Misch's Contemporary Implant Dentistry : Misch's Contemporary Implant Dentistry Elsevier EBook on VitalSource

Dental implant surgery is an artform. To help you advance your skills and become a master of implant prosthetics, Misch's Contemporary Implant Dentistry, 4th Edition uses a multidisciplinary approach to cover the industry's most current processes and surgical procedures. The new edition of this text continues to provide comprehensive, state-of-the-art information on the science and discipline of contemporary implant dentistry. Covering the breadth of dental implant surgery, it includes full-color, in-depth coverage of both simple and complicated clinical cases, with practical guidance on how to apply the latest research, diagnostic tools, treatment planning, implant designs, and materials. New author Randolph R. Resnik, is an internationally known educator, clinician, and researcher in the field of Oral Implantology and Prosthodontics who will continue Dr. Misch's legacy and teachings. Content reflects original author's philosophy and surgical protocols for dental implants giving you a system for achieving predictable outcomes. Evidence-based approach to dental implant procedures features state-of-the-art guidance supported by the best available research evidence. Rich art program throughout text highlights and clarifies key clinical concepts and techniques with over 2,500 images, radiographs, full-color clinical photographs, line art, and diagrams. Definitive resource in implant dentistry provides you with authoritative state-of-the art guidance by recognized leader in the field. Internationally known author, Randolph R. Resnik, DMD, MDS is a leading educator, clinician, author and researcher in the field of Oral Implantology and Prosthodontics. Surgical protocols provide the latest, most up-to-date literature and techniques that provide a proven system for comprehensive surgical treatment of dental implant patients. Thoroughly revised content includes current diagnostic pharmacologic and medical evaluation recommendations to furnish the reader with the latest literature-based information. Proven strategies and fundamentals for predictable implant outcomes Latest implant surgical techniques for socket grafting and ridge augmentation procedures Proven, evidence-based solutions for the treatment of peri-implant disease Includes the use of dermal fillers and botox in oral implantology Up-to-date information on advances in the field reflects the state-of-the-art dental implantology. Addition of an ExpertConsult site allows you to search the entire book electronically. Front Cover IFC MISCH’S CONTEMPORARY IMPLANT DENTISTRY MISCH’S CONTEMPORARY IMPLANT DENTISTRY Copyright Contributors Foreword Dedication About the Authors Preface Acknowledgments Contents I - Scientific Basis 1 - Rationale for Dental Implants Increasing Demand for Dental Implants Patients Living Longer Age-Related Tooth Loss Patients More Socially Active and Esthetic Conscious Higher Prevalence of Partial and Complete Edentulism Partial Edentulism Total Edentulism Anatomic Consequences Of Edentulism Conventional Prosthesis Complications Fixed Partial Denture Morbidity Removable Partial Denture Morbidity Complete Denture Morbidity Advantages of Implant-Supported Prostheses Maintenance of Bone Occlusion Stability Occlusal Awareness Masticatory Efficiency General Health Higher Success in Comparison To Other Treatments Increased Biting Force Nutrition Phonetics Psychological Health The Future of Implant Dentistry Techniques Technology Materials 2 - Terminology in Implant Dentistry Generic and Proprietary Terminology Osseointegration Determination of Stability Types of Dental Implants Endosseous Implants Blade Implants Cylinder Implants Screw-Shaped Implants One-Piece versus Two-Piece Small Diameter Implants Bone-Level versus Tissue-Level Implants Implant Macrostructure Implant Threads Microthreads Implant Surfaces Implant Platforms and Connections Connection Type Platform Switched versus Platform Matching Surgical Protocols Immediate Placement after Extraction versus Placement in Healed Sites Bone Grafting Materials for Grafting Bone Augmentation Techniques Sinus Augmentation Bone Graft Properties Surgical Instrumentation Implant Drills Drivers Implant Mounts Wrenches Implant Components Guided Surgery Implant Restorations Loading Protocols Standardized and Custom Components Impression Procedures Impression Techniques Screw-Retained versus Cement-Retained Restorations Implant Overdenture Peri-implant Disease Other Types of Implants Eposteal Implants Transosteal Implants Zygomatic and Pterygoid (Tubero-Pterygo-Maxillary) Implants Conclusion References 3 - Functional Basis for Dental Implant Design Function and Implant Design Occlusal Forces and Implant Design Force Type Force Magnitude Force Direction Force Duration Implant Geometry Implant Shape Implant Diameter Implant Length Implant Features Implant Collar Implant Prosthetic Connection Implant Threads Thread Pitch Thread Shape Thread Depth Implant Apical Region Implant Materials Biocompatibility Strength Corrosion Resistance Modulus of Elasticity Functional Basis for Dental Implant Design Summary References 4 - Bone Physiology, Metabolism, and Biomechanics Osteology Differential Osteology of the Maxilla and Mandible Temporomandibular Articulation Bone Physiology Specific Assessment Methodology Mineralized Sections Polarized Light Fluorescent Labels Microradiography Microindentation, Backscatter Imaging, and Microcomputed Tomography Autoradiography Nuclear Volume Morphometry Classification of Bone Tissue Woven Bone Lamellar Bone Composite Bone Bundle Bone Skeletal Adaptation: Modeling and Remodeling Cortical Bone Growth and Maturation Cutting and Filling Cones Structural and Metabolic Fractions Bone Metabolism Calcium Conservation Diet Endocrinology Skeletal Compromise Metabolic Bone Disease Biomechanics Sutures Implant-Anchored Orthodontics Retromolar Implant Anchorage External Abutment Mechanism Internal Abutment Mechanism Mini-Implants for Orthodontic Anchorage Summary Acknowledgments References 5 - Biomaterials for Dental Implants Compatibility of Surgical Biomaterials and the Role of Synthetic Materials Bulk Properties History of Materials and Designs Research and Development Physical, Mechanical, and Chemical Requirements for Implant Materials Physical and Mechanical Properties Corrosion and Biodegradation Stress Corrosion Cracking Toxicity and Consideration Metals and Alloys Titanium and Titanium-6 Aluminum-4 Vanadium Cobalt-Chromium-Molybdenum–Based Alloy Iron-Chromium-Nickel–Based Alloys Other Metals and Alloys Ceramics and Carbon Aluminum, Titanium, and Zirconium Oxides Bioactive and Biodegradable Ceramics Based on Calcium Phosphates Bone Augmentation and Replacement Endosteal and Subperiosteal Implants Advantages and Disadvantages Bioactive Ceramic Properties Forms, Microstructures, and Mechanical Properties Density, Conductivity, and Solubility Current Status and Developing Trends Carbon and Carbon Silicon Compounds Zirconia Zirconia Chemical Composition Types of Zirconia Implants Zirconia Implant Success Studies Polymers and Composites Structural Biomedical Polymers Composites Inserts and Intramobile Elements Future Areas of Application Surface Characteristics Surface Characterization and Tissue Interaction Tissue Interactions Integration With Titanium and Alloys Cobalt and Iron Alloys Ceramics Hydroxyapatite Porous and Featured Coatings Titanium Plasma Sprayed Hydroxyapatite Coating Other Surface Modifications Surface Cleanliness Surface Energy Passivation and Chemical Cleaning Sterilization Summary Acknowledgments References II - Biomechanical Properties of Dental Implants 6 - Clinical Biomechanics in Implant Dentistry Loads Applied to Dental Implants Mass, Force, and Weight Forces Components of Forces (Vector Resolution) Three Types of Forces Stress Deformation and Strain Stress-Strain Relationship Impact Loads Force Delivery and Failure Mechanisms Moment Loads Clinical Moment Arms Occlusal Height Cantilever Length Occlusal Width Fatigue Failure Moment of Inertia Summary References 7 - Stress Treatment Theorem for Implant Dentistry Biomechanical Overload Surgical Failure Early Loading Failure Impact of Occlusal Overload on Mechanical Components Screw Loosening Implant Component Biomechanical Complications Marginal Bone Loss Occlusal Trauma: Bone Loss Periosteal Reflection Hypothesis Implant Osteotomy Hypothesis Autoimmune Response of Host Hypothesis Biological Width Hypothesis Occlusal Trauma Cellular Biomechanics Engineering Principles Bone Mechanical Properties Animal Studies Clinical Reports Discussion Bone Physiology Implant Design Biomechanics Biomechanical Stress Effects on Treatment Planning Prosthesis Design Patient Force Factors Bone Density Key Implant Positions and Implant/Abutment Number Key Implant Positions Splinting Implant Size Available Bone Implant Design Summary References 8 - Treatment Planning: Force Factors Related to Patient Conditions Bite Force Parafunction Bruxism Diagnosis Fatigue Fractures Occlusal Guards to Determine Direction of Force Clenching Diagnosis Fatigue Fractures Treatment Planning for Bruxism and Clenching (Table 8.2) Progressive Bone Loading Greater Surface Area Occlusion Prosthesis Design Occlusal Guard Tongue Thrust and Size Treatment Planning for Tongue Thrust and Size Crown Height Space Biomechanic Consequences of Excessive Crown Height Space Excessive Crown Height Space Masticatory Dynamics (Patient Size, Gender, Age, and Skeletal Position) Arch Position Opposing Arch Summary References 9 - Dental Implant Surfaces Introduction Surface Roughness Review of Implant Surfaces Subtractive Processes Etching with Acid Blasting with an Abrasive Material Treatment with Lasers Additive Processes Hydroxyapatite Coating and Titanium Plasma Spraying Oxidation or Anodization Biological Responses and Interaction with the Implant Surface Role of Surface Roughness in Peri-implant Disease Future Directions Bisphosphonate Surfaces Statins Antibiotic Coating Functionalization with Biologically Active Substances Usage of Biologically Active Peptides Zirconia Implants Biomimetic Formation of Hydroxyapatite on the Implant Surface Summary References III - Fundamental Science 10 - Medical Evaluation of the Dental Implant Patient Medical Evaluation Medical History Extraoral and Intraoral Examinations Vital Signs Blood Pressure Pulse Temperature Respiration Height Weight Laboratory Evaluation Urinalysis Complete Blood Cell Count White Blood Cell Count Red Blood Cell Count Hemoglobin Hematocrit Bleeding Tests Physical Examination Clinical Laboratory Testing Biochemical Profiles (Serum Chemistry) Normal Range Serum Glucose Serum Calcium Inorganic Phosphorus Alkaline Phosphatase Lactic Dehydrogenase Bilirubin Aminotransferases Creatinine Estimated Glomerular Filtration Rate Blood Urea Nitrogen Systemic Disease and Oral Implants American Society of Anesthesiologists Physical Status Classification Cardiovascular Diseases Hypertension Angina Pectoris Myocardial Infarction Dental Implant Management Congestive Heart Failure Subacute Bacterial Endocarditis and Valvular Heart Disease Cerebrovascular Accident Dental Implant Implications Treatment Summary Additional Cardiovascular Disorders Endocrine Disorders Diabetes Mellitus Diabetes and Dental Implant Healing Implant Failure Dental Implant Management Treatment Summary (Diabetes) Thyroid Disorders Dental Implant Management Hypothyroidism Adrenal Gland Disorders Hyperparathyroidism Dental Implant Management Xerostomia Dental Implant Management Pregnancy Additional Endocrine Disorders and Treatment Implications Hematologic System Erythrocytic (Red Blood Cell) Disorders Dental Implant Implications Treatment Summary Anemia Dental Implant Implications Leukocytic Disorders Platelet Disorders Additional Hematologic Disorders and Treatment Implications Pulmonary System Chronic Obstructive Pulmonary Disease Additional Pulmonary Disorders and Treatment Implications Digestive System Liver Disease (Cirrhosis) Stomach Ulcers Inflammatory Bowel Disease Additional Digestive Disorders and Treatment Implications Bone Diseases Osteoporosis Dental Implant Implications Fibrous Dysplasia Dental Implant Implications Treatment Summary Vitamin D Disorders (Osteomalacia) Hyperparathyroidism Osteitis Deformans (Paget Disease) Dental Implant Implications Treatment Summary Multiple Myeloma Osteomyelitis Dental Implant Implications Treatment Summary Osteogenesis Imperfecta Cemento-Osseous Dysplasia Ectodermal Dysplasia Radiation Dental Implant Implications Additional Bone Diseases Systemic Autoimmune Diseases Sjögren Syndrome Dental Implant Implications Systemic Lupus Erythematosus Dental Implant Implications Scleroderma Dental Implant Implications Rheumatoid Arthritis Dental Implant Implications Human Immunodeficiency Virus Dental Implant Implications Miscellaneous Sleep Apnea Elderly (Increased Age) Dental Implant Implications Adolescent (Decreased Age) Dental Implant Implications Smoking Dental Implant Implications Treatment Summary Alcohol Dental Implant Implications Psychological Medications of Interest to Implant Dentistry Bisphosphonates Diagnosis of Drug-Induced Osteonecrosis of the Jaw Active Lesions Testing Drug Holiday Recommendation125 Additional Recommendations Treatment Summary New Therapies for Osteoporosis Monoclonal Antibodies Immunosuppressive Drugs Glucocorticoids (Long-Term Use) Cytostatics Tamoxifen Aromatase Inhibitors Treatment Summary of Immunosuppressive Drugs Biologics Common Disorders Using Biologics for Treatment Age-Related Macular Degeneration Psoriatic Arthritis Rheumatoid Arthritis Polymyalgia Rheumatica Eczema (Atopic Dermatitis) Multiple Sclerosis Fibromyalgia Breast Cancer Treatment Summary for Biologic Medications Oral Antithrombotic Medications Warfarin Sodium Medication Modification Medical Consultation Aspirin Studies Recommendations Plavix (Clopidogrel) Novel Oral Anticoagulants Bleeding Treatment Summary Herbal Supplements Selective Serotonin Reuptake Inhibitors Treatment Summary Allergies Treatment Summary Medical Consultation and Clearance References 11 - Radiographic Evaluation in Oral Implantology Imaging Objectives in Oral Implantology Phase 1 Phase 2 Phase 3 Presurgical Imaging (Phase 1) Radiographic Modalities Used in Oral Implantology Periapical Radiograph Uses in Oral Implantology Panoramic Radiograph Use in Oral Implantology Magnetic Resonance Imaging Use in Oral Implantology Cone Beam Tomography (CBCT) Types of Computed Tomography Scanners Medical Effective Dose Range of Cone Beam Computed Tomography Bone Density Scanning Technique Artifacts Incidental Findings Complication Prevention Normal Radiographic Anatomy Mandibular Anatomy Mandibular Canal and Associated Anatomy Mental Foramen Incisive Canal Anterior Loop Accessory and Double Foramina Hypomineralization of the Mandibular Canal Mandibular Ramus (Donor Site for Autogenous Grafting) Lingual Concavities (Posterior) Retromolar Canal/Foramen Mandibular Symphysis (Implant Placement and Bone Donor Site) Maxillary Anatomy Premaxilla Nasopalatine Canal/Incisive Foramen Infraorbital Foramen Paranasal Sinuses Nasal Cavity Maxillary Sinus Membrane Ostiomeatal Complex Maxillary Ostium Uncinate Process Hiatus Semilunaris Anatomic Variants Concha Bullosa Paradoxical Middle Turbinate Deviated Septum Haller Cells Agger Nasi Cells Maxillary Sinus Septa Maxillary Sinus Hypoplasia Inferior Turbinate and Meatus Pneumatization (Big-Nose Variant) Buccal Thickness of Bone in Premaxilla Intraosseous Anastomosis Canalis Sinuosus Calcified Carotid Artery Atheroma Pathologic Conditions in the Paranasal Sinuses Odontogenic Rhinosinusitis (Periapical Mucositis) Acute Rhinosinusitis Chronic Rhinosinusitis Allergic Rhinosinusitis Fungal Rhinosinusitis (Eosinophilic Fungal Rhinosinusitis) Pseudocysts (Mucous Retention Cyst) Retention Cysts Primary Maxillary Sinus Mucocele Postoperative Maxillary Cyst Squamous Cell Carcinoma and Adenocarcinoma Maxillary Sinus Antroliths Radiology Reports Images Provided Diagnostic Objectives Radiographic Findings Radiographic Impression Recommendations Radiologist Name and Signature Level 4: Clinical Significance. This is critical patient record information Typical Radiographic Descriptions Radiographic Findings Maxilla Sinuses Nasal Cavity Air Space TMJ Other Findings Dental Findings Reporting Implant information Existing Implants Implant Measurements Alternative Report Style for “Incidental Radiographic Findings” Styles of Radiology Reports Intraoperative Imaging Immediate Postsurgical Imaging Abutment and Prosthetic Component Imaging Postprosthetic Imaging Recall and Maintenance Imaging Evaluation of Alveolar Bone Changes Legal Issues and Cone Beam Computed Tomography To Take a Scan or Not Technical Parameters Field of View Interpreting the Scan Referral to Radiologist Waiver of Liability Summary References 12 - Applied Anatomy for Dental Implants Surgical Anatomy of the Maxilla as an Organ Muscles Attached to the Maxilla Orbicularis Oris Muscle Incisivus Labii Superioris Muscle Buccinator Muscle Levator Labii Superioris Muscle Levator Anguli Oris (Caninus) Muscle Sensory Innervation of the Maxilla Posterior Superior Alveolar (Dental) Nerve Infraorbital Nerve Middle Superior Alveolar (Dental) Nerve Anterior Superior Alveolar (Dental) Nerve Palatine Nerve Nasopalatine (Sphenopalatine) Nerve Arterial Supply to the Maxilla Venous Drainage of the Maxilla Lymphatic Drainage Surgical Anatomy of the Mandible Muscle Attachment to the Mandible Lingual or Medial Attachments Buccal or Facial Muscle Attachments Innervation of the Lower Jaw and Associated Structures Inferior Alveolar (Dental) Nerve Lingual Nerve Nerve to the Mylohyoid Long Buccal Nerve Blood Supply to the Maxilla and Mandible General Concepts Maxilla Mandible References 13 - Dental Implant Infections Introduction Overview of Oral, Head, and Neck Infection and Spread Signs and Symptoms of Oral Infection Spread of Head and Neck Infection Fascial Spaces of the Neck Microbiology of Dental Implant Infection Causes and Risks of Dental Implant Infection Infection Before the Implant Placement Active Infection Site Periodontal Disease Chronic Periodontitis Immediate Loading in Periodontal Disease Perisurgical Infection Severe Postsurgical Infection Osteomyelitis Medication-Related Osteonecrosis of the Jaws Biologics Peri-implant Disease Peri-mucositis and Peri-implantitis Biofilm Prophylactic Antibiotics References 14 - Pharmacology in Implant Dentistry Antimicrobials Antibiotics Prophylactic Antibiotics Complications of Antibiotic Prophylaxis Antibiotics Used in Implant Dentistry Macrolides Clindamycin Tetracyclines Fluoroquinolones Metronidazole Prophylactic Antibiotics in Oral Implantology Therapeutic Use of Antibiotics: Postoperative Infections Therapeutic Antibiotics in Implant Dentistry Chlorhexidine Use of Chlorhexidine in Oral Implantology Miscellaneous Citric Acid Management of Postoperative Inflammation Nonsteroidal Antiinflammatory Drugs Glucocorticosteroids Mechanism of Action Adrenal Suppression Timing Glucocorticoid Use in Implant Dentistry Contraindication to Glucocorticosteroids Cryotherapy Postsurgical Pain Management Mechanism of Pain Protocols Postoperative Pain Preemptive Analgesia Postoperative Medications Nonopioid Medications Narcotics (Opioids) Combination Analgesic Therapy for Postoperative Pain Analgesic Agents in Oral Implantology Mild Pain Moderate Pain Severe Pain Control of Postoperative Surgical Pain Pain Control Protocol Preoperative Evaluation Development of a Pain Control Protocol Local Anesthetics Lidocaine Mepivacaine Articaine Long-Acting Anesthetics Local Anesthetic Overdosage Post-Surgical Anesthetic Use Sedative Agents Benzodiazepines Diazepam (Valium) Midazolam (Versed) Triazolam (Halcion) Additional Sedative Anxiolytics Fentanyl Propofol (Diprivan) Reversal Agents Comprehensive Pharmacologic Protocol Possible Drug Interactions in Oral Implantology References IV - Treatment Planning Principles 15 - Interactive Computed Tomography and Dental Implant Treatment Planning Evaluation and Determination of the Ideal Implant Position Prior To Obtaining a CBCT Fabrication of Radiographic Template (Scanning Template) Radiopaque Material Flapless Template Techniques Scanning Process Obtaining a Cone Beam Computed Tomography Scan Medical Scan vs. Cone Beam Computed Tomography Obtain Dataset Integrate Dataset Into Specialized Software Reconstruction (Manipulation of Data to Formulate a Treatment Plan) Determination of Panoramic Curve Mandibular Canal Identification Methods for Identifying the Mandibular Canal Evaluation of Bone Density Virtual Implant Placement Safety Zone Bone Graft Simulation Treatment Plan to Surgical Placement Surgical Template Fabrication Commercial In-Office Surgical Implant Placement With Surgical Template Surgical Restriction Templates Non-limiting Design Partial-Limiting Design Complete-Limiting Design CBCT Templates by Support Tooth-Supported Guides Indications Requirements (one of the following) Bone-Supported Guides Indications Soft Tissue–Supported Guides Indications Requirements CBCT by Drill Guidance (Fig. 15.23) Pilot Guide (Fig. 15.24) Universal Guide (Fig. 15.25) Fully Guided (Fig. 15.26) Requirements of a Surgical Template Surgical Template Fabrication Additional Types of Templates (Guides) Stereolithographic Models Surgical Guidance Templates and Navigation Systems Studies Stackable Templates for Provisional Restorations (Immediate Smiles) Digital Technology Optical Impressions Digital Systems Digital Scanner Process Implant Treatment Planning Restorative Implant Applications Laboratory Implant Applications Materials Surgical Template Complications Overheating the Bone Inadequate Access Difficulty in Template Seating Summary References 16 - Available Bone and Dental Implant Treatment Plans Literature Review Implant Size Implant Width (Diameter) Implant Height (Length) Measurement of Available Bone Available Bone Height Available Bone Width Available Bone Length Available Bone Angulation Divisions of Available Bone Division A (Abundant Bone) Division B (Barely Sufficient Bone) Bone Spreading Division C (Compromised Bone) Treatment Options Division D (Deficient Bone) Summary References 17 - Prosthetic Options in Implant Dentistry Completely Edentulous Prosthesis Design Partially Edentulous Prosthesis Design Prosthetic Options Fixed Prostheses FP-1 FP-2 FP-3 Removable Prostheses RP-4 RP-5 Summary References 18 - Bone Density: A Key Determinant for Treatment Planning Influence of Bone Density on Implant Success Rates Etiology of Variable Bone Density Bone Classification Schemes Related to Implant Dentistry Misch Bone Density Classification Determining Bone Density Location Radiographic Evaluation Tactile Sense Scientific Rationale of a Bone Density–Based Treatment Plan Bone Strength and Density Elastic Modulus and Density Bone Density and Bone–Implant Contact Percentage Bone Density and Stress Transfer Treatment Planning Summary References 19 - Treatment Plans Related to Key Implant Positions and Implant Number Key Implant Positions Rules for a Fixed Implant Prosthesis Rule # 1: Minimize Cantilevers Rule # 2: Limit the Number of Adjacent Pontics Rule # 3: Implant Positioned in Canine Site Rule # 4: Implant Positioned in Molar Site Rule # 5: Implant Positioned in Each Arch Segment Implant Number Additional Treatment Planning Principles Independent Prosthesis Splinted Implants Treatment Planning Should Not Be Dictated by Finances Summary References V - Edentulous Site Treatment Planning 20 - Treatment Plans for Partially and Completely Edentulous Arches in Implant Dentistry Partially Edentulous Arches History Classification of Partially Edentulous Arches Treatment Planning: Class I Division A Treatment Plans Division B Treatment Plans Division C Treatment Plans Division D Treatment Plans Treatment Planning: Class II Division A Treatment Plans Division B Treatment Plans Division C Treatment Plans Division D Treatment Plans Treatment Planning: Class III Division A Treatment Plans Division B Treatment Plans Division C or Division D Treatment Plans Treatment Planning: Class IV Division A Treatment Plans Division B Treatment Plans Division C and D Treatment Plans Classification of Completely Edentulous Arches Type 1 Division A Division B Division C Type 2 Type 3 Summary References 21 - Preimplant Prosthodontic Factors Related to Surgical Treatment Planning Overall Evaluation Maxillary Anterior Tooth Position Existing Occlusal Vertical Dimension Methods to Evaluate Occlusal Vertical Dimension Subjective Methods Objective Methods Mandibular Incisor Edge Position Existing Occlusal Planes (Posterior Maxillary and Mandibular Planes of Occlusion) Specific Criteria Lip Lines High Lip Line Mandibular Lip Line Maxillomandibular Arch Relationship Existing Occlusion Crown Height Space Excessive Crown Height Space Reduced Crown Height Space Temporomandibular Joint Extraction of Teeth with Hopeless or Guarded Prognosis Caries Endodontic Therapy Periodontal Disease Existing Prostheses Arch Form Natural Teeth Adjacent to Implant Site Abutment Options Adjacent Bone Anatomy Cantilevers Attaching Implants to Teeth Etiology Existing Tooth Mobility Prosthesis Movement Implant Mobility Guidelines for Joining Implants to Teeth Natural Tooth with No Clinical Mobility Rigid Connectors Are Contraindicated Nonrigid Connectors Are Contraindicated Pier (Intermediary) Abutments Natural Abutment Evaluation Abutment Size Crown/Root Ratio Tooth Position Parallelism Caries Root Configuration Root Surface Area Endodontic Evaluation Periodontal Status Soft Tissue Support Pretreatment Prostheses Fixed Treatment Prostheses Removable Treatment Prostheses Postimplant Placement Transitional Prosthesis Occlusal Vertical Dimension Esthetic Assessment 22 - Single and Multiple Tooth Replacement: Treatment Options Tooth Replacement Single Missing Tooth No Treatment Advantages Disadvantages Removable Partial Denture Advantages Disadvantages Resin-Bonded Fixed Partial Denture Advantages Disadvantages Fixed Partial Denture Advantages Disadvantages Single-Tooth Implant Advantages Disadvantages Specific Single-Tooth Implant Indications Anodontia Single-Tooth Implant Size Specifics Anterior Teeth Replacement Mandible Maxillary Posterior Teeth Replacement Premolar Replacement Multiple Missing Teeth No Treatment Advantages Disadvantages Removable Partial Denture Implant-Supported Multiple Crowns (Fig. 22.18) Disadvantages Types of Prostheses Screw-Retained Restorations Advantages Disadvantages Cement-Retained Restorations Advantages Disadvantages Miscellaneous Restorations Angulated screw channel Screw-cementable (combination) prosthesis Ideal Positioning for Screw and Cement-Retained Prosthesis Abutment Options Abutments for Cement-Retained Restorations Standardized (Stock) Abutments Custom Abutments Abutments for Screw-Retained Restorations Restorative Materials Zirconia Lithium Disilicate and Lithium Silicate Metal-Ceramic Gold Alloy Polymethylmethacrylate References 23 - Treatment Planning for the Edentulous Posterior Maxilla Inherent Disadvantages of Posterior Maxilla Treatment Poor Bone Density Decreased Available Bone Increased Pneumatization of the Maxillary Sinus Resultant Increased Crown Height Space Lingual Oriented Ridge Position Anatomic Location Increased Biting Force Requirement of Greater Surface Area Diameter Implants and Minimized Occlusal Forces Maxillary Sinus Has High Incidence of Pathology Treatment History Treatment of the Posterior Maxilla—Literature Review Sinus Graft Options for the Posterior Maxilla Misch-Resnik Maxillary Posterior Classification Subantral Option 1: Conventional Implant Placement Subantral Option 2: Sinus Lift and Simultaneous Implant Placement Subantral Option 3: Sinus Graft with Immediate Endosteal Implant Placement Subantral Option 4: Sinus Graft Healing and Extended Delay of Implant Insertion References 24 - The Edentulous Mandible: Fixed Versus Removable Prosthesis Treatment Planning Mandibular Treatment Planning Principles Anteroposterior Spread Mandibular Flexure Medial Movement Torsion Implant Overdentures Advantages (RP-4 and RP-5) Enhanced Soft Tissue Support Increased Chewing Efficiency Compared with Conventional Dentures Less Expense/Implants Esthetics Ease of Hygiene Parafunctional Habits Less Food Impaction Review of the Overdenture Literature Mandibular Overdenture Treatment Planning (RP-4 and RP-5) Anatomy of the Mandible Mandibular Implant Site Selection Overdenture Treatment Options Overdenture Option 1 Overdenture Option 2 Overdenture Option 3 Overdenture Option 4 Division C−h Anterior Mandibles Patient Education on Various Mandibular Overdenture Options Fixed Prosthesis Fixed Prosthesis Advantages Psychological Improved Speech Decreased Soft Tissue Irritation Increased Biting Force Less Bone Resorption Less Soft Tissue Extension Less Long-Term Expenses Less Interocclusal Space Requirement Patients with Limited Dexterity Increased Chewing Efficiency Mandibular Fixed Prosthesis (FP-1, FP-2, and FP-3) Implant Treatment Options for Fixed Restorations Treatment Option 1: The Brånemark Approach Treatment Option 2: Modified Brånemark Technique Treatment Option 3: Anterior Implants and Unilateral Posterior Implant Treatment Option 4: Anterior Implants and Bilateral Treatment Option 5: All-on-Four Protocol Summary References 25 - The Edentulous Maxilla: Fixed versus Removable Treatment Planning Treatment Planning Factors Smile Line Lip Support Ridge Position Soft Tissue Crown Height Space (Interocclusal Space) Literature Review Fixed Maxillary Treatment Plans Maxillary Fixed Prosthesis Treatment Option 1 (Box 25.1) Maxillary Fixed Prosthesis Treatment Option 2 Maxillary Fixed Prosthesis Treatment Option 3 Maxillary Fixed Treatment Option 4: All-on-Four Removable Maxillary Treatment Plans Maxillary Removable Implant Overdenture Treatment Options Option 1: Removable Maxillary RP-4 Implant Overdenture Option 2: Removable Maxillary RP-5 Implant Overdenture Summary References VI - Implant Surgery 26 - Basic Surgical Techniques and Armamentarium Flap Design Maintain Blood Supply Flap Design to Provide Access Full-Thickness Reflection Minimize Trauma to Tissue Vertical Release Incisions Maintain Flap Margins Over Bone Prevent Desiccation of Tissue Flap Mobility Types of Flaps Flapless Papilla Sparing Envelope Triangular and Trapezoidal Vestibular Proper Incision Technique Proper Incision Positioning Use of a Sharp Scalpel Blade Scalpel Technique Avoid Vital Structures Proper Scalpel Grip Pencil Grip Fingertip Grip Palm Grip Surgical Armamentarium Instrument to Incise Tissue Scalpel/Surgical Blades Instruments to Reflect Tissue Instruments to Grasp Tissue Instruments to Remove Bone/Tissue Rongeur forceps Surgical burs Bone file Instruments to Remove Tissue From Extraction Sockets or Bony Defects Bone-Grafting Instruments Bone scrapers Grafting spoon and condenser Surgical Scissors Hemostats Instruments to Retract Tissue Instruments to Hold Mouth Open Instruments to Hold Drapes Handpieces/Motors Osteotomes Sinus Curettes Aseptic Technique Sterile Field Surgical Scrub Utilization of Ideal Suturing Materials and Techniques Suture Type Absorbable Nonabsorbable Suture Qualities High Tensile Strength Low Tissue Reactivity Absorbable Treatment Implications Suture Size Suture Needle Suturing Technique Interrupted Continuous Horizontal/Vertical Mattress Suturing Instruments Tissue Pickups Needle Holders Suture Scissors Suturing Knots Treatment Implications References 27 - Implant Placement Surgical Protocol Pre-Implant Placement Protocols Flap Design Surgical Approaches Dental Implant Osteotomy Preparation Decreasing Heat During Osteotomy Preparation Irrigation versus No Irrigation Graduated versus One-Step Drilling Drilling Speed Drilling Time Drilling Pressure Intermittent versus Continuous Drilling Insertion Torque Bone Density Factors Related to Implant Preparation Literature Review Bone Density Classifications Osseodensification Generic Drilling Sequence Step 1: Pilot Drill Step 2: Position Verification Step 3: Second Twist Drill Step 4: Final Shaping Drills Step 5: Crest Module and Bone Tap Drills Step 6: Implant Insertion Dental Implant Surgical Protocol 1 (D1 Bone) Dense Cortical (D1) Bone Advantages of D1 Bone Disadvantages of D1 Bone Implant Osteotomy Drilling Sequence Bone Healing Dental Implant Surgical Protocol 2 (D2 B