Beruflich Dokumente
Kultur Dokumente
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J o ur
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Ed u c a Journal of Academy of Dental Education, 17–21 ISSN (Online) : 2348-2621
Abstract
The treatment planning phase of implant prostheses is dependent on the restorative dentist’s knowledge and experience
in prosthetic dentistry. Clinically, for implant prostheses, natural occlusal concepts can be applied. However, a natural
tooth has a support design i.e. periodontal ligament that reduces the forces to the surrounding crest of bone compared
to the same region around an implant. If biomechanical stresses are likely to increase in a clinical condition, occlusal
mechanisms to decrease the stresses should be implemented by the dentist and an occlusal scheme should be developed
that minimizes risk factors and allows the restoration to function in harmony with the rest of the stomatognathic system.
Implant-protected occlusion is proposed as a way to overcome mechanical stresses and strain from the oral muscula-
ture and occlusion, by avoiding initial and long-term loss of crestal bone surrounding implant fixtures. Implant-protected
occlusion can be accomplished by factors like decreasing the width of the occlusal table, increasing the surface area of
implants, reducing the magnification of the force and improving the force direction. The dentist can minimize overload on
bone-implant interfaces and implant prostheses, maintain an implant load within the physiological limits of individualized
occlusion, and ultimately provide long-term stability of implants and implant prostheses by following above mentioned
factors.
goal of Implant-Protective occlusion is to maintain the 5. Non-interference of all posterior teeth on the work-
occlusal load transferred to the implant within the physi- ing side with either the lateral anterior guidance or the
ologic limits of each patient.1 This articles aims to provide border movements of the condyles.9
an overview on implant occlusal principles and consid-
erations that will help the restoring dentist to focus on An appropriate occlusal pattern can be found based
extending the service life of the restoration and the con- on the above criteria though there is no one occlusal
necting abutments. pattern for all individuals. Three ideal occlusal schemes
have been stated that are accepted and recognized, that
describe the manner in which the teeth should and
2. Discussion should not contact in various functional and excursive
Occlusion can be defined as ‘the act of closure or state positions of the mandible. These include balanced occlu-
of being closed or shut off ’. Unfortunately the term sion, group function occlusion and mutually protected
denotes a static morphologic tooth contact relationship occlusion9.
in dentistry. However the term should have the concept
of a multi factorial relationship between the teeth and 2.1 Difference between Natural Teeth and
the other components of masticatory system in its defini- Implant10
tion9. An ideal occlusion is an occlusion compatible with
Differences between natural tooth and endosseous dental
the stomatognathic system providing good esthetics and
implants under occlusal loading are summarized below
efficient mastication without creating physiologic abnor-
(Figure 1).
malities. Five concepts important for an ideal occlusion
The basic difference between endosseous dental
had been described by Dawson (1974):
implants and natural teeth is that a natural tooth has a
1. Stable stops on all the teeth when the condyles are support design that reduces the forces to the surround-
in the most superior posterior position (Centric ing crest of bone compared to the same region around
Relation) an implant. A dental implant is in direct contact with the
2. An anterior guidance that is in harmony with the bor- bone through osseointegration while a natural tooth is
der movements of the envelope of function. suspended by the periodontal ligament (PDL). The PDL
3. Disclusion of all the posterior teeth on the balancing distributes occlusal stresses away along the axis of natural
side. teeth and absorbs shocks. However, an endosseous dental
4. Disclusion of all the posterior teeth in protrusive implant lacks those advantages of the PDL and connected
movements. to the bone by osseointegration.
implant prostheses. Weinberg21 claimed that in the pro- tongue biting during function. However, no occlusal
duction of bending moment, cusp inclination is one of the contacts occur on lingual cusp. The buccal contours of
most significant factors. The resultant bending moment the crown are contoured to reduce the occlusal table and
can be decreased by reduction of cusp inclination with offset loads on the implant.
a lever-arm reduction and improvement of axial loading
force.
4. Conclusion
3.6 Crown Height The osseointegrated implants lack mechanoreceptors and
The original anatomical crown is often shorter than the a shock absorbing function because they are ankylosed to
implant crown height, even in Division A bone. Crown the surrounding bone without the periodontal ligament.
height may act as a vertical cantilever with a lateral load One of the main causes for peri-implant bone loss and
and a magnifier of stress at the implant to bone interface15. implant/implant prosthesis failure is occlusal overload.
Many clinical complications such as screw loosening or
3.7 Occlusal Contact Position fracture, prosthesis fracture, continuing marginal bone
loss, implant fracture, and implant loss may be attributed
Within the diameter of the implant, the ideal primary
to implant overload. By application of biomechanical
occlusal contacts in implant prosthesis will reside within
principles such as reducing the cantilever length, pas-
the central fossa. Within 1mm of the periphery of the
sive fitting of prostheses, narrowing the buccolingual/
implant, secondary occlusal contact should remain to
mesiodistal dimensions of the prosthesis, reducing cusp
decrease moment loads. Marginal ridge contacts should
inclination, eliminating excursive contacts, and centering
be avoided as these may be the most damaging as these
occlusal contacts, these complications can be prevented10.
create cantilever effects and bending moments.
Implant occlusion should be adjusted periodically and
re-evaluated to prevent them from developing potential
3.8 Implant Crown Contour overloading clinical sequelae, thus providing implant lon-
Once the teeth are lost, edentulous ridge resorbs in a gevity14.
medial direction for maxilla and lingually for mandibular
arch, therefore endosteal implants are usually placed more
lingual than their natural predecessors. The diameter and 5. References
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