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• Shillingburg Fundamentals Of Fixed Prosthodontics Pdf Free Download
• Fundamentals Of Fixed Prosthodontics Pdf Free Download
• Shillingburg Fundamentals Of Fixed Prosthodontics 4th Edition Pdf Free Download

An introduction to fixed partial dentures and cast metal, metal- ceramic, and all-ceramic restorations, for students and practitioners. Discusses fundamentals of treatment planning, occlusion, and tooth preparation and details the use of specific techniques and instruments, in chapters on articulation of casts,.

The ideal occlusal scheme for an implant prosthesis is designed to control the biomechanical stress on the implant system, provide a prosthetic and biologically acceptable implant interface, and maintain long-term stability of the marginal bone, soft tissue and prosthesis. Due to fundamental differences between teeth and implants, which were discussed in of this series, modifications must be made in the development of occlusal schemes for implant prosthetic rehabilitation.

The principles of implant-protected occlusion (IPO), a concept developed by Dr. Carl Misch, address several conditions to decrease stress to the implant system.

1 Here, we’ll discuss IPO further and present specific recommendations for achieving an ideal occlusal scheme for the single implant prosthesis. Implant Positioning. Ideal positioning of the implant within the bone is vitally important to minimize stress to the implant system.

Occlusal forces are typically three-dimensional, with components directed along one or more of the clinical coordinate axes. An axial load over the long axis of an implant body generates less overall stress and a greater proportion of compressive stress compared with an angled force to the implant body.

Strict adherence to ideal implant placement should be followed (Table 1). Ideally, the implant body should be positioned perpendicular to the curves of Wilson and Spee to minimize the possibility of non-axial, angled forces. In the posterior region, large occlusal table designs present many inherent complications.

A buccal or lingual cantilever in the posterior region results in an offset load, and the principles of force magnification from Class I levers apply. The greater the offset, the greater the load to the implant system.

Offset loads may also result from buccal or lingual occlusal contacts, which can exert increased moment, compressive, tensile and shear forces on the entire implant system. The width of the occlusal table should be directly proportional to the implant body diameter. Normally, a 30–40 percent reduction in the occlusal table is recommended. With maxillary implants, the palatal contour of the prosthesis is out of the esthetic zone and is a stamp cusp for occlusion, creating an offset load. Hence, the palatal contour should be reduced to decrease the offset load to the implant body. The buccal cusp should remain similar to the natural tooth contour for proper esthetics; however, it should have no occlusal contact. Mandibular posterior implants should have the buccal contour modified to narrow the occlusal table and decrease offset loads.

The lingual contour of the mandibular implant crown should be similar to the natural tooth to prevent tongue biting during function; however, it should be void of contacts. In some instances, the opposing tooth may require recontouring of a cusp to help direct the occlusal force along the long axis of the implant body. This is especially indicated if supraeruption of the opposing tooth has occurred. Increased cusp inclination of the implant prosthesis will most likely result in an angled load to the implant body.

The occlusal contact along any of the angled cusps results in a non-axial force vector. Studies have shown that for every 10-degree increase in cusp inclination, a 30 percent increase in torque will result. 1 Therefore, the clinician should adhere to a more shallow, or monoplane, cusp height, which will decrease force-related complications.

Shillingburg Fundamentals Of Fixed Prosthodontics Pdf Free Download

Cusp inclination is an often-neglected factor in the production of occlusion. Ideally, the implant prosthesis should have no angled occlusal loads. Studies have shown that the cortical bone of human long bones is strongest in compression, 30 percent weaker in tension, and 65 percent weaker in shear.

5 Therefore, the elimination or reduction of all shear loads to the implant system is mandatory because of the inherent weakness of bone — as well as porcelain, titanium components and cement — to shear loads. An angled load to the implant long axis increases the compressive forces at the crest of the ridge on the opposite side of the implant, adding to the tension component of force along the same side as the load. The greater the angle of force to the long axis of the implant body, the greater the potentially damaging load at the crest of the bone, which usually results in crestal bone loss. Ideally, there should exist no clinical non-axial loading of the implant system.

If this cannot be accomplished, then treatment plan modifications need to be made, such as increasing the number of implants, increasing the surface area by selecting a larger implant diameter, splinting the implants, and creating a narrow occlusal table. In some cases, the implant restoration may even be modified from a fixed to a removable prosthesis to incorporate increased soft-tissue support to share the distribution of forces. A premature contact occurs when an occlusal contact interferes with the normal movement and positioning of the mandible upon closure.

Studies have shown that premature contacts, or hyperocclusion, may cause bone loss or implant failure. 6 Patients with implants exhibit lower awareness and perception of the damaging interferences because of the lack of a periodontal ligament (PDL). Therefore, the occlusion should always be meticulously evaluated on a continuous basis, and irregular and malpositioned cusps should be modified on the opposing dentition.

The surface area of a premature contact is usually minute; however, the magnitude of stress to the bone will increase proportionately (Stress = Force/Area). Because the premature contact is most often on an inclined plane, the horizontal component of the load increases the shear crestal stresses and the overall amount of stress to the entire implant system.

The implant system, including the restorative material, abutment screw and cement retaining the crown, is at increased risk because shear loads raise the possibility of complications. The elimination of premature occlusal contacts is especially important when habitual parafunction is present because of the increased duration and magnitude of occlusal forces. Occlusal contacts should allow for wide freedom of 1.0–1.5 mm in centric relation and maximum intercuspation (MI).

This will minimize the possibility of premature contacts and allow for a more favorable force distribution. 7 Ideal Occlusal Contact Position. In the anterior region, a single implant is more susceptible to premature contacts because of the horizontal movement of the adjacent teeth. Studies have shown that natural teeth can move horizontally ranging from 56 to 108 microns, with a greater capacity for movement in the anterior than the posterior. 8 In an ideal occlusion scheme, the anterior segments are used whenever possible to disocclude the posterior teeth. When an anterior implant is being restored, whenever possible the natural teeth should be utilized as the stress-bearing component of the occlusal scheme to prevent overstressing the implant prosthesis. Unfortunately, in the anterior, premature contacts often go unnoticed by the clinician, especially with patients exhibiting parafunctional habits.

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Occlusal contacts should be evaluated under heavy biting forces and during all excursive movements to ensure premature contacts are not present. In the posterior region, the occlusal contact should be on a flat surface perpendicular to and within the diameter of the implant body, which directs axial forces within the central fossa.

This occlusal contact position usually is accomplished by increasing the width of the central fossa, which is positioned over the center of the implant abutment, to 2 to 3 mm. A secondary contact may be accomplished within 1 mm of the periphery of the implant body. Marginal ridge contacts should be avoided, as they create cantilever and bending moment forces. The opposing cusp should be recontoured to occlude with the central fossa of the implant crown directly over the implant body.

Thus, the laboratory technician should identify the center of the implant body and then fabricate a flat central fossa, parallel to the curves of Wilson and Spee (Table 2). The potential problem arises when the patient “feels” the occlusion to be ideal even though premature contacts are present. Ideally, natural teeth should exhibit greater initial contacts in comparison to implants through timing of the contacts. When strong or parafunctional bite forces cause depression of the adjacent natural teeth, they are closer to the implant, thus possibly overloading the implant.

In cases where implant restorations oppose each other, the prostheses must account for the vertical movement of the adjacent teeth. The goal of timed occlusal contacts is to eliminate the mobility differences between teeth and implants. This will allow for an even distribution of occlusal load and prevention of premature contacts and increased loads.

First, due to the initial difference in vertical movement of the natural tooth and implant, the implant crown should have no contact in light biting force, which can be verified using shimstock articulating paper (i.e., less than 12 microns thick). Then, after a greater occlusal force is applied to the articulating paper, equal contact of implant crown and natural teeth should occur. This “timed” contact will account for the mobility differences between the teeth and implants. The proximal contact area is a highly important component of the implant prosthesis occlusal scheme. With a single edentulous site, the adjacent teeth may shift or rotate, which poses multiple issues.

Due to the movement and resultant angulation of the adjacent teeth, a “point” contact will result with the future implant prosthesis. This not only poses problems with food impaction, formation of black triangles, increased caries and periodontal issues, but also complicates the seating of the final prosthesis. Prior to the final impression, the adjacent proximal areas should be adjusted with guide planes so the surfaces are parallel. This is most often achieved with the use of a flat-end cylinder diamond bur. A broader contact area will result, and one path of insertion will allow for easier seating of the prosthesis. The patient should be informed of the modifications to the adjacent teeth during the treatment planning phase and prior to implant placement.

This will prevent patient questions and possible dissatisfaction later in the prosthodontic process. The broader contacts will also establish a greater surface area to distribute forces between the implant and the adjacent teeth. When cantilevered and offset loading of the mesial and distal proximal areas occurs, the wider contact area will lessen the resultant non-ideal forces. Ideally, the occlusal scheme that should be maintained for single implant restorations is mutually protected occlusion. This type of occlusion scheme occurs when maximum intercuspation coincides with the optimal condylar position or centric relation. When posterior teeth are in contact, the forces are directed along the long axis of the implant, reducing forces on and contact between the anterior teeth. During lateral and protrusive movements, no posterior occlusal contacts should be present, as the forces are directed to the anterior teeth.

In summary, the goal of implant-protected occlusion for a single implant prosthesis is to minimize occlusal overload. Clinicians should incorporate these principles into their implant restorations to maintain forces within physiologic limits and to provide long-term stability of the implant system. While this article presented specific recommendations for occlusion for single implant prostheses, the next article in this series will provide recommendations for full-arch fixed implant prostheses. Dental implant prosthetics.

Louis: Mosby; 2014. Esposito M, Ekestubbe A, Grondahl K.

Radiological evaluation of marginal bone loss at tooth surfaces facing single Branemark implants. Clin Oral Implants Res. 1993 Sept;4(3):151-7. Tarnow DP, Cho SC, Wallace SS.

The effect of inter-implant distance on the height of inter-implant bone crest. J Periodontol. 2000 Apr;71(4):546-9.

Shillingburg Fundamentals Of Fixed Prosthodontics 4th Edition Pdf Free Download

Contemporary implant dentistry. Louis: Mosby; 2007. Reilly DT, Burstein AH. The elastic and ultimate properties of compact bone tissue. Miyata T, Kobayashi Y, Araki H, Ohto T, Shin K. The influence of controlled occlusal overload on peri-implant tissue.

Part 3: A histologic study in monkeys. Int J Oral Maxillofac Implants. 2000 May-Jun;15(3):425-31. Kim Y, Oh TJ, Misch CE, Wang HL. Occlusal considerations in implant therapy: clinical guidelines with biomechanical rationale.

Clinical Oral Implants Res. 2005 Feb;16(1):26-35. Shillingburg HT, Hobo S, Whitsett LD, et al. Fundamentals of fixed prosthodontics.

Chicago: Quintessence; 1997. Functional occlusion: from TMJ to smile design.

Louis: Mosby; 2007. Misch CE, Bidez MW.

Occlusion and crestal bone resorption: etiology and treatment planning strategies for implants. In: McNeil C, editor. Science and practice of occlusion. Chicago: Quintessence; 1997.

Contemporary Fixed Prosthodontics, 4th Edition is a comprehensive, user-friendly text that offers dental students and practitioners an excellent opportunity to understand the basic principles of fixed prosthodontics. This text provides a strong foundation in basic science, followed by practical step-by-step clinical applications. Procedures are presented in an organized, systematic format, and are illustrated by over 3,000 clear, high-quality drawings and photographs, now in full-color. The material is logically divided into sections that cover planning and preparation, clinical procedures, and laboratory procedures. The text also includes two invaluable appendices that provide an updated list of dental materials and equipment, as well as a guide to manufacturers. Key Features. Section I: Planning and Preparation 1.

History Taking and Clinical Examination 2. Diagnostic Casts and Related Procedures 3. Treatment Planning 4. Principles of Occlusion 5. Periodontal Considerations 6. Mouth Preparation Section II.

Clinical Procedures - Part I 7. Principles of Tooth Preparation 8. The Complete Cast Crown Preparation 9.

The Metal-Ceramic Crown Preparation 10. The Partial Veneer Crown, Inlay, and Onlay Preparations 11. Tooth Preparation for All-Ceramic Restorations 12. Restoration of the Endodontically Treated Tooth 13. Implant-Supported Fixed Prostheses 14. Tissue Management and Impression Making 15.

PRovisional Restorations Section III: Laboratory Procedures 16. Communicating with the Dental Laboraotry 17. Working with Casts and Dies 18. Wax Patterns 19. Framework Design and Metal Selection for Metal-Ceramic Restorations 20. Pontic Design 21. Retainers for Removable Partial Dentures 22.

Investing and Casting 23. Color Science, Esthetics, and Shade Selection 24.

Metal-Ceramic Restorations 25. All-Ceramic Restorations 26. Resin-Retained Fixed Partial Dentures 27. Fiber-Reinforced Composite Fixed Prostheses 28. Connectors for Fixed Partial Dentures 29.

Finishing the Cast Restoration Section IV. Clinical Procedures - Part II 30. Evaluation, Characterization, and Glazing 31. Luting Agents and Cementation Procedures 32. Postoperative Care Appendix A: Dental Materials and Equipment Index Appendix B: Manufacturers' Index.