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Implant Dentistry:
From Failure to Success
Emphasizing the need for diligent planning, precise
techniques, and complete cooperation among all members of the implant team, the
authors advocate a sequential treatment approach and the use of long-term,
screw-retained, fixed provisional prostheses to enhance patient comfort and
function and to improve treatment predictability. They also share strategies
they have learned through experience for reducing prosthetic, surgical, and
technical complications. Detailed clinical cases demonstrate the most common
types of failure and the steps taken to restore function.
Contents
Foreword
Preface
Contributors
1Sequential Approach to Rehabilitation of Failing Cases/Ira D. Zinner, Francis
V. Panno
2 Diagnosis and Treatment Planning for Implant-Supported Fixed
Prosthodontics/Ira D. Zinner, Yale E. Schnader
3 Presurgical Prosthodontics/Ira D. Zinner, Stanley Markovits
4 Troubleshooting and Managing Surgical Problems/Stanley A. Small
5 Second-Stage Screw-Retained Provisional Prostheses/Ira D. Zinner, Lloyd S.
Landa
6 Occlusal Considerations to Prevent Prosthesis and Component
Complications/Trudy M. Burke, Yale E. Schnader
7 Maxillary Sinus Grafts and Prosthetic Management/Ira D. Zinner, Stanley A.
Small
8 Sinus Augmentation and the Prevention and Management of Maxillary Sinus
Complications/Scott D. Gold
9 Technical Considerations to Optimize Prosthetic Success/Paul Federico, Patrick
E. Reid, Ira D. Zinner
10 Repair and Replacement of Damaged or Fractured Implant Components/Curtis E.
Jansen
11 Salvaging a Failed Implant-Supported Fixed Prosthesis in the Completely
Edentulous Patient/Israel M. Finger, Stanley Markovits, Ariel J. Raigrodski
12 Esthetic Considerations in Implant Dentistry/Lloyd S. Landa, George P.
Argerakis
13 Legal Aspects of Implant Practice/Milton Palat
Index
Preface
Since implant prosthodontics were introduced in the 1980s, my implant team has
been involved in the treatment of implant failures. Most unsuccessful cases are
the result of a lack of communication among the team members, insufficient
knowledge of each member’s responsibilities, false assumptions, and attempts by
practitioners to treat situations for which they were not trained. This book was
written to teach practitioners sequential treatment planning for and management
of failed cases.
Understanding failures and their causes is more difficult with implant-supported
prostheses than with conventional prosthodontics, perhaps because of the greater
risk or invasiveness of the procedure and/or the greater expense to the patient.
Nonetheless, the principles of conventional prosthodontics must remain central
in the treatment of patients with implant-supported prostheses. Complications
frequently occur as a result of poor diagnosis and treatment planning, a lack of
proper case sequencing, or inadequate use of provisional prostheses. Inadequate
technical skill in the fabrication of the prostheses also can cause failure. In
addition, management of patients with failed prostheses requires the restorative
practitioner not only to solve and prevent further failure but also to defuse
legal problems between patients and their previous clinicians.
Implant dentistry is prosthetically driven, not surgically based. Therefore, the
restorative clinician is the director of the team and bears the responsibility
for the end result of treatment. Because patients often blame the restorative
clinician for any complications, it is important for clinicians to understand
not only the need for retrievability of the prosthesis and its components, but
also the surgical requirements and the technical nuances of prosthesis
fabrication.
When implant prosthodontics was first taught at the University of Toronto and
the Mayo Clinic in the 1980s, the surgeon and the prosthodontist were educated
as a team: the prosthodontist learned about surgery and the surgeon learned
about prosthodontics. This allowed both members of the team to understand the
challenges faced by the other team member. Unfortunately, today, surgical and
prosthetic training are usually taught independently, placing both team members
at a significant disadvantage.
Successful treatment must begin with an optimal, sequential prosthetic diagnosis
and treatment plan. After the treatment plan has been formulated, the surgical
consultation is completed and the treatment plan is modified as needed. The
laboratory technician must be involved in all stages of planning because the
technical requirements of the prosthesis will influence treatment. Throughout
the process, it is also important that the patient be kept informed of the
protocol for treatment and maintenance of implant-supported prostheses as well
as their advantages, disadvantages, and limitations.
Clinicians should keep in mind the following principles to minimize failures of
implant prostheses. To achieve optimum patient management and treatment, all
practitioners involved need to work as a team, and the team must agree on the
diagnosis and treatment-planning sequence. The sequential approach to treatment
necessitates a team that functions well together. Clinicians should be able to
achieve the treatment goals without the use of a removable prosthesis following
implant placement. Fixed provisional prostheses improve the patient’s comfort,
esthetics, and function and should be used whenever possible. After the implants
have been uncovered, long-term use of metal-reinforced provisional prostheses
allows time for the tissues to heal and for the practitioner to create an
esthetic restoration. This type of second-stage provisional prosthesis also
serves as a protective mechanism for the clinician: if an implant fails or if a
component is changed, any modifications can be made before the definitive
prosthesis is completed. Finally, use of screw retention facilitates inspection
of components, repairs, and the addition or removal of implants and is
recommended for provisional prostheses. Screw-retained prostheses demand
absolute precision and skill during fabrication, but their predictability and
retrievability are indispensable.
Edited by
Ira D. Zinner, DDS, MSD
Clinical Professor
Director of Full-Mouth Rehabilitation Program
Louis Blatterfein Department of Prosthodontics
Division of Reconstructive and Comprehensive Care
New York University College of Dentistry
New York, New York
Francis V. Panno, DDS
Associate Dean for Clinical Affairs
Ira E. Klein Chair and Professor
Louis Blatterfein Department of Prosthodontics
Division of Reconstructive and Comprehensive Care
New York University College of Dentistry
New York, New York
Stanley A. Small, DDS
Associate Clinical Professor
Anthony S. Mecca Department of Oral and Maxillofacial Surgery
Division of Biological Science, Medicine, and Surgery
New York University College of Dentistry
New York, New York
Lloyd S. Landa, DDS, MSD
Clinical Professor
Louis Blatterfein Department of Prosthodontics
Division of Reconstructive and Comprehensive Care
New York University College of Dentistry
New York, New York
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