When evaluating CBCT (cone beam computed tomography) imagery used to help periodontists choose sites for implant placement, there are two different types of “slices” to look at — oblique slices and orthoradial slices. The orthoradial slice is straight up and down, while the oblique slice is slanted, similar to a forward slash on a computer. These slices help periodontists visualize the anatomical structures in the mouth and evaluate where the optimal placement of a dental implant would be. Although which slice is used depends largely on the treating periodontist’s preferences, studies are showing that the oblique slice tends to be more accurate than the orthoradial slice, helping periodontists to achieve better patient outcomes. Oblique slices tend to be a better choice than orthoradial slices for implant placement in the posterior region or when planning implants that are tilted and if orthoradial slices are used, caution should be exercised.
Occlusal adjustment is the modification of the biting surfaces of a tooth, or teeth, to improve function or morphology. Occlusal adjustment is often used in conjunction with prosthetic placement and involves the grinding and shaping of selected tooth surfaces to improve contact patterns. Bite adjustments may also be made due to night-grinding issues and the discomfort or disfunction this causes for patients. The results of the occlusal adjustment procedure cannot be reversed, which means significant study of the patient’s mouth, tooth surfaces, and bite must occur before any action is taken. This study is usually accomplished through studying the bite contact within the patient’s mouth as well as through the use of dental impressions. Side effects of dental bite adjustment may include some pain or discomfort, though these are usually mild. Occlusal adjustment cost may vary depending on the dental insurance and the extent of the bite adjustment procedure.
An occlusal guard is often called a night guard or a bruxism guard. It protects against bruxism, which is the clenching or grinding of the teeth that happens primarily at night. Because the jaw puts an extreme amount of pressure per square inch on the teeth, grinding and clenching the jaw at night can result in damage to the teeth and painful symptoms of TMJ, or temporomandibular joint disorder. Occlusal guards can be custom-made by a dentist to fit a patient’s mouth exactly, or they can be purchased over the counter. While over-the-counter occlusal guards are less expensive than custom-crafted, they can have a negative impact on oral health if not used properly. Custom-fitted occlusal guards provide patients with better bruxism relief without the discomfort of ill-fitting plastic or metal parts that are one-size-fits-all. Occlusal guards can prevent jaw strain, fatigue, pain, and the chipping or breaking of teeth.
The occlusal load refers to the amount of force applied by the jaw when closing to a dental implant. Occlusal loading is essentially the process by which the force is applied, e.g. biting or chewing. Because the teeth and jaws can create a great amount of force between them, it’s critical that dental implant hardware be designed to withstand a high occlusal load. Many periodontists will use specialized tools to measure a patient’s occlusal load prior to selecting implant hardware, such as pressure sheets, strain gauges, and piezo-electric sensors. Bite force, or occlusal loading, can also be measured using masticatory computational models. By using three-dimensional occlusal load measurements, dental health professionals can enrich the assessment of a patient’s masticatory performance. In patients with bruxism, or the unconscious habit of grinding the teeth at night, the occlusal load may be much higher than in patients without bruxism. Periodontists should account for any conditions which may cause excess grinding of the teeth, including anxiety and drug use.
Occlusal overload refers to when the amount of “bite force,” or occlusal force, is greater than the teeth can withstand. Often, the term occlusal overload is used in conjunction with other dental implant terminology, however, it can also be used in discussions of bruxism. Bruxism is a condition where the patient unconsciously bites down, clenches, or grinds their teeth, usually at night, which increases their occlusal force exponentially. When discussing implant dentistry, occlusal overload can significantly increase the risk of implant rejection. Occlusal force should be measured by the treating periodontist carefully before selecting the size, shape, material, and surface texture of dental implant hardware. The amount of occlusal force that the implant can withstand must be less than the actual occlusal force of the patient’s jaw. If not, occlusal overload occurs, which can permanently damage the prosthetic crown or potentially even the implant hardware underneath. The patient’s gum and bone tissue can also become injured.
The occlusal table is the surface of a tooth that comes into contact with the opposite tooth. These are the grinding surfaces of the teeth that help break down food and the largest occlusal tables tend to be on the back teeth, or molars. The bicuspid teeth also have an occlusal table, and an occlusal load is the amount of force applied to the occlusal table by the jaw or external force. The jaw can exert a great deal of pressure per square inch, which is why teeth — specifically the enamel — is the strongest substance in the body. Injury can occur to the occlusal table, which is called occlusal trauma. The most common type of occlusal trauma is from bruxism, where the surfaces of the occlusal table become damaged and worn from excessive clenching and biting, usually during sleep. Occlusal trauma can also be caused by external forces, such as a blow to the head.
A one-part implant, also called a one-piece dental implant, is one of two types of implants used by dental professionals today. The other is a two-part implant. The two-part dental implant features a design of two separate pieces — the surgical implant or implant screw, and the prosthetic abutment. The implant must be placed first and finished with a cover screw to allow for healing. When the implant has healed over a period of several weeks, the cover screw is removed and the prosthetic is placed. A one-piece dental implant features the surgical implant and the prosthetic abutment in a single part. The one-part implant was intended to eliminate structural weakness, also known as a microgap, that comes with a two-piece implant design. During this procedure, the implant screw is placed and finished with a healing abutment. Often, one-piece dental implants are loaded with a temporary restoration until healing is complete.
A one-piece abutment is an abutment that connects into a dental implant without the use of an additional retaining screw. The abutment can be retained by cement, friction, or screw threads. While one-piece abutments are often used as an immediate method of restoring missing teeth, they can be complicated as the correct angulation must be achieved for the implant to fit properly. In order to attain the correct angulation, the dental professional is often required to position the abutment intraorally. In addition, further complications can arise as the positioning procedure may interfere with primary stability and impair osseointegration. However, the one-piece abutment also has a variety of advantages. The one-piece composition provides additional strength as it removes the structural weakness found in the two-piece implant. The one-piece abutment also requires fewer components reducing the overall inventory and gives the dental professional more precise control over the final fitting of the implant.
A one-piece implant is a type of dental implant in which the endosseous and abutment portions consist of one unit. The one-piece implant was originally designed to address the structural weakness issues that were part of the two-piece implant. The one-piece implant increases the strength and stability of the prosthesis by eliminating the weakest point of the two-piece implant, the abutment interface. In addition, the one-piece implant is an effective choice for patients or surgical sites where there is not enough bone to properly support a prosthesis. Despite these advantages, one-piece dental implants do have a disadvantage in that they are less flexible than the two-piece implant due to their single-unit construction. This lack of flexibility prevents more detailed adjustments once placed. After imaging and a careful evaluation of the patient’s dentition and underlying bone, the dental practitioner will determine which type of implant will best fit the patient’s needs.
The one-screw test is a test used to check the fit of a multiple unit screw-retained dental restoration. It is one of several different types of clinical assessments that may be done to check for implant framework misfit. To perform the one-screw test, a single screw is placed in the terminal dental implant abutment and evaluation is made on the opposite side. If the framework rises or has a ledge, detected clinically or radiologically, the fit is considered inaccurate. This test provides essential information regarding any implant framework misfit present in a fixed prosthesis. Such misfits can cause a variety of issues including the alteration of biomechanical function, increased stress on the implant screws and framework, and the prevention of bone resorption following an implant placement. One possible way to reduce the likelihood of implant framework misfit is to section the framework diagonally prior to placement.