Treatment Planning for Immediate Loading Cases

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Dr. Barry Levin is a Diplomate of the American Board of Periodontology and a Clinical Associate Professor at the University of Pennsylvania School of Dental Medicine. Dr. Levin maintains a private practice limited to peridontics and implants located at 7848 Old York Road, Suite 100, Elkins Park, PA 19027. His main office telephone number is (215) 635-0465 and his website can be accessed at http://.www.TRESS-LEVIN.com. Dr. Levin has graciously offered to share some of his views on implant dentistry.

Osseonews (ON): Dr. Levin do you find that you are receiving more and more requests from your referring dentists for immediate load cases?

Dr. Levin: Yes, we have seen a dramatic increase in this treatment option.

ON: What are some of the key factors in treatment planning this kind of a case?

Dr. Levin: First of all the referring dentist should have a very good idea of how the case is going to be restored. A thorough diagnostic work-up is necessary. This may entail diagnostic casts and a diagnostic wax-up.

ON: What are some of the key features of treatment planning in regard to the occlusion?

Dr. Levin: The occlusion must be carefully evaluated. If immediate loading is planned, then the adjacent teeth on either side of the crown or short span fixed partial denture should bear the occlusal loading and guidance.

ON: So you must plan to distribute the forces of occlusion and guidance so that you are not applying force to the implant supported crown or short span fixed partial denture.

Dr. Levin: Exactly. The implants need time for osseointegration. They should not be subjected to the forces of occlusion or guidance during that time.

ON: What about long span fixed partial dentures that cross the midline and have cross-arch stabilization?

Dr. Levin: This is a different set of parameters. This kind of prosthesis can support occlusal loading and guidance because of the broad distribution of stress over a wide span of the arch.

ON: How would you define immediate loading in these cases?

Dr. Levin: For the single crown or short span fixed partial denture you are really talking about immediate aesthetics. You are filling up an edentulous space with a prosthesis that looks like it should be in occlusal function. It is not. Just looks that way and provides the patient with a more aesthetic option than a removable appliance.

ON: What recommendations do you have for general dentists and prosthodontists regarding treatment planning for edentulous spaces?

Dr. Levin: All things being equal I feel strongly that treatment planning involving implants offers many advantages over treatment planning for single crowns, fixed partial dentures and removable partial or complete dentures. I think we should be advocating the implant option as a primary treatment plan rather than an alternative treatment plan.
Gary J. Kaplowitz, DDS, MA, MEd, ABGD

Editor-in-Chief, Osseonews.com

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