Select slides from the Implant Restorative Study Club's August 2014 meeting. The lecture was provided by Dr. Douglas Weir, a Prosthodontist practicing in Bloomington, Indiana.

1. Select
Slides
from
Prosthodon1cs
of
Central
Indiana
–
Implant
Restora1ve
Study
Club
Presented
by:
Dr.
Douglas
Weir
August
28,
2014

2. • The
Big
Picture
• Origins
of
“All-­‐on-­‐4”
• Pathway
to
Learning
• The
Four
Basic
Concepts
• Pa1ent
Factors

4. AP
spread
is
NOT
a
radiographic
metric

5. NOTE
HARD
PLASTIC
BOXING
at
least
3X
A-­‐P
spread

6. WE
CAN’T
EVEN
AGREE
ON
THE
NAME
OF
THESE
THINGS!
• All-­‐on-­‐4
is
a
trademark
name
of
Nobel
BioCare
• Teeth
Express
(BioHorizon)
• RevitaliZe
(Zimmer)
• Screw
Retained
Fixed-­‐Hybrid
Denture
or
Bridge
• Fixed
Detachable
Removable
Denture
• Fixed
Hybrid
• Hybrid
Bridge
• “Hybridge”

7. WHICH
EXPLAINS
THIS:
Add
up
the
cost,
for
one
arch

8. THREE?

10. • Amazingly,
the
appeal
crosses
all
demographic
norms.
Once
the
concept
is
understood,
there
is
widespread
desire
on
the
part
of
these
pa1ents
to
pursue
treatment.
• The
main
barriers
are
sa1sfactory
bone
parameters,
prosthe1c
limita1ons
and
financial
resources.
• The
results
are
life
changing
for
pa1ents.

11. Primary
support
from
cor1cal
bone
Medullary
bone
is
secondary
support
An
angled
implant
emerges
through
cor1cal
plate
in
an
oval-­‐not
a
circle
and
has
longer
cor1cal
plate
contact
down
the
long
axis
A
longer
implant
when
angled
creates
more
surface
area
in
medullary
bone
Able
to
reach
cor1cal
bone
at
apex
Must
be
connected
by
a
precision-­‐fit
bar
ANGLED
IMPLANTS

12. – Can1levering
the
distal
implants
allows
restora1on
back
to
the
first
molar
by
angling
implants
up
to
45
degrees
– follow
medial
wall
of
the
maxillary
sinus
– extend
distal
to
mental
foramen
» no
sinus
lid
» less
risk
of
paresthesia
of
lower
anterior

13. UNDERSTANDING
THE
ALVEOLOPLASTY

14. 15
MM
OF
PROSTHETIC
SPACE
15mm
measured
from
crest
of
bone
to
proposed
incisal
edge
of
prosthe1c
design
during
surgery
12mm
from
margin
of
supra
gingival
mul1-­‐unit
abutment
to
proposed
incisal
edge
of
prosthesis
Cau1on:
angled
abutments
are
1.5mm-­‐2.0mm
taller
due
to
design
of
the
double
screw
reten1on-­‐implant
may
need
to
be
placed
deeper
when
pre-­‐planning-­‐
especially
in
anterior

15. WHY
15MM?
1-­‐2
mm
of
space
between
bone,
1ssue
and
prosthesis
Milled
1tanium
bar
is
4
mm
minimum
Prosthe1c
teeth
8-­‐10
mm
or
more

16. IMMEDIATE
CONVERSION
A
temporary
immediate
denture
is
fabricated
prior
to
surgery.
It
is
either
lined
with
a
1ssue
condi1oner
at
delivery
and
placed
over
healing
caps
and
worn
as
a
full
denture,
or
converted
into
a
fixed
hybrid
temporary
appliance
at
the
surgery
if
the
implants
achieve
35
Ncm
during
placement.
Some
doctors
prefer
to
make
a
master
impression
and
have
a
lab
perform
the
conversion
overnight
for
delivery
the
next
day.
Others
do
everything
at
the
surgical
appointment.

18.
SOMETIMES
WE
OVERESTIMATE
OUR
PREPAREDNESS
SOMETIMES
WE
UNDERESTIMATE
THE
CHALLENGE
NEVER
DO
BOTH
AT
THE
SAME
TIME

20. BASIC
ENGINEERING
PRINCIPLES
Triangula1on
of
force
vectors-­‐more
than
a
century
of
experience