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Objectives

  • To develop in each student an understanding of the history of implant dentistry.
  • To introduce the student to the concept of osseointegration. To develop an understanding of the scientific basis of implant-host relations and interactions.
  • To teach the student how to include implants in their overall diagnosis and treatment planning for their patients.
  • To familiarize the student with an overview of the surgical techniques and healing time required for implants.
  • To introduce to the student basic fixed and removable prosthodontic techniques for implants. Students will be introduced to restoring single tooth crowns, three-unit fixed partial dentures and implant overdentures on implants. This will include knowledge on temporization procedures for implant restorations. Students who successfully complete the treatment plan for implant patients for clinical treatment will be able to apply this knowledge.
  • To encourage the student to seek further courses in implant dentistry for more expertise and for familiarity with other implant systems.
  • To make the student aware of the limitations of implants by illustrating implant failure, soft tissue problems, prosthodontic (mechanical) complications, and the need for recall of implant patients.
  • To impress on the student the need to follow the rapidly expanding research in dental implants, which directly affects current treatment modalities.
  • To introduce the student, by means of a short preclinical laboratory, to implant components.
  • To encourage each student to identify and treat an implant patient so that they may become familiar with implant treatment.
  • To be able to identify the level of difficulty of implant treatment which might need care of a specialist.
  • Note: A goal of this section is not that you will become an expert in implant dentistry. This is an introductory course.

1. General Information

The Implant Dentistry Lecture Series takes place on Tuesday mornings for fifty minutes from May 3 - August 2. Students are divided into 10 small groups and rotate throughout this course. The course meets in the Preclinical Laboratory.

1.1. Course Requirements

1.1.1. Attendance

Attendance at all lectures is necessary and important for you. Examination questions are taken from lecture and slide material, the syllabus, and the implant dentistry manual. Videotapes shown during lectures and handouts given out in lectures will be test material.

1.1.2. Grading

The grade for the Implant Dentistry course will be divided as follows:

10% Complete Denture Practical Exam I and II
20% Projects
10% Quiz
30% Examination I-Midterm
30% Examination II-Final

Examinations will have a maximum of 50 multiple-choice questions.

There will be one make-up examination each for each examination. These may be essay/fill-ins or multiple-choice questions.

1.2. Implant Hands-On Laboratory

There will be one hands-on laboratory session that all members of the class must attend. There are two three-hour sessions in the Preclinical Laboratory. One-half of the class will be assigned to each session for each session.

1.3. Seminar - Implant Overdentures

The group seminar (16-17 students/group) is included into this Implant Dentistry Course starting on May 17 and will be ended on July 12 with the seminar "Implant Retained Overdentures".

Students MUST attend the scheduled Seminar (see student schedule). "Implant Overdentures" given in the first ten weeks on Tuesday mornings by Dr. Chaimattayompol. This is an additional laboratory or "hands-on" portion of this course. It covers implant overdentures (removable implant prostheses).

There will be examination questions from the seminar in the Final Examination.

1.4. Reading/Viewing Assignments

Suggested textbook: "Boucher's Prosthodontic Treatment for Edentulous Patients," Editors Zarb, Bolender, Carlsson, Eleventh Edition, Mosby 1997, Chapters 26, 27, 28, 29, 30.

"Contemporary Implant Dentistry", Editors Misch CE, 3rd edition, Mosby 2005, Chapter 12, 13*, 15.

In this syllabus, you will also see a list of more suggested textbooks and a list of DVD/CD ROMs.

NOTE: HANDOUTS/CD ROM MUST BE PICKED UP DURING CLASS TIME. EXTRAS MAY BE AVAILABLE AFTER CLASS, FROM YOUR CLASS REPRESENTATIVE, WITHIN ONLY A FEW WEEKS OF THE START OF THE COURSE.

1.5. Implant Clinical Experience

Each student must do one implant clinical experience as a minimum procedural experience (see your MCP document). This can include:

  1. Diagnosis and treatment planning (Implant Step Sheet)
  2. Implant Crown
  3. Implant Fixed Partial Denture
  4. Implant Overdenture

The Implant Dentistry Step Sheet must be used for all of these procedures. It is turned in to the Department of Prosthodontics and Operative Dentistry.

1.6. Office Hours

The Instructor's teaching schedule can be verified in front of his/her office room.

Any of your suggestions during the course will be met with enthusiasm and appreciation. Feel free to use e-mail. Thank you.

1.7. Lecture/Projects Schedule

Class Class Title Instructor
Class 1 Overview of the course Didactic/TUSDM Clinical Protocols Dr. Chaimattayompol
Class 2 Introduction/History of Dental Implants/Definitions/Success Rates/Complications Dr. Arbree
Class 3 Patient Selection/Diagnosis and Treatment Dr. Arbree
Class 4 The Principles of Osseointegration Dr. Chapman
Class 5 Implant Surgery
Class 6 Implant Supported Single Crown Dr. Chaimattayompol
Class 7 Examination I
Class 8 Implant Assisted Removable Partial Overdentures Dr. Chaimattayompol
Class 9 Implant Supported Fixed Partial Denture I Dr. Chaimattayompol
Class 10 Implant Supported Fixed Partial Denture II Dr. Chaimattayompol
Class 11 Peri-Implant Soft Tissue Management Dr. Chaimattayompol
Class 12 Maintenance/Recare/Complication Dr. Chaimattayompol
Class 13 Review All Lectures Dr. Chaimattayompol
Class 14 Exam II

2. Implant Dentistry Manual Acknowledgements and Table of Contents

Editors:

Carole Alton, B.D.S., D.M.D.

Nancy S. Arbree, D.D.S., F.A.C.P., M.S.

Nopsaran Chaimattayompol, D.D.S., D.M.D., M.P.H.

Contributors:

Robert J. Chapman, D.M.D.

Copyright© 2004 Fourth Edition

We are grateful to Nobel Biocare USA, Inc. for allowing their images to be reproduced here.

Special thanks to the following authors who helped with drawings and slides:

Dr. Carole Alton, Dr. Nancy Arbree, Dr. Nopsaran Chaimattayompol, and Dr. Kyuho Lee

Special thanks to our word processors Bobbi Jo Meserve, Delroy Mckenley and Sharon O'Neil

2.1. Table of Contents

Please note only content for Chapters 1, 3, and 8 is included in the Tufts OpenCourseWare Implant Dentistry course.

CHAPTER 1 1
Introduction 1
History 2
Consensus Conferences 7
Conditions for application of criteria: 8
Other Implant Systems 9
Success Rates 9
Complications 11
Nutrition and Quality of Life 12
References 13
CHAPTER 2 16
Osseointegration 16
Basic Research 17
Basic Tissue Response 17
Summary of the factors necessary for maintaining osseointegration 19
Surface characteristics of dental implants 19
Qualities of Ti 19
Titanium Plasma Spray Coated 20
Bone Maturation 20
Summary of Requirements to Achieve Osseointegration: 22
CHAPTER 3 24
Diagnosis and Treatment Planning 24
Indications 25
Contraindications 27
Another Contraindication 28
Initial Evaluation 28
Oral Examination 29
Existing Prosthesis 29
Initial Surgical Consultation 30
Advanced Radiographic Techniques in Implant Dentistry: CT Scans 30
Sequence of Treatment 31
Duties of Dentist and Assistant 34
Evaluation of Mounted Casts/Anatomic Considerations 37
Diagnostic Wax-up/Wax Try-in 39
Edentulous Considerations for Diagnostic Try-in 39
Partially Edentulous Considerations for Diagnostic Try-In 39
Fabrication of Interim Prosthesis 40
Treatment Plan 40
Final Surgical Consultation 40
Stent 40
CHAPTER 4 44
Surgical Templates 44
Introduction 45
Two Types of Surgical Templates 46
Preliminary Procedures 46
Acrylic Resin Template Procedures 47
Prescription 54
Example 54
Radiographic Templates 55
Summary 55
References 56
CHAPTER 5 57
Implant Components 57
Implant Components 58
Basic terminology 58
Overview of procedures and instruments for each visit and subsequent laboratory phase 62
Diagnosis, Treatment Planning and Stage I Surgery (See Implant Dentistry Step Sheet) 62
References 67
CHAPTER 6 68
Surgical Considerations 68
Anatomical Considerations in Implant Dentistry 69
Anatomical Considerations 71
Surgical Procedures 73
Basic Elements for Successful Surgery 78
Further Considerations for Implant Surgery 78
Peri-Implant Tissues-Bone Implant Interface 78
Bone Volume 79
References 86
Single Tooth Implants and Implant Crowns 91
Hygiene - Summary Comparison: 94
Indications for Placing a Single Tooth Implant: 94
Contraindications to Placing a Single Tooth Implant: 94
Diagnostic Considerations for Single Tooth Implant 95
Diagnosis, Treatment Planning: Preliminary Impressions, Mounted Diagnostic Casts, Radiographs, Tooth Wax-up, Stent Fabrication 101
Transitional or Interim Prostheses/Abutment Selection 104
Selection of the definitive Cera One abutment: 105
Torque Control of Cera One Abutment 109
Pouring the Impression 112
Follow-up and Recall 119
References 120
CHAPTER 8 128
Implant Supported Fixed Partial Dentures 128
Transitional or Interim Prostheses/Abutment Selection 137
Preliminary Impressions 142
Technique 142
Custom Tray Fabrication 142
Final Impression Technique 144
Impression 147
Confirmation Jig 149
References 159
CHAPTER 9 161
Implant-Assisted Complete Denture Restorations 161
Relines/"Retrofits" 161
CHAPTER 10 204
CHAPTER 11 218
IMPLANT PROTOCOLS 218