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About This WebinarWhat: Key Implant Position: A Biomechanical Rationale to Treatment Planning |
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There are over 100,000 combinations of missing teeth, with various bone volumes in the edentulous sites. As a consequence, treatment planning to replace missing teeth has been an art form. However, today bone augmentation procedures can usually regenerate residual bone to more ideal conditions. Therefore an assumption in an ideal treatment plan should be there is adequate bone present in the edentulous sites to insert dental implants.
In any fixed prosthesis replacing two or more adjacent teeth, there are locations which are more important than others, from a biomechanical perspective. These specific locations may be called "key" to restore the patient. "Key" implant locations are important enough to do a bone augmentation procedure if inadequate bone is found at this site.
When the missing teeth in a partially edentulous patient are to be replaced with dental implants, there are four guidelines to establish the key implant locations:
1. No cantilever
2. No 3 pontics
3. The canine rule
4. The first molar rule
Cantilevers are force magnifiers. Three adjacent pontics not only overload the adjacent abutments, the flexure of the metal is 27 times the flexure of a 1 pontic prosthesis. The canine and first molar sites are key positions for an arch, and whenever messing should be replaced with an implant (rather than a pontic).
Once these key positions are determined, the additional implants required to restore the patient are considered based upon patient force factors and the bone density in the edentulous sites.

Carl E. Misch, BS, DDS, MDS, PhD (h.c.)
Dr. Carl E. Misch is currently a Clinical Professor and Director of Oral Implantology at Temple University School of Dentistry. He was the Director of the Implant Residency Program at Pittsburgh Dental School from 1982 to 1990. He maintains a private practice restricted to implant dentistry in Beverly Hills, Michigan.
Accolades of Dr. Misch include:
*Graduated Magna cum laude from the University of Detroit Dental School
*MDS in Prosthodontics and an Implant Fellowship at the University of Pittsburgh Dental School.
*Diplomate and Past President of the Board of Oral Implantology/Implant Dentistry.
*Fellow of 13 different societies, including the American College of Dentists and the International College of Dentists.
*Co-Chairman of the Board of Directors of the International Congress of Implantologists (ICOI), representing 98 countries
*Published over 220 scientific articles.
*Repeatedly lectured in every state in the United States as well as 47 countries.
*Written 4 textbooks on implant surgery, bone grafting, prosthetics and treatment of complications, which has been translated into 5 languages.
*Trained more than 3,500 doctors in the Misch Implant Institute over the last 25 years.
For more information, see (www.misch.com)
