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ePaper created 2017-10-06, 11:56:35 | version 1.38.0
14 (cid:9)DENTAL TRIBUNE(cid:9) Pakistan Edition(cid:9)May 2017 Kinesiographic analysis of lateral excursive movement on the horizontal plane: the retrusive component By Drs. Andrea Papini, Gianfranco Cesaretti & Patrizia De Fabianis T he temporomandibular joint (TMJ) has a functionally complex articulation that during phylogeny underwent an adaptation also linked to posture change after the acquisition of upright posture and subsequent reduction of the postglenoid process. This articulation supports numerous functions of the stomatognathic apparatus, and the part physiologically designed to withstand greater loads associated with mastication is essentially the frontal one; the rear portion of the TMJ is unfit to absorb retrusive forces owing to the poor support of the thin bone component and the histological characteristics of the tissue component. The purpose of this article was to analyze the angles of lateral tracings both on the frontal plane and on the horizontal one Continued on Page 15 Relation between the interincisal point movement and the working condyle movement. Considerations for Long Term ... Continued from page 11 Titanium but designed in 1965) is still very functional and a work horse for hybrid prosthesis. The surfaces have improved much but its basic design and biomechanical considerations will be valid for another 50 years. Premature adoption of technology or materials is fraught with shortcomings and unknown consequences. Classical examples of potential catastrophic failures include the TPS coatings, HA surface modifications, sintered 3. Leave what's new and latest to the risk takers, stick with proven and tried systems. 4. Implants are the last resort in treatment planning- exhaust all conservative, conventional modalities 5. Implants should replace missing teeth not replace teeth. 6. Expensive implants don't mean success rates are better, cheaper does not mean everything works you get what you pay for. There is no substitute for evidence based practice. 7. Consider every implant as a failing entity and around the unilateral subperiosteal implants and the blade implants in the anterior sextant (Fig 2). After careful examination, it was decided that none the maxillary implants was salvageable. Treatment plan was formulated to stage the case to permit healing of the inflamed soft tissue and resorbed bone.(cid:9) The entire maxillary frame had to be sectioned and removed piecemeal (Fig 3, 4). An immediate denture was fabricated and the tissues were allowed to heal for a period of two months. (Fig 5) A Indexing the Wax up for Framework Fabrication Framework Try-in-Verfication with one screw test Facebow transfer and jaw relation records Fig 11 Fig 12 Fig 13 Ceramic overlay of Final Prosthesis Fig 14 Case in Centric Occlusion Post op Rasiographs Fig 15 Fig 16 Fig 17 Fig 18 Mutually Protected occlusal scheme Over-engineered Reconstruction for Long Term Outcome surfaces, flapless surgeries, guided surgeries, immediate loading, costly BMPs and the list goes on.(cid:9) The message is very simple - one crawls before they walk and you must learn to walk before you can run. The same is true for implant dentistry. The novice today has a wide choice - you can become a complete arch implant specialist with 4 implants and guided surgery over a weekend or spend a year learning the basics and judiciously treatment plan cases with customized solutions. Half of the participants of our Maxicourses that we run in the U.S. and overseas have practitioners who have placed hundreds of implants and got their training through corporate education. One does not become a musician by buying a piano or a musical instrument, nor can you become a pilot by buying a plane. Training in implant dentistry has be-come a fad. Most courses are offered through companies and the company's sole interest is to sell their system. There is a whole world of treatment plan that is out there before the system can be utilized. Lets not place the cart before the horse. The void is very apparent the time is now for implementing judicious treatment plans. Lets serve our patients with what they need and not what we want them to have. Iyer's Top 10 Guidelines for Predictable Implantolgy 1. Diagnose the problem first and don't treat because you have a tool that you can use. 2. Measure the disease and provide the therapy, don't sell concepts. the trick is to do the best you can to maintain it as long as you can. 8. Select the system that does not change its product line every year. 9. There are no short cuts or faster way to get success in life and implants are no different. 10.The success rates of implants are inversely proportional to the number of years you practice implants. Case Report(cid:9) This case reports will provide a rationale for a sound sequential treatment plan in the management of long term failure of dental implants.(cid:9) Judicious use of implants and their treatment planning should have long term considerations. I used to perform subperiosteal implants and blade implants in the past. One of the reasons for not using them now is not because they fail, but because in the long term, in the event of a failure, it can have some irrevers-ible consequences. This case under-scores the importance of over engineering cases from the beginning so that when patients live into their 90s they don't become incapacitated, not being able to chew their food properly and lose the benefits of implants that they enjoyed for a long period of time.(cid:9) A 78 year old Caucasian female pre-sented to my practice for rehabilitation and management of a failing maxillary implant reconstruction. She reported having some implants 27 years ago and it has been troubling her with symptoms of sinus infections and movement of the entire maxillary prosthesis (Fig 1). Radiograph revealed bone loss sterolithographic model was created to assess the con-dition of the remaining bone (Fig 6). A decision was made to reconstruct the maxilla with bilateral sinus augmentation. The anterior sextant had bone loss till the anterior nasal spine.(cid:9) Six months following the augmentation, nine implants were placed in the augmented bone (Fig 7). Stage II surgery was performed after a healing period of 8 months. Impressions were taken (Fig 8). A Universal modified abutment was utilized to bring all of the platforms equi-gingival (Fig 9). A verification jig was utilized to check for passivity and accuracy of the positions of the abutments (Fig 10). The metal frame was indexed, cast and tried in (Fig 11, 12). Face bow transfer record was obtained for orientation relationship. (Fig 13) Porcelain overlay for an FP3 prosthesis was processed and inserted (Fig 14, 15 ) A mutually protected occlusal scheme was designed (Fig 16). The patient's vertical was maintained. The post op radiograph reveals a stable outcome. (Fig 17) The anterior cantilevered crowns provide for optimal esthetics in the extremely resorbed anterior maxilla. The post operative outcome provided an esthetic and functional rehabilitation of the failing implant FPD (Fig 18). The provision of pontics enhanced the outcome in the esthetic zone and in this case it favored the design due to the atrophy that precluded implant placement in the premaxilla. (cid:9) The case has been in function for over 5 years and the patient has been on recare every 4 months. - DT