When we have patients with an existing maxillary denture who want to transition to some type of implant prosthesis, there are many things to consider when we are treatment planning these types of cases. Number of implants, A/P spread, and vertical space are a few important clinical decisions that must be made. The decision to do a fixed or removable prosthesis, however, can be patient driven, meaning, most patients will want a fixed prosthesis if given the choice.
When looking at tissue health requirements for implants, both before placing them and ongoing, lot of things to consider. Before, what I want you to think of is two millimeters.
As general dentists, when we think about developing our implant team and with some training, we can get comfortable with all aspects of this. If only one person has to visualize the case all the way through, it makes a little bit easier. We are going to start with our usual data, our photos and all the things that we would do to do our occlusal analysis. We should add a CBCT to this process and begin to figure out where the tooth or the teeth will be in space, so we can start our reverse engineering process.
So we get asked a lot about the importance of surgical guides in implant dentistry. One of the more common things I hear is they work with a surgeon or a periodontist, and they have never really liked surgical guides, and so they just work without them.
When you're looking at designing centric stops for implants, whether it's a single implant crown or a full-arch fixed prostheses, it's very important first to understand the difference between implants and teeth.
Let's talk about how to cement a bridge every single time in 30 minutes or less. Now, cementing a bridge is a little bit different than a single-unit crown because you have three teeth involved in the occlusion, you have interproximal contacts. You have a lot of issues.
I think if you look initially, the key is to have a good plan. So if you have not planned exactly where the teeth go, in the neutral zone and in the mouth, then they are doomed to fail in some way, some shape, some form.
When patients come to us with existing maxillary dentures and want to transition to afixed implant supported prosthesis, sometimes the treatment planning process can be a little confusing and a little challenging.
And we tend to maybe let the patient drive that decision and we end up doing a fixed prosthesis. But really the question is, is that the best prosthesis for them?
When looking at implants versus teeth, it is very important to consider the differences between them. There are many differences.
One difference that's very important for us as Dawson Dentists to consider is that a tooth has a periodontal ligament, the PDL. An implant does not.
An implant is essentially an ankylosed unit.
So recently, there's been a lot of debate as to whether we should be using screw-retained restorations on our implants or cement-retained restorations. I think the trend lately toward screw-retained restorations has been driven by research that shows retained cement in that delicate sulcus around the implant is the leading cause of peri-implantitis.