Restoration with implants in patients with recessive dystrophic epidermolysis bullosa and patient satisfaction with the implant-supported superstructure

PURPOSE: The use of endosseous implants in the prosthetic restoration of edentulous patients with recessive dystrophic epidermolysis bullosa (RDEB) may provide improved outcomes when compared with traditional prosthetic methods. The aim of this study was to evaluate the feasibility of placing endosseous implants in patients with RDEB and to compare the treatment outcomes of fixed and removable implant-supported restorations in the edentulous maxilla or mandible with the main emphasis on patient response. MATERIALS AND METHODS: Six patients with RDEB were treated with implants. All patients were completely edentulous in either the maxilla or mandible and had marked oral involvement, with alterations in the soft and hard tissues in all cases. Three patients were treated with fixed, screw-retained implant-supported prostheses, and 3 were treated with removable implant-supported prostheses. Six months after prosthetic restoration, patients were given a questionnaire to assess their psychologic well-being and satisfaction with the implant-supported restoration marked on a visual analog scale. RESULTS: A total of 38 dental implants (21 maxillary, 17 mandibular) were placed in 6 patients. The implant success rate was 97.9%. The average follow-up from implant placement was 5.5 years (range, 1 to 9). The fixed and removable implant-supported prostheses were associated with improvements in comfort and retention, function, esthetics and appearance, taste, speech, and self-esteem. The level of satisfaction was slightly higher in patients with a fixed prosthesis. CONCLUSION: These findings suggest that endosseous implants can be successfully placed and provide support for prostheses in patients with RDEB. Patients with fixed prostheses and overdentures were satisfied with their implant-supported prostheses in the edentulous maxilla and mandible.     

Treatment outcomes of fixed or removable implant-supported prostheses in the edentulous maxilla. Part I: patients' assessments

STATEMENT OF PROBLEM: Distinct clinical parameters determine whether fixed or removable implant-supported prostheses are indicated to restore the edentulous maxilla. However, there is a strong belief that fixed implant prostheses meet with greater patient acceptance and satisfaction, but this may differ from the patients' perceptions, their psychological responses to treatment, and their assessments of the treatment outcome. PURPOSE: This prospective clinical study compared the treatment outcomes of fixed and removable implant-supported restorations in the edentulous maxilla with the main emphasis on the patient's point of view.Material and methods: Twenty patients who requested an implant-supported superstructure to restore the edentulous maxilla were asked to complete a questionnaire measuring their satisfaction with the present situation and the psychologic impact of their oral health status with their responses marked on a Visual Analog Scale (VAS). Ten patients were treated with a fixed, screw-retained implant prosthesis (group 1), and 10 were treated with a removable, implant-supported and bar-retained overdenture (group 2). Six months after prosthetic rehabilitation, patients were again given the questionnaire to assess their psychologic well-being and satisfaction with the implant-supported restoration. RESULTS: Both prosthesis designs were associated with significant improvements in comfort and retention, function, esthetics and appearance, taste, speech, and self-esteem. No difference was found between the 2 groups with respect to how the patients assessed the implant therapy. However, the results indicated that patients in group 2 experienced greater differences between pretreatment and posttreatment scores for the parameters esthetics, taste, and speech. Treatment costs per unit were significantly higher in group 1 than in group 2. CONCLUSION: Patients in groups 1 and 2 were similarly satisfied with their implant-supported prostheses in the edentulous maxilla with regard to their well-being and the cost-utility, irrespective of whether the restoration was fixed or removable.     

Treatment planning: implant-supported partial overdentures

When multiple anterior teeth are missing, many options of replacement are available. Traditionally, the choice was between a fixed or removable prostheses. Today, with the predictability of dental implants, the options of tooth replacement range from removable partial dentures to implant-supported fixed prostheses. The choice of which restoration that will best provide occlusion and esthetics depends on multiple factors including the number and location of missing teeth, the residual ridge form in relation to the replacement teeth, the relationship of the maxillary and mandibular anterior teeth, the condition of teeth adjacent to the edentulous span, the amount of bone available for implant placement, the patients "smile line" and display of teeth, lip support, and financial constraints. When there is minimal loss of the ridge contour, restorations that emerge from the ridge are the most functional and esthetic restorations, adhesive-type fixed partial dentures, conventional fixed partial dentures, and implant-supported restorations can be indicated with the choice of restoration dependent on a risk benefit and cost benefit analysis. When there is a loss of ridge contour due to residual ridge resorption or trauma, the decision becomes more complex as not only does the tooth structure need to be replaced, the ridge form also has to be replaced. (Figures 1 and 2). This can be assessed clinically as illustrated by Figures 1 and 2 where a dis crepancy in arch form and ridge form in relation to the adjacent teeth and/or opposing arch can be observed. Other considerations are lip support and display of the teeth when smiling. This article presents a case and rationale for implant-supported par tial overdentures. Many authors have written on the merits of com plete overdentures. The complete overdenture has proven to be an improvement over conventional complete prostheses with respect to chewing efficiency, patient comfort and satisfaction. In partial edentulism, the implant-supported overdenture has several advantages, some in common with a removable partial denture.     

Teaching implant dentistry in the predoctoral curriculum: a report from the ADEA Implant Workshop's survey of deans

In 2004, a survey of the deans of U.S. and Canadian dental schools was conducted to determine the implant dentistry curriculum structure and the extent of incorporating implant dentistry clinical treatment into predoctoral programs. The questionnaire was mailed to the deans of the fifty-six dental schools in advance of the ADEA Implant Workshop conference held in Arizona in November 2004. Out of the fifty-six, thirty-nine responded, yielding a response rate of 70 percent. Thirty-eight schools (97 percent) reported that their students received didactic instruction in dental implants, while one school (3 percent) said that its students did not. Thirty schools (86 percent) reported that their students received clinical experience, while five schools (14 percent) reported that theirs did not. Four schools (10 percent) did not respond to this question. Fifty-one percent of the students actually receive the clinical experience in restoring implants, with the range of 5-100 percent. Of those schools that provide clinical experience in restoring implants, four schools (13 percent) reported that it is a requirement for them, while twenty-eight schools (88 percent) reported that it is not a requirement for them. Three schools (9 percent) did not respond. The fee for implants is 45 percent higher than a crown or a denture, with a range of 0-100 percent. Twenty-nine schools (85 percent) indicated that they did receive free components from implant companies, while five schools (15 percent) did not. The conclusions of this report are as follows: 1) most schools have advanced dental education programs; 2) single-tooth implant restorations are performed at the predoctoral level in most schools; 3) implant-retained overdenture prostheses are performed at the predoctoral level in most schools; 4) there is no predoctoral clinical competency requirement for surgical implant placement in all schools that responded to the survey; 5) there is no predoctoral clinical competency requirement for implant prosthodontics in most schools that responded to the survey; 6) prosthodontic specialty faculty are often responsible for teaching implant prosthodontics at the predoctoral level; 7) periodontics and oral and maxillofacial faculty are commonly responsible for teaching implant surgery at the predoctoral level; 8) support from implant companies is common for dental schools, with most providing for implant components at discounted costs; and 9) there is a lack of adequately trained faculty in implant dentistry, which is a significant challenge in providing predoctoral students with clinical experience with dental implants.     

A model for an integrated predoctoral implant curriculum: implementation and outcomes

The implementation of an implant dental curriculum in U.S. dental schools has been consistently increasing from 33 percent in 1974 to 97 percent in 2004. Among these, only 51 percent have clinical components implemented. A survey of students conducted in 2004 at New York University College of Dentistry (NYUCD) showed an inadequacy in clinical implant restoration experience by graduation. This prompted the development of an extensive dental implant curriculum at NYUCD to meet the needs of the dental students. This report addresses the challenges in implementing such a curriculum and describes a step-by-step approach to develop a program that encompasses didactic, simulation, and patient care components. In 2005, a fully integrated predoctoral implant curriculum was initiated. In 2008, nearly all of the NYUCD students (91.8 percent) completed implant restorations/prosthesis on patients. An assessment revealed a 30 percent increase in students' positive perceptions of the implant curriculum. Based on our experiences at NYUCD, it is recommended that an implant curriculum become part of the core predoctoral curriculum and be integrated throughout the four years of dental education. This article reports on a model for a pre-doctoral implant curriculum, which includes planning, curriculum implementation, program management, and post-implementation stages. Using this model, dental schools can develop implant education for their students that is adapted to their institutional missions, priorities, and resources.     

Removable partial denture design involving teeth and implants as an alternative to unsuccessful fixed implant therapy: a case report

Various dental implants have been used, and high success rates have been reported. However, as their uses increase, implant failures have been reported. There are partially edentulous patients with an initial treatment plan of an implant-supported fixed partial denture. At times, one or more strategic implants fail to osseointegrate. In situations where financial, systemic, or local conditions preclude the use of a fixed partial denture, a well constructed removable partial denture can be an excellent treatment alternative. It has been reported that prosthesis support can be improved with the use of osseointegrated dental implants, with improved preservation and maintenance of existing hard and soft tissues around dental implants. This article describes the prosthodontic rehabilitation of a partially edentulous patient by the use of a removable partial denture design involving teeth and implants as an alternative to unsuccessful fixed implant therapy. This treatment option solved a difficult clinical problem derived from the failure of two strategic implants and provided the patient with an esthetic and functional prosthesis.     

Prosthodontic treatment with implant fixed prosthesis for a patient with ectodermal dysplasia: A clinical report

Oral characteristics of ectodermal dysplasia (ED) include hypodontia or anodontia of the primary or permanent teeth, impacted teeth, malformed and widely spaced peg-like teeth, and underdeveloped alveolar ridges. Patients with this disease often need a multidisciplinary approach to treatment planning and dental treatment to regain appropriate function, esthetics, and comfort. The definitive treatment plan may include removable, fixed, or implant-supported prostheses or a combination of these options. Depending on the remaining available alveolar bone and the pattern of missing teeth, the ideal treatment option for an adult ED patient often includes the use of implants. This clinical report describes the multidisciplinary approach to diagnosis and treatment of ED in a 37-year-old woman. The treatment included a mandibular implant-supported fixed denture and a maxillary conventional overdenture fabricated to establish acceptable occlusal vertical dimension, esthetics, and oral function.     

Flapless CAD/CAM-guided surgery for staged transition from failing dentition to complete arch implant rehabilitation: a 3-year clinical report

The transition of patients from failing dentition to complete arch implant rehabilitation often requires that the patient be rendered edentulous and has to wear a complete removable dental prosthesis for varying periods of time. This is objectionable to many patients. A staged treatment approach allows a fixed interim restoration, patient comfort, and prosthodontic control throughout the rehabilitation process. CAD/CAM-guided flapless implant surgery has the advantage of prosthetically driven implant placement and minimal postoperative sequelae. A patient with a failing dentition was treated with this combined protocol and was followed up for 3 years after loading. Implant and prosthesis survival rates were 100%, with no technical complications encountered up to the last recall. The purpose of this clinical report is to describe a combination of CAD/CAM-guided flapless surgery and a staged treatment approach, thereby giving the patient a tooth-supported or implant-supported fixed interim prosthesis during the entire rehabilitation process. The various surgical, laboratory, and prosthetic stages are illustrated for the complete arch prosthetic rehabilitation, and the 3-year follow-up outcome is reported.     

Posttreatment quantification of patient experiences with full-arch implant treatment using a modification of the OHIP-14 questionnaire

Patient well-being is always the goal of rehabilitation of edentulism; however, evaluations of treatment success often overlook the patient's subjective feelings about comfort, function, speech, social image, social inhibitions, psychological discomfort, and/or disabilities. The purpose of this study was to assess these patient responses using an oral health questionnaire. To assess such feelings, a self-administered 20-question multiple-choice patient-reported Edentulous Patient Impact Questionnaire was developed, based upon the previously validated Oral Health Impact Profile patient-assessment tool. Responses were solicited from randomly selected patients treated with an implant-supported, fixed, immediately loaded full arch prosthesis. The questionnaires were completed by 250 patients. Of the respondents, 95% described themselves as being either extremely satisfied (74%) or satisfied (21%) with their new teeth, and 98% said they would definitely recommend similar treatment (88%) or consider recommending it (10%) to a friend or colleague. Based upon an oral health impact survey completed by 250 patients treated with full-arch implant-supported, immediately loaded fixed dental prostheses, it appears that patient satisfaction is high and that treated patients would generally be willing to recommend this treatment to others.     

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.     

Implant-retained dentures for full-arch rehabilitation: a case report comparing fixed and removable restorations

Dental implants as abutments for full-arch restorations are a well-documented treatment modality. This report presents a case in which the patient was treated initially with fixed restorations supported by either implants or natural teeth and subsequently treated with a removable implant/telescopic crown-supported overdenture. Advantages and disadvantages of each approach are described and discussed. While the fixed restoration resulted in a functionally satisfactory treatment outcome, the patient was displeased with the esthetic appearance. The main concern was the unnaturally long tooth shape necessary to compensate for the insufficient alveolar ridge height. Replacement of the existing restoration with an implant-supported removable overdenture led to a functionally and esthetically acceptable result. When deciding whether to use a fixed or removable implant-supported full-arch restoration, a multitude of factors must be considered. Due to the possible need for additional surgical steps to enhance the esthetic appearance surrounding fixed restorations, removable implant-supported partial dentures often are the better choice.     

Conservative rehabilitation of missing teeth before placement of implant dentures: clinical reports

Although implant-supported restorations often are preferred for the replacement of missing teeth, their high cost means that they can be given only to patients who can afford them. The clinical reports in this article describe interim conservative restorations made after orthodontic treatment to achieve esthetics, phonation, and function until implant-supported dentures were made. In all cases, the patients who received fiber-reinforced resin composite fixed partial dentures returned for follow-up visits at three-month intervals and reported no complaints during a year of follow-up visits. The desired esthetics can be achieved with temporary conservative treatment until the implant dentures are applied; if this treatment meets the patient's esthetic expectations, the final restoration can be fabricated according to these contours.     

Level of satisfaction in patients with maxillary full-arch fixed prostheses: zygomatic versus conventional implants

PURPOSE: To evaluate the satisfaction of patients with maxillary fixed prostheses supported by conventional and/or zygomatic implants. MATERIALS AND METHODS: Patients restored with complete maxillary implant-supported fixed prostheses were included in the study. They were divided into 2 groups: those with at least 1 zygomatic implant (the zygomatic group) and those with no zygomatic implants (the nonzygomatic group). Twelve months after prosthesis delivery, subjects indicated their satisfaction with the new prosthesis on a visual analog scale. Prostheses were rated in terms of general satisfaction, comfort and stability, ability to speak, easy of cleaning, esthetics, self-esteem, and functionality. RESULTS: Forty-six patients participated in the study (23 in each group). The mean level of satisfaction was high; the groups differed significantly only in satisfaction with esthetics. Patients in the zygomatic group had a higher average score for esthetics than those in the nonzygomatic group. Those who had previously worn conventional removable prostheses gave a higher score for functionality to the implant-supported fixed prosthesis compared to the removable prosthesis. CONCLUSION: Patient satisfaction with zygomatic implant-supported fixed prostheses was similar to that for fixed prostheses supported by conventional implants.     

Perceptions of outcomes of implant therapy in patients with ectodermal dysplasia syndromes

PURPOSE: The purpose of this study was to evaluate patient-specific outcomes and satisfaction using dental implants in a population affected with ectodermal dysplasia. MATERIALS AND METHODS: Patient-based data were collected using a self-reported survey instrument sent to patients belonging to a private patient foundation and/or treated previously at a government clinic. A standardized survey instrument was developed to evaluate patient satisfaction, outcomes, and potential complications using dental implants. RESULTS: The survey instrument was mailed to 253 affected individuals self-reported to have various forms of ectodermal dysplasia and who were voluntarily participants in the National Foundation for Ectodermal Dysplasias and/or were participants in the US National Institute for Dental Craniofacial Research Intramural Ectodermal Dysplasia clinical research program. A total of 109 responses were obtained (43% response rate). The duration following completion of implant therapy ranged from to 1 to 23 years. Of the 109 participants, 50% reported either an implant or prosthetic complication with implant treatment, and 24% reported some form of failure with implant therapy. However, 91% of participants reported being either satisfied or very satisfied with dental implants, and 95% reported that the treatment was worth the time and cost. CONCLUSIONS: Affected individuals receiving tooth replacement therapy with dental implants reported satisfaction with the outcome. A higher level of complications, including infection, mechanical problems, and implant loss, relative to the unaffected population was reported.     

Dental implants in geriatric patients: a retrospective study of 47 cases

PURPOSE: To determine the overall success of dental implants placed in geriatric patients. PATIENTS: Dental implants were placed in 47 geriatric patients who were 79 or more years of age at the time of the procedure. The study group was composed of 27 men and 20 women, with a median age of 89 years and a range of 79 to 99 years of age at the time of implant surgery. A total of 73 dental implants were placed in the maxilla and 87 dental implants placed in the mandible. All implants were restored with fixed implant-supported prostheses or removable implant-supported prostheses. Eleven of the patients underwent maxillary sinus augmentation with porous hydroxyapatite and platelet-rich plasma. Seven patients had their implants immediately loaded. RESULTS: A total of 160 dental implants were placed in the 47 geriatric patients. One hundred fifty-nine integrated successfully. In the case of the failed implant, the site was grafted and another implant was placed 5 months subsequent to the initial failure. This replacement implant integrated and has been in function for 6 months. The survival rate for dental implants placed in the maxilla was 99% and in the mandible was 100% in our geriatric population. CONCLUSION: Treatment with dental implants can be predictable and safe for the rapidly growing geriatric population. Geriatric patients who are medically stable are suitable candidates for osseointegrated implant surgery, which facilitates oral function, comfort, and quality of life. A review of the 47 geriatric patients treated supports the conclusion that dental implants can be successfully placed and restored with fixed implant-supported or removable implant-supported prostheses.     

Veterans Administration Cooperative Dental Implant Study — Comparisons between fixed partial dentures supported by blade-vent implants and removable partial dentures. Part I: Methodology and comparisons between treatment groups at baseline

This study was conducted to determine whether fixed partial dentures supported by dental implants provide an acceptable alternative to conventional removable partial dentures in patients with Kennedy class I or class II edentulous conditions. The acceptability of the new treatment will be based on success rates, impact on the health of the remaining dentition, masticatory performance, patient satisfaction, and maintenance care and cost. The study was planned also to provide comparisons between two designs commonly used by dentists for fabricating removable partial dentures. The designs differed only in terms of the type of the retainer (clasp type) and tooth support (rest location).A total of 272 patients with Kennedy class I and class II edentulous conditions were assigned on a random basis to one of the treatment groups, 134 to receive a removable partial denture and 138 a fixed partial denture supported by a blade-vent implant. All of the patients were medically screened and met prespecified criteria for oral hygiene, bone support for abutment teeth, and size of the residual ridge.Thirty-four patients were eliminated from the study before completion of their treatment. An additional six patients with early implant failures were reentered in the study and followed up as a separate group. The remaining 232 patients received comprehensive dental care, including removable partial dentures for 118 and fixed partial dentures for 114 patients.A series of examinations, radiographs, masticatory performance tests, patient satisfaction, food selection questionnaires, and dietary history were completed before initiation of the treatment, 16 weeks after the insertion of an RPD or an implant, and thereafter at 6-, 18-, 36-, and 60-month intervals. In addition, patients were seen at 6-month intervals for a recall dental examination, oral prophylaxis, plaque instructions, radiographic survey of the implant, and any needed dental treatment.The randomization stratification approach produced two treatment groups with comparable age, number of remaining maxillary and mandibular teeth, type of opposing dentition, and percent of patients with Kennedy class I and class II edentulous conditions. The mean scores of bone support, tooth mobility, and sulcular depths of abutment teeth were also similar. Significant but comparable improvements in oral hygiene and sulcular depth occurred in the two groups after treatment. The periodontal health scores at the 16-week interval serve as the baseline to measure subsequent changes in periodontal health. This prospective longitudinal study with prespecified criteria for implant and removable partial denture failure should provide reliable estimates of failure rates, number and types of complications, maintenance care needs, and total costs for the two treatment modalities and the two RPD designs.     

Patients' satisfaction following implant therapy. A 10-year prospective cohort study

AIM: To analyse the patients' perception of implant therapy, 10 years following installation of titanium oral implants. MATERIAL AND METHODS: As a part of a prospective cohort study of patients with ITI(R) dental implants, 104 patients were recruited to answer a questionnaire with 13 statements on the subjective perception of implant treatment, 5-15 years after implant installation (mean: 10.2 years). In addition, the patients were asked to mark a visual analogue scale (VAS) in which 0 indicated "total discontent" and 100 "total satisfaction" with the statements mentioned in the questionnaire. Results from the qualified questions answered were then compared with those obtained from VAS analysis. RESULTS: One hundred and four patients, with 214 installed oral implants participated. Forty-eight percent of the implants were reconstructed with single crowns and 52% with fixed partial dentures (FPD). The cumulative survival rate of the implants at 10 years was 93%. Two of the statements addressing function and chewing comfort yielded very high patient satisfaction (97% highly satisfied or satisfied, mean VAS: 94+/-13). Comparing chewing comfort for teeth or implants, respectively, 72.1% perceived no difference between the two, 17.3% felt more secure when masticating on teeth and 7.7% when masticating on implants (mean VAS: 54+/-24). The vast majority (96%, mean VAS: 96+/-10) was highly satisfied or satisfied with phonetic function and with aesthetics (97%, mean VAS: 93+/-13). A great majority of the patients (93%, mean VAS: 89+/-19) had no problems with cleansing the implant reconstruction. Indeed, one-third (37%, mean VAS: 55+/-27) indicated more ease to clean implants than to clean teeth. About half of the patients (47%) had noticed bleeding of the mucosa or the gingiva following brushing. In addition, half (47%) of those noticing bleeding felt that bleeding was less marked around implants than around teeth. Again, the vast majority of patients (92%, mean VAS: 92+/-14) indicated complete fulfilment of the treatment, i.e. the outcome satisfied their expectations. The same majority (94%, mean VAS: 93+/-17) would be willing to undergo the same treatment again, and (89%, mean VAS: 93+/-16) would even recommend such treatment to friends and relatives, if indicated. The cost for implant therapy was deemed to be reasonable to a large extent (87%, mean VAS: 85+/-20). CONCLUSION: Using oral implants, more than 90% of the patients were completely satisfied with implant therapy, both from a functional and aesthetic point of view. The costs associated with implant therapy were considered to be justified. This was determined by both qualified questions and the use of VAS after 10 years of function.     

The milled bar-retained removable bridge implant-supported prosthesis: a treatment alternative for the edentulous maxilla

Restoration of the edentulous jaw with dental implants can be achieved using either an implant-supported prosthesis, such as a fixed bridge, or an implant-retained prosthesis, such as a traditional overdenture. The implant-retained prostheses use edentulous ridges as primary stress-bearing regions, and through stress-breaking mechanisms, the implants are not loaded during function. However, the success rates of maxillary overdentures do not appear to be as good as for mandibular overdentures; this may be attributable to the adverse loading conditions, short implant length, poor quality of bone, number of implants used, flexible bar design, or poor treatment planning. Many articles have also described the numerous problems and multiple visits required in maintaining a traditional bar-retained overdenture restoration, often making it more expensive in the long term than a fixed restoration. The milled bar implant-supported prosthesis offers the benefits of both fixed and removable restorations. Its infrastructure provides the same rigidity as the fixed restoration, owing to the precise fit to the superstructure, which is removable, to promote adequate access for hygiene, yet it still provides lip support and maintains close contact with the soft tissues. These advantages enhance phonetics, esthetics, correct lip support, maintenance, and patient comfort.
CLINICAL SIGNIFICANCE
Restoring esthetics and function for the edentulous patient requires a multidiscipline approach for success. This article discusses the techniques for restoring function and esthetics for these patients, using a milled bar restoration supported and retained by dental implants.     

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.