Implant Prosthodontics
(Standards of Care)
1. Medical-Dental History
A thorough medical and dental history is obtained from the patient's dental record to include required medical and/or dental consultations. Any medical or dental conditions are considered in the treatment plan.
2. Diagnostic Articulated Casts and Radiographs
Accurate, clean, bubble-free reproductions of the existing dental anatomy should be fabricated. Casts should be accurately articulated at the proposed vertical dimension of occlusion to reveal available mesial-distal, buccal-lingual, and interocclusal space for implant placement. Appropriate radiographs will be available. Measuring guides will be used and potential distortions understood.
3. Treatment Plan
A plan based on sound surgical and prosthodontic procedures will be formulated. Upon approval of the mentors, a treatment plan that the resident is technically capable of completing under staff supervision can be initiated.
4. Diagnostic Waxing and Surgical Guide
Guides should indicate the desired location and inclination of implants during Phase I placement. Surgical guides will be fabricated for every patient. For overdenture or hybrid prostheses, dentures will be fabricated to the wax stage to determine proper location of implants, type of abutments for stage 2, and ultimately the type of retention mechanism, i.e.: clips, locator, ERA, etc. A surgical guide will be made based on this information. For partially edentulous prostheses, a complete waxing will be completed to determine contours of the final prosthesis, type of prosthesis to be fabricated, i.e.: cemented vs. screw retained, type of abutment for stage 2, etc.: Final position of implants will be based on these decisions. A surgical guide will be fabricated based on this information.
5. Phase I - Post Surgical Period
Existing removable partial dentures or complete dentures should be relieved, adjusted, and relined with a soft liner to accommodate tissue changes within the surgical area. Functional forces to the implants should be eliminated or minimized during the initial phase of osseointegration.
6. Phase 2 - Surgery/Preliminary Impressions
- Transmucosal abutments will be placed at the appropriate time. Complete seating of the abutments to underlying fixtures must be verified radiographically, if not visible clinically.
- Accurate, clean, bubble free impressions with appropriate transfer analogs should be made after abutment connection is verified.
7. Final Impression
The final impression must be an accurate representation of the implant abutments or fixtures and surrounding tissues. A verification jig will be made at the impression appointment or from the master cast to verify the accuracy of the impression on prostheses of more than one tooth.
8. Record Bases
Base plates should be stable and accurate. When completely seated, they should have intimate contact to implant analogs, with no movement. Occlusion rims must be contoured to provide proper support to lips and surrounding tissues.
9. Jaw Relation Records
Jaw relation records should be made in centric relation at the established vertical dimension. For the hybrid prosthesis, there must be at least 12mm between the maxillary incisal/occlusal plane and mandibular edentulous ridge to allow adequate space for artificial tooth placement. A facebow will be used when indicated. Acceptable shades and molds should be selected.
10. Wax Try-In
The correct centric relation position, occlusal vertical dimension, lip support, midline, occlusal plane and phonetics should be verified. The size, shape, shade, and anterior arrangement should be accepted by the patient and doctor. For a hybrid type prosthesis, the mandibular anterior teeth should be above the transmucosal abutment and gold coping connections. The extension of the posterior occlusion beyond the center of the distal abutments should be in accordance with the number, size, location/configuration of the implants.
11. Framework
The casting for the super-structure must be evaluated to verify proper cantilever length and contours. The casting should seat completely, while passive, to all abutments. If not, the framework should be separated and soldered or remade.
In the case of the partially edentulous the framework should be designed as best as possible to duplicate contours of normal anatomy. Adequate metal substructure for proper porcelain application on axial and occlusal surfaces must be present.
12. Insertion
The completed prosthesis must possess a passive, accurate fit to each abutment cylinder. A clinical remount procedure should be accomplished to eliminate occlusal interferences. All resin and metal surfaces should be highly polished without sharp projections. Access openings should be blocked out with suitable resin or composite material following final seating of the prosthesis.
13. Home Care Instructions
A demonstration of the proper cleaning and care of the implant prosthesis must be given to the patient at the time of insertion. The patient should be given a follow-up appointment to evaluate and reinforce home care.
14. Post-Insertion Care
Following insertion of the implant prosthesis, the patient must be seen every three (3) months for the first year and semi-annually thereafter for prophylaxis and recall.
15. Standards of Care
All patients will be evaluated utilizing the appropriate standards of care forms.
Implant Prosthodontics Standards of Care Evaluation Form
Implant Placement Standards of Care Evaluation Form