Graftless Solutions for the Edentulous Patient

443 Pages·2018·41.29 MB·English

by  Saj Jivraj (eds.)

BDJ Clinician’s Guides
Saj Jivraj
Editor
Graftless
Solutions for
the Edentulous
Patient
BDJ Clinician’s Guides
More information about this series at http://www.springer.com/series/15753
Saj Jivraj
Editor
Graftless Solutions
for the Edentulous Patient
Editor
Saj Jivraj
Anacapa Dental Art Institute
Oxnard, California, USA
ISSN 2523-3327 ISSN 2523-3335 (electronic)
BDJ Clinician’s Guides
ISBN 978-3-319-65857-5 ISBN 978-3-319-65858-2 (eBook)
https://doi.org/10.1007/978-3-319-65858-2
Library of Congress Control Number: 2017964316
© Springer International Publishing AG 2018
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recita-
tion, broadcasting, reproduction on microfilms or in any other physical way, and transmission or infor-
mation storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar
methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publica-
tion does not imply, even in the absence of a specific statement, that such names are exempt from the
relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, express or implied, with respect to the material contained herein or for any errors
or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims
in published maps and institutional affiliations.
Printed on acid-free paper
This Springer imprint is published by Springer Nature
The registered company is Springer International Publishing AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Foreword
Implant dentistry has evolved tremendously over the last three decades especially
for the treatment of the fully edentulous patients.
In the recent past, implant dentistry, a form of “pre-prosthetic” surgery, included
large bone grafting procedures in preparation for the placement of the implants.
Generally, the implants were placed 6–12 months after the grafting procedures in a
2-stage, delayed load protocol.
The need to wear a removable prosthesis or at times to abstain from wearing any
form of dental prosthesis while the grafts were healing as well as the extended treat-
ment times and the multiple procedures needed prior to the placement of dental
implants to support a fixed prosthesis deterred patients from seeking care.
Today, the “graftless concepts” eliminate the need for grafting and long waiting
periods prior to the reconstruction of the edentulous or the patients with “terminal
dentition”. The ability to remove the patient’s failing dentition, place implants and
fabricate a fixed, immediate load prosthesis has changed the manner in which many
of our colleagues treat their patients in 2017.
The vast body of literature confirming that the graftless approach has the same or
at times better long-term outcome as compared to the 2-stage, delayed loading pro-
tocols has led to better patient care, higher patient acceptance of treatment while
still maintaining long-term success data.
It is prudent at this point in time to consider why such a change in paradigm and
treatment planning has occurred by reviewing the major research and development
findings over the last several decades.
In the 1980s, understanding bone biology and refining the surgical techniques for
the preparation of the osteotomy and placement of the implant was the focus in
research and development of implant dentistry. We were content if osseointegration
had occurred and referred the patient for prosthetic reconstruction of the implants
regardless of the number, angulation or distribution of the implants.
In the 1990s we began to understand the limits of functional loads placed on
osseointegrated implants. Attention to understanding the biomechanical limits of
the hardware improved the management of the functional loads placed on implants
resulting in more predictable, long-term outcomes.
In the 2000s, research focused on “graftless concept” using tilted implants as
well as distal site anchorage by using the Zygoma implant propelled treatment plan-
ning to an unprecedented level. The ability to treat a subgroup of patients declared
v
vi Foreword
as “untreatable” with the quad zygoma concept has certainly expanded the services
available for the treatment of our patients.
The authors of this text have outlined the treatment planning, surgical as well as
the prosthetic protocols and techniques for the treatment of the edentulous as well
as the “terminal dentition” patients. They have honoured and highlighted the objec-
tives advocated by Professor PI Branemark which include:
• Simplification
• Interdisciplinary management
• Predictable outcomes
• Patient-centred treatment planning
Congratulations to the editor, Dr. Saj Jivraj, for his leadership in collaborating
with experienced clinicians in producing this updated text for the treatment plan-
ning of the edentulous patients with a fixed, implant-supported prosthesis.
“…a decisive factor in patient care is simplification of treatment, which should
be based on identifying and utilizing the enormous capacity of existing original
anchoring tissues…”
Simplification, understanding and appreciating when a treatment option is ade-
quate vs. optimal.
In conjunction with my colleagues Drs. Zarrinkelk, Ferro and Yeung, we discuss
treatment planning using conventional “analogue” techniques. It is appropriate to
highlight that the appreciation of “analogue” planning is critical and crucial if the
clinician would like to transition using the digital workflow.
Drs. Pikos, Pozzi, Arcurrl and Moy comprehensively present the integration of
digital treatment planning into the contemporary implant practice.
Interdisciplinary management of every patient’s treatment plan resulting in a
predictable outcome, which can only be achieved by following documented and
evidence-based treatment options.
Drs. Tunkiwala and Kher in collaboration with Mizuno and Torosian discuss the
intricacies of the final prosthesis, which was envisioned in the treatment planning
stage. They underscore the concept of “begin with the end in mind” in their step-by-
step discussions of the various stages for the fabrication of the planned definitive
prosthesis.
The ability to prevent as well as manage complications is essential for both the
surgical and the restorative care provider. Drs. Bongard, Powel and Dawood discuss
the various techniques and algorithms for the management of complications with
the graftless concept.
Long-term success in treatment planning for the fully edentulous patients is
strongly linked to the ability to control the occlusal forces. Our colleagues must
recognize that recall appointments must be pragmatic. Not only should the recall
appointment address the patients oral hygiene but documenting the stability of the
abutment and the prosthetic screws is absolutely critical.
“…the continuous cross arch rigid connection of the prosthesis to the implants
by ensuring tight abutment and prosthetic screws is essential for long term
success…”.
Foreword vii
Drs. Moldovan and Jivraj communicate these important considerations in their
discussions in the Chapter 16 of this book.
The time and the passion invested in continuing education and discussions with
our colleagues enriches the hearts and minds of all involved in treatment planning
and executing the various treatment options for the edentulous patients.
In the immortal words of PI Branemark,
“Listening to the needs and the demands of the patient and executing treatment
plans in the best interest of our patients is paramount.”
San Francisco, CA, USA Edmond Bedrossian
Foreword
Dental implants are one of the most significant developments in the treatment of
patients who are missing teeth. When the method to place and restore these implants
was presented to North America at the Toronto Conference more than 30 years ago,
a strict protocol was adhered to.
Over time, researchers and clinicians have taken advantage of better imaging,
CAD/CAM technology, newer materials and implant designs to innovate and
develop methods of shortening treatment times while obtaining predictable out-
comes for patients.
These methods and materials have been used and reported on by multiple authors
and some of these authors have collaborated on this book. Collectively they have
contributed to this particular method of restoring edentulous patients and elucidated
not only the mechanics of placing and restoring implants but more importantly man-
aging atypical situations, patient selection and management of complications.
Readers of this book will clearly understand a clear treatment protocol that will
lead to predictable outcomes for their patients. In addition this body of work can
help clinicians decide on whether this mode of treatment is suitable for their patients
and help them to avoid any complications that may occur. This information will also
allow the clinician to decide when it is appropriate to refer a patient to more experi-
enced colleagues.
I have known Dr. Jivraj personally for over 15 years and can attest to his dedica-
tion to patient care and using a solid evidence base to make treatment decisions.
Rest assured he has taken the same care in assembling this experienced group of
clinicians and teachers to share their experiences and knowledge on this focused
subject.
Winston Chee, D.D.S., F.A.C.P.
University of Southern California
Los Angeles, CA, USA
ix
Foreword
Dr. Saj Jivraj has assembled in this textbook a quintessential team of talented world-
renown surgeons and restorative dentists who extensively share their vast knowl-
edge in the latest innovations in Implant Dentistry. In order to address the
ever-increasing magnitude of patients in need of extensive implant treatment, graft-
less implant solutions must be combined with an in-depth knowledge of surgical
and restorative procedures through a rigorous and well-coordinated interdisciplin-
ary approach.
This textbook displays in an effective and methodical manner the modern foun-
dation for the diagnosis and graftless treatment of edentulous patients with fixed
implant-supported prosthetics. It provides clear and understandable concepts
through basic and advanced implant principles that are required in the initial com-
prehensive diagnosis and digital workflow all the way through the interdisciplinary
teamwork necessary to manage tilted and zygomatic implants, and ultimately pro-
duce high-quality full arch implant supported restorations.
We have greatly benefited over the past years at Augusta University from the
great teachings of Dr. Jivraj and we trust that this important work will be enjoyed
worldwide as a reference textbook in modern implant dentistry.
Gerard J. Chiche
The Dental College of Georgia
Augusta, GA, USA
xi