The role of the restorative dentist in the diagnosis and maintenance phases of implant therapy--Part II: Prosthetic planning.

Prosthetic planning is critical to the success of the diagnostic phase of implant therapy and is used to establish fixture numbers, position and the optimal occlusal scheme, based on the design of the definitive prosthesis. The prosthetic needs of the patient, anticipated functional and parafunctional forces, restoration fabrication and serviceability are all considered. A clear picture of the intended rehabilitation is provided to the surgical team and expedites the consultation between implant team members. Comprehensive diagnostic planning using mounted diagnostic casts and diagnostic wax-ups will provide definite parameters for fixture number, position and alignment, and permit the fabrication of radiographic and surgical templates as the treatment sequence progresses. Patients need to be informed of the time and expense involved in the diagnostic phase of implant therapy prior to the initiation of the planning process. The practitioner conducting the selection and planning phase is entitled and should expect financial remuneration commensurate with the time and effort required to achieve the objectives of this phase of implant therapy. The Planning Process Using mounted diagnostic casts and diagnostic wax-ups: 1. Establish fixture numbers and position; 2. Establish the optimal occlusal scheme; 3. Design the definitive prosthesis; 4. Fabricate a surgical template. Design Principles--Summary 1. The location and number of fixtures dictates the prosthetic design and influences restorative success. 2. A restoration must be designed to distribute forces to the fixtures without overloading the bone, and therefore be able to withstand anticipated functional and parafunctional loading. 3. Design for optimal function and esthetics with a regard for patient comfort and maintenance.