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Dental Implant Loading Protocol
Dental Implant Loading Protocol
2. steady state: comprises the range between disuse atrophy and physiologic overload
zone, and is associated with organized, highly mineralized lamellar bone.
3. physiologic overload and
4. pathologic overload zones: peak stain magnitude of over 4000 μ-strain may result in
net bone resorption.
Immediate Loading
History
Tarnow 1997: 96% success
Rationale:
control of the following factors can justify immediate loading
Indications:
1. Patient with centric occlusal contacts on anterior teeth
2. Division D1, D2, careful with D3 and not with D4 ( D1: anterior
mandible, D2: posterior mandible, D3: anterior maxilla, D4:
posterior maxilla)
3. Screw threaded 4 mm or more diameter implant
Contraindications
Severe parafunction: crestal bone loss and implant failure
Bone can be classified according to structure, composition, density and volume.
Lekholm, Zarb et al. have classified bone quality and volume in to four types,
expressed as type I, II, III and VI. This classification closely resembles a more recent
classification by Misch. Misch separates bone quality and volume in to two distinct
classifications that can be combined for patient specific diagnostic purposes and drill
protocol procedures. Bone quality is classified in to four groups D1, D2, D3, and D4
whereby the Misch classification suggests a location, composition and a measurable
density reading (Hounsfield units) for each type of bone.
D1 bone is composed of almost all cortical bone mass located primarily in the anterior
mandible. A Hounsfield unit reading of 1250 and above indicates D1 bone.
D2 bone is composed of a thick crestal layer of cortical bone and coarse trabecular
bone underneath the cortical bone. This type of bone can mostly be found in the
anterior and posterior mandible. A Hounsfied reading between 850 to 1250 units is
indicative of D2 bone.
D3 bone is composed of a porous crestal layer of cortical bone and fine trabecular bone
underneath the cortical bone. This type of bone can mostly be found in the anterior and
posterior maxilla but also in the posterior mandible. A Hounsfield reading between 350
and 850 units is indicative of type D3 bone.
D4 bone is composed of primarily fine trabecular bone and often the absence of cortical bone.
This type of bone can mostly be found in the posterior maxilla and poses the greatest challenge
in implant placement. A Hounsfield reading between 150 and 350 units is indicative of D4 bone.
Progressive Bone Loading
The rod decelerates when it touches the implant and accelerates when it first
rebounds off the implant. Periotest measures elapsed time from initial contact
to the first rebound off the implant.
The greater the implant stability, the shorter the elapsed time is. Conversely, the
longer the rod is in contact with the implant, the less stable the implant is.
Periotest
Reverse torque:
This “pass-fail” test has the potential for the implant to be lost, is not
quantitative and is not suitable for longitudinal testing.
Resonance frequency analysis: Osstell
This technique uses a hand-held frequency response
analyzer connected to a transducer by a wire.
A model has to be created to perform a, the geometric data of the implant, the
mechanical properties of the bone and the parameters of the bone-implant
interface have to be determined, a so-called finite element network has to be
created.
Implant protective occlusion
Guidelines:
1. Timing of occlusal contact
2. Influence of surface area
3. Mutually protected articulation
4. Implant body orientation and load direction
5. Bone mechanics
6. Crown cusp angle
7. Cantilevers
8. Crown height
9. Occlusal contact position
10.implant crown contour
11.Design to the weakest arch
12.Occlusal materials