Implants in Clinical Dentistry Implants in Clinical Dentistry Richard M Palmer PhD, BDS, FDS, RCS (Eng), FDS RCS (Ed) Professor of Implant Dentistry and Periodontology, Guy’s, Kings and St Thomas’ Hospitals Medical and Dental Schools, London, SE1 9RT, UK Brian J Smith BDS, MSc, FDS RCS (Eng) Consultant in Restorative Dentistry, Unit of Restorative Dentistry, Guy’s and St Thomas’ Hospitals Trust, London, SE1 9RT, UK Leslie C Howe BDS, FDS RCS (Eng) Consultant in Restorative Dentistry, Guy’s and St Thomas’ Hospitals Trusts and Specialist in Restorative Dentistry and Prosthodontics, 21 Wimpole Street, London W1M 7AD, UK Paul J Palmer BDS, MSc, MRD RCS (Eng) Specialist in Periodontics, 21 Wimpole Street, London W1M 7AD and Postgraduate Tutor in Implant Surgery, Guy’s, Kings and St Thomas’ Hospitals Medical and Dental Schools, London, SE1 9RT, UK MARTIN DUNITZ C O N T E N T S Preface vii Acknowledgements ix Part I—Overview 1 Overview of implant dentistry 3 Part II—Planning 2 Treatment planning: general considerations 27 3 Single tooth planning in the anterior region 35 4 Single tooth planning for molar replacements 47 5 Fixed bridge planning 53 6 Diagnosis and treatment planning for implant dentures 69 Part III—Surgery 7 Basic factors in implant surgery 85 8 Flap design for implant surgery 97 9 Surgical placement of the single tooth implant in the anterior maxilla 105 10 Implant placement for fixed bridgework 115 11 Immediate and early replacement implants 123 12 Grafting procedures for implant placement 131 Part IV—Prosthodontics 13 Single tooth implant prosthodontics 157 14 Fixed bridge prosthodontics 183 15 Implant denture prosthodontics 215 Part V—Complications and Maintenance 16 Single tooth and fixed bridge 235 17 Implant dentures 251 Index 263 vi CONTENTS P R E FA C E This book is based upon our combined experi- we felt that it was essential to gain experience in ences of working together in the treatment of other leading implant systems to allow compari- patients with dental implant prostheses at Guy's son and to educate ourselves and our students. Hospital and in private practice over the last 10 We were thus able to appreciate some of the years. While the chapters are not attributed to features of other systems such as single stage specific authors, the surgical chapters are mainly implant surgery and the development of implant the work of Richard and Paul Palmer; the implant surfaces which gave the potential for more rapid denture chapters, Brian Smith; and the fixed osseointegration and earlier loading. We were also prosthodontics, Leslie Howe. Our initial experi- one of the initial teams to evaluate the Astra Tech ences were with the Brånemark system, which ST implant. We believe that the four implant established a benchmark in implant treatment, systems (Astra Tech, Brånemark/Nobel Biocare, with high success rates using meticulous tech- Frialit and ITI Straumann) described in this book niques. It was immensely valuable to use this cover most of the important features of modern system at a time when it rapidly developed to implant design and that the information contained allow sophisticated treatment of the complete within this text could apply to many more systems clinical spectrum. Working in an academic institute that are available today. Richard M Palmer PhD, BDS, FDS RCS(Eng), FDS RCS(Ed) Brian J Smith BDS, MSc, FDS RCS(Eng) Leslie C Howe BDS, FDS RCS(Eng) Paul J Palmer BDS, MSc, MRD RCS(Eng)