Hi everybody, welcome to Quick Tips. In this edition, I want to talk about dental implants from an occlusal perspective. And first, let's begin with some key points about how implants are different than teeth.
Remember that Dental Implants:
- Lack a periodontal ligament and therefore transmit far greater load to the bone and the restorations that are on the implants.
- Will not change position when the neutral zone is altered, and they will not experience compensatory eruption or intrusion when the vertical dimension is altered on the teeth around it. If we miss proper occlusal timing, vertical dimension, or neutral zone, then we rely on the host to tolerate these changes, and that's just not predictable.
- Simply put, implants don't adapt. And the fact that they don't adapt like teeth, if we miss something in the occlusion, and the teeth adapt and the implants don't, that can create load problems on the implants when we don't even know it.
Transcription continued below...
So one of the rules that we have followed for quite some time is the concept of splinted, shared, and shallow.
The splinted is the only one that I think we can omit now because our implant systems and the abutment systems have become so good that if you have two implants right next to one another, I think it's perfectly okay to treat them like individual teeth and not splint the restoration. So let's look at what we mean by shared and shallow when we're thinking about creating guidance.
First, let's look at an example of say a lateral incisor.
When that patient closes-- we have to understand is if they close all the teeth that have periodontal ligaments - and of course, all the teeth will - will move a little bit where the implant won't. And if you adjust this person's bite, so the mark on the implant looks exactly the same as the mark on the tip, that implant will very likely be overloaded.
So first help I'll give you is that when you're adjusting for an implant, just make sure the mark on the tooth is extremely faint compared to the mark on the teeth around it. That will help provide a little give to the ligaments and not overload that implant. If you have a technology like a T-Scan, that is beautiful because that actually shows you the timing, and that's where we really learn this important rule.
Now, from the standpoint of our guidance, what we really want is to make sure, on a single tooth like that, we just don't rub it laterally. So in the protrusive or left or right movement, just make sure that the teeth are carrying the load, and we skip over that tooth completely.
Now, the other example is any case where you have a canine involved.
Now, this is four implants in three through six. Might be three implants, doesn't matter, the canine's involved. We have to understand that tooth or that implant is going to be carrying some of the load, and this is where the shared and shallow concept kicks in. We're certainly going to adjust the contacts, so they're lighter than the teeth just like we did before. But notice in this example in our protrusive and our left lateral movement, we're going to create a shared approach, have multiple teeth carrying the load. In this case, both the canine and the bi's are helping, more of a group function, and we're going to keep that guidance as shallow as possible. The steeper the guidance, the more lateral pressure they can put on those implants. So shared and shallow is really where it's at with these types of cases.
This has been Quick Tips. If you think about the three S's as you look at all these type of restorations that involve implants, you'll think about making sure that the load on it lighter than the teeth as we examine the dots, and I think you're going to have a lot of success. So good luck and we'll see you next time on Quick Tips.