Published on January 20, 2016
1. AVAILABLE BONE
2. CONTENTS INTRODUCTION AVAILABLE BONE BONE HEIGHT BONE WIDTH BONE LENGTH BONE ANGULATION CROWN HEIGHT SPACE DIVISION OF BONE SUMMARY
3. Introduction Long term success in implant dentistry requires certain important criteria .There are more than 50 criteria that are required in treatment planning. Once the prosthodontic needs of the patient have been determined,the most important criteria is the available bone.
4. AVAILABLE BONE Describes the external architecture or the quantity of bone present in edentulous area considered for implants
5. AVAILABLE BONE 1.5-2mm-Surgical error. Root form implants-width Diameter and Mesiodistal length of available bone length of implant Height of bone available
6. Implant width S=F/A 0.25mm increase in diameter,5-8% surface area increases. Increase in dia-less stress at crestal bone implant interface. Implant Height Also affects total surface area. 3mm longer implant 20-30% increase in surface area. Initial stability of implant
7. It is measured in terms of Bone height Bone width Bone length Bone angulation Crown-height space
8. Available bone height Radiographic Evaluation- OPG Anterior regions of jaws- greatest height Maximum height-Maxilla and mandible-sites The minimum bone height for a predictable long term endosteal implant survival is 12 mm.
9. Skeletal relationships-Class 2 and class 3 Posterior jaws –more limiting for implant height Suggested bone height -12mm
10. Available bone height Dense bone may accommodate shorter implant but a porous bone may require longer implant. More imp.as affects implant length and crown height. Once the minimum bone height is established width is more important than additional height.
11. Available bone width Measured between the facial and lingual plates at the crest . The crest is supported by a wider base. Osteoplasty Exception-ant maxilla
12. Available bone width Minimum bone width for a 4mm root form implant is more than 6 mm. Reduced width -narrower diameter implant. Initial width of available bone is related to crestal bone loss,after loading.
13. Available bone length The mesiodistal length of bone in an edentulous area is limited by adjacent teeth or implant. Implant - 1.5 mm adjacent tooth and 3mm from adjacent implant -For a bone width of 5mm the minimum length is 8mm.
14. Ideal implant width for single tooth or multiple implants. Natural tooth being replaced
15. Available bone angulation It represents the root trajectory in relation to occlusal plane. Acceptable bone angulation depends on the width of the ridge. For wider ridges bone angulation can be as much as 25 degrees . For narrower ridges acceptable angulation is 20 degrees
16. Ideally,angulation is: 1.Perpendicular to occlusal forces. 2.Aligned with forces of occlusion 3.Parallel to long axis of prosthodontic restoration.
17. Rarely bone angulation remains ideal. Mandibular Teeth: lingually inclined in posterior region and labial inclination in anterior region. Anterior region in both jaws is usually deficient in bone Posterior mandible –submandibular fossa dictates angulation
18. Crown-Height space Vertical distance from the crest of the ridge to the occlusal plane. Affects appearance , amount of moment of force on the implant and surrounding crestal bone. Considered as a vertical cantilever. Greater the CHS,greater the moment of force,or lever arm. Ideally,CHS should be =,< 15mm.
19. LEKHOLM and ZARB (1985) TYPE 1 TYPE2 TYPE3 TYPE4
20. Classification of available bone DIVISION A DIVISION B DIVISION C DIVISION D Misch and Judy in 1985
21. DIVISION A BONE Consists of abundant bone in all directions Dimensions Width>6mm Height>12mm Length>7mm Angulations<25 degrees CHS < or =15mm
22. DIVISION A BONE Treatment options Division A root forms or wider implants . All prosthetic options. Limited inter arch space. (High profile O-ring) Osteoplasty .
23. Fixed Prosthetic options FP-1 FP-2
24. FP-3 restoration in Div A bone
25. Removable prosthesis
26. DIVISION B BONE Barely sufficient bone. Ridge width is reduced. M-D width of bone is less…so 3mm implants.
27. DIVISION B BONE Dimensions Width 2.5mm-6mm B+ :4-6mm B-w:2.5-4mm Height> 12mm Length> 6mm Angulations <20 degrees CHS <15mm
28. Treatment options 3 Rx:- 1) Modify the narrower div B bone to div A by osteoplasty However after osteoplasty the ridge height should not become <10 mm And place division A root form
29. 2) Narrow diameter division B root form angulation <20 available bone length atleast 12mm to ensure adequate surface area for narrow diameter implants The design of prosthesis also changes with osteoplasty procedures.
30. 3) Ridge augmentation In cases where osteoplasty will result in ridge height less than 10mm, ridge augmentation instead should be done.
31. Bone spreader-an alternative
32. DIVISION C(COMPROMISED BONE) Deficient in one or more dimensions Resorption first occurs in width .The bone is called C-w Then in height. The bone is called C-h Posterior maxilla VS Anterior maxilla Posterior mandible VS anterior mandible.
33. Inform patient about bone loss
34. Dimensions unfavorable in Width (c-w) :0 to 2.5mm Height(c-h)-<12mm Angulation (c-a)>30 degrees CHS > 15mm
35. Uncommon sub category C-a Avbl bone adequate in height and width Angulation greater than 30 degree
36. Treatment options 1)C-w ridge a) Osteoplasty which converts it to C-h ridge type with adequate width b) Bone augmentation can be done
37. Treatment options 2)C-h ridge can be treated with a) Greater no of endosteal implants of reduced height. b) Ridge augmentationton to upgrade div C to div A c) Subperiosteal –Circumfrential and unilateral. Disk design implants
38. DIVISION D (DEFICIENT BONE) Characterized by severe atrophy of alveolar process as well as basal bone Basal bone loss: Flat maxilla Pencil-thin mandible CHS>20mm
39. Treatment options Ridge augmentation is the treatment of choice. Complete implant supported dentures indicated Fixed restorations X RP-5 not suggested.
40. 90 percent of autogenous graft resorbs in 5 years- so not intended for denture support. Chances of dental cripple.
41. Subperiosteal implants-the myth. If adequate bone present in mandibular anteriors with D bone in posteriors- Root form implants. Tripodal sub-periosteal implants. Mandibular staple implants Ramus frame implants
42. Summary In implant dentistry prosthesis is designed at onset of treatment to satisfy patients needs and desires. Bone is THE most critical criteria in determining the success.
43. References Misch 3rd edition Babbush:art and science
1. Int J Oral Implantol. 1990;7(1):9-17. Divisions of available bone in implant dentistry. Misch CE(1). Author information: (1)University of ...
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