Solutions Dental Implants
Occlusion and partial endentulas care
Posted on 2/28/2023 by Greg Kammeyer
Occlusion in the Partially Edentulous Implant Case

Conventional thinking has been to place the initial restoration with slightly less occlusal contact than the adjacent teeth, given the teeth depress into the socket and the implant doesn’t. So contact in “light occlusion” should have no contact, and “after chewing hard” the occlusal contacts should be similar. After 38 years of implant surgery & prosthetics, I’ve found all too often the restorations are totally out of occlusion. This omits one of the huge benefits of dental implants > protecting the adjacent teeth. As a result, all too often a RCT tooth next to an implant out of occlusion will fracture.
Although this protects the bone/implant interface initially if the implant is integrated, that hyper occlusion is not needed. Sadly a frequent comment from the restoring dentist is that they “will shift into position over time”….which I seldom see. I encourage each of you to stay to the original protocol on occlusal contact. Integrated implants will take more than their share of the occlusal load. If you are in doubt about the integration predictability note the following;
1) Time is our friend-The longer an implant is not in function or in function, the more bone to implant contact develops and as well the peri-implant bone density.
2) Grafted bone takes years to get close to native bone density-so implants that are placed in heavily grafted cases should sit more time. Moderately pneumatized sinus grafts for example.
3) Bone heals more slowly in the non-active patients, particularly the elderly-blood flow is essential to wound healing
4) Although I routinely use ISQ scores on all our cases, it is important to consider
a) How well integrated does the implant look radiographically,
b) Which part of the mouth are the implants in? (Mandibular anterior = strongest bone, maxillary posterior = weakest bone).
c) ANY prolonged implant symptoms can be signs of less integration, especially tenderness to palpation over the mucosa over the implant
d) Other medical factors may be affecting bone healing that may not show up on the above signs/symptoms: SSRI’s, PPI’s, immunosuppressant’s, Smoking, Diabetes etc
e) Implants over time don’t move, yet teeth do: I encourage you to check the occlusion on all implants at routine hygiene visits.
All implants are not completely integrated. Bone to Implant Contact (BIC) can vary from 50-80% with successfully integrated implants yet I have read a number of papers that showed substantially less BIC with long term implant success. Hence seeing some minor black areas between the implant and bone radiographically, may not be associated with implant failure.
Yours for better health,
Greg Kammeyer, DDS, MS, DABOI
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