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1 Introduction to Implant Dentistry 1
Introduction 1
Purpose of Textbook 1
Conventional Dentistry Versus Implant Dentistry 2
Predictability of Fixed Prosthodontics 2
Predictability of Implant Prosthodontics 3
Economics of Implant Dentistry 4
Prognostic Indicators for Teeth 5
Periodontal Disease 5
The Heavily Restored Tooth 6
The Furcation-Involved Tooth 8
The Periodontal Prosthesis Patient 9
Difficult Aesthetic Cases 10
Classification of Ridge Defects 12
Treatment Prognosis for the Dentition 15
Summary 18
Bibliography 18
2 Implants and Implant Restorative Components 21
Introduction 21
Implants 21
Implant/Abutment Connections 25
External Implant/Abutment Connections 25
Internal Implant/Abutment Connections 27
Healing Abutments 30
Conventional, Stock Healing Abutments 30
CAD/CAM Healing Abutments 32
Custom Healing Abutments 34
Impression Copings 35
Implant Impression Copings 35
Pickup Impression Copings (Open Tray) 36
Transfer Impression Copings (Closed Tray) 37
Low-Profile Conical Abutment Impression Copings 38
Scan Bodies 38
Abutments 39
Low-Profile Conical Abutments (LPCA) 40
LOCATOR Overdenture Abutments 41
Stock Abutments 42
UCLA Abutments 44
CAD/CAM Abutments 47
Milled Titanium 47
Milled Zirconia 50
Multiunit Abutments 54
Screws (Clinical) 54
Abutment/Retaining Screws 55
Preload Screw Mechanics 56
Cylinders 57
Definitive Cylinders 57
Interim Cylinders 57
Drivers and Placement Instruments 58
Drivers/Driver Tips 58
Laboratory Components 60
Implant Analogs/Replicas 61
Abutment Analogs/Replicas 62
Try-In Screws 63
Abutment Holders 63
Polishing Protectors 64
Bibliography 65
3 Diagnosis and Treatment Planning in Implant Restorative Dentistry 69
Patient Selection 69
Medical History 69
Diagnostic Procedures 70
Radiographs 70
CBCT (Cone Beam Computed Tomography) Scans 72
Scanning Appliances/Surgical Guides 74
Diagnostic Casts 75
Laboratory-Generated Surgical Guides 75
Physical Examination 78
Extraoral Examination 78
Intraoral Examination 78
Diagnostic Articulator Mounting 79
Diagnostic Wax Patterns 79
Implant Bone Volume 80
Implant Restorative Volume 83
Treatment Planning 85
Edentulous Patients 86
Overdentures 87
Restorative Volume 87
Fixed Implant-Retained, Full-Arch Prostheses-Edentulous Jaws 89
Milled Titanium Frameworks 92
Milled Zirconia Frameworks 94
High-Performance Polymers (HPP) 95
Crown-and-Bridge Type Prostheses 95
Partially Edentulous Patients 96
Screw-Retained Restorations 96
Treatment Goals 96
Benefits 96
Limitations 97
Cement-Retained Restorations 98
Benefits 98
Limitations 99
Angled Screw Channel Abutments 99
Peri-Implant Disease 99
Implant Loading Protocols 101
Unloaded Healing, Two-Stage Surgical Protocol 101
Unloaded Healing, Single-Stage Surgical Protocol 102
Early Loading 102
Immediate Occlusal Loading 103
Immediate Non-Occlusal Loading 103
Patient Consultation 104
Principles of Treatment Planning 104
Informed Consent 104
Summary 105
Bibliography 105
4 Treatment of Edentulous Mandibular Patients: (1) Implant-Retained Framework Overdenture and Resilient Attachments; (2) Resilient Attachments and Two Interforaminal Implants 111
Literature Review 111
Clinical Case Presentation Mandibular Implant-Supported Overdenture with CAD/CAM Framework and Resilient Attachments 117
Clinical Case Presentation Implant-Supported Overdenture with Resilient Attachments and Two Interforaminal Implants 142
Bibliography 156
5 Replacement of Single Teeth with CAD/CAM Implant Restorations: Implant-Level Impressions, Intraoral Scanning, Cement and Screw-Retained Crowns 159
Literature Review 159
Replacement of Individual Teeth 159
Single-Unit Implant Restorations 161
Computer-Assisted Design/Computer-Assisted Machining (CAD/CAM) Healing Abutments/Scan Bodies 162
Intraoral Scanning 167
Models from Digital Impressions 169
Clinical Case Presentation Posterior, Cement-Retained Single-Implant Restoration 170
Clinical Case Presentation Anterior, Screw-Retained Single-Implant Restoration (Angled Screw Channel) 185
Bibliography 197
6 Fixed Dental Prostheses: Retreatment of a Patient with a Fractured Implant-Retained Fixed Dental Prosthesis; CAD/CAM Abutments and a Cement-Retained Fixed Dental Prosthesis; Intraoral Scanning and Screw-Retained Fixed Dental Prosthesis (Atlantis™ Bridge Patient-Specific Suprastructures) 199
Literature Review 199
Clinical Case Presentation Implant-Level Impression/Screw-Retained Fixed Dental Prosthesis 204
Clinical Case Presentation Intraoral Scanning/Screw-Retained Fixed Dental Prosthesis (Atlantis™ Bridge Patient-Specific Suprastructure) 219
Bibliography 235
7 Accelerated Treatment Protocol of a Patient with Edentulous Jaws and CAD/CAM Titanium Framework/Fixed Hybrid Prostheses 237
Literature Review 237
Original Treatment Protocol 239
Accelerated Treatment Protocol 242
Clinical Case Presentation Four Months Post Implant Placement and Immediate Occlusal Loading 243
Bibliography 275
8 Treatment of Edentulous Patients with Immediate Occlusal Loading: Conventional Surgical and Computer-Generated Surgical Guides 279
Literature Review 279
Introduction 279
The Preosseointegration Era 280
The Osseointegration Era 281
Immediate Occlusal Loading in the Edentulous Mandible 282
Immediate Occlusal Loading in Edentulous Maxillae 285
Clinical Case Presentation Mandibular Immediate Occlusal Loading with Clinical Conversion of Mandibular Immediate Denture 286
Clinical Case Presentation Maxillary Immediate Occlusal Loading Using Computer-Generated Surgical Guide with Clinical Conversion of Maxillary Immediate Denture 312
Bibliography 324
9 Treatment of Edentulous Patients with Immediate Occlusal Loading: Conventional Surgical/Prosthetic Protocols 327
Literature Review 327
Immediate Occlusal Loading 327
Computer-Guided Surgery 328
Clinical Case Presentation Conventional Surgical and Restorative Protocols 332
Bibliography 367
10 Treatment of Partially Edentulous Patients with Immediate Non-Occlusal Loading Protocols (Intraoral Scanning, CAD/CAM Abutment, and Definitive Maxillary Central Incisor Restoration; Co-Axis Implant and Restoration) 371
Literature Review 371
Clinical Case Presentation INOL Protocol and Intraoral Scanning 375
Clinical Case Presentation INOL Protocol with Co-Axis Implant 396
Bibliography 408
11 Computed Tomography (CT) Guided Surgery/Immediate Occlusal Loading with Full-Arch Prostheses in Edentulous Patients 411
Literature Review 411
Immediate Occlusal Loading 411
Tilted Implants 412
Diagnostic Imaging 413
Computed Tomography (CT) 415
Interactive Computed Tomography (ICT) 417
Interactive Computer Software 418
Computer-Guided Surgery 418
Overview of CT Guided Surgical and Prosthetic Protocols 419
Surgical Guides 419
Master Tubes 419
Prosthetic Laboratory Kit-Implant Analog Mounts 420
Surgical Kit Components 420
Fabrication of Master Cast for Immediate, Fixed Provisional Prosthesis 421
Abutment Selection for Fixed, Screw-Retained Provisional Prostheses 422
Fabrication of a Screw-Retained Provisional Prosthesis 424
Clinical Patient Presentation Ill-Fitting Maxillary Denture; Mandibular Implant-Supported Overdenture 425
Clinical Patient Presentation Maxillary and Mandibular Terminal Dentitions; Computer-Guided Surgery with Metal Surgical Guides 448
Bibliography 463
12 Guidelines and Maintenance Procedures for Fixed, Full-Arch, Implant-Retained Prostheses 465
Introduction 465
Full-Arch Hybrid Prostheses 465
Historical Perspectives 466
Original Protocol 466
Immediate Occlusal Loading for Full-Arch Prostheses 466
Clinical Complications 467
Mechanical 467
Biologic: Peri-Implant Mucositis/Peri-Implantitis 470
Treatment (Peri-Implant Mucositis) 472
Treatment (Peri-Implantitis) 473
Innovations in Full-Arch Designs 475
Prosthesis Design/Materials 476
Hygiene/Maintenance Protocol for Immediately Loaded Full-Arch Prostheses 477
Hygiene/Maintenance Protocol for Definitive Full-Arch Prostheses 478
At-Home Hygiene 478
Plaque Control–Dentifrice 478
Plaque Control–Mechanical 478
Recall Appointments 479
Recall Interval/Schedule 479
Examination 480
Radiographs 481
Professional Maintenance 485
Prosthesis Removal 487
Cleaning the Removed Prosthesis 488
Conclusions 488
Bibliography 488
Index 493

The fourth edition of Implant Restorations: A Step-by-Step Guide provides a wealth of updated and expanded coverage on detailed procedures for restoring dental implants. Focusing on the most common treatment scenarios, it offers concise literature reviews for each chapter abd easy-to-follow descriptions of the techniques, along with high-quality clinical photographs demonstrating each step.
Comprehensive throughout, this practical guide begins with introductory information on incorporating implant restorative dentistry in clinical practice. It covers diagnosis and treatment planning and digital dentistry, and addresses advances in cone beam computerized tomography (CBCT), treatment planning software, computer generated surgical guides, rapid prototype printing and impression-less implant restorative treatments, intra-oral scanning, laser sintering, and printing/milling polymer materials. Record-keeping, patient compliance, hygiene regimes, and follow-up are also covered.
• Provides an accessible step-by-step guide to commonly encountered treatment scenarios, describing procedures and techniques in an easy-to-follow, highly illustrated format
• Offers new chapters on diagnosis and treatment planning and digital dentistry
• Covers advances in cone beam computerized tomography (CBCT), computer generated surgical guides, intra-oral scanning, laser sintering, and more
An excellent and accessible guide on a burgeoning subject in modern dental practice by one of its most experienced clinicians, Implant Restorations: A Step-by-Step Guide, Fourth Edition will appeal to prosthodontists, general dentists, implant surgeons, dental students, dental assistants, hygienists, and dental laboratory technicians.

Carl Drago, DDS, MS, Diplomate of the American Board of Prosthodontics (ABP), is in private practice near Milwaukee, Wisconsin, USA; is a section editor for the Journal of Prosthodontics; and is an adjunct associate professor at the Marquette University School of Dentistry in Milwaukee, Wisconsin, USA.

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