functional zone. dental implants, treatment planning, traumatic zone, ischematic zone, inter forminal zone, sinus zone

1. Treatment Plan for
Implants in Function Zone
Vinay PavanKumar K
Post graduate student
AECS Maaruti Dental College

2. Rx
planning &
Functional
zone
FIZ 1
FIZ 3
FIZ 4
FIZ 2

3. “ CSR of dental implants is generally high and that
implant location plays an important role in implant
success.CSR of implants in the mandible seems to
be slightly higher than in maxilla—about a 4%
difference. The success rate of implants in the
anterior regions seems to be higher than in the
posterior regions of the jaws, mostly due to the
quality of bone: about 12% difference between
anterior maxilla and posterior maxilla, and about 4%
difference between anterior mandible and posterior
mandible”
Tolstunov L. Implant zones of the jaws: implant location and related
success rate. J Oral Implantol. 2007;33(4):211-20

4. Treatment Planning
“If you are not planning for success, then
you are planning for failure”
treatment plan tret-mant pla˘n:
The sequence of procedures planned for the
treatment of a patient after diagnosis – GPT 8

5. Functional implant zones (FIZ)
Functional implant zones (FIZ) are the
alveolar jaw regions where dental implants
can be inserted with or without
supplemental surgical procedures for the
purpose of functional prosthetic
rehabilitation of the stomatognathic
system

6. Functional implant zones (FIZ)
• Zone 1 (FIZ-1): traumatic zone
zone of the alveolar ridge of premaxilla
• Zone 2 (FIZ-2) : sinus zone,
bilateral zone of the alveolar ridge of
posterior maxilla located at the base of
maxillary sinus from the second
premolar to pterygoid plates

7. Functional implant zones (FIZ)
• Zone 3 (FIZ-3) : interforaminal zone,
a zone of the alveolar ridge of anterior
mandible (symphyseal area)
• Zone 4 (FIZ-4): ischemic zone,
a bilateral zone of the alveolar ridge of
posterior mandible from the second
premolar to the retromolar pad.

8. FIZ 1 : Traumatic zone
• It including eight anterior teeth: 4 incisors, 2
canines and 2 first premolars
• The anterior maxilla has protruding alveolar
process with thin labial and thick palatal cortical
plates covering and protecting upper front teeth
• This prominent positioning is is responsible for
bone and soft-tissue injuries of the facial
skeleton during fall, RTA and domestic trauma

9. • Post extraction bone resorption is 3
dimensional, with the greatest loss of bone in
the bucco-palatal (the width)
• Mainly on the buccal side of the alveolar ridge
• 50% bone loss occur during the 12 months
following tooth extraction.
• 2/3rd of the horizontal bone loss occurs within 3
months and 1/3rd takes place within the
remaining 9 months of the first year post
extraction

10. • The loss of bone height is smaller,
reported to be about 1 mm within the first
6 months post extraction
• The data of healing and remodeling of
the alveolar crest after the tooth loss are
especially important in the premaxillary
area due to esthetic considerations.
• Implant rehabilitation in FIZ 1 often
entails staged hard and soft tissue
procedures to rebuild collapsed tissue
and achieve the original and natural
esthetics, function, and phonetics

11. Atleast consider 10 dynamics should be considered
during implant treatment in the anterior maxilla :
1. A detailed history of facial trauma or a tooth loss
2. A comprehensive clinical and radiographic examination
including conventional (PA, occlusal, panoramic x-rays)
and tomographic imaging.
3. Early bone augmentation procedures and bone grafting
techniques to improve and reconstruct missing or deficient
alveolar ridge and create an adequate foundation for an
endosseous implant

12. 4. Consider soft tissue grafting to increase or create a layer of
attached gingiva, treat all patients as having a high smile
line
5. Consider slightly more palatal implant placement to engage
the remaining palatal cortex with its strength needed for
primary implant stability without compromising esthetics
and function
6. Use an anatomically tapered implant design with a good
adaptation to the surrounding socket
7. Consider two-stage surgery and avoid immediate load

13. 8. If immediate provisionalization is utilized, take the
prosthesis out of occlusion, use protective occlusal
schemes; consider prosthetic remodeling techniques for
an improvement of implant emergence profile
9. Wait sufficient amount of time before fully loading of an
implant with a history of alveolar crest grafting (at least 6
months)
10. Instruct patient to avoid heavy biting for at least one year
after delivery of the final prosthesis, avoid any front facial
trauma or contact sport, and maintain meticulous oral
hygiene

14. FIZ 2 : Sinus Zone
FIZ 2 : bilateral maxillary posterior zone that extends
from the second premolar to the pterygoid plates is
located at the base of maxillary sinuses
compromised bone quality (types 3 and 4) ; increase
an implant failure rate
sinus pneumatization after
a loss of posterior
tooth/teeth necessitates
sinus lift procedure with
vertical bone augmentation

15. Guidelines for posterior teeth
• The predictability of the outcome of an
implant restoration in the posterior part of
the mouth is dependent on :
1. Available space
2. Implant number and position
3. Occlusal considerations
4. Type of prosthesis
5. Overall treatment plan

16. Available space
• Available ossesous space:
-7.5 mm of bone height is required for a 6 mm fixture
- 8.5 mm is required for a 7 mm fixture
• at least 2 mm of bone between the apical end of the implant
and neurovascular structures
• The implant should be at least 1.5 mm : the adjacent teeth
• The implant should be at least 3 mm : an adjacent implant
• A wider diameter implant should be selected for molar teeth

17. • molar implant restorations : 2.5 mm away from the adjacent
tooth to allow development of appropriate restorative contours
• 6 mm of bone (buccolingually) : 4 mm diameter implant
• Available restorative space :
- 10 mm of space : the residual ridge & the opposing occlusion
- 7 mm would be considered the bare minimum
• Minimal enameloplasy or minimal restorative therapy
may be considered to create space

18. Implant number and position
• The number of implants is dependent on bone
quantity and quality
• Maxilla : 1 implant for each tooth
• Cantilever type prostheses have been associated
with higher rates of failure
• The clinician has to decide if a bone
augmentation procedure is justified or whether a
more simple approach of cantilevering would
suffice

19. • With three implants; offset the implants and position
them for a tripod effect
• Use of a wider diameter implant provides an equivalent
benefit to the non linear configuration
• When insufficient osseous volume exists in the posterior
maxilla and the patient does not want to undergo a sinus
augmentation procedure, consideration giving implant
placement in the tuberosity area

20. Occlusal considerations
• Implant protected occlussion :
The centric contacts are adjusted with light
occlusal contact on the implants; the rationale
being the opposing natural dentition is often
compressed on firm closure
• Cuspal inclinations on implant supported
restorations should also be shallower
• Anterior disclusion is easier when posterior
occlusal anatomy is shallow

21. Type of restoration
• Cemented v/s Screw retained
• Splinted v/s Non splinted
• Abutment level v/s implant level restoration

22. Overall Rx Plan
• Decisions to use implants should be based on
prosthetically oriented risk assessment
• Prosthetically oriented risk assessment involving
comprehensive evaluation of potential abutment
teeth
• the decision should be based on risk assessment
and cost effectiveness of the procedures

23. FIZ 3 : INTERFORAMINAL ZONE
This zone of mandibular alveolar ridge is located
between mental foramen on each side or from the
first premolar tooth on one side to the first
premolar tooth on the other side
• It has thin and narrow alveolar ridge often requires an
especially careful and skilled surgical implant insertion
• A successful placement of 2 to 6 in edentulous arch
cases offer a stable foundation for a variety of implant-
retained and implant-supported removable and fixed
mandibular prostheses

24. FIZ 4: ISCHEMIC ZONE
The alveolar process of posterior mandible is
located behind the mental foramen on each side
and extends from the second premolar to the
retromolar pad
• Vascularization to the alveolar ridge and teeth
diminishes with loss of teeth, in elderly patients with
alveolar crest resorbtion other chronic conditions
results in “Relative ischemia”. Thus it called has
Ischemic Zone

25. • Decrease of blood supply to the bone and soft
tissue can compromise bone growth, repair, and
maintenance and increase failures of bone grafting
and implant integration, amplifying rate of early
implant failures
• A heavy masticatory demand during function,
especially for people with parafunctional habits
• Two to three implants : replacement of missing
second premolar, first molar occasionally second
molar

26. Posterior mandibular implants should be placed such
that the exit angle of the screw access should point
towards the inner incline of the palatal cusp
Placement of two implants in molar positions can
compensate for poor bone quality by double the
anchorage surface area
Double implants closely mimic the anatomy
•eliminates antero-posterior cantilever,
•reduction of rotational forces exerted
•reduction of screw loosening

28. Dental implant success–failure
analysis based on implant location

29. Other considerations
• The use platform switched helps in the preservation
of the crestal bone
• Osteoconductive roughened implant surface
topography (acid-etched, RBM) significantly
improve an implant success rate in any zone of the
jaws by enhancing primary mechanical implant
stability and BIC
• Better Implant stabilty : immediate loading, reducing
healing time, maintaining a crestal bone level and
facilitating an implant hygiene

30. Reference
• Misch CE. Contemporary implant dentistry. Elsevier
Health Sciences; 3rd edition 2014
• Tolstunov L. Implant zones of the jaws: implant
location and related success rate. J Oral
Implantol. 2007;33(4):211-20
• Jivraj S, Chee W. Treatment planning of implants in
posterior quadrants. British dental journal. 2006 Jul
8;201(1):13-23.
• Dolanmaz D, Senel FC, Pektas ZÖ. Dental Implants in
Posterior Maxilla: Diagnostic and Treatment Aspects.
International journal of dentistry. 2012;2012.