessment
- 0.1 Patient demand
- 0.2 Overarching considerations
- 0.3 Local history
- 0.4 Anatomical location
- 0.5 General patient history
- 0.6 Risk assessment & special high risk categories
  - 5.1 Risk assessment & special high risk categories
  - 5.2 age
  - 5.3 Compliance
  - 5.4 Smoking
  - 5.5 Drug abuse
  - 5.6 Recreational drugs and alcohol abuse
  - 5.7 Parafunctions
  - 5.8 Diabetes
  - 5.9 Osteoporosis
  - 5.10 Coagulation disorders and anticoagulant therapy
  - 5.11 Steroids
  - 5.12 Bisphosphonates
  - 5.13 BRONJ / ARONJ
  - 5.14 Radiotherapy
  - 5.15 Risk factors
1 Diagnostics
- 1.1 Clinical Assessment
  - 0.1 Lip line
  - 0.2 Mouth opening
  - 0.3 Vertical dimension
  - 0.4 Maxillo-mandibular relationship
  - 0.5 TMD
  - 0.6 Existing prosthesis
  - 0.7 Muco-gingival junction
  - 0.8 Hyposalivation and Xerostomia
- 1.2 Clinical findings
  - 1.1 Occlusion
  - 1.2 Alveolar atrophy and insufficiency
  - 1.3 Skeletal consequences of edentulism
  - 1.4 Head-neck cancer
- 1.3 Clinical diagnostic assessments
  - 2.1 Microbiology
  - 2.2 Salivary output
- 1.4 Diagnostic imaging
  - 3.1 Imaging overview
  - 3.2 Intraoral radiographs
  - 3.3 Panoramic
  - 3.4 CBCT
  - 3.5 CT
- 1.5 Diagnostic prosthodontic guides
  - 4.1 Prosthodontic guides overview
  - 4.2 Wax-up, arrangement, mock-up
  - 4.3 Splints and imaging for surgery
  - 4.4 Provisionals
2 Treatment Options
- 2.1 Mucosally-supported
  - 0.1 Mucosally supported - Overview and important considerations
  - 0.2 Complete denture
  - 0.3 Immediate denture
  - 0.4 Occlusal schemes
- 2.2 Implant-retained/supported, general
  - 1.1 Prosthodontic options overview
  - 1.2 Number of implants maxilla and mandible
  - 1.3 Time to function
  - 1.4 Submerged or non-submerged
  - 1.5 Soft tissue management
  - 1.6 Hard tissue management, mandible
  - 1.7 Hard tissue management, maxilla
  - 1.8 Need for grafting
  - 1.9 Healed vs fresh extraction socket
  - 1.10 Digital treatment planning protocols
    
    9.1 Digital treatment planning protocols, introduction
    
    9.2 Digital treatment planning protocols, NobelClinician
- 2.3 Implant prosthetics - removable
  - 2.1 Implant overdenture, overview
    
    0.1 Implant overdenture, introduction
    
    0.2 Overdenture retention devices, overview
  - 2.2 Secondary splinting
  - 2.3 Primary splinting
- 2.4 Implant prosthetics - fixed
  - 3.1 Fixed implant prosthesis, introduction
  - 3.2 Screw-retained restorations
    
    1.1 Screw-retained
    
    1.2 Implant-supported vs abutment-supported
  - 3.3 Cement-retained restorations
    
    2.1 Cement-retained
    
    2.2 Abutment materials
  - 3.4 Framework materials
    
    3.1 Framework materials
    
    3.2 Veneering with ceramic
    
    3.3 Veneering with Acrylic
- 2.5 Comprehensive treatment concepts
3 Treatment Procedures
- 3.1 Surgical
  - 0.1 Surgical considerations
    
    0.1 Anesthesia
    
    0.2 Peri-operative care
    
    0.3 Post-operative care
    
    0.4 Flap-or flapless
    
    0.5 Wound closure
    
    0.6 Intra-operative complications
    
    0.7 Guided vs non-guided
    
    0.8 Semi-guided surgery with prosthetic template
    
    0.9 Guided surgery with drill guides
  - 0.2 Surgical protocols - general
    
    1.1 Crestal incision
    
    1.2 Choice of implant
    
    1.3 Parallel implant placement
    
    1.4 Tapered implant placement
    
    1.5 Insertion torque
    
    1.6 Insertion height
    
    1.7 Implant angulation
  - 0.3 Surgical protocols - mandible
    
    2.1 Implant placement with open flap procedure - mandible
    
    2.2 Grafting, mandible
  - 0.4 Surgical protocols - maxilla
    
    3.1 Implant placement - maxilla
    
    3.2 Grafting, maxilla
    
    3.3 Sinus lifting
    
    3.4 Zygomatic implants
    
    3.5 Pterygoid implants
    
    3.6 Problems and complications in maxillary implant surgery
- 3.2 Removable prosthetics
  - 1.1 Complete dentures
    
    0.1 Complete denture clinical protocol
    
    0.2 Complete denture impressions
    
    0.3 Complete denture - maxillo-mandibular relations
    
    0.4 Complete denture trial placement
    
    0.5 Complete denture placement
    
    0.6 Complete denture post-placement
  - 1.2 Implant overdentures
    
    1.1 Overdenture clinical protocol
    
    1.2 Implant overdenture impressions
    
    1.3 Implant overdenture maxillo-mandibular relations
    
    1.4 Implant overdenture trial placement
    
    1.5 Implant overdenture placement
    
    1.6 Implant overdenture post-placement
- 3.3 Fixed prosthetics
  - 2.1 Fixed implant prosthesis clinical protocol
  - 2.2 Impressions
    
    1.1 Impressions - overview
    
    1.2 Splinted vs unsplinted impression copings
    
    1.3 Open versus closed tray
    
    1.4 Parallel vs non-parallel
  - 2.3 Maxillo-mandibular relations
  - 2.4 Trial placement
  - 2.5 Framework trial placement
  - 2.6 Placement
  - 2.7 Post-placement
4 Aftercare
- 4.1 Surgical aftercare
  - 0.1 Medication
  - 0.2 Post-operative soft tissue management
  - 0.3 Suture removal
  - 0.4 Post-surgical recommendations
- 4.2 Prosthetic aftercare
  - 1.1 Esthetic and function check
  - 1.2 Provisionals / temporary prosthesis
  - 1.3 Oral hygiene instructions
  - 1.4 Occlusal guard
- 4.3 Post-treatment complications and management
  - 2.1 Bleeding
  - 2.2 Soft tissue and hard tissue
  - 2.3 Patient compliance / recall
  - 2.4 Biologic complications
  - 2.5 Esthetic complications
- 4.4 Recall visits and logistics
  - 3.1 Recall visits - overview
  - 3.2 Patient expectations
  - 3.3 General health check
  - 3.4 Professional oral hygiene
  - 3.5 Implant overdenture maintenance
  - 3.6 Occlusion check
  - 3.7 Probing
  - 3.8 Inflammation, infection
    
    7.1 Inflammation and infection - overview
    
    7.2 Infection, microbiological diagnostics
  - 3.9 Radiological control

治疗指南

封闭取模方式与开放取模方式

Key points

当种植体不够平行，无法从多个印模帽中取出印模时，特别适合采用开放取模方式
当种植体相互之间足够平行时，可以采用封闭取模方式

开放取模方式

在制作固定全口义齿时，开放取模方式是制作最终印模的两种选择之一（另一种选择是封闭取模方式）。当种植体不够平行，无法从多个印模帽中取出印模时，特别适合采用开放取模方式。

临时内冠可以使用流动复合树脂、印模石膏或丙烯酸树脂连接（图 1）。连接印模帽有助于提高最终印模和模型的精确度，并且便于制作验证夹具。

印模托盘上涂上粘合剂，然后装入高粘度印模材料。同时，印模帽周围采用了低粘度印模材料，用于获取软组织的形态（图 2）。单相印模材料可以用作高粘度和低粘稠度组合的一种方便实用的替代材料。放入带负载的定制托盘，使用一根手指或棉签擦拭咬面开口，露出印模帽的咬面，以便在印模材料发生聚合之前找到螺丝，并方便之后松开螺丝。

印模材料聚合之后，松开临时内冠中的螺丝，然后取下印模。印模应记录缺齿牙嵴，并包含临时内冠或印模帽（图 3）。另一种方法是使用修改过的库存托盘制作最终印模。将种植体替代体固定到印模帽，然后将印模送至技工室，以供制作最终模型和咬合堤。

封闭取模方式

下列情况适合采用封闭取模方式：

当种植体相互之间足够平行时
当颌间距离有限且使用螺丝固定的印模帽的空间不足时

在制作固定全口义齿的封闭式托盘印模时，可以使用库存托盘或定制托盘。封闭式托盘印模帽放在种植体或复合基台和制作的印模上（图 4）。印模材料聚合之后，印模从封闭式托盘印模帽上脱离。然后取下封闭式托盘印模帽，并将种植体或基台替代体连接到印模帽。然后将组合式印模帽替代体组件插入到最终印模。

临床分类

种植体

治疗指南

Edentulous

印模 - 概述

印模的目的是精确获取制作修复体所需的相关组织轮廓，以使修复体与粘膜紧密接合或与种植体贴合良好。
精确展现粘膜轮廓的最终模型的优势在于，修复体可以与这些轮廓接合，从而达到以下目的：
美观，美齿部位的修复体与粘膜之间看不到空隙或阴影
实现最佳功能，能够准确发音
便于患者清洗，以确保对口腔进行充分清洁，从而保证组织健康
精确展现种植体位置（高度、角度、方向、相邻软组织轮廓）的最终模型的优

种植体

立即观看

治疗指南

Edentulous

在体外研究实验中，已对夹板固定和非夹板固定印模技术做了比较。实验结果显示，相比于用来制作印模的参考模型，夹板固定印模技术通常能够获得更精确的主模型。实验还对各种夹板固定技术做了评估，包括使用自聚合树脂、印模石膏和金属夹板，总体结论是，这三种技术都可以提高主模型的精确度。但是，如果使用自聚合树脂，应当通过切割和重新使用树脂来确保最后一次聚合的体积尽可能小，从而尽量减少聚合萎缩。
显然，最重要的问题在于临床效果是否有所改善，且到目前为止，尚无有力的证据证明，使用非夹板固定技术制

种植体

立即观看

治疗指南

Edentulous

印模 - 平行与非平行种植体

必须评估种植体之间是否平行。如果种植体之间相互完全平行（图 1），可以采用封闭取模方式。由于种植体之间相互平行，因此可以从口腔内取出聚合的种植体，同时没有明显阻力。是否用夹板固定所有印模帽取决于临床医师的个人偏好。

种植体

立即观看

问题

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问题反馈

封闭取模方式与开放取模方式

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封闭取模方式与开放取模方式

开放取模方式

封闭取模方式

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Scientific References

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