The document discusses dental implant treatment planning and considerations. It notes that proper diagnosis, history taking, treatment planning, investigations, biomechanical factors and system requirements are important. Key factors in treatment planning include a patient's oral hygiene, medical conditions, dental condition, occlusion, age and finances. Clinical, radiographic and laboratory investigations are outlined. Guidelines are provided for optimal implant positioning and limitations on cantilevers and adjacent pontics. Risk factors for implant failure and the influence of implant diameter and length on stress distribution are examined through studies. All-on-4 treatment is discussed and a study shows three implant restorations may not adequately support occlusal loads while four implants with a 10mm cantilever can properly resist loading

1. Member A.O.I.A
Fellow I.C.O.I
Scientific consultant of sybron implant solutions
Manager of implant direct company
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6. 1) Proper diagnosis
2) Proper History taking
3) Proper treatment planning
4) Proper investigations
5)Proper biomechanical considerations
6) Proper knowledge of your system requirement
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7. Patient’s Oral Hygiene
Patient’s medical condition
Patient’s Dental condition
Patient’s occlusion
Patient’s age
Soft tissue assessment
Patient’s financial status
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8. A) Medical history :
Diabetes
Osteoporosis
Heavy smoker
H.I.V.
B) Dental History
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9. It’s not always an
implant therapy
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11. Clinical investigations
Radiographic investigations
Laboratory investigations
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12. Periapicals
O.P.G.
Lateral cephalometric
Computed tomography (c.t.)
Cone beam c.t. (c.b.c.t.)
3D cat scans
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20. Key Implant positioning :
1. Canine 1st Molar rule
2. No cantlivers
3. No 3 adjacent pontics.
4. Arch segments
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26. How Far Can I Cantilever From Implants?
Cantilevers can be your best friend or your worst
enemy.
!
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27. When used intelligently, a cantilever can allow
you to replace a missing tooth without an
additional implant.
But when physics are ignored, a cantilever can be
the cause of fractured porcelain, screw
loosening, bone destruction, and other nasty
surprises.
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29. Multiply by 1.5 to 2.5
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30. Luigi Baggi, DDS,a Ilaria Cappelloni, MS,b Michele Di Girolamo,
DDS,c Franco Maceri, MS,d and Giuseppe Vairo, MS, PhDe
(J Prosthet Dent 2008;100:422-431)
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31. Load transfer mechanisms and possible failure of
osseointegrated implants are affected by
implant shape, geometrical and mechanical
properties of the site of placement, as well as
crestal bone resorption.
Suitable estimation of such effects allows for
correct design of implant features.
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32. The purpose of this study was to analyze the
influence of implant diameter and length on
stress distribution
and to analyze overload risk of clinically
evidenced crestal bone loss at the implant neck in
mandibular and maxillary
molar periimplant regions.
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33. Stress-based performances of 5 commercially available implants
(2 ITI, 2 Nobel Biocare,
and 1 Ankylos implant; diameters of 3.3 mm to 4.5 mm, bone-
implant interface lengths of 7.5 mm to 12 mm) were
analyzed by linearly elastic 3-dimensional finite element
simulations, under a static load (lateral component: 100 N;
vertical intrusive component: 250 N). Numerical models of
maxillary and mandibular molar bone segments were generated
from computed tomography images, and local stress measures
were introduced to allow for the assessment of
bone overload risk. Different crestal bone geometries were also
modelled. Type II bone quality was approximated, and
complete osseous integration was assumed.
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34. Maximum stress areas were numerically located at the implant
neck, and possible overloading could occur
in compression in compact bone (due to lateral components of
the occlusal load) and in tension at the interface
between cortical and trabecular bone (due to vertical intrusive
loading components). Stress values and concentration
areas decreased for cortical bone when implant diameter
increased, whereas more effective stress distributions for
cancellous bone were experienced with increasing implant
length.
Finally, dissimilar stress-based performances were exhibited for
mandibular and maxillary placements, resulting in higher
compressive stress in maxillary situations.
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35. Implant designs, crestal bone geometry, and site of
placement affect load transmission mechanisms.
Due to the low crestal bone resorption documented by
clinical evidence, the Ankylos implant based on the
platform switching concept and subcrestal positioning
demonstrated better stress-based performance and lower
risk of bone overload than the other implant systems
evaluated.
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36. Numerical results suggest that implant diameter
may be more effective than implant length as a
design parameter to control the risk of bone
overload. For a given implant in the molar
region, the worst load transmission mechanisms
arise with maxillary placement, and implant
biomechanical behavior greatly improves if bone
is efficiently preserved at the crest.
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43. ALL ON 4
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44. Evaluation of the structural behavior of three and four
implant-supported fixed prosthetic restorations by
finite element analysis
Santiago Correa PhDa,*, Juliana Ivancik MScb, Juan Felipe Isaza
MSca, Mauricio Naranjo DDSc
Received 7 October 2010; received in revised form 16 June 2011; accepted 19 July
2011
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45. Finite elements analysis of three and four
implant-supported prostheses was
performed to determine the stresses in the
superstructure, implants and cortical bone
and, therefore, the failure prediction for
each restoration.
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47. failure in the three implant-supported
prosthesis for all cases analyzed. The same
applies for the four-implant prosthesis of 15
mm cantilever length. However, four
implants and a cantilever length of 10 mm
passed the failure criteria and were
considered safe.
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48. The results from the patient analyzed showed that
fixed support prostheses on three implants are not
recommended from a structural point of view
because they do not adequately support occlusal
loads. Excessive stress in the superstructure and
the cortical bone can be expected, which would
anticipate the failure of the restoration. Fixed
support prostheses on four implants with a
cantilever length of 10 mm properly resist occlusal
loading.
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55. YES OR NO
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