palnificacion parte 1

Cr iter ios de selecci贸n del paciente candidato a implantes par te 1 Alejandro Kleinman DDS.

Patient’s selection criteria

Patient D esir e Dental Evaluation Systemic Evaluation

oCost oTime oOptions Note: Always diagnose every patients with optimum treatment option, fallowed by alternative treatment options.

Patient’s selection criteria

Patient Desire Systemic Evaluation Dental Evaluation

•Metabolic bone disease •Osteoporosis ?

•Radiation •Liver disease (Cirrosis) •Psicologic problems •Diabetes •Smoke •Non realistic expectations •Adolescence •Pregnancy •Immunocompromised Patients

Patient’s selection criteria

Patient Desire Systemic Evaluation D ental Evaluation

Occlusion Maximum intercuspation Centric Relation Occlusal interferences Parafunctional habit & wear facets Anterior guidance Occlusal plane

Patient’s selection criteria

Patient Desire Systemic Evaluation D ental Evaluation Arch shape and size Interarch relationship Adjacent teeth evaluation Esthetic evaluation

Patient’s selection criteria

Patient Desire Systemic Evaluation D ental Evaluation Arch shape and size Interarch relationship Adjacent teeth evaluation Esthetic evaluation

Patient’s selection criteria

Patient Desire Systemic Evaluation D ental Evaluation Arch shape and size Interarch relationship Adjacent teeth evaluation Esthetic evaluation

Soft & hard tissue evaluation Tissue health Attached gingiva Perio biotype Residual bone Smile line

Patient’s selection criteria Soft & hard tissue evaluation Tissue health Attached gingiva Perio biotype Residual bone Smile line

Patient’s selection criteria Soft & hard tissue evaluation Tissue health Attached gingiva Perio biotype Residual bone Smile line

Patient’s selection criteria Soft & hard tissue evaluation Tissue health Attached gingiva Perio biotype Residual bone Smile line

Immediate provisionalization

Patient’s selection criteria Soft & hard tissue evaluation Tissue health Attached gingiva Perio biotype Residual bone Smile line

Immediate provisionalization

Patient’s selection criteria Soft & hard tissue evaluation Tissue health Attached gingiva Perio biotypoe Residual bone Smile line

Final crown

Patient’s selection criteria •Health assesment Clinical examination •X-rays •Pictures •Mounted study models •Diagnostic wax-up •Interdisciplinary consultation

D I AGN OST I C T OOL S

Patient’s selection criteria Pictures

Patient’s selection criteria •Diagnostic set-up

Patient’s selection criteria Diagnostic wax-up Surgical guide

Patient’s selection criteria Diagnostic wax-up Surgical guide

Patient’s selection criteria Diagnostic wax-up Surgical guide

Patient’s selection criteria Diagnostic wax-up Surgical guide

Patient’s selection criteria Diagnostic wax-up Surgical guide

Patient’s selection criteria Diagnostic set-up X-ray guide

Patient’s selection criteria X-ray examinations Routi ne Rx. Especi a l Rx.

Per i a pi ca l Pa nor a mi c T omogr a phy CT sca n Cone bea m tomogr a phy

Patient’s selection criteria Lekholm and Zarb, 1985

X-ray examinations

Horizontal

Quantity of bone Vertical

Quality of bone

Patient’s selection criteria

X-ray examinations

Effect of Poor Bone Quality #Implants Type 1-3 Bone

Engquist '88 van S.ghe '90 Jaffin '91 Johns '92 Fugazzotto '93 Smedberg '93

141 491 952 453 851 53

% Failure relative to # Implants placed 2,938

Failures (%)

Type 4 Bone

Failures (%)

15 19 29 16 12 0

198 67 102 57 512 33

52 4 36 16 22 12

91 (3)

969

143 (15)

97%

85%

Patient’s selection criteria X-ray examinations Single Missing Tooth

Template fabrication

Patient’s selection criteria X-ray examinations Single Missing Tooth Evaluation of the osseous edentulous ridge.

Probing technique using a measuring guide.

(Ridge mapping)

Patient’s selection criteria X-ray examinations

Partially Edentulous

X-ray examinations

Partially Edentulous

Patient’s selection criteria

Patient’s selection criteria Partially Edentulous

Partially Edentulous

Patient’s selection criteria