small-diameter implants - dentalcetoday.com · small-diameter implants: ... impressions, shade (a2...

Continuing Education

Small-Diameter Implants:A Treatment Consideration for

the Maxillary Edentulous PatientAuthored by

Brian J. Jackson, DDS

Course Number: 167

Upon successful completion of this CE activity 2 CE credit hours may be awarded

A Peer-Reviewed CE Activity by

Opinions expressed by CE authors are their own and may not reflect those of Dentistry Today. Mention of

specific product names does not infer endorsement by Dentistry Today. Information contained in CE articles and

courses is not a substitute for sound clinical judgment and accepted standards of care. Participants are urged to

contact their state dental boards for continuing education requirements.

Dentistry Today, Inc, is an ADA CERP Recognized Provider. ADA CERP isa service of the American Dental Association to assist dental professionalsin indentifying quality providers of continuing dental education. ADA CERPdoes not approve or endorse individual courses or instructors, nor does itimply acceptance of credit hours by boards of dentistry. Concerns orcomplaints about a CE provider may be directed to the provider or to ADA CERP at ada.org/goto/cerp.

Approved PACE Program ProviderFAGD/MAGD Credit Approval doesnot imply acceptance by a state orprovincial board of dentistry orAGD endorsement. June 1, 2012 toMay 31, 2015 AGD PACE approvalnumber: 309062

LEARNING OBJECTIVESAfter participating in this CE activity, the individual will learn: • Principles for incorporating small-diameter implants(SDIs) into the treatment of the maxillary edentulouspatient.

• A treatment technique for using SDIs to assist in theretention and stability of a maxillary complete overdenture.

ABOUT THE AUTHORDr. Jackson graduated from Utica Collegecum laude with a BS degree in biology. Hereceived his DDS degree at StateUniversity of New York at Buffalo, School ofDental Medicine. Dr. Jackson com pletedpostgraduate training at St. Luke’s

Memorial Hos pital Center’s general practice residencyprogram and completed his formal oral im plantology training atNew York University School of Dentistry. He is a Dip lomate ofthe American Board of Oral Im plantol ogy/Implant Den tistry, anhonored Fellow of the American Acad emy of Implant Dentistry(AAID), and a member of the ADA.�Currently, he serves astrustee for the AAID, and is past president of the Northeastdistrict of the AAID, as well as, past president of the Oneida-Herkimer County Dental Society. Dr. Jackson is an attendingstaff dentist for Faxton-St. Luke’s Healthcare general practiceresidency program. He is a faculty member of the Las VegasMaxi course in Oral Im plantology. He has presented oral im -plantol ogy lectures internationally and has published peer-reviewed articles in various journals. Dr. Jackson is treasurerfor the AAID’s Re search Foundation and a scientific reviewerfor the Jour nal of Oral Implantol ogy. He can be reached [email protected].

Disclosure: Dr. Jackson is a paid lecturer and key opinionleader for 3M ESPE.

INTRODUCTIONSmall-diameter implants (SDIs) ap peared in the disciplineof im plant dentistry as retainers for a transitional prosthesiswhile conventional sized en dosseous implantsosseointegrated. Recent FDA ap proval of SDIs for long-term use has broadened their indications. The incorporationof SDIs for the treatment of the maxillary edentulous patientwith atrophic alveolar bone and large pneumatized sinuseshas demonstrated successful outcomes. The SDI protocolfor the edentulous maxilla is im plant placement anterior tothe sinus with delayed loading of the complete maxillaryoverdenture. This article and the case re port presenteddemonstrate the use of SDIs to assist in the retention andstability of a maxillary complete overdenture.

Implant dentistry has become a major aspect of clinicaldental practice due to the biological concept ofosseointegration. Al though conventional size endosseousim plants re ceived FDA approval in 1970, SDIs haverecently gained similar approval.1 In 2004, the FDAapproved SDIs for long-term use for full and partial denturestabilization as well as fixed multiunit prostheses. Thisapproval applies to implants less than 3 mm in diameter,and more specifically, 1.8 mm, 2.1 mm, and 2.4 mm, andcorresponding lengths greater than 10 mm. Theapplications of SDIs for increased stability and retention ofoverdentures have demonstrated successful clinicaloutcomes. As a result, the indications for SDIs for long-termuse have gained wider acceptance and interest.

Although the mandibular complete denture patient hasexperienced the majority of clinical limitations, the maxillaryedentulous condition demonstrates a similar compromisedstate in regards to form and function. The demand forcomplete removable dentures will continue to increase asthe United States edentulous population approaches 40million.2 The incorporation of SDIs to aid in stability andretention for the maxillary complete denture patient canenhance speech, function, aesthetics, and comfort.3 Mostim portantly, dental implants retard the rate of alveolar boneresorption in the maxilla.4,5 As a result, the SDI-retainedmaxillary overdenture can achieve patient expectations anddemonstrate excellent treatment outcomes.

The SDI design, as well as the surgical and prostheticprotocol, possesses various characteristics for a successful


1

Small-Diameter Implants: A Treatment Consideration for theMaxillary Edentulous PatientEffective Date: 11/1/2013 Expiration Date: 11/1/2016

treatment plan for the edentulous maxilla. The one-piece,small-diameter (2.4 mm) design possesses strength whileengaging the atrophic cortical alveolar ridge and underlyingcancellous bone (Figure 1). The strength of the SDI isassociated with the one-piece design and the materialnature of the titanium alloy (Ti-6AI-4V) structure. Thesurgical protocol consisting of a flapless, partial osteotomyapproach simplifies the procedure and risks for the generalor medically compromised patient. The prosthetic stage canbe initiated as an immediate load or under traditional stageprotocols, depending on biomechanics as it relates to thequality and quantity of bone. This minimally invasiveapproach unique with SDIs parallels other such trends inhealthcare services.6

The case presented in this paper demonstrates theutilization of SDIs to retain a maxillary completeoverdenture. The treatment plan was approached in astaged manner, in cluding initial extraction with sitepreservation followed by subsequent implant placementand prosthetic reconstruction. The man dibular arch wastreated with conventional, nonimplant dental approaches.The treatment was completed in 13 months with a resultantideal clinical outcome while achieving patient expectations.

CASE REPORTA 73-year-old male presented to the office with a chiefcomplaint of “my upper denture rocks all over the placewhen I eat.” The clinical evaluation of the patient exhibitedan existing complete maxillary denture with severely wornand fractured prosthetic teeth (Figure 2).

The maxilla contained 3 remaining teeth with extracoronalgold copings serving as tooth retained overdenture retainers(Figure 3). The maxillary teeth exhibited recurrent caries and severe horizontal bone loss. The mandibular archdemonstrated a chronic periapical abscess associated withthe mandibular left second molar (No. 18) and severalmobile teeth including the mandibular lateral incisors (Nos. 23 and 26) and mandibular right first premolar (No. 28) due to severe bone loss. The mandibular canines(Nos. 22 and 27) and mandibular left first premolar (No. 21)demonstrated moderate bone loss without pathologicalmobility (Figure 4). A diagnosis for the patient consisted ofdental caries, moderate to severe periodontitis, and a

collapsed vertical di mension of occlusion (VDO).Treatment plans were presented and the agreed upon

final prosthesis was the following:l Maxilla: 6 SDI overdenturel Mandible: mandibular removable partial denture (RPD).The treatment plan was ap proached in a staged manner

consisting of extractions with bone grafting followed by im plantplacement and prosthetic re con struction. The medical historywas unremarkable except that the patient took a multivitamin


2

Small-Diameter Implants: A Treatment Consideration for the Maxillary Edentulous Patient

Figure 1. Small-diameter implant (SDI)2.4 mm x 13 mm.

Figure 2. Initial clinicalview—centric occlusion.

Figure 3. Initial clinicalview of maxilla.

Figure 4. InitialPANOREX.

daily. Surgical consent was reviewed and signed, and thepatient was scheduled for the initial procedure.

The initiation of treatment was the extraction of allremaining maxillary teeth (Nos. 3, 5, 8, and 11) with con-current socket grafting. Tooth removal was accomplishedusing 301, 34S elevators and a universal 151 forceps. Aftercomplete debridement of the socket with a double-endedcurette, a mineralized irradiated bone Allograph (Miner -oss/Puros) in a 1:1 ratio was packed into the socket. Adense polytetrafluorethylene barrier (Cytoplast) and 4.0vicryl sutures were used to secure the Al lograph material.The existing complete denture was relined with a soft relinematerial (COE-SOFT [GC Amer ica]). The mandibular archpreprosthetic treatment consisted of the extractions of teethNos. 18, 23, 26, and 28 without site preservation techniques.

The complete denture stage of treatment was initiated 6 weeks postextraction. Maxillary denture fabrication wasapproached in a conventional manner with secondaryimpressions, shade (A2 VITA Shade Guide [Vident]), andmold (P8 Blueline [Ivoclar Vivadent]) selection. A maxillary-mandibular relationship was established, and at prosthetictry-in, the maxillary complete denture and mandibular RPDwere evaluated for occlusion, aesthetics, phonetics, andvertical dimension. After pa tient acceptance, the finalprosthesis was processed, polished, and placed.

The SDI surgical procedure was in itiated 6 monthspostextraction (Figure 5). The patient was prepped, draped,and asked to rinse with a chlorhexidine mouthwash for 30seconds. Platelet rich plasma (PRP) was obtained after a20-cc draw from the right median cubital vein utilizingstandard phlebotomy techniques. A single-spin centrifugewas utilized for PRP processing. A local anaesthetic wasadministered, consisting of 4 carpules (72 mg) of 2%Lidocaine with 1:100,000 epinephrine using a buccal andpalatal infiltration ap proach. A surgical guide was placedover the soft tissue and 3 bleeding points were establishedwith an en dodontic ex plorer. The surgical guide wasfabricated from .020x-wide coping and temporary crownand bridge material size 5-1/8-in square (Buffalo DentalManufacturing), which was adapted to a diagnostic stonemodel. The purpose of the template was to delineatemesial-distal spacing of individual implants. This type oftemplate is not utilized during osteotomy preparation but

establishes the position of the most distal implant as itrelates to the anterior aspect of the maxillary sinus.

A 2-mm diameter tissue punch was utilized to createaccess to the crest of the ridge with the bleeding pointsserving as its center (Figures 6 and 7). A long shank No. 2round surgical bur was used to create a dimple in the crestof the maxillary alveolar ridge. A 5-mm partial osteotomywas made with a 1.1-mm stainless steel drill. The implantplacement protocol included the use of a finger driver andthumb wrench to fully seat three 2.4 x 13 mm titanium alloySDIs (3M ESPE) (Figure 8). The same protocol wasperformed on the contralateral side to complete a total ofsix 2.4 x 13 mm SDIs (Figure 9). Relief was made in the


3


Figure 5. Presurgicalview—edentulous maxilla.

Figure 7. Two-mmdiameter bleeding sites.

Figure 6. Tissue punch.

Figure 8. Three 2.4 x13 mm titanium alloySDIs.

undersurface of the complete maxillary denture with the aidof pressure indicating paste to prevent physical trauma tothe SDIs and to ensure maintenance of the VDO. The softtissue was soaked with PRP, and PRP was also placed intothe relief “reservoirs” in the undersurface of the denture(Figures 10 and 11). The incorporation of PRP was toexpedite hard- and soft-tissue healing through enhancedgrowth factor concentrations such as platelet derivedgrowth factor, transforming growth factor beta-1 andepithelial growth factors.7-9 The pa tient was givenpostoperative instructions, ice was applied to the upper lipof the face, and the patient was discharged.

The SDI prosthetic stage was initiated after a 6-monthosseointegration period. The undersurface of the completedenture consisted of 6 relieved areas where the SDIprosthetic o-balls were positioned. The direct (intraoral)prosthetic attachment technique consisted of placingshims, the o-ring housing complex onto the o-ball, andverification of centric relation (Figure 12). A hard relinematerial was expressed into the denture reservoirs andaround the o-ring housings. The patient was guided intocentric relation and the chin was supported to maintainVDO. After a 7-minute autocuring period, the denture was removed from the mouth, trimmed, and polished(Figures 13 to 15). If shims were present intraorally or in thedenture, they were removed. The complete denture wasseated onto the SDIs and retention, aesthetics, phonetics,and vertical dimension were confirmed.

DISCUSSIONMinimally invasive surgical ap proaches to healthcareservices continue to evolve, and SDI protocols paralleledthis trend.10 Although the edentulous mandibular denturepa tient demonstrates limitations in form and function, themaxillary edentulous patient is not free of concerns. Theutilization of SDIs in the edentulous maxilla can enhancestability, retention, and comfort for the complete denturepatient. More importantly, this minimally invasive procedurecan meet pa tient expectations while obtaining successfullong-term outcomes.11

The success rates of SDIs in the max illa for retainingoverdentures are enhanced when they mimic conventionalimplant osseointegration protocols.12 The success of SDIs is

based on the critical need for rigid osseous fixation atplacement and mature bone when placed into function.13

Maxillary bone is composed of a thin cortical layer and a robustcancellous component (Type III). Therefore, SDIs are placedinto partial and undersized osteotomies to ensure rigid fixation.The retentive features cured into the maxillary denture are


4


Figure 10. Platelet richplasma application—intraorally.

Figure 11. Platelet richplasma—under surface of denture.

Figure 9. Six 2.4 x 13mm titanium alloy SDIs.

Figure 12. O-ringhousings.

Figure 13. Maxillaryoverdenture—under surface.

engaged after the implants have integrated for a 6-monthperiod. This protocol ensures that biomechanical loading of themaxillary overdenture is initiated in mature bone.

The physical composition of an SDI demonstrates astable implant system. The SDI material is designed andmanufactured as a one-piece titanium alloy material. Thisdesign eliminates the microgap and small retaining screw,thereby eliminating the po tential for loose or broken screws.The physical properties of titanium alloy (Ti-A16-V4) exhibitgreater tensile and shear strength in comparison tocommercial pure medical grade titanium.14 The threaddesign is grit-blasted and acid-etched, enhancing surfacearea and roughness, which encourages bone apposition.15

The smooth collar and microthreads encourage soft-tissueadhesion via a hemi des mo somal adherence.16

A proper diagnosis based on a sound radiographic andclinical evaluation is critical in gaining data that facilitatesproper implant place ment.17 A radio graphic-surgicaltemplate facilitates a flapless approach by delineating thelocation of the maxillary sinus and potential individual implantsites. A radiopaque material incorporated into the templatecan approximate the anterior aspect of the sinus, therebypreventing the placement of implants into the maxillary sinusor associated Type IV bone quality. A clinical exam withmanual palpation of the alveolar ridge aids in site selectionfor implant placement. This examination involves tracing thebuccal and palatal bony walls with an index finger and thumbto confirm irregularities in bone (ie, undercuts). In addition,ridge mapping can be performed under local anesthesia withsurgical calipers to determine buccal-palatal thickness.These diagnostic procedures aid in the ability to performimplant placement via a flapless approach.

It should be noted that cone beam computedtomography (CBCT) technology provides 3-dimensional (3-D) views of soft tissue and osseous architecture. Theincorporation of a 3-D generated surgical guide can assistin implant placement, prosthetic design, and safety. Theutilization of a mu coperiosteal flap to visualize the ridge andcritical structures prior to os teotomy preparation combinedwith a CBCT can further enhance surgical outcomes.However, in the specific case presented in this article, theauthor’s decision to prepare the partial osteotomy flaplesswas based on previous site preservation (socket grafting) at

the time of tooth extraction, and an adequate zone ofkeratinized tissue. Although in many cases CBCTtechnology can be advantageous prior to flapless implantsurgery, in this specific case the diagnostic proceduresdescribed and clinical experience delivered safe andpredictable results.

The treatment plan in the case presented focused onincreasing the retention, support, and comfort of theprevious prosthesis, which consisted of a maxillaryoverdenture retained with 3 cemented gold copings on re -sidual roots. The new prosthesis was designed with theconcept that retention was a critical key for a successfuloutcome. A maxillary overdenture consists of a minimum of6 SDIs located anterior to the maxillary sinus. The rationalefor 6 implants is based on the quality of bone andbiomechanical loads. The Type III bone associated with themaxilla is soft in comparison to the bone quality of themandible (Type I and II). The biomechanical loads appliedto the im plants follow the equation: stress is equal to forcedivided by area. By increasing the number of implants in themaxilla, stress is reduced, thereby increasing longevity ofthe SDIs and prosthesis.18 The incorporation of additionalim plants (greater than 6) is determined by the availablespace, opposing occlusion, and quality of bone.

The success of the SDI maxillary overdenture relies onthe fundamental principles of complete dentureconstruction.19 The SDIs serve as re tentive components,but support, stability, and additional retention are derived


5


Figure 15. Final clinicalview, centric relation.

Figure 14. FinalPANOREX.

from basic anatomical structures. A border molded customtray is used to capture border extension and post damwithin the secondary impression. The post dam is a criticalaspect for overdenture retention with the use of SDIs. Theaesthetic component of the denture starts with the width ofthe teeth. The width of the nose is equivalent to the width ofthe 4 maxillary incisors, and their length is determined bythe distance from the incisal papilla to the upper lip atrest.20 The maxillary posterior teeth should not bepositioned coronal to the anterior teeth. The creation of a“re verse smile-line” deviates from the aesthetic ideal withregards to the plane of occlusion.

The occlusal design in this case report was developed inaccordance with orthopedic and orthodontic relationships.The jaw relationship was pseudo Class III due to a severelyatrophied maxilla in relationship to the man dible. The anteriortooth setup demonstrated 2 mm in overbite and overjet withthe posterior maxillary teeth set in crossbite. The maxillarybuccal cusps were placed in the central fossa of themandibular posterior teeth. The im plant occlusal scheme wasde veloped in a bilateral balanced occlusion with 20°anatomical teeth for the maxillary denture.21-23 Themandibular RPD teeth were set up in accordance withstandard occlusal principles with zero degree monoclineteeth. This ap proach centered the force over the alveolarridge of both arches, thereby preserving the alveolar bone.

The surgical phase of SDIs is minimally invasive due tothe flapless approach, partial osteotomy preparation, andimplant placement protocol. The flapless approach allowsfor an implant placement procedure without excessivebleeding, ideal for all patients and more specifically, themedically compromised. A tissue punch can be used togain access to the osseous crest when sufficientkeratinized tissue is present. The partial osteotomyprocedure lends itself to rigid fixation of the implant whileincreasing bone quality via compression. The maxillaryosteotomy is created with a 1.1-mm diameter drill that issignificantly smaller than the 2.4-mm diameter implant. Thisprotocol establishes the needed rigid fixation in soft, Type IIIbone. The im plant is auto-advanced, creating the completeosteotomy while compressing the bone as it proceedsapically. In effect, the implant is acting like an osteotome. It

is critical when using the finger driver and thumb wrench tobe cognizant of the direction and angulation of the implant,therefore avoiding critical vital structures and maintainingparallelism to adjacent implants. It is critical to followstringent surgical protocols to prevent early and late stageimplant failure.24

The prosthetic stage is initiated after a conventionalosseointegration period of 6 months. The maturation ofbone is crucial for long-term success of the maxillary SDIoverdenture. The retentive o-ring housings can beincorporated via an indirect (laboratory) or direct (intraoral)technique. The direct (intraoral) ap proach was utilized inthis case due to parallel implants and because a newmaxillary denture was completed prior to implantplacement. An autocuring composite resin material isefficient in “picking up” the o-ring housing complex. The o-ball prosthetic design has exhibited a long history ofretention success while being simple in design. The o-ringhousing complex allows for easy retrieval and replacement,making maintenance a simple process. The palatal aspectof the denture should not be removed because it aids instability, support, and retention of the denture. The removalof the palatal vault of the denture may increase crestal boneloss due to enhanced load on the implants.

CONCLUSIONThe utilization of SDIs has grown in clinical practice sinceFDA approval for long-term use. The minimally in vasiveprotocol, and reduced treatment times and cost favor theincorporation of this alternative to conventional implants.The usage of SDIs to aid in retention of the overdenturepatient should be a treatment consideration for theedentulous max illa. Al though the current body of evidenceis promising, the need for long-term studies is essential forwidespread accep tance by the dental profession.

ACKNOWLEDGEMENTThe author would like to acknowledge Mel anie Fink, CDA; Taty ana Lyubez han ina, DA; Anita Elwell, CDA; and RobertWeig and CDT (Utica Dental Lab oratory, Uti ca, NY) for theirclinical and laboratory expertise in the preparation of thismanuscript.


6


REFERENCES1. Christensen GJ. The ‘mini’-implant has arrived. J Am

Dent Assoc. 2006;137:387-390.2. Douglass CW, Shih A, Ostry L. Will there be a need for

complete dentures in the United States in 2020? JProsthet Dent. 2002;87:5-8.

3. Shatkin TE, Shatkin S, Op penheimer BD, et al. Mini den -tal implants for long-term fixed and removable prosthe -tics: a retrospective an alysis of 2514 implants placedover a five-year period. Com pend Contin Educ Dent.2007;28:92-101.

4. Salinas TJ. Implant prosthodontics. In: Miloro M, Ghali GE,Larsen PE, et al, eds. Pete r son’s Principles of Oral andMax illo facial Surgery. 2nd ed. Lon don, England: BCDecker; 2004:263.

5. Bergendal T, Engquist B. Implant-supportedoverdentures: a longitudinal pro spective study. Int JOral Maxillofac Implants. 1998;13:253-262.

6. Bulard RA, Vance JB. Multi-clinic evaluation using mini-dental implants for long-term denture stabilization: apreliminary bio metric evaluation. Compend Con tin EducDent. 2005;26: 892-897.

7. Giannobile WV. Periodontal tissue engineering bygrowth factors. Bone. 1996;19(suppl 1):23S-37S.

8. Nathan C, Sporn M. Cytokines in context. J Cell Biol.1991;113:981-986.

9. Park JB, Matsuura M, Han KY, et al. Periodontalregeneration in class III furcation defects of beagledogs using guided tissue regenerative therapy withplatelet-derived growth factor. J Periodontol.1995;66:462-477.

10. Gibney JW. Minimally invasive implant surgery. J OralImplantol. 2001;27:73-76.

11. Griffitts TM, Collins CP, Collins PC. Mini dental implants:an adjunct for retention, stability, and comfort for theedentulous patient. Oral Surg Oral Med Oral Pathol OralRadiol Endod. 2005;100:e81-e84.

12. English CE, Bohle GC. Diagnostic, procedural, and cli ni -cal issues with the Sendax mini dental implants. Com -pend Contin Educ Dent. 2003;24(11 suppl 1):3-25.

13. Balkin BE, Steflik DE, Naval F. Mini-dental implantinsertion with the auto-advance technique for on goingapplications. J Oral Implantol. 2001;27:32-37.

14. Lemons JE, Bidez MW. Biomaterials and biomechanicsin implant dentistry. In: McKinney RV, ed. EndostealDental Implants. St. Louis, MO: Mosby Year Book; 1991.

15. American Society for Testing and Materials (ASTM).Surgical and Medical Devices. Vol 14.01. Philadelphia,PA: ASTM; 1996.

16. James RA, McKinney RV, Meffert RM. Tissue surroundingdental implants. In: Misch CE. Contem po rary ImplantDentistry. 2nd ed. St. Louis, MO: Mosby; 1999:239-251.

17. Becker W, Goldstein M, Becker BE, et al. Minimallyinvasive flapless implant placement: follow-up resultsfrom a multicenter study. J Periodontol. 2009;80:347-352.

18. Brunski JB. In vivo bone response to biomechanicalloading at the bone/dental-implant interface. Adv DentRes. 1999;13:99-119.

19. Moses CH. Physical considerations in impressionmaking. J Prosthet Dent. 1953;3:449-463.

20. Frush JP, Fisher RD. Dentogenics: its practicalapplication. J Prosthet Dent. 1959;9:914-921.

21. Pound E, Murrell GA. An introduction to denturesimplification. J Prosthet Dent. 1971;26:570-580.

22. English CE. Critical A-P spread. Implant Soc. 1990;1:2-3.23. Payne SH. A posterior set up to meet individual

requirements. Dent Digest. 1941;47:20-22. 24. Albrektsson T, Zarb G, Worthington P, et al. The long-

term efficacy of currently used dental im plants: a reviewand proposed criteria of success. Int J Oral MaxillofacImplants. 1986;1:11-25.


7


POST EXAMINATION INFORMATION

To receive continuing education credit for participation inthis educational activity you must complete the programpost examination and receive a score of 70% or better.

Traditional Completion Option:You may fax or mail your answers with payment to DentistryToday (see Traditional Completion Information on followingpage). All information requested must be provided in orderto process the program for credit. Be sure to complete your“Payment,” “Personal Certification Information,” “Answers,”and “Evaluation” forms. Your exam will be graded within 72hours of receipt. Upon successful completion of the post-exam (70% or higher), a letter of completion will be mailedto the address provided.

Online Completion Option:Use this page to review the questions and mark youranswers. Return to dentalcetoday.com and sign in. If youhave not previously purchased the program, select it fromthe “Online Courses” listing and complete the onlinepurchase process. Once purchased the program will beadded to your User History page where a Take Exam linkwill be provided directly across from the program title.Select the Take Exam link, complete all the programquestions and Submit your answers. An immediate gradereport will be provided. Upon receiving a passing grade,complete the online evaluation form. Upon submitting the form, your Letter Of Completion will be providedimmediately for printing.

General Program Information:Online users may log in to dentalcetoday.com any time inthe future to access previously purchased programs andview or print letters of completion and results.

POST EXAMINATION QUESTIONS

1. Which is a small-diameter implant (SDI) characteristic that is critical for surgical andprosthetic success?

a. One-piece design.

b. Titanium alloy structure.

c. Ball/o-ring prosthetic attachment.

d. All of the above.

2. The ideal osseointegration period for a maxillaryoverdenture is:

a. Immediate.

b. 3 months.

c. 6 months.

d. 1 year.

3. The surgical site preparation protocol for SDIs isbest described as:

a. Partial osteotomy.

b. Complete osteotomy.

c. Osteotome technique.

d. Ridge expansion.

4. The minimum number of SDIs to retain a maxillary denture is:

a. 2.

b. 4.

c. 6.

d. 8.

5. The ideal diagnostic information prior to implantsurgery is:

a. Ridge mapping.

b. Manual palpation.

c. Cone beam computed tomography.

d. All of the above.

6. The ideal implant occlusal scheme when a completemaxillary overdenture opposes a completemandibular denture is:

a. Canine guidance.

b. Group function.

c. Bilateral balanced.

d. None of the above.

7. The success of maxillary implant cases whencompared with mandibular implant cases isgenerally:

a. Higher.

b. Lower.

c. Equal.

d. No comparison data is available.


8


8. Small-diameter implants demonstrate the highest success rate when placed in:

a. Fresh extraction sockets.

b. Healed sites.

c. Nonhealed sites.

d. Presence of periapical pathology.

9. The most frequent prosthetic maintenance procedurefor a maxillary SDI overdenture is:

a. Reline denture base.

b. Surgical exposure of ball prosthetic attachment (hyperplasia).

c. Replace o-rings.

d. Fabricate new overdenture.

10. The most critical objective for SDI surgicalplacement is:

a. Performing a complete osteotomy.

b. Obtaining rigid fixation.

c. Flapless approach.

d. Immediately loading the prosthesis.


9


PROGRAM COMPLETION INFORMATION

If you wish to purchase and complete this activitytraditionally (mail or fax) rather than online, you mustprovide the information requested below. Please be sure toselect your answers carefully and complete the evaluationinformation. To receive credit you must answer at least 7 ofthe 10 questions correctly.

Complete online at: dentalcetoday.com

TRADITIONAL COMPLETION INFORMATION:Mail or fax this completed form with payment to:

Dentistry TodayDepartment of Continuing Education100 Passaic AvenueFairfield, NJ 07004

Fax: 973-882-3622

PAYMENT & CREDIT INFORMATION:

Examination Fee: $40.00 Credit Hours: 2.0

Note: There is a $10 surcharge to process a check drawn on any bank other than a US bank. Should you have additionalquestions, please contact us at (973) 882-4700.

o I have enclosed a check or money order.

o I am using a credit card.

My Credit Card information is provided below.

o American Express o Visa o MC o Discover

Please provide the following (please print clearly):

Exact Name on Credit Card

Credit Card # Expiration Date

Signature

PROGRAM EVAUATION FORMPlease complete the following activity evaluation questions.

Rating Scale: Excellent = 5 and Poor = 0

Course objectives were achieved.

Content was useful and benefited your clinical practice.

Review questions were clear and relevant to the editorial.

Illustrations and photographs were clear and relevant.

Written presentation was informative and concise.

How much time did you spend reading the activity and completing the test?

What aspect of this course was most helpful and why?

What topics interest you for future Dentistry Today CE courses?



ANSWER FORM: COURSE #: 167Please check the correct box for each question below.

1. o a o b o c o d 6. o a o b o c o d





PERSONAL CERTIFICATION INFORMATION:

Last Name (PLEASE PRINT CLEARLY OR TYPE)

First Name

Profession / Credentials License Number

Street Address

Suite or Apartment Number

City State Zip Code

Daytime Telephone Number With Area Code

Fax Number With Area Code

E-mail Address

/

Dentistry Today, Inc, is an ADA CERP RecognizedProvider. ADA CERP is a service of the AmericanDental Association to assist dental professionals inindentifying quality providers of continuing dentaleducation. ADA CERP does not approve or endorseindividual courses or instructors, nor does it implyacceptance of credit hours by boards of dentistry.Concerns or complaints about a CE provider may bedirected to the provider or to ADA CERP atada.org/goto/cerp.

Approved PACE Program ProviderFAGD/MAGD Credit Approval doesnot imply acceptance by a state orprovincial board of dentistry or AGDendorsement. June 1, 2012 to May 31, 2015 AGD PACE approvalnumber: 309062

10

small-diameter implants - dentalcetoday.com · small-diameter implants: ... impressions, shade (a2...

Documents