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“Rules of 10”
Guidelines for Successful Planning and Treatment
of Mandibular Edentulism Using Dental Implants
by
Lyndon F. Cooper, DDS, Ph.D;
Bryan M. Limmer, DMD; and W. Day Gates III, DDS, MS
The treatment of mandibular edentulism
using dental implants is now well
established as a biologically sound
treatment option. More than 40 years
after Swedish orthopedic surgeon
Per-Ingvar Brånemark intro duced the
process of transforming oral function
in the edentulous patient using endosseous
dental implants, a picture
of success has emerged that is recognized
worldwide. The use of one or
two implants to retain a mandibular
overdenture and the use of four or
more implants to support and retain
a fixed dental prosthesis is widely
known to provide improved function
and increased satisfaction in the
edentulous patient when compared to
conventional denture therapy. 1-6
The three “Rules of 10” for treatment planning dental implant therapy
in the edentulous mandible are designed to improve the success of both the
endosseous implants and the prosthesis. These “rules” acknowledge and
provide a method to control the mechanical environment, addressing factors
affecting implant and prosthesis longevity, including magnitude of forces,
resistance of the prosthesis against these forces, and the biology of bone and
its ability to respond to loading environments. The rules specify that for any
implant-retained overdenture (IRO) or implant-supported fixed prosthesis (ISFP),
there must be a minimum of 10 mm of alveolar dimension (inferior/superior)
and a minimum of 10 mm of interocclusal (restorative) dimension measured
from the soft tissue ridge crest to the occlusal plane. Additionally, for an ISFP, the
anterior/posterior distribution of implants must be greater than 10 mm. This
article provides support in the literature for these rules and illustrates their
application in the treatment of mandibular edentulism.
The contemporary literature demonstrates
a high degree of survival
over the 10- to 20-year time horizon
when implants are placed in the
parasymphyseal mandible and restored
with an IRO or with an ISFP. 7-10
These studies invoke inclusion and
exclusion criteria that favor success,
benefit from the local factors of
mandibular bone quality and quantity,
and commonly employ the use of an
opposing maxillary denture. However,
all the studies indicate high
and lasting rates of implant survival.
Less well documented and perhaps
equally significant is the quality
of the prosthesis, its longevity and
maintenance requirements, and the
related issues of patient-perceived
satisfaction. There is also a history
– “Rules of 10” — Guidelines for Successful Planning and Treatment of Mandibular Edentulism Using Dental Implants – 91