Dental Implants: Surgical & Prosthetic Perspective
If an implant is not placed in the right position or with the correct angulations, then the prosthesis will be compromised. Although this may seem like an obvious statement, it brings to light that an implant must be guided by the position of the final prosthesis. Any other method leaves room for complications and the probability of poor results.
When treatment planning an implant case, we need to work our way back from the prosthesis to the implant. A wax up of the final prosthesis needs to be done. This will give us a guide for whether enough bone is present or if we have enough prosthetic space available. The bone volume can be determined based on the final position of the prosthesis. This means that if there is not adequate bone in the area, a bone graft must be planned to support the positioning of the implant with the correct orientation. Furthermore, we will also be able to demonstrate whether there is an adequate amount of prosthetic space to the opposing teeth.
Ideal vertical space required from ridge to the opposing tooth is 7 mm and the minimum space required is 4mm (this may result in a screw-retained prosthesis) the minimum bone width required is 7mm for a regular platform implant. This must be planned in such a way that the implant is centered on the posterior teeth and slightly palatal to the incisal edge on the anterior teeth for cement retained prosthesis and in the cingulum for a screw-retained prosthesis. All this information can be visualized comparing the waxed up models to the edentulous models.
The surgical guide will be fabricated based on the wax up that demonstrates the final position of the prosthesis. Therefore, as you can see the implant treatment is dictated by the final position of the teeth, in relation to one another. I recommend obtaining study models for any possible implant patient prior to the extraction(s), since this will be valuable information that can be used at the time of implant therapy. The days are long gone when treatment plans were based on placing an implant wherever the bone is. If the final outcome is not fully functional, maintainable and esthetically pleasing; regardless of the successful integration of the implant, the case is compromised and is considered a failure. In conclusion, the importance of the restorative dentist is vital and the surgeon must have a greater appreciation and knowledge for the prosthetic planning of these cases in order to make them successful. A collaborative team approach is paramount.
The Palm Beach Center for Oral Surgery and Dental Implants providing quality care to Delray Beach, Boca Raton, Boynton Beach, and Palm Beach County. 561.900.9080 www.PasqualOMS.com