資料內(nèi)容文稿教程iti education week2014pow

1、Treatment Planning for the Prevention of technical complicationsEdmond PowBDS, MDS(Pros), PhD, MRACDS(Pros), FRACDS, FCDSHK(Pros), FHKAM, FICDAssociate Professor & Postgraduate Programme Director in OralabilitationDeputy Postgraduate Programme Director in Implant DentistryFaculty of Dentistry, T

2、he University ofSpecialist in ProsthodonticsChairman, Specialty Board in Prosthodontics, College of Dental Surgeons ofOsseointegrationMore than 50 years clinical documentationImplant treatment is a predictable option for replacing missing teeth!Replacing single toothReplacing multiple teethFull arch

3、abilitationMaxillary reconstructionMandibular reconstructionMaxillofacial implants using navigationMaxillofacial prosthesisTam CK, McGrath C, Ho MY, Pow EHN, Luk HWK, Cheung LK. Psychosocial and quality of life outcomes of prosthetic auricularabilitation with CAD/CAM technology. Int J Dent 2014; 1-1

4、2.Implant survival rates (5yr)Single crown (95.6%)Fixed partial denture (97.7%)Edentulous fixed (87.7%Max, 96.7%Mand)Edentulous removable (76.6%Max, 95.7%Mand)Bryant SR et al. JOMI 2007;22(Suppl):117-139.Weber H, Sukotjo C. JOMI 2007;22(Suppl):140-172.No matter how successful the implanttreatment is

5、, failuappens!No matter how successful the implant treatment is,failuappens!Classifications of implant complicationsn Early Biologicaln Late Mechanicaln Aestheticn Surgical Functionaln ProsthodonticMechanical failuresn Prosthesis leveln Abutment leveln Implant leveln Opposing teeth/prosthesesMechani

6、cal complications. Goodacre et al. (2003)Overdenture retention loss/adjustment30%Acrylic fracture22%Overdenture relines19%Overdenture clip/attachment fracture17%Porcelain fracture14%Overdenture fracture12%Opposing prosthesis fracture12%Acrylic resin base fracture7%Prosthesis screw loosening7%Abutmen

7、t screw loosening6%Prosthesis screw fracture4%Metal framework fracture3%Abutment screw fracture2%Implant fracture1%Cumulative 5-yr occurrence of technical complications in implant prosthesesVeneer fractureScrewLooseningScrew fractureFramework fractureImplant fractureFPD13.2%1.5%5.8%0.8%0.4%SC4.5%12.

8、7%0.3%3.0%0.1%Pjetursson et al 2004 COIRJung et al 2008 COIRFractured acrylic facingManagement of fractured facingBefore repair, you have to differentiate :n Impact failures: hard food, accidentn Fatigue failures: after thousands of chewing cyclesAdhesive vs cohesive failuresAdhesive failures: labor

9、atory problems,bonding failures,contamination, incompatibility of materialsCohesive failures: unsupported porcelain, acrylic resin too thinCeramic chipin Zr-based prosthesisn 2.92% per year (Zr)n 0.59% per year (PFM)Sailer et al. JOMI 2009Enhance Porcelain-Zr bondn Inertness of Zr (cannot be etched

10、or bonded)n Sandblastingn Coefficient of thermal expansion (CTE)n Cooling raten Other surface treatmentsStrength of 3-unit zirconia FDPs1. Lab A, Zr framework, veneering A2. Lab B, Zr framework, veneering A3. Lab C, Zr framework, veneering A4. Lab C, Zr framework, veneering B5.Lab C, Zr full size, n

11、o veneeringRosentritt et al. Clin Oral Invest 2010Cracked acrylicFractured bar and screwsOPG showing two IMZ implantsWhat to do?n Status of implantsn Parts availabilityn Fixed vs removablen Splint?n Attachment?Two new implants connected with barScrew loosening or fractureScrew loosening or fractureV

12、ery common in the old daysn Hand tightening (<10Ncm)n Titanium or gold alloy screwLess common nown Torque wrench (up to 35Ncm)n Surface treated screws e.g.TorqTite, Gold-TiteSurface treated screws vs ordinary screwsImplant abutment screw rotations and preloads for four different screw materials a

13、nd surfaces. J Prosthet Dent 2001;86:24-32.Compare screws of TorqTite, Gold-Tite, gold alloy, titanium alloy: TorqTite and Gold-Tite abutment screws withenhanced surfaces that help reduce the coefficient of friction produced greater rotational angles and preload values than the conventional gold all

14、oy and titanium alloy screws.Management of screw looseningn Find out the cause and contributing factorsn Retighten the loose screw?n Replace the loose screw with a new one?n Evaluate againManagement of screw fractureRetrieve the fractured endwithn Artery forcep/pliersn Proben Plasticn Round burn Ret

15、rieval kitRetrieve a fractured abutment screwRetrieved fractured abutment screwSingle tooth replacementCement-retained crownCrown was found loosenedn Cement interface?n Abutment screw level?n Implant-bone interface?Loose abutment screw of a cemented crownn Drill a hole via the crownn Locate the abut

16、ment screwn Untighten the abutment screw and retrieve thecrown in one piecen Check the implantn Retighten the abutment screw and cover the access hole orn Remake the crownThe abutment screw was fractured during tighteningn Worst scenarion Screw cold welded inthe implant?n What to do?Pow EHN, Wat PYP

17、. A technique for salvaging an implant-supported crown with a fractured abutment screw. J Prosthet Dent 2006;95:169-70.n Use turbine with diamond bur to remove the fractured end andeliminate internal thsn Make an impression of the screw hole and the external hex connectionImpression post plus Durala

18、y co3 years laterThe messages aren Use surface-treated screwsn Replace the old screws if necessaryn Dont untighten and tighten the screws if not neededn Dont overtorque the screwsSolution: Morse taper connectionn No gap or micromovementn Low risk of loosening/fracturen Strongn rotationalMorseExterna

19、ltaperhexFull maxillary arch vs edentulous mandibleImplant-supported bridgePatient complained about loosenessFractured implantRetrieval of the bridge with abutment plus half of the implantWhy it failed?What to do?n Remove/leave the fractured implant?n Fixed? Place another one at the same/other site?

20、n Removable? What attachments?n How to temporize?Temporization by using the failed bridgeImplant-supported overdenturePartially edentulous vs edentulousClinical examinationInsertion of five implantsPost-operative OPGDelivery of a fixed implant bridgeScrew-retained acrylic bridge supported by gold fr

21、ameworkFremitus of all maxillary teethReduce vertical dimension to ease the loadExtraction of all mobile teethEight implants placedSix implants survivedScrew-retained bridge insertedProstheses in-situLoose bridge after biting on an appleDesign a prosthesis with built-in mechanical receptors which pr

22、ovide feedback to the brain and minimize overloading?Retrospective analysis of porcelain failures of metal ceramic crowns and fixed partial dentures supported by 729 implants in 152 patients: Patient-specific and implant-specific predictors of ceramic failure.Kinsel & Lin J Prosthet Dent 2009n M

23、etal ceramic prostheses (SCs or FPDs) had approximately 7times higher odds of porcelain fracture and 13 times greater odds of a fracture requiring either repair or replacement when in occlusion with another implant-supported restoration, as compared to opposing a natural tooth.n Patients exhibiting

24、bruxism or not wearing an occlusal device had approximately 7 times higher odds and 2 times higher odds of porcelain fracture when compared to patients without bruxism and patients not wearing an occlusal device.The messages aren Beware of parafunctional habitsn Beware of patients with square faces

25、with strong masseter muscles, no matter how old they are!In,Most of the failures can be avoided by careful case selection and treatment planning!Identify parafunctional casesPlan and place your implants to distribute the loadDesign your superstructures with minimal cFabricate passive fitting framewo

26、rkAvoid occlusal interferencesPrepare for failuresleversSelected publications on dental implants1.Wat PYP, Pow EHN,TW. A new prosthodontic technique for fabricating cement-retained implant-supported prostheses.tessence Int 2000;31:187-190.2.Pow EHN, Wat PYP,TW. Retrievable cement-retained implant-to

27、oth-supported prosthesis: A new technique. Implant Dent 2000;9:346-350.3.Luk HWL, Pow EHN, McMillan AS, Hui CF. A double casting technique to minimize distortionwhen constructing fixed partial dentures on implants. J Prosthet Dent 2004;91:93-96.4.Pow EHN, McMillan AS. A locating splint for placing i

28、mplant abutments. J Prosthet Dent2004;91:97-98.5.Pow EHN, McMillan AS. A modified implant healing abutment to optimize soft tissue contours:A case report. Implant Dent 2004;13:297-300.6.Pow EHN. A time-saving technique for selection, insertion and provisionalization when using angulated abutments fo

29、r dental implants. J Prosthet Dent 2005;93:403.7.Yeung RWK, Jin LJ, Pang M, Pow EHN. Human histologic and electromicroscopic analysis with synthetic peptide enhanced hydroxyapatite in the maxillary sinus elevation procedure: a case report. Implant Dent 2005;14:237-241.8.Pow EHN, Wat PYP. A technique

30、 for salvaging an implant-supported crown with a fracturedabutment screw. J Prosthet Dent 2006;95:169-70.9.Chen ZF, Pow EHN. A technique for the fabrication of an immediate implant-supported provisional restoration using a fractured natural tooth. J Prosthet Dent 2008;100:89-90.10.Wat PYP, Pow EHN,

31、Chau FSW, Leung KCM. A surgical guide for dental implant placement inan edentulous jaw. J Prosthet Dent 2008;100:323-325.11.Pow EHN, Leung KCM. Recent innovations in dental implantology. Expressions 2008;2:11.12.Chen ZF, Pow EHN, Wang Y, Luo ZB. Clinical evaluation of ceramic implant abutments in an

32、terior restorations. Ann R Australas Coll Dent Surg 2008;19:67-70.Selected publications on dental implants13.Pow EHN, Leung KCM. Prosthodontic complications in dental implant therapy.Dent J2008;5:79-83.14.Chik FF, Chan WK, Pow EHN,TW. Management of non-restorable maxillary premolars with immediate i

33、mplants, immediate provisional restorations, and definitive screw-retained CAD/CAM zirconia abutment crowns: A report of five cases.Dent J 2009;6:31-8.15.Au Yeung NKH, Pow EHN. Minimally invasive sinus-lift technique with simultaneous installation of a wide diameter implant: a case report.Dent J 200

34、9;6:98-102.16.Wong TL, Wat PYP, Pow EHN, McMillan AS.abilitation of a mandibulotomy/onlay/graftreconstructed mandible using a milled-bar over-partial implant prosthesis: A clinical report. J ProsthetDent 2010;104:1-5.17.Luk LCK, Pow EHN, Li TKL,TW. Comparison of ridge mapand cone beam computerized t

35、omography for planning dental implant therapy. Int J Oral Maxillofac Implants 2011;26:70-74.18.Wat PYP, Wong ATY, Leung KCM, Pow EHN. Proximal contact loss between implant-supportedprostheses and adjacent natural teeth: A clinical report. J Prosthet Dent 2011;105:1-4.19.Ng CH, Pow EHN,TW, Lo ECM. De

36、ntal implant practice amonggeneral dental practitioners in 2004 and 2008. Implant Dent 2011;20:95-105.20.Liu D, Matinlinna JP, Pow EHN. Insights into porcelain and zirconia bonding. J Adhesion SciTechnol 2012;26:1249-1265.21.Liu JY, Pow EHN, Chen ZF, Zheng J, Zhang XC, Chen J. The mandarinshortened

37、version of oral health impact profile for partially edentate patients with implant-supported prostheses. J Oralabil 2012;39:591-599.22.Pow EHN, Yeung KKC, Matinlinna JP. Effects of silanes alone and their blends with HEMA on resin-titanium bonding. J Adhesion Sci Technol 2012;26:2505-2515.Selected p

38、ublications on dental implants23.Cheung LK, Chua HDP, Hariri FB, Pow EHN, Zheng L. Alveolar distraction osteogenesis for dental implants following fibular reconstruction: a case series. J Oral Maxillofac Surg 2013;71:255- 271.24.Liu D, Matinlinna JP, Pow EHN, Tsoi J, Shibata Y, Miyazaki T. A new modified laserpretreatment for porcelain zirconia bonding. Dent Mater 2013;29:559-565.25.Lee LTK, Pow EHN, Leung KCM. Conversion of a maxillary complete denture to an interim implant-su