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Implant Dentistry
Summer 2005
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| Predictable implant prosthesis. (Photo by Dr. N. Chaimattayompol.) |
This course provides fundamental and foundational knowledge relevant to simple surgical and prosthodontic procedures for today's implant dentistry. A series of lectures and slide lectures, all containing instructive clear-cut images, cover advancements in restorative sciences, for example the Session 5 Fixed Partial Denture (FPD) Slide Lecture.
This course is devoted to the fundamentals of Implant Dentistry in order to provide students with basic concepts and foundation for the discussion of the diagnosis, treatment planning and sequence of treatment with the patients, practice coordinators and prosthodontic faculty members. Within this first semester, students will explore all simple to moderate implant prosthodontic treatment modalities for patient care in the predoctoral clinic. More complex implant treatment plans that involve advanced prosthodontic or surgical procedures and/or Type IV patients based on Tufts Patient Classification System will be discussed and referral procedures to the Post Graduate Prosthodontics Clinic and/or the Implant Center, when indicated, will be presented.
- History of Dental Treatment Lecture Slides
- Session 8: Single Tooth Implant Crowns Lecture Slides
- Session 5: Implant FPD Lecture Slides
- Chapter 1: Introduction
- Chapter 8: Implant Supported Fixed Partial Dentures
Objectives
- To develop in each student an understanding of the history of implant dentistry.
- To introduce the student to the concept of osseointegration. To develop an understanding of the scientific basis of implant-host relations and interactions.
- To teach the student how to include implants in their overall diagnosis and treatment planning for their patients.
- To familiarize the student with an overview of the surgical techniques and healing time required for implants.
- To introduce to the student basic fixed and removable prosthodontic techniques for implants. Students will be introduced to restoring single tooth crowns, three-unit fixed partial dentures and implant overdentures on implants. This will include knowledge on temporization procedures for implant restorations. Students who successfully complete the treatment plan for implant patients for clinical treatment will be able to apply this knowledge.
- To encourage the student to seek further courses in implant dentistry for more expertise and for familiarity with other implant systems.
- To make the student aware of the limitations of implants by illustrating implant failure, soft tissue problems, prosthodontic (mechanical) complications, and the need for recall of implant patients.
- To impress on the student the need to follow the rapidly expanding research in dental implants, which directly affects current treatment modalities.
- To introduce the student, by means of a short preclinical laboratory, to implant components.
- To encourage each student to identify and treat an implant patient so that they may become familiar with implant treatment.
- To be able to identify the level of difficulty of implant treatment which might need care of a specialist.
- Note: A goal of this section is not that you will become an expert in implant dentistry. This is an introductory course.
1. General Information
The Implant Dentistry Lecture Series takes place on Tuesday mornings for fifty minutes from May 3 - August 2. Students are divided into 10 small groups and rotate throughout this course. The course meets in the Preclinical Laboratory.
1.1. Course Requirements
1.1.1. Attendance
Attendance at all lectures is necessary and important for you. Examination questions are taken from lecture and slide material, the syllabus, and the implant dentistry manual. Videotapes shown during lectures and handouts given out in lectures will be test material.
1.1.2. Grading
The grade for the Implant Dentistry course will be divided as follows:
| 10% |
Complete Denture Practical Exam I and II |
| 20% |
Projects |
| 10% |
Quiz |
| 30% |
Examination I-Midterm |
| 30% |
Examination II-Final |
Examinations will have a maximum of 50 multiple-choice questions.
There will be one make-up examination each for each examination. These may be essay/fill-ins or multiple-choice questions.
1.2. Implant Hands-On Laboratory
There will be one hands-on laboratory session that all members of the class must attend. There are two three-hour sessions in the Preclinical Laboratory. One-half of the class will be assigned to each session for each session.
1.3. Seminar - Implant Overdentures
The group seminar (16-17 students/group) is included into this Implant Dentistry Course starting on May 17 and will be ended on July 12 with the seminar "Implant Retained Overdentures".
Students MUST attend the scheduled Seminar (see student schedule). "Implant Overdentures" given in the first ten weeks on Tuesday mornings by Dr. Chaimattayompol. This is an additional laboratory or "hands-on" portion of this course. It covers implant overdentures (removable implant prostheses).
There will be examination questions from the seminar in the Final Examination.
1.4. Reading/Viewing Assignments
Suggested textbook: "Boucher's Prosthodontic Treatment for Edentulous Patients," Editors Zarb, Bolender, Carlsson, Eleventh Edition, Mosby 1997, Chapters 26, 27, 28, 29, 30.
"Contemporary Implant Dentistry", Editors Misch CE, 3rd edition, Mosby 2005, Chapter 12, 13*, 15.
In this syllabus, you will also see a list of more suggested textbooks and a list of DVD/CD ROMs.
NOTE: HANDOUTS/CD ROM MUST BE PICKED UP DURING CLASS TIME. EXTRAS MAY BE AVAILABLE AFTER CLASS, FROM YOUR CLASS REPRESENTATIVE, WITHIN ONLY A FEW WEEKS OF THE START OF THE COURSE.
1.5. Implant Clinical Experience
Each student must do one implant clinical experience as a minimum procedural experience (see your MCP document). This can include:
- Diagnosis and treatment planning (Implant Step Sheet)
- Implant Crown
- Implant Fixed Partial Denture
- Implant Overdenture
The Implant Dentistry Step Sheet must be used for all of these procedures. It is turned in to the Department of Prosthodontics and Operative Dentistry.
1.6. Office Hours
The Instructor's teaching schedule can be verified in front of his/her office room.
Any of your suggestions during the course will be met with enthusiasm and appreciation. Feel free to use e-mail. Thank you.
1.7. Lecture/Projects Schedule
| Class |
Class Title |
Instructor |
| Class 1 |
Overview of the course Didactic/TUSDM Clinical Protocols |
Dr. Chaimattayompol |
| Class 2 |
Introduction/History of Dental Implants/Definitions/Success Rates/Complications |
Dr. Arbree |
| Class 3 |
Patient Selection/Diagnosis and Treatment |
Dr. Arbree |
| Class 4 |
The Principles of Osseointegration |
Dr. Chapman |
| Class 5 |
Implant Surgery |
|
| Class 6 |
Implant Supported Single Crown |
Dr. Chaimattayompol |
| Class 7 |
Examination I |
|
| Class 8 |
Implant Assisted Removable Partial Overdentures |
Dr. Chaimattayompol |
| Class 9 |
Implant Supported Fixed Partial Denture I |
Dr. Chaimattayompol |
| Class 10 |
Implant Supported Fixed Partial Denture II |
Dr. Chaimattayompol |
| Class 11 |
Peri-Implant Soft Tissue Management |
Dr. Chaimattayompol |
| Class 12 |
Maintenance/Recare/Complication |
Dr. Chaimattayompol |
| Class 13 |
Review All Lectures |
Dr. Chaimattayompol |
| Class 14 |
Exam II |
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2. Implant Dentistry Manual Acknowledgements and Table of Contents
Editors:
Carole Alton, B.D.S., D.M.D.
Nancy S. Arbree, D.D.S., F.A.C.P., M.S.
Nopsaran Chaimattayompol, D.D.S., D.M.D., M.P.H.
Contributors:
Robert J. Chapman, D.M.D.
Copyright© 2004 Fourth Edition
We are grateful to Nobel Biocare USA, Inc. for allowing their images to be reproduced here.
Special thanks to the following authors who helped with drawings and slides:
Dr. Carole Alton, Dr. Nancy Arbree, Dr. Nopsaran Chaimattayompol, and Dr. Kyuho Lee
Special thanks to our word processors Bobbi Jo Meserve, Delroy Mckenley and Sharon O'Neil
2.1. Table of Contents
Please note only content for Chapters 1, 3, and 8 is included in the Tufts OpenCourseWare Implant Dentistry course.
CHAPTER 1
|
1 |
| Introduction |
1 |
| History |
2 |
| Consensus Conferences |
7 |
| Conditions for application of criteria: |
8 |
| Other Implant Systems |
9 |
| Success Rates |
9 |
| Complications |
11 |
| Nutrition and Quality of Life |
12 |
| References |
13 |
CHAPTER 2
|
16 |
| Osseointegration |
16 |
| Basic Research |
17 |
| Basic Tissue Response |
17 |
| Summary of the factors necessary for maintaining osseointegration |
19 |
| Surface characteristics of dental implants |
19 |
| Qualities of Ti |
19 |
| Titanium Plasma Spray Coated |
20 |
| Bone Maturation |
20 |
| Summary of Requirements to Achieve Osseointegration: |
22 |
CHAPTER 3
|
24 |
| Diagnosis and Treatment Planning |
24 |
| Indications |
25 |
| Contraindications |
27 |
| Another Contraindication |
28 |
| Initial Evaluation |
28 |
| Oral Examination |
29 |
| Existing Prosthesis |
29 |
| Initial Surgical Consultation |
30 |
| Advanced Radiographic Techniques in Implant Dentistry: CT Scans |
30 |
| Sequence of Treatment |
31 |
| Duties of Dentist and Assistant |
34 |
| Evaluation of Mounted Casts/Anatomic Considerations |
37 |
| Diagnostic Wax-up/Wax Try-in |
39 |
| Edentulous Considerations for Diagnostic Try-in |
39 |
| Partially Edentulous Considerations for Diagnostic Try-In |
39 |
| Fabrication of Interim Prosthesis |
40 |
| Treatment Plan |
40 |
| Final Surgical Consultation |
40 |
| Stent |
40 |
CHAPTER 4
|
44 |
| Surgical Templates |
44 |
| Introduction |
45 |
| Two Types of Surgical Templates |
46 |
| Preliminary Procedures |
46 |
| Acrylic Resin Template Procedures |
47 |
| Prescription |
54 |
| Example |
54 |
| Radiographic Templates |
55 |
| Summary |
55 |
| References |
56 |
CHAPTER 5
|
57 |
| Implant Components |
57 |
| Implant Components |
58 |
| Basic terminology |
58 |
| Overview of procedures and instruments for each visit and subsequent laboratory phase |
62 |
| Diagnosis, Treatment Planning and Stage I Surgery (See Implant Dentistry Step Sheet) |
62 |
| References |
67 |
CHAPTER 6
|
68 |
| Surgical Considerations |
68 |
| Anatomical Considerations in Implant Dentistry |
69 |
| Anatomical Considerations |
71 |
| Surgical Procedures |
73 |
| Basic Elements for Successful Surgery |
78 |
| Further Considerations for Implant Surgery |
78 |
| Peri-Implant Tissues-Bone Implant Interface |
78 |
| Bone Volume |
79 |
| References |
86 |
| Single Tooth Implants and Implant Crowns |
91 |
| Hygiene - Summary Comparison: |
94 |
| Indications for Placing a Single Tooth Implant: |
94 |
| Contraindications to Placing a Single Tooth Implant: |
94 |
| Diagnostic Considerations for Single Tooth Implant |
95 |
| Diagnosis, Treatment Planning: Preliminary Impressions, Mounted Diagnostic Casts, Radiographs, Tooth Wax-up, Stent Fabrication |
101 |
| Transitional or Interim Prostheses/Abutment Selection |
104 |
| Selection of the definitive Cera One abutment: |
105 |
| Torque Control of Cera One Abutment |
109 |
| Pouring the Impression |
112 |
| Follow-up and Recall |
119 |
| References |
120 |
CHAPTER 8
|
128 |
| Implant Supported Fixed Partial Dentures |
128 |
| Transitional or Interim Prostheses/Abutment Selection |
137 |
| Preliminary Impressions |
142 |
| Technique |
142 |
| Custom Tray Fabrication |
142 |
| Final Impression Technique |
144 |
| Impression |
147 |
| Confirmation Jig |
149 |
| References |
159 |
CHAPTER 9
|
161 |
| Implant-Assisted Complete Denture Restorations |
161 |
| Relines/"Retrofits" |
161 |
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| 1 |
Lecture |
Overview of the Course Didactic/TUSDM Clinical Protocol |
|
| 2 |
Lecture |
Introduction/History of Dental Implant/Definitions/Success Rates/Complications |
|
| 3 |
Lecture |
Patient Selection/Diagnosis and Treatment |
|
| 4 |
Lecture |
The Principles of Osseointegration |
|
| 5 |
Lecture |
Implant Surgery |
|
| 6 |
Lecture |
Implant Supported Single Crown |
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| 7 |
Lecture |
Exam |
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| 8 |
Lecture |
Implant Assisted Removable Partial Overdenture |
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| 9 |
Lecture |
Implant Supported Fixed Partial Denture I |
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| 10 |
Lecture |
Implant Supported Fixed Partial Denture II |
|
| 11 |
Lecture |
Peri-implant Soft Tissue Management |
|
| 12 |
Lecture |
Maintenance/Complications |
|
| 13 |
Lecture |
Review All Lectures |
|
| 14 |
Lecture |
Exam |
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