occlusion in implant prostheses

Abstract

There are many biological and physiological differences between natural teeth and implants. So, it isn’t appropriate to apply the occlusion rules of natural teeth directly to implant-supported restorations. One of the most important reasons for this is the absence of natural periodontal tissues around the tooth around the implant. This situation deprives the implant of the shock absorption ability of the natural tooth and applying excessive force to the implant may cause irreversible problems. If the damage to the surrounding tissue of the implant is detected early, recycling may be possible or the damage can be stopped, but if the problem is advanced, implant may be lost. Affected soft tissues around the implant can cause periimplant gingivitis , and if not treated periimplantitis can occur. Finally, implant loss may occur due to bone loss over time. In such patients, prosthetic examination should be performed besides periodontal treatment, and occlusal adjustments should be made if destruction of periodontal tissues due to occlusion is suspected. Meanwhile, some damage may occur on the implant spacers and implant. Fractures, cracks and decimentation may occur in implant-supported prostheses. To minimize these occlusal forces on the implant and bring it to a tolerable level, some modifications should be made in the occlusion and an occlusion that will protect the health of the implant should be obtained. We aimed to reveal the researches on these modifications and to ensure that sufficient knowledge is reached to provide a near ideal implant occlusion when making an implant-supported prosthesis.

Keywords

• Dental occlusion
• dental prosthesis implant-supported
• periodontal ligament

İmplant Üstü Protezlerde Oklüzyon

Abstract

Doğal dişler ve implantlar arasında biyolojik ve fizyolojik olarak birçok farklılık vardır. Bu sebeple doğal dişlerdeki oklüzyon kurallarının implant destekli restorasyonlarda direkt uygulanması uygun bulunmamaktadır. Bunun en önemli sebeplerinden birisi implant çevresinde, diş çevresinde bulunan doğal periodontal dokuların bulunmamasıdır. Bu durum implantı doğal dişte bulunan şok absorpsiyon yeteneğinden yoksun kılar ve implanta fazla kuvvet geldiği durumlarda geri dönülmez problemler oluşturabilir. İmplantın çevre dokusunda meydana gelen hasar erken tespit edildiği takdirde geri dönüşümü mümkün olabilir veya oluşan hasar durdurulabilir ancak problem ileri düzeydeyse bu durum implantın kaybına sebep olabilir. İmplant çevresindeki yumuşak dokunun etkilenmesiyle periimplant gingivitis, tedavi edilmediği durumlarda periimplantitis görülebilir. Sonuç olarak zaman içerisinde oluşan kemik kaybından kaynaklı implant kaybı oluşabilir. Bu tip hastalarda periodontal tedaviye ek olarak protetik muayene de yapılmalı ve periodontal dokularda oluşan harabiyetin oklüzyon kaynaklı olduğundan şüpheleniliyorsa oklüzal düzenlemeler de mutlaka yapılmalıdır. Aynı zamanda implant ara parçaları ve implant üzerinde de birtakım hasarlar oluşabilir. İmplant üstü protezlerde de kırılmalar, çatlamalar ve desimantasyon meydana gelebilmektedir. İmplanta gelen bu oklüzal kuvvetleri minimalize etmek ve tolere edilebilecek düzeye getirmek için oklüzyonda birtakım modifikasyonlara gidilmeli ve implant sağlığını koruyacak bir oklüzyon elde edilmelidir. Bu derlemedeki amacımız bu modifikasyonlarla ilgili araştırmaları ortaya koymak ve bir implant üstü protez yaparken ideale yakın bir implant oklüzyonu sağlayabilmek için yeterli bilgi düzeyine ulaşılmasını sağlamaktır.

Keywords

• Diş oklüzyonu
• İmplant destekli diş protezi
• Periodontal bağ

References

1. Buser D, Ruskin J, Higginbottom F, Hardwick R, Dahlin C, Schenk RK. Osseointegration of titanium implants in bone regenerated in membrane-protected defects: a histologic study in the canine mandible. Int J Oral Maxillofac Implants. 1995;10(6):666-681.
2. Hämmerle CHF, Wagner D, Brägger U, et al. Threshold of tactile sensitivity perceived with dental endosseous implants and natural teeth. Clin Oral Implants Res. 1995;6(2):83-90.
3. Lindhe J, Berglundh T. The interface between the rnucosa and the implant. Periodontology 2000. 1998; 17: 47-54.
4. Listgarten, M. A., Lang N.P., Schroeder HE, Schroeder A. Periodontal tissues and their counterparts around endosseous implants. Clin Oral Impl Res. 1991;2(3):1- 19.
5. Sekine, H., Komiyama, Y., & Hotta, H. Mobility characteristics and tactile sensitivity of osseointegrated fixturesupporting systems. In van steeberghe D, editor: Tissue integration in oral maxillofacial reconstruction, Amsterdam, 1986. Excerpta Medica, 326-332.
6. Hillam DG. Stresses in the periodontal ligament. J Periodontal Res. 1973;8:51–56.
7. Schulte W. Implants and the periodontium. Int Dent J. 1995;45:16–26.
8. Apse, P, Ellen R, Overall C, Zarb A. Microbiota and crevicular collagenase activity in the osseointegrated dental implants sulcus: A comparison of sitesin edentulous and partially edentulous patients. Clin Oral Impl Res.1990; 1:8-12.

9. Berglundh T, Lindhe J, Johnson K, Ericsson I. The topography of the vascular systems in the periodontal and peri-implant tissues in the dog. J Clin Periodontol.1994;21:189-193.
10. Adell R. Tissue integrated prostheses in clinical dentistry. IntDent J. 1985;35:259–265.
11. Misch CE. Implant design considerations for the posterior regions of the mouth. Implant Dent. 1999;8:376– 386.
12. Lundgren D, Laurell L. Biomechanical aspects of fixed bridgework supported by natural teeth and endosseous implants. Periodontology. 2000;1994:23–40
13. Nissan, J., Ghelfan, O., Gross, O., Priel, I., Gross, M., & Chaushu, G. The effect of crown/implant ratio and crown height space on stress distribution in unsplinted implant supporting restorations. Journal of oral and maxillofacial surgery, 69(7), 1934-1939.
14. Gross MD. Occlusion in implant dentistry. A review of the literature of prosthetic determinants and current concepts. Aus Dent J. 2008;53(suppl 1):S60–S68.
15. Fu JH, Hsu YT, Wang HL. Identifying occlusal overload and how to deal with it to avoid marginal bone loss around implants. Eur J Oral Implantol. 2012;(5 suppl):S91–S103.
16. Kozlovsky A, Tal H, Laufer B-Z, et al. Impact of implant overloading on the peri-implant bone in inflamed and non-inflamed peri-implant mucosa. Clin Oral Implants Res 2007;18:601–610
17. Gross, M. D. Occlusion in implant dentistry. A review of the literature of prosthetic determinants and current concepts. Australian dental journal, 53, S60-S68.
18. Kim Y, Oh TJ, Misch CE, Wang HL. Occlusal considerations in implant therapy:clinical guidelines with biomechanical rationale. Clin Oral Implants Res. 2005 Feb;16(1):26-35.
19. Gerard Byrne. Fundamentals of implant dentistry. June 2014.
20. Vanlıoğlu, B., Özkan, Y., & Özkan, Y. K. İmplant destekli restorasyonlarda oklüzyon. Atatürk Üniversitesi Diş Hekimliği Fakültesi Dergisi, 2011(4), 57-64.
21. Minsley GE and Koth DL: İn; McKinney RV, "Endosteal Dental Impiants" Mosby Co, St. Louis, 1991.
22. Bayındır F ve Denizoğlu S: Dental İmplant Protezleri için Oklüzyon Tipinin Seçimi, Atatürk Üniversitesi Dişhekimliği Fakültesi Dergisi,1999; 9(1), 87-90,
23. Acar, A., and Özgür İnan. "İmplant destekli protezlerde okluzyon." Cumhuriyet Üniversitesi Dişhekimliği Fakültesi Dergisi 4.1 (2001): 52-56.
24. Cohen SR and Orenstein JH: The Use of Attachments in Combinatıon Implant and Natural-Tooth Fixed Partial Dentures: A Technical Report. Int J Oral Maxillofac Impiants, 9, 230-334, 1994
25. Weinberg, L.A. Reduction of implant loading with therapeutic biomechanics. Implant Dentistry,1998; 7: 277–285.
26. Kim Y, Oh TJ, Misch CE, Wang HL. Occlusal considerations in implant therapy:clinical guidelines with biomechanical rationale. Clin Oral Implants Res. 2005 Feb;16(1):26-35.
27. Ismail HA, Yousief SA, Mahrous AI, Shaban AA, Azzeghaiby SN, Aljehani D. Clinical and Radiographic Evaluation of Median Lingualized Occlusion in Implant Retained Mandibular Complete Overdenture. J Int Oral Health. 2015;7(Suppl 1):5-8.
28. Rocha, C. O., Longhini, D., Pereira, R. P., Lima, A. L., Bonafé, F. S., & Arioli Filho, J. N. Masticatory efficiency in complete denture and single implant-retained mandibular overdenture wearers with different occlusion schemes: A randomized clinical trial. The Journal of Prosthetic Dentistry.2021
29. Kim, Y., Oh, T. J., Misch, C. E., & Wang, H. L. Occlusal considerations in implant therapy: clinical guidelines with biomechanical rationale. Clinical oral implants research, 2005;16(1), 26-35.
30. Mattheos N., Schittek Janda M., Zampelis A., Chronopoulos V. Reversible, non-plaque-induced loss of osseointegration of successfully loaded dental implants. Clin. Oral Implants Res. 2013;24(3):347–354. doi: 10.1111/clr.12009.
31. Graves, C. V., Harrel, S. K., Rossmann, J. A., Kerns, D., Gonzalez, J. A., Kontogiorgos, E. D., ... & Abraham, C. The role of occlusion in the dental implant and peri-implant condition: a review. The open dentistry journal,2016; 10, 594.
32. Çopuroğlu, A., Öztürk, B. B., Ağca, U., Özkurt Kayahan, Z., & Kazazoğlu, E. İmplantüstü protezlerde oklüzyon. 7tepe Klinik Dergisi,2023; 18(3), 68-74.
33. Demir, A., & Dede, M. İmplant destekli protezlerin başarısında oklüzyonun önemi. Sağlık & bilim 2023: odontoloji-ı, 131.
34. Nunn M.E., Harrel S.K. The effect of occlusal discrepancies on periodontitis. I. Relationship of initial occlusal discrepancies to initial clinical parameters. J. Periodontol. 2001;72(4):485–494. doi: 10.1902/ jop.2001.72.4.485.
35. Merin RL. Repair of peri-implant bone loss after occlusal adjustment: a case report. J. Am. Dental Assoc. 2014;145(10):1058–62.