List of Contributors xiii Foreword xv Preface xvii Acknowledgments xix 1 Introduction to Implant Dentistry 1 Introduction 1 Purpose of Textbook 1 Conventional Dentistry Versus Implant Dentistry 2 Predictability of Fixed Prosthodontics 2 Predictability of Implant Prosthodontics 3 Economics of Implant Dentistry 4 Prognostic Indicators for Teeth 5 Periodontal Disease 5 The Heavily Restored Tooth 6 The Furcation-Involved Tooth 8 The Periodontal Prosthesis Patient 9 Difficult Aesthetic Cases 10 Classification of Ridge Defects 12 Treatment Prognosis for the Dentition 15 Summary 18 Bibliography 18 2 Implants and Implant Restorative Components 21 Introduction 21 Implants 21 Implant/Abutment Connections 25 External Implant/Abutment Connections 25 Internal Implant/Abutment Connections 27 Healing Abutments 30 Conventional, Stock Healing Abutments 30 CAD/CAM Healing Abutments 32 Custom Healing Abutments 34 Impression Copings 35 Implant Impression Copings 35 Pickup Impression Copings (Open Tray) 36 Transfer Impression Copings (Closed Tray) 37 Low-Profile Conical Abutment Impression Copings 38 Scan Bodies 38 Abutments 39 Low-Profile Conical Abutments (LPCA) 40 LOCATOR Overdenture Abutments 41 Stock Abutments 42 UCLA Abutments 44 CAD/CAM Abutments 47 Milled Titanium 47 Milled Zirconia 50 Multiunit Abutments 54 Screws (Clinical) 54 Abutment/Retaining Screws 55 Preload Screw Mechanics 56 Cylinders 57 Definitive Cylinders 57 Interim Cylinders 57 Drivers and Placement Instruments 58 Drivers/Driver Tips 58 Laboratory Components 60 Implant Analogs/Replicas 61 Abutment Analogs/Replicas 62 Try-In Screws 63 Abutment Holders 63 Polishing Protectors 64 Bibliography 65 3 Diagnosis and Treatment Planning in Implant Restorative Dentistry 69 Patient Selection 69 Medical History 69 Diagnostic Procedures 70 Radiographs 70 CBCT (Cone Beam Computed Tomography) Scans 72 Scanning Appliances/Surgical Guides 74 Diagnostic Casts 75 Laboratory-Generated Surgical Guides 75 Physical Examination 78 Extraoral Examination 78 Intraoral Examination 78 Diagnostic Articulator Mounting 79 Diagnostic Wax Patterns 79 Implant Bone Volume 80 Implant Restorative Volume 83 Treatment Planning 85 Edentulous Patients 86 Overdentures 87 Restorative Volume 87 Fixed Implant-Retained, Full-Arch Prostheses-Edentulous Jaws 89 Milled Titanium Frameworks 92 Milled Zirconia Frameworks 94 High-Performance Polymers (HPP) 95 Crown-and-Bridge Type Prostheses 95 Partially Edentulous Patients 96 Screw-Retained Restorations 96 Treatment Goals 96 Benefits 96 Limitations 97 Cement-Retained Restorations 98 Benefits 98 Limitations 99 Angled Screw Channel Abutments 99 Peri-Implant Disease 99 Implant Loading Protocols 101 Unloaded Healing, Two-Stage Surgical Protocol 101 Unloaded Healing, Single-Stage Surgical Protocol 102 Early Loading 102 Immediate Occlusal Loading 103 Immediate Non-Occlusal Loading 103 Patient Consultation 104 Principles of Treatment Planning 104 Informed Consent 104 Summary 105 Bibliography 105 4 Treatment of Edentulous Mandibular Patients: (1) Implant-Retained Framework Overdenture and Resilient Attachments; (2) Resilient Attachments and Two Interforaminal Implants 111 Literature Review 111 Clinical Case Presentation Mandibular Implant-Supported Overdenture with CAD/CAM Framework and Resilient Attachments 117 Clinical Case Presentation Implant-Supported Overdenture with Resilient Attachments and Two Interforaminal Implants 142 Bibliography 156 5 Replacement of Single Teeth with CAD/CAM Implant Restorations: Implant-Level Impressions, Intraoral Scanning, Cement and Screw-Retained Crowns 159 Literature Review 159 Replacement of Individual Teeth 159 Single-Unit Implant Restorations 161 Computer-Assisted Design/Computer-Assisted Machining (CAD/CAM) Healing Abutments/Scan Bodies 162 Intraoral Scanning 167 Models from Digital Impressions 169 Clinical Case Presentation Posterior, Cement-Retained Single-Implant Restoration 170 Clinical Case Presentation Anterior, Screw-Retained Single-Implant Restoration (Angled Screw Channel) 185 Bibliography 197 6 Fixed Dental Prostheses: Retreatment of a Patient with a Fractured Implant-Retained Fixed Dental Prosthesis; CAD/CAM Abutments and a Cement-Retained Fixed Dental Prosthesis; Intraoral Scanning and Screw-Retained Fixed Dental Prosthesis (Atlantis(tm) Bridge Patient-Specific Suprastructures) 199 Literature Review 199 Clinical Case Presentation Implant-Level Impression/Screw-Retained Fixed Dental Prosthesis 204 Clinical Case Presentation Intraoral Scanning/Screw-Retained Fixed Dental Prosthesis (Atlantis(tm) Bridge Patient-Specific Suprastructure) 219 Bibliography 235 7 Accelerated Treatment Protocol of a Patient with Edentulous Jaws and CAD/CAM Titanium Framework/Fixed Hybrid Prostheses 237 Literature Review 237 Original Treatment Protocol 239 Accelerated Treatment Protocol 242 Clinical Case Presentation Four Months Post Implant Placement and Immediate Occlusal Loading 243 Bibliography 275 8 Treatment of Edentulous Patients with Immediate Occlusal Loading: Conventional Surgical and Computer-Generated Surgical Guides 279 Literature Review 279 Introduction 279 The Preosseointegration Era 280 The Osseointegration Era 281 Immediate Occlusal Loading in the Edentulous Mandible 282 Immediate Occlusal Loading in Edentulous Maxillae 285 Clinical Case Presentation Mandibular Immediate Occlusal Loading with Clinical Conversion of Mandibular Immediate Denture 286 Clinical Case Presentation Maxillary Immediate Occlusal Loading Using Computer-Generated Surgical Guide with Clinical Conversion of Maxillary Immediate Denture 312 Bibliography 324 9 Treatment of Edentulous Patients with Immediate Occlusal Loading: Conventional Surgical/Prosthetic Protocols 327 Literature Review 327 Immediate Occlusal Loading 327 Computer-Guided Surgery 328 Clinical Case Presentation Conventional Surgical and Restorative Protocols 332 Bibliography 367 10 Treatment of Partially Edentulous Patients with Immediate Non-Occlusal Loading Protocols (Intraoral Scanning, CAD/CAM Abutment, and Definitive Maxillary Central Incisor Restoration; Co-Axis Implant and Restoration) 371 Literature Review 371 Clinical Case Presentation INOL Protocol and Intraoral Scanning 375 Clinical Case Presentation INOL Protocol with Co-Axis Implant 396 Bibliography 408 11 Computed Tomography (CT) Guided Surgery/Immediate Occlusal Loading with Full-Arch Prostheses in Edentulous Patients 411 Literature Review 411 Immediate Occlusal Loading 411 Tilted Implants 412 Diagnostic Imaging 413 Computed Tomography (CT) 415 Interactive Computed Tomography (ICT) 417 Interactive Computer Software 418 Computer-Guided Surgery 418 Overview of CT Guided Surgical and Prosthetic Protocols 419 Surgical Guides 419 Master Tubes 419 Prosthetic Laboratory Kit-Implant Analog Mounts 420 Surgical Kit Components 420 Fabrication of Master Cast for Immediate, Fixed Provisional Prosthesis 421 Abutment Selection for Fixed, Screw-Retained Provisional Prostheses 422 Fabrication of a Screw-Retained Provisional Prosthesis 424 Clinical Patient Presentation Ill-Fitting Maxillary Denture; Mandibular Implant-Supported Overdenture 425 Clinical Patient Presentation Maxillary and Mandibular Terminal Dentitions; Computer-Guided Surgery with Metal Surgical Guides 448 Bibliography 463 12 Guidelines and Maintenance Procedures for Fixed, Full-Arch, Implant-Retained Prostheses 465 Introduction 465 Full-Arch Hybrid Prostheses 465 Historical Perspectives 466 Original Protocol 466 Immediate Occlusal Loading for Full-Arch Prostheses 466 Clinical Complications 467 Mechanical 467 Biologic: Peri-Implant Mucositis/Peri-Implantitis 470 Treatment (Peri-Implant Mucositis) 472 Treatment (Peri-Implantitis) 473 Innovations in Full-Arch Designs 475 Prosthesis Design/Materials 476 Hygiene/Maintenance Protocol for Immediately Loaded Full-Arch Prostheses 477 Hygiene/Maintenance Protocol for Definitive Full-Arch Prostheses 478 At-Home Hygiene 478 Plaque Control-Dentifrice 478 Plaque Control-Mechanical 478 Recall Appointments 479 Recall Interval/Schedule 479 Examination 480 Radiographs 481 Professional Maintenance 485 Prosthesis Removal 487 Cleaning the Removed Prosthesis 488 Conclusions 488 Bibliography 488 Index 493.