Management of a Fractured Multiunit Maxillary Implant‐Supported Fixed Prosthesis with Stripped Abutment Screws Using a Hybrid Cement‐Retained and Screw‐Retained Design: A 5‐Year Follow‐Up Clinical Report

Fracture and loosening of implant‐supported prostheses (ISPs) are complications encountered in routine dental practice. In the present report, management of a fractured maxillary full‐arch cement‐retained (CR) fixed dental prosthesis supported by six implants is presented. Due to stripped screws, complications were encountered that prevented the retrieval of two of the six abutment screws, which was managed by using a hybrid retention approach, whereby a single full‐arch CR and screw‐retained (SR) ISP was used. The techniques used to successfully retrieve four of the abutment screws are described. The final retention design involved a combination of three CR and three SR restorations, which offers the advantages of both retention designs.     

Intraoral Luting: Modified Prosthetic Design to Achieve Passivity,Precision of Fit,and Esthetics for a Cement‐Retained,Implant‐Supported Metal‐Resin‐Fixed Complete Denture

An intraoral luting technique between electroformed gold copings and a metallic framework for a cement‐retained, implant‐supported metal‐resin‐fixed complete‐denture is presented. The peculiarity is the different prosthetic design with the metallic framework that was 1.5 mm shorter than the margin of the electroformed copings. As a consequence, the conventional thick prosthesis margin (electroformed copings, cement for the luting phase, framework) was modified into a thin electroformed prosthesis seal (0.3 mm) just beyond the apical limit of the esthetic material. Passive fit between the framework and the electroformed gold copings was achieved during the intraoral luting phase. The procedure was efficient and standardized and enhanced esthetics.     

A Prosthesis Retention System for Full‐Arch,Fixed, Implant‐Supported Prosthesis

Full‐arch, fixed, implant‐supported prostheses can be designed to be cement‐ or screw‐retained. Both retention mechanisms have a few inherent disadvantages. A fixed attachment system has been introduced to circumvent the disadvantages of both screw and cement retention. This system eliminates the screw access holes and the use of cement. The number of intraoral procedures required is also reduced. The purpose of this article is to report a case using the Locator F‐Tx Attachment System to facilitate fabrication of an esthetic, clinician‐retrievable, full‐arch implant‐supported fixed dental prosthesis.     

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.     

A 30‐Year Follow‐Up of a Patient with Mandibular Complete‐Arch Fixed Implant‐Supported Prosthesis on 4 Implants: A Clinical Report

Mandibular complete‐arch fixed implant‐supported prostheses are recognized as one of the earliest and most popular prostheses in implant dentistry. This prosthesis was the main focus in the early era of osseointegration. Despite its widespread popularity, few clinical reports have described long‐term follow‐up greater than 10 years for this type of prosthesis. This report describes a 30‐year follow‐up of a patient who underwent treatment for a mandibular complete‐arch fixed implant‐supported prosthesis with 4 machined surfaced implants, opposing a maxillary complete denture. This report documents a variety of photographs and radiographs taken over a period of 30 years to compare bone levels at various stages of care and maintenance, including de novo bone formation underneath the distal cantilevers due to functional loading. The biologic and biomechanical response to this treatment protocol and long‐term clinical observations and prosthodontic outcome and maintenance needs are also addressed.     

Prospective 10‐Year Cohort Study Based on a Randomized,Controlled Trial (RCT) on Implant‐Supported Full‐Arch Maxillary Prostheses. Part II: Prosthetic Outcomes and Maintenance

Background: Long‐term follow‐up studies (i.e., over 5 years), focusing on prosthetic outcomes and maintenance of implant‐supported reconstructions in the edentulous maxilla, are scarce in the literature. Purpose: The purpose of this study was to evaluate and report 10‐year data on outcomes and maintenance of screw‐retained implant‐supported full‐arch casted titanium‐resin prostheses in the edentulous maxilla. Materials and Methods: In the randomized control trial cohort of 24 patients, the outcome and maintenance of 23 bridges were registered. Results: One patient dropped out of the study prior to the 10‐year control. Of the 23 remaining patients, 21 still had their original frameworks; one framework fractured after 8 years and one was remade after 7 years to create better support for the acrylic. The remaining 23 prostheses showed criteria of success, survival, and failure in 9, 82, and 9%, respectively. Tightening of two assembly screws was necessary in one patient. No detrimental effects were seen because of long cantilever extensions or opposing dentition. A total of 4.7 resin‐related complications per prosthesis were observed; tooth fracture was the most common prosthetic complication. There was an indication of greater prevention in the number of resin‐related complications with the use of lingual gold onlay compared with a resilient mouth guard, 0.71 and 1.67, respectively per bridge. The bridges were removed and reinserted 0.83 times per patient. No abutment or abutment screw fractures were registered. Conclusion: Fracture or wear of the reconstruction materials were considered predictable risks when using resin‐based suprastructure materials. Status of opposing dentition and length of cantilevers did not confer additional risk. The use of a lingual gold onlay indicated prevention of resin‐related complications. Future research should focus on the suprastructure materials to predict better overall treatment results of implant‐supported full‐arch bridges in the edentulous maxilla.     

Oral rehabilitation of a patient with bruxism and cluster implant failures in the edentulous maxilla: a clinical report

For most patients with failed dental implants, the placement of new implants is the only option that allows for retreatment with a fixed dental prosthesis. This clinical report describes the rehabilitation of a patient with a history of bruxism and cluster implant failures in the edentulous maxilla 10 years after the insertion of a milled bar overdenture. Seven failed implants were removed and simultaneous bone grafting was performed. After an 8-month healing period, 8 dental implants with new surfaces were placed. These supported a metal ceramic fixed complete denture with a metal occlusal surface. The prosthesis was retained with 3 sections of milled bars and 3 set screws. This clinical report describes the details of the treatment with an emphasis on prosthetics.     

Comparing bar and double-crown attachments in implant-retained prosthetic reconstruction: a follow-up investigation

Objectives: A removable implant‐retained dental prosthesis in an edentulous mandible can use telescopic crowns or a bar superstructure as anchorage elements for an overdenture. The aim of this study was to compare the clinical results for bar‐anchored and telescopic crown‐retained overdentures in implant prosthetic treatment of the toothless lower jaw with two or more implants placed in the intraforaminal region. Material and methods: A clinical and radiographical comparison was made of the telescope vs. the bar method for removable prosthetic rehabilitation treatments in patients with an edentulous mandible. For evaluation of the clinical data, the sulcus fluid flow rate, Periotest values, and the peri‐implant bone loss were recorded. Results: In the follow‐up examinations, 19 implant losses were reported between insertion and review of 328 implants. The frequency distribution of the observed loss rates showed no treatment‐specific trend. In the group with bar‐treated implants, failure led to ‘group loss’ of the whole prosthetic superstructure. Failure of one of the double‐crown‐stabilized full dental prosthesis could usually be adapted so that the overdenture remained usable even without re‐implantation. Conclusions: After comparing all the clinical parameters evaluated, no significant difference between the stabilization of full dentures via conus and telescopic crowns and bar‐anchored dentures could be found. The choice of one particular method remains the decision of the professional treating the patient.     

Fixed Implant‐Retained Rehabilitation of the Edentulous Maxilla: 11‐Year Results of a Prospective Study

Objectives: The aim of the present study was to assess long‐term survival and success rates of implants in the edentulous maxilla restored with an implant‐supported fixed prosthesis. Materials and Methods: Seventeen edentulous patients received six to eight implants and implant‐supported fixed prostheses by one surgeon. Yearly recalls were conducted by two examiners over a period of 11 years. Survival and success rates (biological complications) were determined; marginal bone loss was examined radiographically. Furthermore, microbiological tests as well as test for interleukin‐1 composite genotype were assessed and potential risk factors were evaluated. Results: After a mean time of 11.26 years, 15 patients of 17 could be reexamined. Out of 94 implants, three were lost in one patient. Mean marginal bone loss reached 0.88 mm, two patients (at seven implants) showed bone loss of ≥3.2 mm. Survival rate of implants reached 96.8%. Success rates on implant level hit 92.6% according to the criteria of Albrektsson and colleagues and 83.0% in accordance with Karoussis and colleagues. One prosthesis had to be renewed. Conclusion: Within the limitation of this study, restoration of the edentulous maxilla with an implant‐supported fixed prosthesis represents an effective tool for rehabilitation over a period of 11 years.     

A Fixed Telescopic Prosthesis Designed to Retrieve and Convert to Fixed-Removable Combination Case: A Clinical Report

This clinical report describes a fixed maxillary telescopic dental prosthesis (FTDP) employing milled base metal copings and a metal superstructure veneered with composite resin, for the restoration in a periodontally compromised patient with uncontrolled diabetes. The telescopic prosthesis framework design incorporated occlusal rest seats in key positions along the arch in case of future posterior tooth loss, in order to be converted to fixed - removable combination prosthesis. The mandible was restored with a conventional fixed ceramo-metal dental prosthesis.Key words: Denture, Partial, Fixed; Denture Design; Denture Bases; Dental Veneers; Denture Precision Attachment; Diabetes Complications; Periodontitis     

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.     

Full Mouth Rehabilitation with Maxillary Tooth Supported and Mandibular Tooth and Implant Supported Combination Prostheses: A 4-Year Case Report

The primary objectives of successful prosthetic rehabilitation are to provide function, esthetics and comfort to the patient. Combination prosthesis is one which is supported by both natural teeth and implant. The periodontal ligament and osseointegrated interface distribute force differently to the supporting bone. Therefore problems can develop when tooth and implants are combined in the same prosthesis. However, clinicians can apply biomechanical principles, to negate the deleterious leverages exerted by the fixed prosthesis by using non rigid components and to equalize the stress applied by the prosthesis on implant and teeth. A case of partially edentulous situation was rehabilitated successfully with a combination of prostheses. Maxillary arch was restored to function with crowns, fixed dental prosthesis and with an extra coronal castable attachment prosthesis and the mandibular arch with a combination of tooth and implant supported attachment prosthesis. The clinical and laboratory steps for the fabrication of these prostheses are explained in this report.     

A Novel Approach for Converting a Mandibular Complete Denture to a Fixed Interim,Screw‐Retained Implant Prostheses: A Case Report

For most of the last century, conventional complete dentures have been the standard of care and the most common treatment for edentulous patients. Technological advancements in fabrication techniques may significantly reduce the number of office visits required to fabricate complete dentures. Immediate occlusal loading with mandibular full arch prostheses has been extensively researched and is now one of the standards of care for edentulous patients. A clinical technique for converting a mandibular immediate complete denture to an interim full arch, screw‐retained fixed prosthesis with novel implant restorative components for immediate loading on four implants is described.     

A prospective clinical study on titanium implants in the zygomatic arch for prosthetic rehabilitation of the atrophic edentulous maxilla with a follow-up of 6 months to 5 years

Background Prosthetic rehabilitation with implant‐supported prostheses in the atrophic edentulous maxilla often requires a bone augmentation procedure to enable implant placement and integration. However, a rigid anchorage can also be achieved by using so‐called zygomatic implants placed in the zygomatic arch in combination with regular implants placed in residual bone. Purpose The aim of the present study was to report on the clinical outcome of using zygomatic and regular implants for prosthetic rehabilitation of the severely atrophic edentulous maxilla. Materials and Methods Sixty‐nine consecutive patients with severe maxillary atrophy were, during a 5‐year period, treated with a total of 69 fixed full‐arch prostheses anchored on 435 implants. Of these, 131 were zygomatic implants and 304 were regular implants. Fifty‐seven bridges were screw‐retained and 12 were cemented. The screw‐retained bridges were removed at the examination appointments and each implant was tested for mobility. In addition, the zygomatic implants were subjected to Periotest^® (Siemens AG, Bensheim, Germany) measurements. The patients had at the time of this report been followed for at least 6 months up to 5 years in loading. Results Two regular implants failed during the study period giving a cumulative survival rate of 99.0%. None of the zygomatic implants was removed. All patients received and maintained a fixed full‐arch bridge during the study. Periotest measurements of zygomatic implants showed a decreased Periotest values value with time, indictating an increased stability. Three patients presented with sinusitis 14–27 months postoperatively, which could be resolved with antibiotics. Loosening of the zygomatic implant gold screws was recorded in nine patients. Fracture of one gold screw as well as the prosthesis occurred twice in one patient. Fracture of anterior prosthetic teeth was experienced in four patients. Conclusions The results from the present study show that the use of zygomatic and regular implants represents a predictable alternative to bone grafting in the rehabilitation of the atrophic edentulous maxilla.     

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.     

金沉积技术在种植固定修复中的临床应用效果观察

目的:探讨金沉积技术在种植固定修复中的临床应用效果。方法:7例牙列缺失与牙列缺损的患者(男性3例,女性4例,年龄22-58岁),共9个修复体,其中单冠6个,无牙颌固定桥3个,植入种植体34个。观察方法为临床检查及x线检查。修复后平均追踪27个月(14-37个月)。结果:所有病例在修复后至最后一次复查未见种植体脱落。所有修复体无折断、松动或破损,修复效果良好,患者满意。一例行金沉积烤瓷单冠修复患者的一个烤瓷单冠在紧固横向螺钉时发生瓷面裂纹,经再次烧结后固定。结论:本研究结果提示金沉积技术用于制作种植体支持的修复体具有良好的生物相容性,美学效果好,同时还可以通过金沉积冠作为固位体解决种植修复体多个固位体之间的被动就位问题,近期临床效果满意。     

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.     

Patient Evaluation of Treatment with Fixed Prostheses Supported by Implants or a Combination of Teeth and Implants

PURPOSE: The objective of this study was to compare treatment outcomes among subjects with complete arch fixed prostheses in the maxilla, supported by implants or a combination of natural teeth and dental implants. MATERIALS AND METHODS: Twenty-one subjects with maxillary tooth- and implant-supported fixed prostheses and 21 subjects with maxillary implant-supported fixed prostheses were identified and included in the study. All abutment teeth in the group with tooth- and implant-supported prostheses were provided with cemented copings that incorporated threads for vertical locking screws. Frameworks were fabricated with a gold alloy that was veneered with acrylic resin or ceramic materials. All frameworks were screw-retained to implants and copings. Frameworks in the group with implant-supported prostheses were fabricated with milled titanium or gold alloy to which denture teeth and resin base material were applied. All prostheses had a minimum of 8 units, at least 4 of which were in one quadrant. Subjects in both groups were mailed a questionnaire consisting of 15 questions focused on various factors related to treatment outcome, such as oral function and patient satisfaction. RESULTS: The response rate was 86%. Both groups reported a high satisfaction rate for most items with few regretting their choice of treatment. Most individuals in both groups reported great improvement in chewing ability and few reported phonetic disturbances. No statistically significant differences were found between the groups. CONCLUSION: The results of the present study showed similarity in questionnaire responses between the 2 groups of participants. High satisfaction was reported both among subjects who received a complete arch fixed prosthesis in the maxilla supported by dental implants only, as well as among those whose prostheses were supported by a combination of natural teeth and dental implants.     

A Simple Technique for Accurate Transfer of Secondary Copings in a Tooth‐Supported Telescopic Prosthesis

Residual ridge resorption is a rapid, progressive, irreversible, and inevitable process of bone resorption. Long‐standing teeth and implants have been shown to have maintained the bone around them without resorption. Thus, overdenture therapy has been proven to be beneficial in situations where few remaining teeth are present. In addition to the various advantages seen with tooth‐supported telescopic overdentures, a few shortcomings can also be expected, including unseating of the overdenture, increased bulk of the prosthesis, secondary caries, etc. The precise transfer of the secondary telescopic copings to maintain the spatial relationship, without any micromovement, remains the most critical step in ensuring the success of the tooth‐supported telescopic prosthesis. Thus, a simple and innovative technique of splinting the secondary copings was devised to prevent distortion and micromovement and maintain its spatial relationship.     

Electromyographic analysis of masticatory and neck muscles in subjects with natural dentition, teeth-supported and implant-supported prostheses

Objectives: To compare the electromyographic (EMG) characteristics of masticatory and neck muscles in patients with natural dentition, teeth‐supported prostheses and implant‐supported prostheses. Materials and methods: Twenty‐five subjects aged 40–80 years were examined. Five patients had maxillary and mandibular implant‐supported fixed prostheses; five patients had mandibular implant‐supported fixed prosthesis and maxillary removable complete denture; seven patients had implant‐supported fixed prosthesis (one arch) and natural dentition or full‐arch tooth‐fixed prosthesis (one arch); and eight control subjects had natural dentition or single tooth‐fixed prostheses. Surface EMG of masseter, temporal and sternocleidomastoid muscles was performed during maximum teeth clenching and unilateral gum chewing. Interarch dental contacts were assessed with shim stocks. Results: All groups had similar interarch dental contacts (P>0.05). During clenching, patients with maxillary and mandibular implant‐supported fixed prostheses had unbalanced standardized masseter and temporalis anterior activities (74%), with significantly larger values found in the other patients and control subjects (all mean values larger than 86%, P=0.017). All patients chewed with significantly larger muscular potentials than control subjects (on average, 1434–2100 μV s vs. 980 μV s, P=0.04), and had altered muscular patterns (left side, P=0.021). The patients with one arch with natural dentition/tooth fixed prostheses had chewing muscular patterns similar to the control subjects. Conclusions: Clenching with the analyzed prostheses was performed with a relative increment of temporalis activity. Neuromuscular coordination during chewing was larger in patients who maintained their teeth or dental roots, independently from the number of dental contacts.