J. Anthony Fraunhofer - The ADA Practical Guide to Dental Implants

1 Cover

2 Title Page The ADA Practical Guide to Dental Implants Luigi O. Massa, DDS Premier Dental Centers, Art & Technology Dental Studio, Boerne, TX, USA J. Anthony von Fraunhofer, MSc, PhD, FADM, FRSC Professor Emeritus, University of Maryland, Baltimore, MD, USA

3 Copyright Page

4 Preface

5 1 Why Dental Implants? Partial and Complete Edentulism in the Twenty‐First Century The Reality of Dental Implants Implants and the Edentulous Patient Implants for Single Crowns and Bridgework Implants vs Endodontic Treatment Conclusions References

6 2 A Brief History of Dental Implants Replacing Missing Teeth Dental Implants References

7 3 Design of Implants The Endosseous Implant The Implant Body and Surface Mini Dental Implants The Implant Cervical Portion The Abutment Connection Final Thoughts References

8 4 Patient Factors Systemic and Oral Health and Implants Infection Bone Quality Patient Factors Conclusion References

9 5 Patient Consults Evaluating the Patient Treatment Options and the Dentist Conclusions

10 6 Treatment Planning and Evaluating Implant Sites Implant Site Evaluation – Healed Bone Implant Site Evaluation – Immediate Site Conclusion

11 7 Implant Scenarios The Single Crown Implant‐Supported Bridgework vs the FPD/RPD The Edentulous Patient Implant Over‐denture Fixed Implant Bridge(S) Conclusions References

12 8 Implant Surgery Treatment Agenda Conclusions Reference

13 9 Bone Grafting Bone Grafting GBR Clinical Sequence Crestal Sinus Augmentation Note Conclusions References

14 10 Guided Surgery Imaging Conclusions References

15 11 Complicated Implant Placement: Immediate Sites Treatment Sequence Implant Placement Immediate Temporization Types of Temporary Restorations Wide‐Body Implants Conclusions Reference

16 12 Full Arch Cases Treatment Modalities for the Edentulous Patient Implant Overdentures Fixed Implant Bridge(S) Material Selection Conclusions References

17 13 Screw‐Retention vs Cement Retention of Restorations Cement Retention of Restorations Screw‐Retained Restorations Conclusions References

18 14 Restoring Dental Implants CAD/CAM Dentistry Advantages and Drawbacks of CAD/CAM Technology Restorative Materials Wear and Abrasion Conclusions References

19 15 Dental Implant Failures Recognizing a Failing Implant Risk Factors for a Failed Dental Implant Hardware Failure Effects of Medications Implant Failures Saving the Failing Implant Conclusions References

20 16 Economics of Dental Implants The Dental Implant Practice Basic Considerations Cost Breakdowns Financing Conclusions References

21 17 Maintaining Dental Implants Preventing Implant Failures Indicators of Implant Problems Natural Teeth vs Implants Patient‐Applied Oral Hygiene Measures Conclusions References

22 Appendix A: Restoring Dental Implants Step 1 Step 2 Step 2a Step 3 Step 4

23 Appendix B: Abutments Healing Abutments Categories of Abutments

24 Appendix C: Bone Graft Materials Bone Grafts in Implant Treatment Successful Bone Grafting Bone Graft Materials Conclusions Reference

25 Index

26 End User License Agreement

1 Chapter 1 Table 1.1 Advantages of dental implants. Table 1.2 Advantages of implants replacing individual teeth. Table 1.3 Disadvantages of implants vs traditional bridgework and RPDs.

2 Chapter 2 Table 2.1 Innovations in dentistry and dental care.

3 Chapter 3 Table 3.1 Purpose of thread designs. Table 3.2 Thread profiles used by various implant manufacturers.

4 Chapter 4Table 4.1 Systemic health conditions considered to adversely impact dental im...Table 4.2 Oral health factors in implant success or failure.Table 4.3 Oral infections hazardous to dental implants.Table 4.4 Type of bone.

5 Chapter 5Table 5.1 Patients' complaints.Table 5.2 Projected cost and masticatory efficiency of dentures vs implants (...Table 5.3 Advantages of implants.

6 Chapter 6Table 6.1 Implant selection criteria.Table 6.2 Criteria for satisfactory implant placement.

7 Chapter 7Table 7.1 Patient complaints and dissatisfactions with complete dentures.

8 Chapter 8Table 8.1 Data collection for treatment planning.Table 8.2 Bone factors in implant planning (≥ denotes greater than or equal t...Table 8.3 Treatment factors for dental implant placement.Table 8.4 Implant system selection.Table 8.5 Selection criteria for implant systems.Table 8.6 Steps in surgical procedure for a simple implant.Table 8.7 Osteotomy procedure.

9 Chapter 9Table 9.1 Selection of barrier membranes.

10 Chapter 11Table 11.1 Rationales for immediate implant placement.

11 Chapter 12Table 12.1 Patient/clinician concerns with complete dentures.Table 12.2 Disadvantages of implants vs traditional CD, bridgework, and RPDs.Table 12.3 Treatment protocols for providing root implants and implant‐suppor...

12 Chapter 17Table 17.1 Factors in the success or failure of implants.

13 Appendix CTable C.1 Indications for bone grafting.Table C.2 Bone graft materials.

1 Chapter 1 Figure 1.1 Projected aging of the United States. Figure 1.2 Prevalence of edentulism by race and ethnicity in adults ≥65 year... Figure 1.3 Implant‐supported overdenture.

2 Chapter 2 Figure 2.1 The subperiosteal implant. Figure 2.2 Schematic diagram of tripodal pin concept. Figure 2.3 Different types of implants. Figure 2.4 Modern screw‐type implant.

3 Chapter 3 Figure 3.1 The basic implant, abutment, and prosthesis Figure 3.2 Comparison of a natural tooth root and an artificial (implant) to... Figure 3.3 Thread designs. Figure 3.4 Thread characteristics.

4 Chapter 4Figure 4.1 Effect of bone type on implant success.Figure 4.2 (a) Tooth #31 requiring extraction due to vertical crack transect...

5 Chapter 6Figure 6.1 Treatment planning for implants.Figure 6.2 The single dental implant, abutment, and crown

6 Chapter 7Figure 7.1 The missing tooth syndromeFigure 7.2 The single crown and implantFigure 7.3 The dental implant vs a three‐unit bridgeFigure 7.4 Posterior implant bridgeworkFigure 7.5 Replacing multiple anterior teeth.Figure 7.6 Implants placed for an implant‐supported over‐denture.Figure 7.7 (a) Fixed implant‐supported bridge(b) Fixed zirconia implant‐...Figure 7.8 Snap‐on implant overdenture

7 Chapter 8Figure 8.1 Design details of the Legacy 4 systemFigure 8.2 (a) Flap reflection to expose the bone. (b) Scoring the cortical ...Figure 8.3 Creating alveolar bone access using a punch.Figure 8.4 Surgical osteotomy kitFigure 8.5 Osteotomy soft bone drills of progressively increasing diameter...Figure 8.6 Dense bone drillsFigure 8.7 Seated healing abutments and sutured flap.Figure 8.8 Cytoplast PTFE sutureFigure 8.9 Pre‐operative radiograph.Figure 8.10 Initial positioning.Figure 8.11 Final positioning.Figure 8.12 Cement retained final restoration placed.Figure 8.13 Failing Maryland bridge.Figure 8.14 Use of a locator drill to check the initial positioning of the i...Figure 8.15 Placement of the implant.Figure 8.16 Transfer placed.Figure 8.17 Cement retained e.max crown placed.

8 Chapter 9Figure 9.1 (a) Tooth #30 with severe bone loss. (b) Tooth extracted and graf...Figure 9.2 (a) and (b) Radiograph and clinical photograph of a narrow ridge....Figure 9.3 Reflecting a flap.Figure 9.4 Decorticated deficient buccal plate.Figure 9.5 Suture flap after membrane and graft placement.Figure 9.6 Clinical situation before and after 9 months of healing.Figure 9.7 Implant placed.Figure 9.8 Implant level impression.Figure 9.9 Final screw‐retained restoration placed.Figure 9.10 Fractured root #14.Figure 9.11 Schematic diagram of a sinus lift.Figure 9.12 Extraction site and osteotomy.Figure 9.13 Close‐up of sinus membrane.Figure 9.14 Implant grafted and sutured. (c) Two‐week follow‐up after suture...