Univesrsitatea Carol Davila Bucuresti
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2 Univesrsitatea Carol Davila Bucuresti
3 In ultimii 20 ani, au fost realizate si audiate foarte multe cursuri referitoare la implanturi si protezare pe implanturi Interesul despre protezarea totala conventionala a scazut inclusiv in curicula universitara
4 A Prosthodontic Wake-Up Call: Reaffirming the Complete Denture, Implants Alone Do Not Solve the Problems: The Old Principles are Still Important Sincerely, Roy T. Hawkinson, DDS, MS, FACP 6405 Telegraph Rd., Ste H-3 Bloomfield Hills, MI 48301
5 Ce notam? Unde si la ce ne uitam?
6
7 ACEST LUCRU DUCE LA EROAREA REABILITARII PROTETICE SI A IMPLANTURILOR
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9 In mod logic Implanturile nu pot fi pozitionate Exact in pozitia unde au fost dintii naturali Chiar daca pacientul a fost Angle cls I
10 Dintii artificiali mandibulari Vor avea o pozitie mai lingualizata Decat a fostilor dinti naturali
11
12
13 In urmatoarele slide-uri Am sa incerc sa descriu contextul si Notiunile necesare pentru a reabilita un pacient edentat total
14 Criteriu estetic Criteriu functional Criteriu bioprofilactic
15 DIMENSIUNEA VERTICALA DE OCLUZIE SPATIUL PROTETIC VERTICAL DISPONIBIL RELATIA CENTRICA
16 POZITIA DE REPAUS MANDIBULAR ESTETICA BIOMETRIC FONETICA
17
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19 INREGISTRARE CU SABLOANE DIN CEARA ORICE INREGISTRARE E BUNA ATATA TIMP CAT OBTINEM RC-INREGISTRARE REPETITIBILA
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21 Montarea machetelor in ARTICULATOR folosind transferul datelor cu arcul facial
22 Intinderea spatiului protetic Distanta dintre mucoasa crestei alveolare si planul de ocluzie=spatiul proetic disponibil in sens vertical!
23 1
24 Decalaj mare-sagital Daca dorim un astfel de aspect estetic aceasta este pozitia dintilor care ne ofera suport pt partile moi
25
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27 Supraproteze-bare=10mm Supraproteze pe implanturi individuale=8-9mm Supraprotezare totala conditionat mobilizabila-15-17mm Coroane metalo-ceramice=4-8mm Coroane metalo-ceramice cu bont angulat=9mm Abuljamra et al.: Evaluation of interarch space for implant restoration in edentoulous patient J Prostodontics 9:
28 Restaurarile fixe necesita un spatiu protetic vertical mai mic Restaurarile tip supraproteza mobilizabila pe implanturi-care necesita un spatiu protetic vertical mai mare
29
30 12-14 mm
31
32 8-10 mm
33 15-17 mm 8-10 mm
34 Cum putem realiza o astfel de reabilitare fara a avea probleme RISC DE FRACTURA?
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36
37
38 Spatiu insuficient Pe durata timpului chirurgical se poate remodela osul pentru obtinerea de spatiu Spatiu insuficient
39
40 Grosimea versantului vestibular a protezei vechi sau a unei noi reabilitari influenteaza estetica si POATE influenta alegerea unei reabilitari fixe sau mobile
41 Extraoral: Norma frontala Norma laterala Intraoral:-pozitionarea grupului frontal maxilar-linia surasului
42 necesitarea unui suport pt buza si obraz poate fi analizata cu o proteza duplicat sau cu o machetare diagnostica cu sau fara versant vestibular Pacientii care au o linie a surasului inalta vorfi reabilitati estetic mai bine daca exista versant vestibular-reabilitare mobila
43
44 Reabilitare fixa Grad de atrofie micrezolvarea estetica prin adaugarea de material care imita gingia Grad de atrofie marerezultatul estetic nu mai poatet fi obtinut prin aceeasi metoda
45 Cheia=machetarea diagnostica
46 Arhiva prof Dr Alexandru Petre Proteza veche folosita pt analiza spatiului protetic disponibil
47
48 F.M. MEDIDENT DENTAL X-RAY INSTITUTE COMPUTERIZED CEPH. TRACING & ANALYSIS DENTAL VOLUMETRIC TOMOGRAPHY All the images are in scale 1:1. No magnification problems.
49 F.M. MEDIDENT DENTAL X-RAY INSTITUTE COMPUTERIZED CEPH. TRACING & ANALYSIS DENTAL VOLUMETRIC TOMOGRAPHY All the images are in scale 1:1. No magnification problems.
50 RIGHT F.M. MEDIDENT DENTAL X-RAY INSTITUTE COMPUTERIZED CEPH. TRACING & ANALYSIS DENTAL VOLUMETRIC TOMOGRAPHY Position 42 All the images are in scale 1:1. No magnification problems.
51 La maxilar Multi factori implicati Economici fonetica Relatii intermaxilare Morfologia crestei Estetica Suport pentru partile Lungimea dintilor moi Managementul tesuturilor moi
52 Elementele componente ale unei proteze pot fi impartite. dinti Versant baza vestibular Arhiva prof Dr A Borrachinni-Facultatea de stomatologie Siena
53 dupa inainte
54 Distanta intermaxilara (1) distanta intre funduri de sac (2) RIM (3) Overlap upper frontal (4) Distanta papila-margine incizala (5) Inclinarea dintilor frontali sup inclinare f de papila incisiva grosimea versantului vestib (6) Lungimea incisivului central (7) distanta punct interincisiv-papila
55 Importanta papilei incisive Pozitionarea papilei incisive este un indicator al rezorbtiei osoase Cu cat e pozitionata mai pe palat-situatia este mai favorabila No palatal crestal No palatal buccal
56 Alte aspecte intraorale Pentru a decide un plan protetic fix pe implaturi, portiunea cervicala a coroanei clinice trebuie sa se situeze in dreptul tesuturilor moi Decalaj mic Decalaj mare
57 Conditii morfologice intrantraorale Pt reabilitare fixa-simetrie creasta edentata. Versantul vestibular-convex iar creasta lata uniforma rotunjita
58 Conditii morfologice intraorale Aceasta creasta este neregulata si asimetrica- un tratament protetic fix pe implanturi e complicat si cu rata mica de succes Arhiva conf Dr L Muntianu Creasta asimetrica
59 Au fost analizata la DVO -estetica -aspecte biometrice Urmeaza analizarea aspectelor functionale
60 Fonatia este una din functiile afectate de pierderea dintilor Refacerea functiei fonatorii prin reabilitarea protetica POATE pune probleme
61 Tanaka a aratat ca zona fonetica in zona anterioara a palatului incepe cu o usoara convexitate in plan sagital. Aceasta suprafata este de 11-13mm 2 si se intinde la 6mm in spatele marginii cervico-palatinale a incisivilor centrali superiori TANAKA H. Speech patterns of edentulous patients and morphology of the palate in relation to phonetics. J Prosthet Dent 1973, 29: 16-28
62 Aspecte intraorale legate de fonatie Cand zona fonetica e afectata de resorbtie este necesara realizarea unui suport palatinal pentru pronuntia lui S, lucru usor de realizat la o reabilitare mobilizabila Resorbtie moderata Resorbtie severa
63
64 Alegerea planului de tratament se face Numai dupa realizarea MACHETEI +ANALIZAREA SPATIULUI PROTETIC DISPONIBIL-in sens vertical(axial si sagital) si orizontal (transversal si antero-posterior)
65 15 mm 15 mm 11 mm Protezare fixa Protezare mobilizabila
66 Criterii esetice biometrice functionale Analiza fonatiei in functie de pozitia papilei incisive si a gradului de atrofie Se ia in calcul raportul dintre creste-clasa scheletala Angle pentru analizarea gradului de propulsie fonetic si a spatiului de inocluzie Thompson
67 Nu putem promite pacientului la momentul chiurgical un anumit tip de reabilitare Este nevoie de documentare fotografica a cazului pe parcurs dpdv estetic pentru a evalua corect cazul Si pentru a obtine consimtamantul informat al pacientului
68 Din pacate Sau din fericire Notiunile valabile in protezarea totala Sunt mai valabile ca oricand
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