Implants · patient case question
Which factor is MOST important to communicate to the laboratory for long-term implant success?
Patient case: Maintenance of a screw-retained implant prosthesis
Patient: Male, 59 years old
Chief Complaint: Attends for review of a screw-retained implant-supported prosthesis placed eighteen months ago.
Background: Non-smoker. Well-controlled hypertension. Good plaque control.
Current Findings: The prosthesis is stable and the peri-implant tissues are healthy, with no bleeding on probing and no radiographic bone loss beyond expected remodelling. He asks what ongoing care the restoration will need.
Show answer and explanation
Correct answer: C. That occlusal forces be directed along the long axis of the implants
- A. Tooth form is an aesthetic preference and does not determine long-term success.
- B. Articulator selection affects the accuracy of occlusal registration but is not the governing factor communicated for longevity.
- C. CORRECT. Implants have no periodontal ligament. There is no proprioceptive feedback to warn of overload and no physiological mobility to absorb it, so a lateral or off-axis force transmits directly into the bone-implant interface as a concentrated stress. Axial loading distributes force favourably; off-axis loading causes crestal bone loss, screw loosening and component fracture. Everything else on this list is secondary.
- D. Shade matters for aesthetics but has no bearing on the biomechanical survival of the implant.
Note: Implant occlusal principles: centric contacts directed axially, no working or non-working excursive contacts on implant-supported units, shallow cusp inclines, narrowed occlusal tables, and anterior guidance carried on natural teeth where possible.