What is the ideal pattern of occlusion for implant supported prosthesis?

Very difficult to answer such a broad question versus a specific treatment planned case. I would refer you to Misch's implant restorative text or any other general implant textbook on prosthetics.

in misch, there is nothing given much regarding occlusion of fixed implant prosthesis v/s fixed implant prosthesis...

While I have always been a staunch supporter of Carl's work, there is one area in which I have a fundamental disagreement; his coneceps of implant supported occlusion. Remember where we have come from historically. We have had poor implant surfaces resulting in reduced bone-to-implant contact and less than adequate abutment connections leading to screw loosening and restoration failure. Much of our "occlusion" concepts have come from strategies to prevent implant or restoration failure. But should we ignore nueromuscular health and the envelope of function just to mitigate implant problems? Implant systems are vastly improved today and we have pretty much eliminated these historical problems. For many years, Carl lectured on a topic entitled "If your implant restoration looks like the tooth you are replacing, you are doing it wrong". I routinely fabricate my restorations to look and function like the tooth I am replacing with identical resultscompared to the older paradigm of reduced occlusal tables, flatter cusps, and only group function.. My feeling has always been to reconstruct the patient to restore neuromuscular health (muscles of mastication and joint apparatus). If the patient was originally in cuspid rise, and I have an implant that is replacing the cuspid, I restore it in cuspid rise. Same is true for group function as long as this is not a pathologic condition. Why should a hybrid restoratio require a different approach. This comes from non-implant supported full denture occlusion where balanced occlusion was designed to prevent denture tipping and loss of suction. But a screw retained restoration has none of these problems. Are you concerned that unbalanced occlusion may result in acrylic fracture if your occlusion is not balanced? Then use a zirconium alternative and restore the patient properly. Old paradigms die hard; we should not let old habits get in the way of appropriate patient care, RJM

Since implants do not have a periodontal ligament, there is no depressive movement when the implant is loaded as there may be with adjacent natural teeth. Therefore, the implant restoration should meet with the identical force as the natural teeth in maximum intercuspation (full force). This will necessarily mean light markings with occlusion paper at normal force. This is obviously not true for a full arch of implants where there are no natural teeth but partially true when there is a single quadrant of implants. When there is a full quadrant of implants and the rest of the arch is natural, there are more factors I look at. First is the opposing occlusion; are they implants or natural teeth? If implants, I will do the same as a single implant by adjusting the contact to be equal in maximum intercuspation. If teeth, I tend to make them the same occlusion as the contralateral side in normal force as there is a depressive moment to the opposing teeth. One might argue that I should do the same as the single restoration. However, I have found that the opposing natural teeth tend to extrude slightly over time, resulting in increased force anyway. So I do not cause an imbalance in the beginning by creating a torqueing movement of the mandible on the implant side. RJM

Thanks.

AAID exam answer is cuspid rise why it all has to do with masticatory dynamics , bone density and bite force. anterior teeth are subjected to 25 psi under normal function while molars go beyond 200 psi .. I read misch but I don't follow misch

the only time I would use group function is with a lower implant prosthesis with an opposing upper full denture. In the cuspid rise occlusal scheme the laterals can also have some participation it all depends on the case.. For all my total reconstruction cases wearing a night guard is mandatory..

I have placed and restored a ton of implants . The best and easiest advise I can give you is to place the occl markings as close to center of the implant body as possible with the patient marking the tooth just lightly . The marking should be with the patients biting with the hardest/heaviest they can produce. That is my 2 cents, Best of luck.