Treatment Using Functionally Fixed Prosthesis: A Case Report

Most dental practitioners as well as their patients prefer to have fixed rather than removable prosthesis. However, there are many clinical situations that prohibit the use of the fixed treatment modality. These clinical cases can vary from, simply not having the proper number of healthy teeth and/or implants to, the esthetically challenging cases of high smile lines and severe loss of alveolar support. The approach of using a traditional removable prosthesis in these situations has always been met with severe compromises. The functionally fixed restoration is a third modality of treatment that can solve many of the problems of the removable restoration and at the same time provide the same comfort and success of the fixed prosthesis. This restoration has a pontic assembly that is removed by the patient for periodontal maintenance. This article presents a case report which describes a technique for treatment of partially edentulous maxilla with severe loss of alveolar support using a fixed removable prosthesis/Andrew’s bridge.

     

Restoring the Edentulous Maxilla Using an Implant-Supported, Matrix-Assisted Secondary Casting

The selection of appropriate implant treatment modalities for the edentulous maxillary arch is complex. Although many patients are candidates for an implant-supported removable prosthesis, two major considerations affecting choice of treatment type are the amount of residual alveolar bone and soft tissue, and cost. A technique is described that employs a cast milled primary bar and a secondary casting constructed using a vacuum-formed 0.040-in plastic matrix. The secondary casting is intimately adapted to the primary bar and incorporates the retentive elements within it. The resulting prosthesis is less expensive than comparable designs, and retentive elements are easily replaceable. The technique is adaptable to most implant systems. The matrix-assisted secondary casting technique provides a design that is esthetic and hygienic. The prosthesis may also be easier to insert and remove than implant-supported removable prostheses that use plunger- or latch-type retention.     

非游离端可摘义齿与固定义齿牙槽骨承力的变形分析

目的：观察非游离端可摘义齿与固定义齿受载前后基牙牙槽骨的变形。方法：选用新鲜人尸离体上下颌骨，制备左下第一恒磨牙缺失模型，先后用铸造三臂卡环为固位体的可摘义齿及整铸双端固定桥对缺失区进行修复。以垂直向均匀加载和集中加载两种方式，用电子散斑干涉技术比较分析基牙牙槽骨受载前后的变形分布。结果：两种修复体都可以使基牙牙槽骨的离面位移减少，以固定修复后基牙牙槽骨的离面位移减少得较为显著。结论：两种设计都有其合理性，以固定义齿修复对于改善牙槽骨的力学状况优于铸造三臂卡环为固位体的活动义齿     

Comparison of speech intelligibility, articulation and oromyofunctional behaviour in subjects with single-tooth implants, fixed implant prosthetics or conventional removable prostheses

The purpose of this controlled study was to determine the impact of a single-tooth implant, fixed implant prosthesis and completely removable dental prosthesis on intelligibility, articulation and oromyofunctional behaviour. Additionally, the self-perceived overall satisfaction of the dental replacements and the effect on speech was questioned. Objective (acoustic analysis) as well as subjective assessment techniques (perceptual evaluation) were used. The satisfaction of single-tooth implant group was very high (100%) followed by a satisfaction of 87% for the fixed implant prosthesis group and 68% for the removable prosthesis group. The results of the phonetic analyses revealed a normal intelligibility and oromyofunctional behaviour in the three groups of dental replacements. Only one type of articulation disorders was observed in the single-tooth implant group, followed by three types of disorders in the removable prosthesis group and six types of disorders in the fixed implant prosthesis group. In this last group, not only 87% of the subjects showed distortions of one or more consonants but also most consonants of the Dutch language were disturbed in comparison with the single-tooth implant and removable prosthesis users. Special attention must be paid to the fricative /s/ because in more than 50% of all groups, this sound is disturbed.     

改良唇-牙-牙槽嵴上颌全口种植义齿分类设计

改良唇-牙-牙槽嵴上颌全口种植义齿分类法是根据牙槽嵴宽度和高度将上颌无牙颌分为3类。Ⅰ类,牙槽嵴宽度高度均适宜,适合种植固定义齿修复;Ⅱ类,牙槽嵴宽度对于种植体足够但是对唇颊支撑不足,适合于固定活动联合修复;Ⅲ类,牙槽嵴高度或宽度不足以支撑种植体植入,需要植骨,或采用穿颧种植体等特殊方式种植,或者采用传统全口义齿修复。第Ⅰ类根据牙槽嵴高度不同又分为2个亚类：第Ⅰ类1亚类,牙槽嵴高度完全没有丧失,适合冠桥式义齿修复;第Ⅰ类2亚类,牙槽嵴高度有部分丧失,适合复合式义齿修复。本设计分类旨在帮助术者在术前明确患者是否适合种植,以及适合采用种植固定义齿还是种植活动义齿修复,有利于更好地选择适应证,减少并发症,获得更好的长期效果。     

Inferior alveolar nerve repositioning in conjunction with placement of osseointegrated implants: a case report

A procedure for relocation of the inferior alveolar nerve to facilitate placement of endosseous implants is described. The technique permits placement of implants in an atrophied mandibular alveolar ridge that lacks sufficient vertical height superior to the mandibular canal. Placement of a fixed prosthesis instead of a removable appliance is facilitated.     

The implant-supported milled-bar mandibular overdenture

Osseointegrated dental implants have been proven successful in the treatment of edentulism. The predictability of the implant‐supported prosthesis has also been established. Several techniques have been described for the successful restoration of the edentulous mandible: fixed‐detachable prostheses with either the original Brånemark hybrid prosthesis design or conventional implant‐supported fixed partial dentures, implant‐retained overdentures, and implant‐supported overdentures. However, in cases of advanced ridge resorption in which facial tissue support is needed from the flanges of the prosthesis or when a removable type of prosthesis is preferred by the patient, an implant‐supported prosthesis is indicated. Electric discharge machining is often used in the fabrication of the bar for an implant‐supported overdenture. This procedure is very costly and technique sensitive. An alternative procedure to fabricate a milled‐bar implant‐supported overdenture is described. This procedure is simple and uses inexpensive equipment and materials. The milled‐bar minimizes lateral and rotational displacement. The overdenture incorporates attachments that provide retention, minimizing possible movement along the path of insertion. This type of prosthesis is available to a broad patient population, especially those with advanced ridge resorption, providing an excellent result at a reduced cost.     

The functionally fixed restoration: a third modality of treatment

Most dental practitioners as well as their patients prefer to have fixed rather than removable restorations. However, there are many clinical situations that prohibit the use of the fixed modality. These clinical cases can vary from simply not having the proper number of healthy teeth and/or implants to the esthetically challenging cases of high smile lines and severe loss of alveolar support. The approach of using a traditional removable prosthesis in these situations has always been met with severe compromises. The functionally fixed restoration is a third modality of treatment that can solve many of the problems of the removable restoration and at the same time provide the same comfort and success of the fixed prosthesis.     

Alternative method for connecting a removable gingival extension and fixed partial denture: a clinical report

In terms of esthetics and hygiene, defects in the alveolar ridge can complicate the design and fabrication of fixed partial dentures. When missing anterior teeth are restored, it may be difficult to achieve a satisfactory appearance without the correction of soft tissue and alveolar defects. When surgical intervention is not an option, a removable gingival extension and fixed prosthesis may be considered. This clinical report describes the use of a custom-made pin system (rather than intra- or extra-coronal attachments) to esthetically connect a removable gingival extension to a fixed partial denture.     

Transition from Failing Dentition to Full‐Arch Fixed Implant‐Supported Prosthesis with a Staged Approach Using Removable Partial Dentures: A Case Series

The present retrospective case series is aimed at evaluating a staged approach using a removable partial denture (RPD) as an interim prosthesis in treatment to correct a failing dentition until such time as a full‐arch fixed implant‐supported prosthesis may be inserted. Eight patients, who had undergone maxillary full‐arch rehabilitation with dental implants due to poor prognosis of their dentitions, were analyzed. All treatment included initial periodontal therapy and a strategic order of extraction of hopeless teeth. An RPD supported by selected teeth rehabilitated the compromised arch during implant osseointegration. These remaining teeth were extracted prior to definitive prosthesis delivery. Advantages and drawbacks of this technique were also recorded for the cases presented. Among the advantages provided by the staged approach are simplicity of fabrication, low cost, and ease of insertion. Additionally, RPD tooth support prevented contact between the interim prosthesis and healing abutments, promoting implant osseointegration. The main drawbacks were interference with speech and limited esthetic results. Implant survival rate was 100% within a follow‐up of at least 1 year. The use of RPDs as interim prostheses allowed for the accomplishment of the analyzed rehabilitation treatments. It is a simple treatment alternative for patients with a low smile line.     

Removable prosthesis supported by implants according to the Cagliari modified conometry technique: case report

This report describes the rehabilitation of a patient who was completely edentulous in the mandible with a removable prosthesis supported by implants on four Straumann Wide-Neck implants placed in the positions of the canines and second molars. The Cagliari modified conometry technique was developed to improve and simplify anchorage systems based on conical copings in a removable prosthesis supported by implants. The connection of the removable prosthesis to the implants is obtained by primary conical copings, which are screwed to the implants, coupled to secondary copings equipped with plastic friction devices (Arch-Friction-Soft, Dental Konos). After the secondary copings are positioned on the primary copings, the secondary copings are fixed with acrylic resin to the removable prosthesis in the mouth, with the goal of passive fit. The prosthesis produced with this method is not a classic implant-supported overdenture but is a removable prosthesis completely supported by implants that is shaped like a fixed prosthesis. This type of prosthesis is extremely stable and has modular retention (plastic friction), creating ideal conditions for oral hygiene. The stability of this type of prosthesis results in psychologic comfort and masticatory performance similar to that of a fixed prosthesis but with the hygiene, esthetics, and lower expense of an overdenture.     

An implant-supported removable partial denture on milled bars to compromise the inadequate treatment plan: a clinical report

Presurgical prosthetic treatment planning is critical for the success of the implant prosthesis. Inadequate treatment plan, due to insufficient discussion between prosthodontist, and surgeon, may result in poor prognosis. A 26-year-old male patient was referred for prosthodontic treatment after implant was placed in the area of teeth #17, 16, 22, 25 and 27, without adequate discussion nor the treatment planning between oral surgeon and prosthodontist. It was found that the patient had two hopeless teeth, and a severely resorbed alveolar ridge. Additional tooth extraction was needed and the type of definitive prosthesis was shifted from fixed type to removable one. Proper pre-surgical treatment planning is essential for the good prognosis. Implant-supported removable prosthesis on milled bars may be a useful treatment option in patients with incorrect angled placement on severely resorbed alveolar ridge.     

Treatment plan for restoring the edentulous maxilla with implant-supported restorations: removable overdenture versus fixed partial denture design.

STATEMENT OF PROBLEM: Restoring the edentulous maxilla with a fixed complete denture or a removable overdenture is a complex and challenging procedure. PURPOSE: This article presents and discusses the crucial factors involved in deciding whether a fixed or removable implant prosthesis should be planned in fulfilling the patient's preference for optimal esthetics, phonetics, comfort, and function. METHODS AND MATERIAL: A concept for treatment planning is presented that enables the practitioner to check the decisive parameters during the first examination and to make the final decision with the help of the reformatted computerized tomography scan. CONCLUSION: If this treatment plan is followed, implants can be placed to comply with the selected prosthetic solution and compromised solutions can be avoided. The fixed design for implant prosthesis is only appropriate for patients with minimal resorption of the alveolar bone and an optimal maxillomandibular relationship. The removable overdenture may be indicated from the outset and is no longer restricted to patients with a compromised situation in which fixed implant prostheses are not feasible.     

A Novel Method for Retention of an Orbital Prosthesis in a Case with Continuous Maxillary and Orbital Defect

Exenteration of the orbital contents as well as removal of a part of maxilla with an ablative surgery for the removal of a malignant tumor can severely affect a person in terms of function, esthetics and psychological trauma. A well-retained, user-friendly, removable maxillofacial prosthesis is the key to successful prosthetic rehabilitation in such cases. Various retentive techniques include using spectacle frame, conformers, adhesives, osseointegrated implants, magnets or buttons. This paper describes a novel technique for retention of silicone orbital prosthesis using acrylic resin base attached to maxillary obturator with the help of pin and socket of an electric plug wherein the latter is attached to the eye prosthesis with the help of a mechanical undercut. This helps in better retention of both the prostheses.     

In vivo evaluation of occlusalcontact area and maximum bite force in patients with various types of implant-supported prostheses

Abstract

Objective. To determine the effects of various implant retained and/or supported prostheses on number of occlusal contacts (NOC), occlusal contact area (OCA)and maximum bite force (BF). Patients and methods: In total, 56 patients were included in the study; five test groups and two control groups. The patients in the treatment groups received implant-supported/retained prosthesis; over-dentures retained with two individual attachments in occlusion with complete denture, with four individual attachments in occlusion with complete denture, with four individual attachments in occlusion with fixed partial dentures or natural dentition, 6-implant retained fixed bridges in occlusion with natural dentition and 8-implant retained fixed bridges in occlusion with natural dentition. The patients in control group 1 were wearing conventional complete maxillary and mandibular dentures, whereas in control group 2 they had fixed full-arch porcelain-fused to metal restorations prostheses for both arches. Dental Pre-scale was used measure the NOC, BF and OCA. Results. There was no statistically significant difference between the treatment and control groups, among the groups with regards to NOC. OCA demonstrated different results among the removable and fixed reconstruction groups. With regards to BF, removable dentures supported with four implants showed higher bite force values than controls and two implant over-dentures. Also, a fixed reconstruction using eight implants showed higher BF values than a fixed reconstruction using six implants. Conclusion. Use of implants for removable dentures and fixed reconstructions improve occlusal contact area and bite force.     

Attachment‐Retained Gingival Prosthesis for Implant‐Supported Fixed Dental Prosthesis in the Maxilla: A Clinical Report

The rehabilitation of edentulous maxillae is a complex procedure due to the involvement of esthetic and functional requirements. A trial maxillary denture can be used to identify the need for adequate upper lip support when replacing removable complete dentures by implant‐fixed dental prostheses. This clinical report describes the outcome of the rehabilitation of an edentulous atrophic maxilla with unfavorable maxillomandibular relationship and deficient upper lip support. A trial denture was fabricated and used to diagnose the need for a prosthesis capable of restoring the upper lip support. The reduced upper lip support was also confirmed by a lateral cephalogram. The patient was rehabilitated by an implant‐fixed dental prosthesis associated with an attachment‐retained gingival prosthesis. The case presented shows that when loss of upper lip support is detected and the patient does not wish to undergo further surgical reconstruction procedure, the retention of a gingival prosthesis using a ball attachment is a satisfactory treatment option.     

Prosthetic restoration following maxillary trauma utilising a fixed removable implant-supported prosthesis: a case report.

Patients with traumatic head injuries may suffer from tooth loss, as well as involvement of associated soft tissues and bone. Conventional prostheses are often bulky and unretentive. Osseo-integrated implants have made it possible to treat these patients with more retentive, aesthetically and functionally improved prostheses. This case illustrates the use of a fixed removable implant-supported prosthesis for a patient with severe maxillary trauma. A bar connecting the implants was individually designed to have parallel sides and vertical channels prepared in it. The corresponding removable prosthesis features retentive pins which engage the prepared grooves in the bar to provide adequate frictional retention and stability for the prosthesis. This treatment modality restored the missing teeth, alveolar bone, soft tissues and oral function while at the same time facilitating good oral hygiene.     

Within-subject comparisons of maxillary fixed and removable implant prostheses: Patient satisfaction and choice of prosthesis

Dental implants provide patients with restorative options for the edentulous maxilla. Both fixed and removable prostheses can be attached to the edentulous maxilla, but the efficacy of different designs has not been determined. In this two-session within-subject crossover trial we compared maxillary implant retained fixed prostheses with removable implant overdentures opposed by mandibular implant-supported overdentures. Sixteen patients, who had previously received mandibular implants, entered the study and received four to six maxillary implants. After dropouts as a consequence of a lack of osseointegration and general health problems, 13 remained. Of these, five received the removable prosthesis first and eight the fixed prosthesis. After 2 months, the prostheses were exchanged and the second was also worn for 2 months. Psychometric measurements of general satisfaction with the prostheses as well as comfort, ability to speak, stability, esthetics, ease of cleaning and occlusion were obtained once each prosthesis had been worn for 2 months. Chewing ability was assessed for seven types of food. Removable long-bar overdentures received significantly higher ratings of general satisfaction than fixed prostheses (P = 0.003). Patients also rated their ability to speak and ease of cleaning significantly better with the removable overdentures. Nine patients chose to keep the removable prosthesis and four preferred to keep the fixed prosthesis. The results suggest that maxillary removable overdentures on multiple implants may provide patients with better function than fixed prostheses.     

Wear of resin denture teeth in partial removable dental prostheses

PurposeTo investigate occlusal wear of resin denture teeth in partial removable dental prostheses worn by partially edentulous patients.MethodsThirty patients with partial removable dental prostheses were included in the study. Thirty-two patients with complete dentures served as a reference group. Occlusal wear after two years was evaluated indirectly using gypsum casts and a three-dimensional laser-scanner device. Overall wear of complete occlusal surfaces and maximum wear of occlusal contact areas were measured. Patient and prosthesis data were analyzed using univariate and multiple linear mixed models.ResultsOverall wear of denture teeth in partial removable dental prostheses was 91 (SD 85) μm, and maximum wear of occlusal contact areas was 329 (SD 204) μm (means and standard deviations). Average and maximum wear values for teeth in complete dentures were both lower than those for teeth in partial removable dental prostheses. However, differences between wear of different types of denture did not reach statistical significance after adjustment for gender, type of tooth, dental status of the opposing jaw, and antagonist material. Statistical analysis revealed that wear was greater for denture teeth occluding with ceramic crowns and/or fixed partial dentures as antagonists.ConclusionsResin denture teeth in partial removable and complete dental prostheses are subjected to clinically important occlusal wear that might destabilize occlusion and cause further problems. Patient-related factors and dental status affect wear behavior and should be taken into consideration when treating patients with removable dentures.     

The effects of preoperative resorption and jaw anatomy on implant success. A report of 303 cases.

The purpose of this paper is to report the outcome of 1097 consecutively implanted endosteal implants (Brånemark®) into 303 jaws, between September 1983 and May 1990. All implants were placed using the prescribed technique suggested by manufacturer, and were restored either with fixed or removable prosthesis. Alveolar bone resorption (quantity) was scored from lesser to greater degree by assigning a value of l–5 to each jaw, and jaw anatomy was scored from l–l, based on decreasing cortical and cancellous bone quality. The data were separated into fixed and removable prosthesis and analyzed to determine the correlation between success and the scored resorption and jaw anatomy, as well as implant position. Assessment demonstrated a maxillary success rate of 93.4% and a mandibular success rate of 97.2% over a 36‐month period (mean). Results of correlations of success with jaw anatomy for both fixed and removable prosthesis revealed that bone quality 4 exhibited the greatest failure rate. Preoperative resorption values (1‐S) had little effect on failure, and quality appears to influence failure more than I quantity.