This book presents the treatment planning, preparation, fabrication, and use of tooth- and implant-supported prosthodontics, both in theory and in practice. Drawing on knowledge accumulated over 30 years in clinical practice, the author describes and illustrates a variety of techniques to guide practitioners toward an esthetic final result while avoiding many of the pitfalls typically associated with partial and complete-arch prostheses. Students and practitioners at all levels will benefit from the author’s vast clinical experience.

ISBN: 0-86715-427-6
978-0-86715-427-6 , 9780867154276

232 pp; 613 illus (591 color)

Table of Contents

Preface
Chapter 1 Esthetic Planning and Tooth Preparation for Porcelain Laminates and Full Crowns
Chapter 2 The Semi-adjustable Articulator: Concept, Modification, and Clinical Application
Chapter 3 Esthetic, Functional, and Vertical Dimension Planning for Complete-Arch Prostheses
Chapter 4 Biomechanics of Tooth- and Implant-Supported Prostheses
Chapter 5 Reduction of Implant Loading via Therapeutic Biomechanics
Chapter 6 Three-dimensional Guidance System for Implant Placement
Chapter 7 Clinical Procedures for Complete-Arch Osseointegrated Prostheses
Chapter 8 Clinical Procedures for Tooth- and Implant-Supported Overdentures and Fixed-Retrievable Prostheses
Chapter 9 Clinical Problems
Chapter 10 Occlusion and Centric Relation Evaluation
Chapter 11 Clinical Techniques for Occlusal Adjustment
Index

Preface

The objective of this atlas is to describe practical, step-by-step clinical procedures for tooth- and implant-supported prosthodontics that will improve long-term success. The concepts and clinical techniques presented are directed primarily at solving practical clinical problems associated with tooth- and implant-supported prosthodontics. Although it was necessary to use photographs of various specific implant systems throughout the text, the descriptions of the required armamentaria deliberately have been made as generic as possible, enabling the principles and techniques discussed to be applied to any implant system.

It is my opinion that once implants have been successfully osseointegrated—regardless of the surface or design—and the prosthesis completed, the determining factor for long-term success is the degree of occlusal loading to the supporting bone. The same can be said for natural tooth–supported prostheses; however, the biomechanical principles associated with each approach are completely different. This is a result of the difference between the respective supporting systems, ie, the stiffness of the osseointegrated interface versus the flexion of the periodontal ligament interface.

This text presents new biomechanical concepts associated with the differential mobility of natural teeth and implants. These new concepts are needed to understand and visualize the interactions of occluding surfaces of prostheses and how they generate and distribute forces to the supporting bone through the periodontal ligament or osseointegrated interfaces. This is especially important in cases where natural teeth and implants are used in the same or opposing arch, or within the same prosthesis.

A new paradigm also is suggested for diagnosis and treatment, calling for preplanning of implant placement that considers the biomechanical factors and force distribution in order to decrease implant and/or tooth loading. This process of remediation of each biomechanical factor in the physiologic chain of events, called therapeutic biomechanics, is designed to diminish the cumulative result (ie, occlusal overload). To maximize the advantages of therapeutic biomechanics, a three-dimensional guidance system for implant placement is recommended. This system accurately integrates the planned occlusion with the residual bone topography.

The use of natural teeth and implants in the same or opposing arch requires the introduction of another new paradigm, called differential occlusal loading. This process requires differential occlusal adjustment, a new technique that distributes the forces of occlusion more equitably between implants and natural teeth.

Lawrence A. Weinberg, DDS, MS, FACD, FICD
Islandia, New York