0 Patient Assessment
- 0.1 Patient demand
- 0.2 Overarching considerations
- 0.3 Local history
- 0.4 Anatomical location
- 0.5 General patient history
- 0.6 Risk assessment & special high risk categories
  - 5.1 Risk assessment & special high risk categories
  - 5.2 age
  - 5.3 Compliance
  - 5.4 Smoking
  - 5.5 Drug abuse
  - 5.6 Recreational drugs and alcohol abuse
  - 5.7 Parafunctions
  - 5.8 Diabetes
  - 5.9 Osteoporosis
  - 5.10 Coagulation disorders and anticoagulant therapy
  - 5.11 Steroids
  - 5.12 Bisphosphonates
  - 5.13 BRONJ / ARONJ
  - 5.14 Radiotherapy
  - 5.15 Risk factors
1 Diagnostics
- 1.1 Clinical Assessment
  - 0.1 Lip line
  - 0.2 Mouth opening
  - 0.3 Vertical dimension
  - 0.4 Maxillo-mandibular relationship
  - 0.5 TMD
  - 0.6 Existing prosthesis
  - 0.7 Muco-gingival junction
  - 0.8 Hyposalivation and Xerostomia
- 1.2 Clinical findings
  - 1.1 Occlusion
  - 1.2 Alveolar atrophy and insufficiency
  - 1.3 Skeletal consequences of edentulism
  - 1.4 Head-neck cancer
- 1.3 Clinical diagnostic assessments
  - 2.1 Microbiology
  - 2.2 Salivary output
- 1.4 Diagnostic imaging
  - 3.1 Imaging overview
  - 3.2 Intraoral radiographs
  - 3.3 Panoramic
  - 3.4 CBCT
  - 3.5 CT
- 1.5 Diagnostic prosthodontic guides
  - 4.1 Prosthodontic guides overview
  - 4.2 Wax-up, arrangement, mock-up
  - 4.3 Splints and imaging for surgery
  - 4.4 Provisionals
2 Treatment Options
- 2.1 Mucosally-supported
  - 0.1 Mucosally supported - Overview and important considerations
  - 0.2 Complete denture
  - 0.3 Immediate denture
  - 0.4 Occlusal schemes
- 2.2 Implant-retained/supported, general
  - 1.1 Prosthodontic options overview
  - 1.2 Number of implants maxilla and mandible
  - 1.3 Time to function
  - 1.4 Submerged or non-submerged
  - 1.5 Soft tissue management
  - 1.6 Hard tissue management, mandible
  - 1.7 Hard tissue management, maxilla
  - 1.8 Need for grafting
  - 1.9 Healed vs fresh extraction socket
  - 1.10 Digital treatment planning protocols
    
    9.1 Digital treatment planning protocols, introduction
    
    9.2 Digital treatment planning protocols, NobelClinician
- 2.3 Implant prosthetics - removable
  - 2.1 Implant overdenture, overview
    
    0.1 Implant overdenture, introduction
    
    0.2 Overdenture retention devices, overview
  - 2.2 Secondary splinting
  - 2.3 Primary splinting
- 2.4 Implant prosthetics - fixed
  - 3.1 Fixed implant prosthesis, introduction
  - 3.2 Screw-retained restorations
    
    1.1 Screw-retained
    
    1.2 Implant-supported vs abutment-supported
  - 3.3 Cement-retained restorations
    
    2.1 Cement-retained
    
    2.2 Abutment materials
  - 3.4 Framework materials
    
    3.1 Framework materials
    
    3.2 Veneering with ceramic
    
    3.3 Veneering with Acrylic
- 2.5 Comprehensive treatment concepts
3 Treatment Procedures
- 3.1 Surgical
  - 0.1 Surgical considerations
    
    0.1 Anesthesia
    
    0.2 Peri-operative care
    
    0.3 Post-operative care
    
    0.4 Flap-or flapless
    
    0.5 Wound closure
    
    0.6 Intra-operative complications
    
    0.7 Guided vs non-guided
    
    0.8 Semi-guided surgery with prosthetic template
    
    0.9 Guided surgery with drill guides
  - 0.2 Surgical protocols - general
    
    1.1 Crestal incision
    
    1.2 Choice of implant
    
    1.3 Parallel implant placement
    
    1.4 Tapered implant placement
    
    1.5 Insertion torque
    
    1.6 Insertion height
    
    1.7 Implant angulation
  - 0.3 Surgical protocols - mandible
    
    2.1 Implant placement with open flap procedure - mandible
    
    2.2 Grafting, mandible
  - 0.4 Surgical protocols - maxilla
    
    3.1 Implant placement - maxilla
    
    3.2 Grafting, maxilla
    
    3.3 Sinus lifting
    
    3.4 Zygomatic implants
    
    3.5 Pterygoid implants
    
    3.6 Problems and complications in maxillary implant surgery
- 3.2 Removable prosthetics
  - 1.1 Complete dentures
    
    0.1 Complete denture clinical protocol
    
    0.2 Complete denture impressions
    
    0.3 Complete denture - maxillo-mandibular relations
    
    0.4 Complete denture trial placement
    
    0.5 Complete denture placement
    
    0.6 Complete denture post-placement
  - 1.2 Implant overdentures
    
    1.1 Overdenture clinical protocol
    
    1.2 Implant overdenture impressions
    
    1.3 Implant overdenture maxillo-mandibular relations
    
    1.4 Implant overdenture trial placement
    
    1.5 Implant overdenture placement
    
    1.6 Implant overdenture post-placement
- 3.3 Fixed prosthetics
  - 2.1 Fixed implant prosthesis clinical protocol
  - 2.2 Impressions
    
    1.1 Impressions - overview
    
    1.2 Splinted vs unsplinted impression copings
    
    1.3 Open versus closed tray
    
    1.4 Parallel vs non-parallel
  - 2.3 Maxillo-mandibular relations
  - 2.4 Trial placement
  - 2.5 Framework trial placement
  - 2.6 Placement
  - 2.7 Post-placement
4 Aftercare
- 4.1 Surgical aftercare
  - 0.1 Medication
  - 0.2 Post-operative soft tissue management
  - 0.3 Suture removal
  - 0.4 Post-surgical recommendations
- 4.2 Prosthetic aftercare
  - 1.1 Esthetic and function check
  - 1.2 Provisionals / temporary prosthesis
  - 1.3 Oral hygiene instructions
  - 1.4 Occlusal guard
- 4.3 Post-treatment complications and management
  - 2.1 Bleeding
  - 2.2 Soft tissue and hard tissue
  - 2.3 Patient compliance / recall
  - 2.4 Biologic complications
  - 2.5 Esthetic complications
- 4.4 Recall visits and logistics
  - 3.1 Recall visits - overview
  - 3.2 Patient expectations
  - 3.3 General health check
  - 3.4 Professional oral hygiene
  - 3.5 Implant overdenture maintenance
  - 3.6 Occlusion check
  - 3.7 Probing
  - 3.8 Inflammation, infection
    
    7.1 Inflammation and infection - overview
    
    7.2 Infection, microbiological diagnostics
  - 3.9 Radiological control

Treatment guidelines

Time to function

Key points

Main considerations of 'time to function' are immediate, early and conventional time frames for restored function
When specific criteria and protocols are met, immediate function is regarded as providing a safe and predictable treatment outcome
Immediate function may logically reduce overall treatment time and eliminate the need for the edentulous patient to wear a temporary removable prosthesis

Conventional Function

Traditional endosseous oral implant treatment protocols ad modum Brånemark required a variable healing period (usually 3-6 months) before prosthesis placement. The healing period was considered necessary to achieve osseointegration and establish a load-bearing interface. The traditional protocol is referred to as “conventional function” and has yielded very good long-term clinical results.

Early function

“Early function” refers to prosthesis placement from 3 days to 3 months after implant placement. Compared to immediate and conventional function protocols, it has lead to comparable documented clinical outcomes.

Immediate function

The prosthesis loading protocol change to one occuring within 3 days of implant placement is referred to as “immediate function”. It has led to promising documented clinical outcomes when judged in the context differences in bone loss, prosthesis- or implant failure, when compared to “delayed function” documentation. Advantages for the patient include reduction in time from implant placement to restored function, an overall reduction in treatment time and elimination of the need to wear a temporary removable prosthesis.

Current experience indicates that oral implants with good primary stability are candidates for immediate function. Primary stability is popularly ascertained either through the surgeon’s feel or through a surrogate measure of stability (insertion torque or resonance frequency analysis RFA). In the absence of good primary implant stability an immediate function protocol is contraindicated.

While immediate function can be considered in many treatment scenarios, the probability of success increases if multiple implants are placed and the immediate function prosthesis “splints” implants together. This augurs well for the use of immediate function protocols for the edentulous maxilla and mandible where multiple implants are routinely placed to support both a provisional and definitive fixed prosthesis.

Fig 2: A fixed prosthesis fabricated prior to surgery is finalized in the patient's mouth and secured with four prosthetic screws. As immediate loading is part of the treatment plan, the patient benefits from a screw-retained provisional prosthesis immediately after surgery.Courtesy of Dr. Armando Lopes, Lisbon

Clinical topics

Treatment guidelines

Submerged or non-submerged

Oral endosseous implants are successful even longterm in the edentulous jaws. After insertion implants osseointegrate. This process is characterized by the development of an intimate bone contact with the implant surface. The direct anchoring of bone to the implant predicts the...

Success & failure

Treatment guidelines

Patient Demand

In order to provide adequate treatment and meet patient satisfaction, it is crucial to evaluate patient expectations. These expectations normally fall into one or more of four categories: function, comfort, esthetics and...

Treatment guidelines

All-on-4® treatment concept

Patients wearing complete dentures often suffer from esthetic and functional discomfort and compromised denture retention and chewing function. Denture adhesives are often applied. Many patients perceive this...

Additional resources

Videos

Paulo Malo: Immediate Function: benefits to patient and practice

The presentation gives an insight on the restoration of edentulous situations from both surgical and restorative aspects, with focus on the immediate function protocol and the All-on-4 solution. Dr Malo reviews the indications and contraindications, advantages and benefits as well...

Videos

Marco Esposito: immediate vs conventional loading: the scientific evidence

Based on a systematic review, supported by the Cochrane library issue 3 2013, the lecture discusses if predictable success rates with immediately loaded implants can be achieved. Dr Esposito compares immediate, early and conventional loading, occlusal vs non-occlusal loading and...

Immediate loading / provisionalization

Videos

Joseph Kan: Evidence-based immediate tooth replacement

Dr Kan leads through a journey on immediate implant placement from both a surgical and prosthetic point of view, discussing aspects of soft and hard tissue condition, interaction of implant size, diameter, position and socket form, influences of crestal bone condition and biologic...

Videos

Joseph Kan: The science and biology of immediate implant placement and tooth rehabilitation in anterior region

Immediate implant and tooth replacement have become a viable treatment option for replacing failing maxillary anterior teeth. However, potential challenges such as implant and esthetic complications may be encountered. The presentation focuses on on the current science...

Questions

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Time to function

Conventional Function

Early function

Clinical topics

Related articles

Treatment guidelines

Submerged or non-submerged

Treatment guidelines

Patient Demand

Treatment guidelines

All-on-4® treatment concept

Additional resources

Videos

Paulo Malo: Immediate Function: benefits to patient and practice

Videos

Marco Esposito: immediate vs conventional loading: the scientific evidence

Videos

Joseph Kan: Evidence-based immediate tooth replacement

Videos

Joseph Kan: The science and biology of immediate implant placement and tooth rehabilitation in anterior region

Scientific References

Questions