With the increasing number of implant pratitioners, the dental laboratories need to be ready to support the demand for implant supported dentures. There are requirements needed in fabricating both fixed and removable dentures. Both dentists and dental technicians should have a common understanding of the techniques and procedures involved. Protocols for both dental clinics and dental laboratories should be established and observed as they work together on implant cases.
Standards for different type of dental implant treatment:
1. When making a fully bone anchored denture, use a mutually protected occlusion to obtain posterior disclusion.
2. When making a overdenture, used a balanced occlusion. The anterior denture teeth are supported by overdenture attachments and the posterior denture teeth are supported by tissues, some molar disclusion is possible to function as a modified mutually protected occlusion.
3. When making a freestanding fixed partial denture for the anterior region including replacement of a canine, use a group function occlusion. During lateral movements, horizontal loads are shared between the natural teeth and the denture.
4. When making a freestanding fixed partial denture for posterior teeth with natural anterior teeth present, use a mutually protected occlusion with posterior disclusion.
Implant supported crown is a good replacement for a missing single tooth.
Dental Implant supported crowns have the following advantages:
- It looks, feels and performs similar to natural dentition.
- Sound adjacent teeth are not compromised to support a dental bridge.
- It preserves the bone.
- It prevents bone collapse and recession.
- Oral health care is almost same as natural tooth.
- It restores esthetics resulting to good self confidence.
Extrinsic Factors Affecting Micromotion in Dental Implants
- Initial stability
- Type of dental implants
- Number of implants
- Location of implants
- Splinting dental implants
Fully bone anchored denture in maxilla can cause problems in phonation. This is due to space between prosthesis and the residual tissues. The use of artificial gingiva resolves phonetic problems due to this space.
Artificial gingiva can be fabricated using a direct sprinkle-on technique with self-cure resin. It can also be done by doing a wax-up and processing with heat-cured resin or silicon material. Artificial gingiva, also known as gum pad, is placed labially between the prosthesis and residual tissues. The artificial gingiva should be cleaned following methods for a removable denture.
Overdenture treatment is a good alternative to a fully bone anchored denture. It is an effective method of treatment for many types of patients.
Overdentures supported by dental implants showed a more consistent chewing pattern. Implant hygiene maintentenance is also less complicated because fewer implants are used. Using fewer dental implants is a financial advantage for the patient.
A contributing factor in bone resorption is local inflammation from plaque accumulation.
1. The direct action of plaque products on bone progenitor cells induces their differentiation to osteoclasts.
2. Plaque products also acts directly on bone, destroying it through a non cellular mechanism.
3. Plaque products stimulategingival cells, causing them to release mediators which in turn induce bone progenitor cells to differentiate into osteoclasts.
4. Plaque products cause gingival cells to release agents that can act as cofactors in bone resorption.
5. Plaque products cause gingival cells to release agents that destroy bone by direct chemical action, without osteoclasts.
The Prosthesis is designed at the onset of dental implant treatment to satisfy the patient’s need and desires and to obtain optimal results. It may range from fixed prosthesis to one with soft tissue support. Once this is established, the required size, number and location of abutments necessary to satisfy the protho requirements are established. The main criteria for proper implant support is the amount of available bone.
Misch CE: Dental Implant Prosthetics, Mosby Inc 2005
Small Diameter Implants (1.8 mm) were originally introduced as transitional implants. It supports provisional restorations. They were designed as immediate loading. The transitional Implants were usually removed at the end of Provisionalization. Six years ago a new line of small diameter implants were introduced, the Mini Dental Implants. The said implants were approved for use as conventional implants. These dental implants are made of commercially pure titanium and are designed as one piece. They have self threading tapered screw design with 1.8 mm to 2.4 mm diameter.