Additional Information
Book Details
Abstract
Written by the foremost authority in the field, Dental Implants Prosthetics, 2nd Edition helps you advance your skills and understanding of implant prosthetics. Comprehensive coverage includes both simple and complicated clinical cases, with practical guidance on how to apply the latest research, diagnostic tools, treatment planning, implant designs, materials, and techniques to provide superior patient outcomes.
-
Treatment supported by clinical evidence equips students with a more targeted evidence-based approach to patient procedures.
- NEW! Emphasis on treatment planning helps decrease the number of visits while providing effective, long-term results for the patient.
- NEW! Focus on the patient presentation offers the latest treatment options for bone harvesting, restoration and recovery.
- NEW! Original illustrations and photos highlight and clarify key clinical concepts and techniques.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Dental Implant Prosthetics, 2/e | i | ||
| Copyright page | ii | ||
| Contributors | iii | ||
| Dedication | iv | ||
| Forewords | v | ||
| Preface | vi | ||
| About the Author | viii | ||
| Acknowledgments | ix | ||
| Table of Contents | xi | ||
| I Introduction | 1 | ||
| 1 Rationale for Dental Implants* | 1 | ||
| Effects of an Aging Population | 2 | ||
| Age-Related Tooth Loss | 3 | ||
| Single-Tooth Edentulism (Single-Tooth Loss) | 3 | ||
| Fixed Partial Dentures (Dental Bridges) | 3 | ||
| Single-Tooth Implants | 5 | ||
| Partial Edentulism (Tooth Loss) | 7 | ||
| Removable Partial Dentures | 8 | ||
| Total Edentulism | 8 | ||
| Anatomical Consequences of Edentulism | 10 | ||
| Bone Loss | 10 | ||
| Soft Tissue Consequences | 12 | ||
| Esthetic Consequences | 14 | ||
| Negative Consequences of Complete Dentures | 16 | ||
| Masticatory Function | 16 | ||
| Systematic Consequences | 17 | ||
| Satisfaction of Prosthesis | 18 | ||
| Speech Effects | 18 | ||
| Psychological Aspects of Tooth Loss | 18 | ||
| Advantages of Implant-Supported Prostheses | 18 | ||
| Summary | 22 | ||
| References | 23 | ||
| 2 Generic Root Form Component Terminology | 26 | ||
| Generic Prosthetic Component Terminology | 28 | ||
| Generic Implant Body Terminology | 28 | ||
| Implant Body Regions | 30 | ||
| Implant Body | 30 | ||
| Crest Module | 30 | ||
| Implant Apex | 31 | ||
| Implant Components | 31 | ||
| Implant Surgery: Stage I | 31 | ||
| Implant Surgery: Stage II | 33 | ||
| Prosthetic Attachments | 33 | ||
| Prosthesis Fabrication | 34 | ||
| Direct Prosthetic Option | 34 | ||
| Indirect Prosthetic Option | 34 | ||
| Laboratory Fabrication | 38 | ||
| Summary | 38 | ||
| References | 45 | ||
| 3 An Implant Is Not a Tooth: | 46 | ||
| Literature Review | 46 | ||
| Longevity | 46 | ||
| Mobility | 48 | ||
| Natural Tooth versus Implant Support Systems | 48 | ||
| Tooth Movement | 48 | ||
| Implant Movement | 48 | ||
| Percussion | 50 | ||
| Pain | 51 | ||
| Probing Depths | 51 | ||
| Bleeding Index | 55 | ||
| Crestal Bone Loss | 56 | ||
| Periodontal Complex versus Direct Bone Interface | 57 | ||
| Radiographic Evaluation | 58 | ||
| Keratinized Tissue Concerns | 59 | ||
| Periimplant Disease | 62 | ||
| Summary | 63 | ||
| References | 63 | ||
| II Basic Sciences | 66 | ||
| 4 Biomaterials for Dental Implants | 66 | ||
| Compatibility of Surgical Biomaterials and the Role of Synthetic Materials | 66 | ||
| Bulk Properties | 66 | ||
| History of Materials and Designs | 66 | ||
| Research and Development | 67 | ||
| Physical, Mechanical, and Chemical Requirements for Implant Materials | 67 | ||
| Physical and Mechanical Properties | 67 | ||
| Corrosion and Biodegradation | 67 | ||
| Stress Corrosion Cracking | 68 | ||
| Toxicity and Considerations | 69 | ||
| Metals and Alloys | 69 | ||
| Titanium and Titanium–6 Aluminum–4 Vanadium (Ti-6Al-4V) | 69 | ||
| Cobalt-Chromium-Molybdenum–Based Alloy | 72 | ||
| Iron-Chromium-Nickel–Based Alloys | 72 | ||
| Other Metals and Alloys | 73 | ||
| Ceramics and Carbon | 73 | ||
| Aluminum, Titanium, and Zirconium Oxides | 73 | ||
| Bioactive and Biodegradable Ceramics Based on Calcium Phosphates | 73 | ||
| Bone Augmentation and Replacement | 73 | ||
| Endosteal and Subperiosteal Implants | 74 | ||
| Advantages and Disadvantages | 74 | ||
| Bioactive Ceramic Properties | 75 | ||
| Forms, Microstructures, and Mechanical Properties | 75 | ||
| Density, Conductivity, and Solubility | 77 | ||
| Carbon and Carbon Silicon Compounds | 78 | ||
| Polymers and Composites | 78 | ||
| Structural Biomedical Polymers | 78 | ||
| Composites | 78 | ||
| Inserts and Intramobile Elements | 79 | ||
| Future Areas of Application | 79 | ||
| Surface Characteristics | 79 | ||
| Surface Characterization and Tissue Interaction | 79 | ||
| Metal and Alloy Surfaces | 79 | ||
| Tissue Interactions | 80 | ||
| Integration with Titanium and Alloys | 81 | ||
| Cobalt and Iron Alloys | 81 | ||
| Ceramics | 82 | ||
| Hydroxyapatite | 82 | ||
| Porous and Featured Coatings | 83 | ||
| Titanium Plasma Sprayed | 83 | ||
| Hydroxyapatite Coating | 84 | ||
| Microchannels | 85 | ||
| Other Surface Modifications | 86 | ||
| Surface Cleanliness | 86 | ||
| Surface Energy | 86 | ||
| Passivation and Chemical Cleaning | 86 | ||
| Sterilization | 87 | ||
| Summary | 87 | ||
| Acknowledgment | 88 | ||
| References | 88 | ||
| 5 Clinical Biomechanics in Implant Dentistry | 95 | ||
| Loads Applied to Dental Implants | 95 | ||
| Mass, Force, and Weight | 95 | ||
| Forces | 95 | ||
| Components of Forces (Vector Resolution) | 96 | ||
| Three Types of Forces | 96 | ||
| Stress | 97 | ||
| Deformation and Strain | 98 | ||
| Stress-Strain Relationship | 98 | ||
| Impact Loads | 100 | ||
| Force Delivery and Failure Mechanisms | 101 | ||
| Moment Loads | 101 | ||
| Clinical Moment Arms | 101 | ||
| Occlusal Height | 101 | ||
| Cantilever Length | 101 | ||
| Occlusal Width | 105 | ||
| Fatigue Failure | 105 | ||
| Moment of Inertia | 105 | ||
| Summary | 106 | ||
| References | 106 | ||
| 6 Bone Response to Mechanical Loads | 107 | ||
| Biological Response | 107 | ||
| Mechanotransduction | 107 | ||
| Biomechanically Based Bone-Remodeling Theories | 108 | ||
| Indicators of the Biological Response | 109 | ||
| Changes in Concentration of Intracellular Mediators | 109 | ||
| Changes in Cellular Proliferation | 110 | ||
| Changes in Cellular Morphology and Organization | 111 | ||
| Altered Expression and Reorganization of Osteoblast Integrins | 111 | ||
| Changes in Gene Expression | 112 | ||
| Limitations of Previous Studies | 113 | ||
| Biomechanical Response | 113 | ||
| Dependence on Direction of Loading | 114 | ||
| Dependence on Rate of Loading | 115 | ||
| Dependence on Duration of Loading | 115 | ||
| Dependence on Species and Anatomical Location | 116 | ||
| Dependence on Side Constraint | 117 | ||
| Dependence on Structural Density | 117 | ||
| References | 118 | ||
| 7 Radiographic Imaging in Implant Dentistry | 126 | ||
| Classification of Radiographic Imaging Techniques | 126 | ||
| Phase 1 | 126 | ||
| Phase 2 | 126 | ||
| Phase 3 | 126 | ||
| Imaging Modalities | 126 | ||
| Presurgical and Diagnostic Imaging (Phase 1) | 127 | ||
| Periapical Radiography | 127 | ||
| Technique | 127 | ||
| Advantages | 128 | ||
| Disadvantages | 128 | ||
| Phase 1 and Phase 2 | 129 | ||
| Abutment and Prosthetic Component Imaging | 129 | ||
| Postprosthetic Imaging (Phase 3 Treatment) | 129 | ||
| Recall and Maintenance Imaging | 130 | ||
| Occlusal Radiography | 131 | ||
| Cephalometric Radiography | 132 | ||
| Panoramic Radiography | 133 | ||
| Computed Tomography | 135 | ||
| History | 135 | ||
| Image Development | 136 | ||
| Types of Computed Tomography Scanners | 136 | ||
| Medical | 136 | ||
| Cone-Beam Computed Tomography | 136 | ||
| Focal Spot | 138 | ||
| Field of View | 139 | ||
| Effective Dose Range of Cone-Beam Computed Tomography Scanners. | 139 | ||
| Interactive Diagnostic Imaging | 139 | ||
| Image Formation | 141 | ||
| Preimplant Evaluation: Diagnosis and Treatment Planning | 141 | ||
| Preimplant Evaluation: Site Evaluation with Implants | 141 | ||
| Preimplant Evaluation: Scanning Prosthesis | 145 | ||
| Preimplant Evaluation: Computer-Assisted Planning Surgical Guides | 145 | ||
| Indications for Computed Tomography–Guided Surgical Guides | 147 | ||
| Immediate Loading Prostheses | 148 | ||
| Magnetic Resonance Imaging | 148 | ||
| Radiographic Imaging of Vital Structures in Oral Implantology | 150 | ||
| Mental Foramen and Mandibular Canal | 150 | ||
| Mandibular Lingual Concavities | 152 | ||
| Mandibular Ramus (Donor Site for Autogenous Grafting) | 152 | ||
| Mandibular Symphysis | 153 | ||
| Maxillary Sinus | 153 | ||
| Recommended Presurgical Treatment Planning | 153 | ||
| Computed Tomography | 154 | ||
| Fabrication of Diagnostic Templates | 154 | ||
| Computed Tomography | 155 | ||
| Implant Imaging in Perspective | 156 | ||
| References | 156 | ||
| III Implant Treatment Planning | 159 | ||
| 8 Stress Treatment Theorem for Implant Dentistry: | 159 | ||
| Natural Tooth versus Implant Support Systems | 160 | ||
| Periodontal Complex versus Direct Bone Interface | 160 | ||
| Biomechanical Design | 161 | ||
| Sensory Nerve Complex versus Direct Bone Interface | 162 | ||
| Occlusal Material | 163 | ||
| Surrounding Bone | 163 | ||
| Failure of Natural Tooth–Supported Prostheses | 164 | ||
| Early Loading Failure | 165 | ||
| Cellular Biomechanics | 165 | ||
| Engineering Principles | 166 | ||
| Occlusal Overload on Prosthetic Components | 168 | ||
| Fatigue Fractures and Complications | 168 | ||
| Prostheses and Component Fractures | 168 | ||
| Screw Loosening | 169 | ||
| Marginal Bone Loss | 170 | ||
| Biological Causes | 171 | ||
| Periosteal Reflection Hypothesis | 171 | ||
| Implant Osteotomy Hypothesis | 171 | ||
| Autoimmune Response of Host Hypothesis | 172 | ||
| “Biological Width” Hypothesis | 172 | ||
| Implant Crest Module Design Hypothesis | 175 | ||
| Biomechanical Causes | 177 | ||
| Occlusal Trauma Hypothesis | 177 | ||
| Engineering Principles | 178 | ||
| Bone Mechanical Properties | 179 | ||
| Animal Studies | 179 | ||
| Clinical Reports | 181 | ||
| Implant Body Design Hypothesis | 182 | ||
| Arrest of Crestal Bone Loss | 184 | ||
| Bone Physiology | 184 | ||
| Implant Design Biomechanics | 184 | ||
| Discussion | 185 | ||
| Summary | 186 | ||
| Effect on Treatment Planning | 186 | ||
| Prosthesis Design | 187 | ||
| Patient Force Factors | 187 | ||
| Bone Density | 187 | ||
| Key Implant Positions | 187 | ||
| Implant Number | 188 | ||
| Implant Size | 188 | ||
| Available Bone | 188 | ||
| Implant Design | 188 | ||
| Summary | 188 | ||
| References | 189 | ||
| 9 Prosthetic Options in Implant Dentistry | 193 | ||
| Completely Edentulous Prosthesis Design | 193 | ||
| Partially Edentulous Prosthesis Design | 195 | ||
| Prosthetic Options | 195 | ||
| Fixed Prostheses | 195 | ||
| FP-1 | 195 | ||
| FP-2 | 197 | ||
| FP-3 | 198 | ||
| Removable Prostheses | 202 | ||
| RP-4 | 203 | ||
| RP-5 | 203 | ||
| Conclusion | 203 | ||
| References | 205 | ||
| 10 Force Factors Related to Patient Conditions (A Determinant for Implant Number and Size) | 206 | ||
| Normal Forces Exerted on Teeth | 206 | ||
| Parafunction | 207 | ||
| Bruxism | 208 | ||
| Diagnosis | 208 | ||
| Fatigue Fractures | 212 | ||
| Occlusal Guards | 212 | ||
| Treatment Planning | 215 | ||
| Clenching | 215 | ||
| Diagnosis | 215 | ||
| Fatigue Fractures | 216 | ||
| Occlusal Guards | 217 | ||
| Prosthetic Considerations | 217 | ||
| Tongue Thrust and Size | 219 | ||
| Crown Height Space | 221 | ||
| Biomechanic Consequences of Excessive Crown Height Space | 222 | ||
| Excessive Crown Height Space | 224 | ||
| Masticatory Dynamics | 230 | ||
| Arch Position | 231 | ||
| Opposing Arch | 232 | ||
| Summary | 233 | ||
| References | 234 | ||
| 11 Bone Density: | 237 | ||
| Influence of Bone Density on Implant Success Rates | 237 | ||
| Etiology of Variable Bone Density | 238 | ||
| Bone Classification Schemes Related to Implant Dentistry | 241 | ||
| Misch Bone Density Classification | 241 | ||
| Bone Density: Location | 242 | ||
| Radiographic Bone Density | 244 | ||
| Bone Density—Tactile Sense | 245 | ||
| Scientific Rationale of a Bone Density–Based Treatment Plan | 245 | ||
| Bone Strength and Density | 245 | ||
| Elastic Modulus and Density | 246 | ||
| Bone Density and Bone–Implant Contact Percentage | 247 | ||
| Bone Density and Stress Transfer | 247 | ||
| Treatment Planning | 248 | ||
| Summary | 250 | ||
| References | 250 | ||
| 12 Treatment Plans Related to Key Implant Positions and Implant Number | 253 | ||
| Treatment Plan Rationale | 253 | ||
| Treatment Fees and Economics | 254 | ||
| Treatment Fees and Risk Factors | 255 | ||
| Treatment Plan Sequence | 255 | ||
| Abutment Options | 255 | ||
| Key Implant Positions | 256 | ||
| No Cantilevers | 257 | ||
| One Missing Tooth | 258 | ||
| Two Missing Teeth | 259 | ||
| Cantilever Option. | 262 | ||
| Three Missing Teeth | 262 | ||
| Four or More Adjacent Teeth Missing | 264 | ||
| Cantilever Options. | 264 | ||
| No Three Adjacent Pontics | 267 | ||
| Three-Pontic Options | 268 | ||
| Canine Rule | 269 | ||
| First Molar Rule | 274 | ||
| Implant Number | 278 | ||
| Influence of Patient Force Factors | 284 | ||
| Influence of Bone Density | 284 | ||
| Maximum Implant Number | 285 | ||
| Full-Arch Mandibular Fixed Prosthesis | 285 | ||
| Full-Arch Maxillary Fixed Prostheses | 285 | ||
| Splinted versus Independent Implant Crowns | 287 | ||
| Independent Crowns | 287 | ||
| Splinted Crowns | 287 | ||
| Summary | 291 | ||
| References | 291 | ||
| 13 Implant Body Size: | 293 | ||
| Character of Forces Applied to Dental Implants | 294 | ||
| Stress and Strain | 294 | ||
| Force Magnitude | 295 | ||
| Force Duration | 295 | ||
| Force Type | 295 | ||
| Force Direction | 296 | ||
| Force Magnification | 296 | ||
| Surface Area | 297 | ||
| Implant Length | 297 | ||
| Longer Implant Lengths | 297 | ||
| Shorter Implant Lengths | 299 | ||
| Rationale of Short Implants | 301 | ||
| Advantages of Short Implants | 301 | ||
| Ideal Implant Length | 303 | ||
| Implant Diameter | 303 | ||
| Wide-Diameter Implants | 303 | ||
| Surgical Advantages | 303 | ||
| Loading Advantages | 304 | ||
| Prosthetic Advantages | 304 | ||
| Disadvantages of Wide-Bodied Implants | 306 | ||
| Narrow-Diameter (Mini) Implants | 307 | ||
| Disadvantages of “Mini” Implants | 308 | ||
| Ideal Implant Width | 309 | ||
| Biomechanics | 309 | ||
| Esthetics | 309 | ||
| Maxillary Anterior Single-Tooth Replacement | 309 | ||
| Multiple Anterior Implants | 310 | ||
| Posterior Tooth Replacement | 312 | ||
| Summary | 312 | ||
| References | 313 | ||
| 14 Available Bone and Dental Implant Treatment Plans | 315 | ||
| Literature Review | 315 | ||
| Available Bone | 317 | ||
| Available Bone Height | 318 | ||
| Available Bone Width | 319 | ||
| Available Bone Length | 320 | ||
| Available Bone Angulation | 321 | ||
| Crown Height Space | 321 | ||
| Divisions of Available Bone | 322 | ||
| Division A (Abundant Bone) | 322 | ||
| Prosthetic Options | 322 | ||
| Division B (Barely Sufficient Bone) | 323 | ||
| Division B–w (B Minus Width) | 326 | ||
| Division C (Compromised Bone) | 326 | ||
| Posterior Regions | 330 | ||
| Prosthetic Options | 332 | ||
| Division D (Deficient Bone) | 332 | ||
| Anterior Regions | 332 | ||
| Posterior Regions | 334 | ||
| Summary | 335 | ||
| References | 338 | ||
| 15 Scientific Rationale for Dental Implant Design | 340 | ||
| Implant Design | 340 | ||
| Surgical Prospective | 340 | ||
| Crest Module Considerations | 340 | ||
| Surgical Aspects | 340 | ||
| “Biologic Width” Designs | 341 | ||
| Occlusal Loading Design. | 343 | ||
| Prosthetic Attachment Designs. | 345 | ||
| Plaque-Related Crest Module Designs. | 347 | ||
| Implant Body Design | 348 | ||
| Functional versus Theoretical Surface Area | 349 | ||
| Surface Condition versus Design | 349 | ||
| Functional Implant Dimension | 350 | ||
| Functional Surface Area | 352 | ||
| Bone–Implant Contact Related to Occlusal Load | 352 | ||
| Implant Body Design Related to Occlusal Forces | 353 | ||
| Force Type and Influence on Implant Body Design | 354 | ||
| Force Direction and Influence on Implant Body Design | 354 | ||
| Bone Cell Response to Implant Body Design | 355 | ||
| Thread Geometry and Functional Surface Area | 356 | ||
| Thread Pitch | 356 | ||
| Thread Depth | 359 | ||
| Thread Shape | 360 | ||
| Implant Design and Bone Response | 361 | ||
| Apical Implant Design Considerations | 363 | ||
| Implant Body Related to Fracture | 364 | ||
| Force Magnitude and Implant Body Design | 364 | ||
| Implant Body Biomaterial Related to Fracture | 366 | ||
| Implant Design Failures Related to Biomaterial and Force Magnitude | 367 | ||
| Force Duration and Implant Body Design | 367 | ||
| Influence on Implant Body Design | 368 | ||
| Summary | 368 | ||
| References | 368 | ||
| 16 Preimplant Prosthodontics: | 372 | ||
| Extraction of Teeth with a Poor Prognosis | 372 | ||
| Prosthetic Considerations | 372 | ||
| Endodontic Considerations | 373 | ||
| Periodontal Considerations | 374 | ||
| 0-, 5-, or 10-Year Rule | 377 | ||
| Clinical Examples | 378 | ||
| Overall Evaluation | 378 | ||
| Maxillary Anterior Tooth Position | 379 | ||
| Existing Occlusal Vertical Dimension | 380 | ||
| Methods to Evaluate Occlusal Vertical Dimension | 382 | ||
| Combination Syndrome | 383 | ||
| Mandibular Incisor Edge Position | 383 | ||
| Existing Occlusal Planes (Posterior Maxillary and Mandibular Planes of Occlusion) | 385 | ||
| Specific Criteria | 386 | ||
| Active Lip Lines | 386 | ||
| Teeth Number | 386 | ||
| Maxillary High Lip Line | 387 | ||
| Mandibular Low Lip Line | 390 | ||
| Existing Occlusion | 391 | ||
| Crown Height Space | 391 | ||
| Biomechanic Consequences of Excessive Crown Height Space | 391 | ||
| Excessive Crown Height Space | 392 | ||
| Reduced Crown Height Space | 394 | ||
| Temporomandibular Joint | 396 | ||
| Existing Prostheses | 396 | ||
| Arch Form | 396 | ||
| Soft Tissue Support | 397 | ||
| Treatment Prostheses | 398 | ||
| Fixed Restorations | 398 | ||
| Progressive Load | 399 | ||
| Financial Barriers | 399 | ||
| Removable Prostheses | 399 | ||
| Occlusal Vertical Dimension | 399 | ||
| Esthetic Assessment | 400 | ||
| Psychologic Attitude | 400 | ||
| Summary | 400 | ||
| References | 401 | ||
| 17 Natural Teeth Adjacent to an Implant Site: | 403 | ||
| Abutment Options | 403 | ||
| Adjacent Bone Anatomy | 404 | ||
| Cantilevers in Partial Edentulism | 406 | ||
| Implants Connected to Teeth | 408 | ||
| Mobility: Vertical Movement | 410 | ||
| Implant and Tooth | 410 | ||
| Prosthesis Movement | 411 | ||
| Implant and Prosthetic Components | 411 | ||
| Horizontal Movement | 411 | ||
| Tooth Mobility | 411 | ||
| Implant Mobility | 411 | ||
| Guidelines for Joining Implants to Teeth | 412 | ||
| Guidelines for Splinting Dental Units | 413 | ||
| Nonrigid Connectors | 414 | ||
| Implant Pier (Intermediary) Abutments | 416 | ||
| Natural Tooth Pier Abutments | 416 | ||
| Transitional Natural Abutments | 417 | ||
| References | 419 | ||
| 18 Diagnostic Casts, Surgical Templates, and Provisionalization | 420 | ||
| Diagnostic Casts | 420 | ||
| Articulators | 420 | ||
| Nonadjustable | 421 | ||
| Class 1: Simple Hinge | 421 | ||
| Class 2: Arbitrary Plane Line (Average Value) | 421 | ||
| Adjustable | 422 | ||
| Class 3: Semiadjustable Articulators | 422 | ||
| Class 4: Fully Adjustable | 422 | ||
| Facebow Transfers | 422 | ||
| Arbitrary | 422 | ||
| Kinematic | 422 | ||
| Selection of Articulator Type | 422 | ||
| Nonadjustable (Class 1 and 2) | 423 | ||
| IV Special Treatment Options | 477 | ||
| 20 Posterior Single-Tooth Replacement: | 477 | ||
| Posterior Missing Tooth | 477 | ||
| Posterior Single-Tooth Replacement Options | 477 | ||
| Removable Prosthesis | 478 | ||
| Resin-Bonded Fixed Partial Denture | 479 | ||
| Maintenance of the Posterior Space | 479 | ||
| Fixed Partial Denture | 480 | ||
| Single-Tooth Implants | 483 | ||
| Contraindications and Limitations of Posterior Single-Tooth Implants | 485 | ||
| Specific Single-Tooth Implant Indications | 485 | ||
| Anodontia | 485 | ||
| Age Limitations | 486 | ||
| Transitional Restorations | 489 | ||
| Implant Body Selection | 490 | ||
| Premolar Implant Replacement | 490 | ||
| First Molar Implant Replacement | 491 | ||
| Summary | 496 | ||
| References | 496 | ||
| 21 Single-Tooth Implant Restoration: | 499 | ||
| Maxillary Anterior Implant Crowns | 499 | ||
| Alternate Treatment Options for Anterior Single-Tooth Replacement | 500 | ||
| Challenging Esthetics | 501 | ||
| Implant Body Position | 502 | ||
| Mesiodistal Position | 502 | ||
| Faciopalatal Position | 503 | ||
| Implant Body Angulation | 503 | ||
| Facial Implant Body Angulation | 503 | ||
| Cingulum Implant Body Angulation | 505 | ||
| Ideal Implant Angulation | 506 | ||
| Implant Depth Position | 508 | ||
| More Than 4 mm from the Adjacent Cementoenamel Junction (Too Deep) | 508 | ||
| Less Than 2 mm Below the Free Gingival Margin (Too Shallow) | 508 | ||
| At 3 mm Below the Free Gingival Margin (Ideal Depth) | 509 | ||
| Stage II Surgery and Soft Tissue Emergence Contours | 510 | ||
| Subtractive Technique | 511 | ||
| Addition Technique | 511 | ||
| Immediate Implant Insertion after Extraction | 514 | ||
| Advantages | 514 | ||
| Disadvantages | 514 | ||
| Extraction and Delayed Implant Placement | 516 | ||
| Prosthetic Phase | 517 | ||
| Abutment Selection | 517 | ||
| Prefabricated Abutments | 517 | ||
| Narrow-Diameter Abutments | 517 | ||
| Wider-Diameter Abutments | 517 | ||
| Premade Anatomic Abutment | 518 | ||
| Ceramic Abutments | 519 | ||
| Angled Abutments | 520 | ||
| Customized Abutments | 520 | ||
| CAD-CAM Abutments | 521 | ||
| Final Preparation and Impression | 521 | ||
| Direct versus Indirect Prosthesis Fabrication | 521 | ||
| Option 1: Direct Technique | 521 | ||
| Laboratory Phase | 525 | ||
| Soft Tissue Model. | 525 | ||
| Option 2: Indirect Technique | 526 | ||
| Laboratory Technique | 526 | ||
| Soft Tissue Model. | 526 | ||
| Final Prosthesis | 526 | ||
| Final Crown Delivery | 529 | ||
| Complications | 529 | ||
| Soft Tissue Compromise | 529 | ||
| Interdental Papilla Deficiency | 530 | ||
| Time Technique | 532 | ||
| Prosthesis Fabrication | 539 | ||
| Direct Restorative Technique | 540 | ||
| Laboratory Procedure | 542 | ||
| Final Crown Delivery | 542 | ||
| Indirect Crown Fabrication | 544 | ||
| Laboratory Procedures | 544 | ||
| Final Crown Delivery | 544 | ||
| Posterior Implant Crowns | 544 | ||
| Posterior Crown Cusp Angle | 546 | ||
| Posterior Implant Crown Contour | 547 | ||
| Mandibular Posterior Crowns | 549 | ||
| Maxillary Posterior Crowns | 549 | ||
| Conclusion | 550 | ||
| Summary | 550 | ||
| References | 550 | ||
| 22 Maxillary Posterior Edentulism: | 553 | ||
| Implant Treatment Plan–Related Factors | 553 | ||
| Bone Width | 553 | ||
| Crown Height Space | 554 | ||
| Poor Bone Density | 554 | ||
| Bone Height | 555 | ||
| Maxillary Sinus Anatomy | 555 | ||
| Expansion of the Maxillary Sinus | 556 | ||
| High Occlusal Forces | 556 | ||
| Implant Size | 557 | ||
| Implant Number | 557 | ||
| Key Implant Number | 557 | ||
| Additional Implants | 558 | ||
| Implant Design | 558 | ||
| Dental Contraindications for Implant Treatment | 558 | ||
| Treatment History | 559 | ||
| Literature Review | 559 | ||
| Sinus Graft Options for the Posterior Maxilla | 560 | ||
| Misch Maxillary Posterior Classification | 561 | ||
| Subantral Option 1: Conventional Implant Placement | 561 | ||
| Subantral Option 2: Sinus Lift and Simultaneous Implant Placement | 561 | ||
| Subantral Option 3: Sinus Graft with Immediate or Delayed Endosteal Implant Placement | 563 | ||
| Subantral Option 4: Sinus Graft Healing and Extended Delay of Implant Insertion | 564 | ||
| Summary | 568 | ||
| References | 570 | ||
| 23 The Edentulous Mandible: | 573 | ||
| Advantages of Mandibular Implant Overdentures | 573 | ||
| Philosophy for Implants in the Edentulous Mandible | 575 | ||
| Disadvantages of Implant Overdentures | 576 | ||
| Review of the Literature | 578 | ||
| Overdenture Treatment Options | 579 | ||
| Overdenture Movement | 579 | ||
| Classification of Prosthesis Movement | 580 | ||
| Prosthesis Movement | 580 | ||
| The Hidden Cantilever | 581 | ||
| Mandibular Implant Site Selection | 581 | ||
| Overdenture Option 1 | 582 | ||
| Overdenture Option 2 | 586 | ||
| Disadvantages | 590 | ||
| Overdenture Option 3 | 590 | ||
| Overdenture Option 4 | 592 | ||
| Overdenture Option 5 | 594 | ||
| Challenging Force Factors: Patient and Anatomic Factors | 596 | ||
| Discussion | 596 | ||
| Summary | 597 | ||
| References | 597 | ||
| 24 The Completely Edentulous Mandible: | 600 | ||
| Comparing Fixed versus Removable Implant Prostheses | 600 | ||
| Force Factors | 602 | ||
| Mandibular Dynamics | 602 | ||
| Medial Movement | 602 | ||
| Torsion | 602 | ||
| Implant Treatment Options for Fixed Restorations | 604 | ||
| Treatment Option 1: The Brånemark Approach | 604 | ||
| Treatment Option 2 | 607 | ||
| Treatment Option 3 | 608 | ||
| Treatment Option 4 | 610 | ||
| Treatment Option 5 | 610 | ||
| Long-Term Treatment Planning | 612 | ||
| Summary | 612 | ||
| References | 613 | ||
| 25 Maxillary Arch Implant Considerations: | 615 | ||
| Edentulous Anterior Maxilla | 615 | ||
| Treatment Limitations | 615 | ||
| Anatomic Limitations | 616 | ||
| Biomechanical Limitations | 617 | ||
| Treatment Options | 619 | ||
| Sequence of Treatment Planning | 619 | ||
| Maxillary Labial Lip Position | 619 | ||
| Key Implant Positions | 620 | ||
| Guideline 1: No Posterior Cantilever | 620 | ||
| Guideline 2: No Posterior Three Adjacent Pontics | 620 | ||
| Guideline 3: The Canine Sites | 620 | ||
| Guideline 4: The First Molar Site | 622 | ||
| Guideline 5: Five-Sided Arch | 623 | ||
| Premaxilla Arch Form | 624 | ||
| Premaxillary Edentulous Treatment Plans | 626 | ||
| Multiple Adjacent Implant Diameters | 626 | ||
| Implant Number and Diameter | 628 | ||
| Posterior Edentulous Maxillae Treatment Plans | 629 | ||
| Implant Diameter | 629 | ||
| Implant Number | 632 | ||
| Crown Height Space and Implant Number | 637 | ||
| Excessive Crown Height Space | 637 | ||
| Biomechanic Consequences of Excessive Crown Height Space | 637 | ||
| Fixed Prosthesis Design | 638 | ||
| Maxillary Implant Overdentures | 639 | ||
| Maxillary Implant Overdenture Treatment Options | 643 | ||
| Option 1: Maxillary RP-5 Implant Overdenture | 644 | ||
| Option 2: Maxillary RP-4 Implant Overdenture | 646 | ||
| Fixed Prosthesis versus Overdenture Complications | 647 | ||
| Conclusion | 648 | ||
| References | 648 | ||
| V Prosthetic Aspects of Implant Dentistry | 650 | ||
| 26 Principles of Fixed Implant Prosthodontics: | 650 | ||
| Protection of the Prosthesis | 650 | ||
| Cement-Retained versus Screw-Retained Implant Fixed Prostheses | 650 | ||
| Retrievable Restoration | 651 | ||
| Advantages of Cement-Retained Prostheses | 652 | ||
| Retrieval of the Cement-Retained Fixed Prosthesis | 652 | ||
| Protection of the Implant | 652 | ||
| Unretained Restorations | 652 | ||
| Passive Casting | 652 | ||
| Correction of Nonpassive Prostheses | 655 | ||
| Progressive Loading | 655 | ||
| Axial Load | 655 | ||
| Hygiene of the Implant Sulcus | 656 | ||
| Esthetics | 656 | ||
| Occlusal Material Fracture | 656 | ||
| Access | 657 | ||
| Component Fracture | 657 | ||
| Cost and Time | 657 | ||
| Advantages of Screw-Retained Prostheses | 658 | ||
| Low-Profile Retention | 658 | ||
| Reduced Moments of Force | 658 | ||
| Risk of Residual Cement in the Sulcus | 658 | ||
| Nonparallel Implants | 659 | ||
| Complications of Cemented Prostheses | 659 | ||
| Residual Cement | 659 | ||
| Difference in Gingival Attachment | 659 | ||
| Position of a Crown Margin | 660 | ||
| The Abutment Flare | 662 | ||
| Abutment Retention | 663 | ||
| Abutment Taper | 664 | ||
| Abutment Surface Area | 664 | ||
| Abutment Height | 665 | ||
| Geometry of Abutment | 665 | ||
| Abutment Surface Texture | 665 | ||
| Resistance and Abutments | 665 | ||
| Types of Abutments for Cement Retention | 668 | ||
| One-Piece Abutment for Cement Retention | 668 | ||
| Two-Piece Abutment for Cement Retention | 669 | ||
| Natural Teeth and Implant Abutments: A Comparison of Prosthetic Indices | 671 | ||
| Crown Margin Location | 671 | ||
| Position for Natural Teeth | 671 | ||
| Crown Margin Position for Implants | 674 | ||
| Knife-Edge Abutment Margin Design | 674 | ||
| Splinted Crowns | 676 | ||
| Natural Teeth versus Implants | 676 | ||
| Path of Insertion | 679 | ||
| Parallelism for Natural Teeth | 679 | ||
| Implant Abutments | 680 | ||
| Nonparallel Abutments | 680 | ||
| Prostheses Fabrication | 683 | ||
| Direct Prosthetic Option | 683 | ||
| Transitional Prostheses | 684 | ||
| Master Casts | 685 | ||
| Indirect Prosthetic Option | 686 | ||
| Option 1 | 686 | ||
| Laboratory Fabrication | 688 | ||
| Occlusal Materials | 689 | ||
| Esthetics | 689 | ||
| Impact Forces | 690 | ||
| Static Occlusal Forces | 690 | ||
| Chewing Efficiency | 690 | ||
| Wear | 690 | ||
| Occlusal Material Fracture | 691 | ||
| Accuracy | 692 | ||
| Interarch Space | 692 | ||
| Conclusion for Occlusal Materials | 693 | ||
| Types of Cements for Implants | 693 | ||
| Provisional Cementation | 693 | ||
| Definitive Cementation | 693 | ||
| Radiopacity | 695 | ||
| Cementation | 695 | ||
| Summary | 696 | ||
| References | 696 | ||
| 27 Digital Technology in Implant Dentistry | 700 | ||
| The Harmony of Function and Esthetics with Digital Technology | 700 | ||
| The Dental Laboratory | 700 | ||
| The Digital Laboratory | 701 | ||
| The Digital Process | 701 | ||
| Linear versus Vertical Manufacturing | 702 | ||
| Digital Diagnostic and Treatment Planning | 702 | ||
| Digital Fixed Prosthetics | 702 | ||
| The Digital Process | 702 | ||
| Communication of Occlusion | 702 | ||
| Computerized Design and Fabrication | 703 | ||
| Dental Impressions | 703 | ||
| Conventional Impression Materials | 703 | ||
| Dimensional Accuracy | 705 | ||
| Capturing Detail | 705 | ||
| Time | 705 | ||
| Intraoral Access | 705 | ||
| Long-term Stability | 706 | ||
| Cost | 706 | ||
| Margins | 706 | ||
| Other Challenges with Conventional Impressions | 706 | ||
| Differentiating Digital Impression Technologies | 707 | ||
| Triangulation of Light Technology | 707 | ||
| Active Wave-Front Sampling Technology | 707 | ||
| Parallel Confocal Imaging Technology | 707 | ||
| A Comparison of Some of the Intraoral Three-Dimensional Digital Scanners | 708 | ||
| Integrated Digital Imaging within the Office Workflow | 711 | ||
| Integrating the Dental Practice and the Laboratory | 713 | ||
| Step-by-Step Process | 714 | ||
| The Future of CAD/CAM Dentistry | 719 | ||
| Conclusion | 720 | ||
| Summary | 722 | ||
| Acknowledgment | 722 | ||
| References | 722 | ||
| 28 Principles for Abutment and Prosthetic Screws and Screw-Retained Components and Prostheses | 724 | ||
| Screw Retention | 724 | ||
| Abutment Screws | 724 | ||
| Screw Loosening of Abutment and Prosthetic Screws | 725 | ||
| Metal Screw Mechanics | 726 | ||
| Preload | 726 | ||
| Torque Magnitude | 726 | ||
| Screw Head Design | 728 | ||
| Thread Design and Number | 729 | ||
| Metal Composition | 730 | ||
| Surface Condition | 730 | ||
| Screw Diameter | 730 | ||
| Abutment Screw Connection | 730 | ||
| Component Fit | 731 | ||
| Antirotational Features | 732 | ||
| Height (or Depth) of the Hexagon | 733 | ||
| Platform Diameter | 733 | ||
| Method to Retighten Abutment Screws | 734 | ||
| Screw-Retained Prostheses | 734 | ||
| Protection of the Prosthesis | 734 | ||
| Advantages of Screw-Retained Prostheses | 735 | ||
| Low-Profile Retention | 735 | ||
| Reduced Moments of Force | 735 | ||
| Risk of Residual Cement in the Sulcus | 735 | ||
| Nonparallel Implants | 736 | ||
| Complications of Screw-Retained Prostheses | 736 | ||
| External Force Factors | 736 | ||
| Passive Screw-Retained Prostheses | 737 | ||
| Passive Castings | 738 | ||
| Impression Procedural Steps | 741 | ||
| Impression Materials | 741 | ||
| Dimensional Changes | 741 | ||
| Permanent Deformation | 741 | ||
| Custom Impression Tray | 742 | ||
| Analog Variance | 743 | ||
| Stone Expansion | 743 | ||
| Acrylic Shrinkage | 744 | ||
| Wax Distortion | 745 | ||
| Metal Casting Shrinkage | 745 | ||
| Porcelain Shrinkage | 746 | ||
| Soldering | 746 | ||
| Screw Fixation | 747 | ||
| Digital Dentistry | 747 | ||
| Complications | 747 | ||
| Screw Fracture | 748 | ||
| Summary | 749 | ||
| References | 749 | ||
| 29 Mandibular and Maxillary Implant Overdenture Design and Fabrication | 753 | ||
| Anatomical Consequences of Edentulism | 754 | ||
| Bone Loss | 754 | ||
| Soft Tissue Consequences | 756 | ||
| Masticatory Function | 756 | ||
| Advantages of an Implant Overdenture | 757 | ||
| Advantages of Implant-Supported Overdentures versus Fixed Prostheses | 758 | ||
| Disadvantages of Implant Overdentures | 759 | ||
| Review of the Literature | 761 | ||
| Overdenture Treatment Options | 762 | ||
| Overdenture Movement | 762 | ||
| Classification of Prosthesis Movement | 763 | ||
| The Hidden Cantilever | 764 | ||
| Overdenture Attachments | 765 | ||
| O-Ring Attachment System | 766 | ||
| O-Rings | 766 | ||
| Metal Encapsulator | 767 | ||
| O-Ring Post | 767 | ||
| Size | 768 | ||
| O-Ring Hardness | 768 | ||
| O-Ring Materials | 768 | ||
| Troubleshooting O-Rings | 768 | ||
| Extrusion and Nibbling | 768 | ||
| Spiral Failure | 769 | ||
| Abrasion | 769 | ||
| Compression Set | 769 | ||
| Installation Damage | 769 | ||
| Hader Bar and Clip | 769 | ||
| Mandibular Implant Site Selection | 771 | ||
| Screw-Retained Superstructures | 772 | ||
| Overdenture Treatment Options | 773 | ||
| Overdenture Option 1 | 774 | ||
| Prosthetic Steps | 778 | ||
| Overdenture Option 2 | 782 | ||
| Disadvantages | 786 | ||
| Prosthesis Fabrication | 786 | ||
| Overdenture Option 3 | 788 | ||
| Overdenture Option 4 | 790 | ||
| Overdenture Option 5 | 794 | ||
| Step-by-Step Restorative Procedure | 796 | ||
| Initial Abutment Selection and Preliminary Impression | 796 | ||
| Laboratory Phase I | 798 | ||
| Final Impression: Second Appointment | 805 | ||
| Laboratory Phase II | 805 | ||
| Wax Try-in and Records: Third Appointment | 805 | ||
| Laboratory Phase III | 806 | ||
| Teeth Try-in: Fourth Appointment | 806 | ||
| Laboratory Phase IV | 806 | ||
| Metal Try-in and Final Delivery: Fifth Appointment | 806 | ||
| Challenging Force Factors: Patient and Anatomical | 807 | ||
| Maxillary Implant Overdentures | 807 | ||
| Consequences of Edentulism | 807 | ||
| Maxillary Overdenture versus a Fixed Prosthesis | 808 | ||
| Advantages | 808 | ||
| Literature Review | 809 | ||
| Treatment Planning Considerations | 810 | ||
| Premaxilla Arch Form: Dentate and Residual Bone | 811 | ||
| Division C–h Incisive Foramen Implant | 813 | ||
| Posterior Implant Location | 813 | ||
| Maxillary Implant Overdenture Treatment Options | 814 | ||
| Maxillary Implant Overdenture Option 1 | 815 | ||
| Maxillary Implant Overdenture Option 2 | 817 | ||
| Maxillary Overdenture Complications | 817 | ||
| Restorative Procedure | 818 | ||
| Summary | 824 | ||
| References | 825 | ||
| 30 Maxillary Arch Fixed Implant Prostheses: | 829 | ||
| Consequences of Anterior Maxillary Edentulism | 830 | ||
| Advantages of a Maxillary Implant Prosthesis | 830 | ||
| Fixed Prosthesis versus Overdenture | 832 | ||
| Treatment Planning Considerations | 834 | ||
| Premaxilla Arch Form: Dentate and Residual Bone | 836 | ||
| Implant Number and Premaxilla Arch Form | 836 | ||
| Posterior Implant Number | 838 | ||
| Sequence of Treatment Planning | 843 | ||
| Maxillary Labial Lip Position | 844 | ||
| Maxillary Incisal Edge Position | 845 | ||
| Occlusal Vertical Dimension | 846 | ||
| Methods to Evaluate Occlusal Vertical Dimension | 847 | ||
| Mandibular Incisor Edge Position | 848 | ||
| Tooth Position: Anterior | 848 | ||
| Existing Occlusal Planes (Posterior Maxillary and Mandibular Planes of Occlusion) | 848 | ||
| Tooth Position: Posterior | 849 | ||
| Fixed Prosthesis Design | 850 | ||
| Active Lip Lines | 850 | ||
| Number of Teeth | 850 | ||
| Maxillary High Lip Line | 850 | ||
| Papillae Height | 856 | ||
| Step-by-Step Fabrication of Fixed Full-Arch Maxillary Prostheses | 856 | ||
| Case 1: Direct Method with CAD-CAM Technology | 856 | ||
| Appointment 1: Abutment Selection, Preparation, Impression, Occlusal Vertical Dimension, Centric Bite Registration, and Transitional Restoration | 856 | ||
| Laboratory Phase 1: Casting Fabrication (or Acrylic Temporary) | 862 | ||
| Appointment 2: Metal Try-In (or Acrylic Try-In) | 862 | ||
| Laboratory Phase 2: Final Restoration | 863 | ||
| Appointment 3: Final Delivery | 864 | ||
| Case 2: Indirect Method (Courtesy of Dr. Ray Hazen, Rochester, Indiana.) | 864 | ||
| Appointment 1: Implant Body Impression | 864 | ||
| Sequence of Treatment | 864 | ||
| Laboratory Phase 1: Abutment Selection and Temporary Fabrication | 866 | ||
| Appointment 2: Final Impression, Reassess Occlusal Vertical Dimension, Delivery of Temporary Prosthesis | 866 | ||
| Laboratory Phase 2: Metal Framework Fabrication | 868 | ||
| Appointment 3: Metal Try-In | 868 | ||
| Laboratory Phase 3: Final Restoration Fabrication | 870 | ||
| Appointment 4: Final Delivery | 870 | ||
| Summary | 870 | ||
| References | 871 | ||
| 31 Occlusal Considerations for Implant-Supported Prostheses: | 874 | ||
| Natural Tooth versus Implant Support Systems | 875 | ||
| Implant-Protective Occlusion | 879 | ||
| Occlusal Considerations for Fixed Implant Prostheses | 880 | ||
| Existing Occlusion | 880 | ||
| Premature Occlusal Contacts | 880 | ||
| Implant Body Orientation | 882 | ||
| Force Direction and Bone Mechanics | 883 | ||
| Prosthetic Angled Loads | 885 | ||
| Solutions to Angled Loads | 887 | ||
| Posterior Crown Cusp Angle | 887 | ||
| Mutually Protected Articulation | 888 | ||
| Cantilevers and Implant-Protective Occlusion | 892 | ||
| Crown Height and Implant-Protective Occlusion | 893 | ||
| Posterior Implant Crown Contour | 893 | ||
| Mandibular Posterior Crowns | 897 | ||
| Maxillary Posterior Crowns | 897 | ||
| Posterior Occlusal Contact Positions | 900 | ||
| Timing of Occlusal Contacts | 902 | ||
| Vertical Movement | 903 | ||
| Horizontal Movement | 905 | ||
| Design to the Weakest Arch | 907 | ||
| Summary by Bone Volume | 907 | ||
| Division A Bone | 907 | ||
| Division B Bone | 910 | ||
| Division C and D Maxillae | 910 | ||
| Conclusion | 910 | ||
| Summary | 910 | ||
| References | 911 | ||
| 32 Progressive Bone Loading: | 913 | ||
| Influence of Bone Density on Implant Success Rates | 913 | ||
| Etiology of Variable Bone Density | 914 | ||
| Misch Bone Density Classification | 916 | ||
| Scientific Rationale of Bone Density–Based Implant Treatment | 917 | ||
| Bone Strength and Density | 917 | ||
| Elastic Modulus and Density | 917 | ||
| Bone Density and Bone–Implant Contact Percentage | 918 | ||
| Bone Density and Stress Transfer | 918 | ||
| Rationale for Progressive Loading | 920 | ||
| Bone Physiology | 920 | ||
| Clinical Studies Supporting Progressive Loading | 921 | ||
| Progressive Loading Protocol | 923 | ||
| Time | 924 | ||
| Initial Healing | 924 | ||
| Diet | 925 | ||
| Occlusal Material | 926 | ||
| Occlusion | 926 | ||
| Prosthesis Design | 926 | ||
| Progressive Loading Phases | 926 | ||
| First Appointment | 927 | ||
| Initial Abutment Selection, Final Impression, and First Transitional Prosthesis | 927 | ||
| Final Impression and Transitional Prosthesis I | 927 | ||
| VI Maintenance | 964 | ||
| 34 Maintenance of Dental Implants | 964 | ||
| Plaque Biofilm and Dental Implants | 964 | ||
| Probing Depths | 966 | ||
| Bleeding Index | 968 | ||
| Crestal Bone Loss | 970 | ||
| Patient Oral Hygiene | 971 | ||
| Instrument Selection | 972 | ||
| Implant Maintenance Procedures | 973 | ||
| Chemotherapeutic Agents | 973 | ||
| Implant Quality of Health Scale: A Clinical Assessment of the Health–Disease Continuum | 973 | ||
| Group I: Optimum Health | 974 | ||
| Group II: Satisfactory Health | 975 | ||
| Group III: Compromised Survival | 976 | ||
| Group IV: Clinical Failure | 976 | ||
| Repair of Ailing, Failing Dental Implants | 977 | ||
| Implant Crown Esthetic Index | 978 | ||
| Summary | 978 | ||
| References | 979 | ||
| Index | 983 | ||
| A | 983 | ||
| B | 983 | ||
| C | 984 | ||
| D | 985 | ||
| E | 986 | ||
| F | 986 | ||
| H | 987 | ||
| I | 987 | ||
| K | 988 | ||
| L | 988 | ||
| M | 988 | ||
| N | 990 | ||
| O | 990 | ||
| P | 990 | ||
| Q | 991 | ||
| R | 991 | ||
| S | 992 | ||
| T | 992 | ||
| V | 993 | ||
| W | 993 | ||
| Y | 993 | ||
| Z | 993 |