Occlusal Considerations
in Implant
Technology of Dental Implant
Dr. Ahmad M. Abu Al-Adous
BDS, MClinDent (Pros)
Implant Occlusal Scheme
• Flat Fossa and Grooves for wide freedom in centric
• Shallow Occlusal Anatomy
• Narrow Occlusal Table - 30% to 40% smaller for molars (Widths >
Implant Diameter - Cantilever Effect - Bending Effect)
• Narrow Table - More Axial, Less non-Axial
• Reduced Cuspal Inclination - Less Bending forces, more axial
• Occlusal Material - Material with high modulus of elasticity
• Night Guard - Parafunction
Single Unit
• Avoid excursive guidance
• Increased proximal contact
Multiple Unit - Anterior
• Light contact in maximum intercuspation (30 μm)
• Flatten vertical and horizontal overlap and protrusive
guidance to reduce lateral forces
• Selective excursive guidance for best biomechanical abutment
distribution
Anterior
• 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.
• 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. Occlusal contacts should be
evaluated under heavy biting forces and during all excursive movements to ensure
premature contacts are not present.
Multiple Unit - Posterior
• Excursive guidance on well-supported
anterior natural teeth with posterior
teeth disclusion in eccentric
movements
• Canine protected or mutually
protected occlusion if canine present
• Group function occlusal scheme if
canine absent/prosthesis replacing
bilateral distal extension
• Optimum abutment support for
working guidance
Posterior
• 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.
Posterior
• 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).
Occlusion Check
• Maximum Intercuspation - Contact in the Centre, Light contact (30 μm)
• Firm occlusion with shim stock (8–30 μm) passing through
• Anterior guidance with natural dentition, if possible
• No contact on lateral movements - working, non-working
• Group Function - if no natural tooth for lateral guidance
Implant Protected Occlusion
. It is an occlusal scheme which reduces the force at the
crestal bone and the implant interface. This concept
was proposed by Dr. Carl E. Misch.
Implant protected occlusion helps in reducing the
noxious load and to maintain the implant load within
the physiological limits of individualized occlusion.
Occlusal overload will lead to biomechanical
complications like early implant failure , early crestal
bone lost, intermediate to late implant failure, screw
loosening, uncemented restoration, component failure,
porcelain fracture, prosthesis fracture and periimplant
disease.
Implant Protected Occlusion
1) No premature occlusal contacts or interferences. Timing of occlusal contacts protected
by natural dentition.
2) Influence of surface area
3) Mutually protected articulation (No lateral excursion)
4) Occlusal load axial to implant body angle
5) Low cusp angle of crowns
6) Crown Height (vertical offset)
7) Cantilever or offset distance ( Horizontal offset)
8) Implant crown contour (narrow B /L dimensions)
9) Selection of occlusal materials
10) Verify implant supported prosthesis have lightened occlusion
Ideal Occlusal Contact Position
• Occlusal contact position determines the direction of force,
which, if not ideal, may be detrimental to the peri-implant hard
and soft tissues. When a patient exhibits parafunction, the
occlusal contact position is even more important.
Strategies To Manage Parafunction Forces
1) Placing increased number of implants.
2) Placing larger diameter implants.
3) Placing implants in positions to reduce bending
overload or positions to promote axial loading.
4) Avoid use of cantilevers or pontics.
5) Use bruxism night guard appliances.
6) Alter occlusal material of prosthetic teeth to be acrylic resin for
removable prosthesis and metal occlusal for fixed prosthesis.
Conclusion
• The proper occlusal scheme, as well as the ultimate success of
the implants and the prosthesis, is based on careful treatment
planning and the consideration of various factors and
principles, which will allow for longevity of the restoration and
harmony with the surrounding tissues.
T ha n k
… yo u
