Complete Artificial Dentition Supported by Endosseous Implants: A Case Report of Total In-office Treatment
This case report demonstrates the construction of a complete restoration of the dentition by the surgical placement of endosseous titanium implants that support a fixed prosthesis in each jaw. The positioning of the implants and teeth in the prostheses are important factors for a successful long-term result. Distribution of the occlusal biting forces over as many implants as possible is important. Off-axial occlusal biting forces should be diverted to the anterior prostheses, where the forces are not as great and the posterior teeth are designed with flat occlusal surfaces that separate during excursionary chewing movements. Medial mandibular flexure caused by the contraction of the medial pterygoid muscle can be addressed by constructing the prosthesis in segments. This is so as not to have a rigid entity encased in flexing bone that may induce stress to the bone, leading to loss of implant integration and failure. Segmenting also insures an appropriate fit of the prosthesis with respect to casting and porcelain firing distortion. Lip support by means of a flange in the prosthesis may be necessary when there has been a large amount of bone loss from edentulous resorption. Cleaning and maintenance of the prostheses every 3 to 6 months is essential.Abstract
Panoramic radiograph of edentulous condition. Figure 2. Computerized tomographic section of edentulous maxilla. Figure 3. Vacu-form demonstrating lip support without a flange. Figure 4. Panoramic radiograph of placed implants
Working casts were mounted on a nonarcon semiadjustable articulator. Figure 6. Centric registration using the provisional complete denture as a guide. Figure 7. Protrusive wax registration. Figure 8. Appearance of provisional fixed partial denture. Figure 9. Close-up of provisional prosthesis. Figure 10. Remount registration of cast substructure
Implant splint groupings. Numbers pertain to particular teeth. Numbers 3 through 5 are the maxillary right first molar and second and first premolars, respectively. Numbers 6 through 8 are the maxillary right canine and the lateral and central incisors, respectively. Numbers 9 through 11 are the maxillary left central and lateral incisors and canine, respectively. Numbers 12 through 14 are the maxillary left first and second premolars and first molar, respectively. Numbers 19 through 22 are the mandibular left first molar, second and first premolar, and canine, respectively. Numbers 23 and 24 are the mandibular left lateral and central incisors, respectively. Numbers 25 and 26 are the right central and lateral incisors respectively. Numbers 27 through 30 are the mandibular right canine, first and second premolars, and first molar, respectively. Figure 12. Schematic of posterior occlusal table
Left working occlusion. Figure 14. Protrusive occlusion. Figure 15. Centric occlusion. Figure 16. Profile of lip support. Figure 17. Preoperative edentulous profile. Figure 18. Panoramic radiograph of final restoration
Contributor Notes
Dennis Flanagan, DDS, is in private practice. Address correspondence to Dr Flanagan at 1671 West Main Street, Willimantic, CT 06225 (dffdds@charter.net)