Implant Planning

Implant planning is about communication and understood outcomes.  This goes for the treatment team as well as the patient.

This was sent to me by a colleague for an opinion.  This patient was given a treatment plan for a permanent crown replacement.  There was no communication between the surgical specialist and the restorative dentist.  And likely none between any dentist and the patient.

Can this be used for an RPD attachment? Possibly.  But the patient was expecting a fixed outcome.

And what do we know from our experiences and the literature what is likely to happen to #28 distal if an implant crown is placed on the implant?

What are the issues with this implant?

  • Resulting crown contours.
  • Hygiene issues.
  • #28 distal…what is likely to happen.  What do we know from experience and the literature?

SINGLE TOOTH MOLAR RESTORATIONS

1. TOOTH OR IMPLANT?

2. IMMEDIATE PLACEMENT / IMMEDIATE TEMP?

3. CEMENT OR SCREW RETAINED?

4. Ti BASE OR MILLED ABUTMENT?

5. CONTOUR, SUPPORT AND EMERGENCE.

6. OPEN CONTACTS AND STRATEGIES.

Literature / Open Contacts

Wei, H.  (2008)  Implant prosthesis and adjacent tooth migration: Preliminary retrospective survey using 3-dimensional occlusal analysis.   Int J Prosthodont (21:4)302-304.

Koori, H.  (2010)  Statistical Analysis of the Diachronic Loss of Interproximal Contact Between Fixed Implant Prostheses and Adjacent Teeth.   Int J Prosthodont (23:6)535-540.

Wat, PY.  (2010)  Proximal contact loss between implant-supported prostheses and adjacent natural teeth: A clinical report.

  J Prosthet Dent. (105:1)1-5

Byun, S  (2015)  Analysis of proximal contact loss between implant supported fixed dental prostheses and adjacent teeth in relation to influential factors and effects.  A cross sectional study.

  Clin Oral Implant Res (26)709-714.

Wong, A.  (2015)  Proximal contact loss between implant-supported prostheses and adjacent natural teeth: a retrospective study. 

  Clin Oral Implant Res. (26)e68-e71.

Greenstein, G.  (2016)  Open contacts adjacent to dental implant restorations. Etiology, incidence, consequences and correction. 

  JADA. (147-1)28-34.

Varthis, Tarnow  (2016)  Prevalance of Interproximal Open Contacts Between Single-Implant Restorations and Adjacent Teeth.

  Int J Oral Maxillofac Implants (31)1089-1092.

174 single tooth implant restorations from 3 months to 11 years.

52.8 % of implant restorations demonstrated ICL; mesial 78.2% distal 21.8 %.

Guidelines for posterior single tooth molars to deal with future open contacts

1. Informed consent and expectation.

2. Screw retain for future retrievability.

3. Broad flat contacts to maintain the contact as long as possible. Flatten distal of adjacent tooth if required.

4. Night time occlusal guard as a “retainer” and to lessen ACPF.

5. Etchable surface for additive resin proximal contact chairside.

6. Class II restoration on adjacent tooth.

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