CASE SERIES OF REHABILITATION OF EDENTULOUS INDIVIDUALS WITH FULL ARCH FIXED PROSTHESIS:
A 46 year old female patient, reported to Dental specialties, Mayo Clinic, Rochester for replacement of missing teeth. She was partially edentulous with masticatory dysfunction, severely compromised remaining dentition with generalized periodontal disease accompanied by xerostomia and discrepant occlusal plane. Decision was made to extract the remaining teeth and roots. Sinus augmentation of the left maxillary sinus was performed by harvesting platelet rich plasma and grafting along with localized autologous particulate bone grafting. Six implants (Mark III TiUnite endosseous implants) were placed in the maxilla and six implants in the mandible and were immediately provisionalised. She underwent rehabilitation with a single piece metal ceramic maxillary restoration and a two piece metal ceramic mandibular restoration split in the midline.
A 50 year old female patient, reported to Dental specialties, Mayo Clinic, Rochester for replacement of missing teeth. She was diagnosed with partial edentulism, nonrestorable remaining maxillary and mandibular teeth and pneumatized left posterior maxilla. It was felt that patient would benefit from undergoing extraction of root tips in the maxillary and mandibular posterior. She would also undergo autogenous bone graft with platelet rich plasma for sinus augmentation of the left maxillary sinus. Endosseous implant (Mark III TiUnite) reconstruction of bilateral maxilla with 6 implants and bilateral mandible with 6 implants was carried out after surgical removal of remaining mandibular teeth. She underwent rehabilitation with a full arch maxillary zirconia restoration and a two piece zirconia mandibular restoration split in the midline.
A 51-year-old gentleman reported to Dental specialties, Mayo Clinic, Rochester with post-traumatic malocclusion and compromised remaining dentition. It was certain that patient would benefit from virtual surgical planning and it was planned that he would undergo LeFort I osteotomy with maxillary advancement, surgical odontectomy of remaining dentition, endosseous implant (Mark III TiUnite) reconstruction of maxilla and mandible by eight and six implants respectively. These were rehabilitated with implant supported full arch maxillary metal ceramic restoration and a two piece metal ceramic mandibular restoration split in the midline.
Being edentulous is a handicap, and the main objective of implant placement is to provide fixed prosthesis or to stabilize complete dentures in the edentulous jaws. The reasons for loss of teeth could be trauma, chronic periodontitis, caries etc. Chronic periodontitis can result in severe loss of periodontium which is often associated with various systemic conditions. Restoring and rehabilitation of edentulous jaws using osseointegrated implants has gained popularity for decades. The above represented cases show rehabilitation with dental implants as the elective treatment after patients expressed their preference for a fixed solution. After performing preliminary radiographic screening, assessing jaw size and relations, the restoration of oral function and esthetics of these patients with fixed screw-retained implant supported prostheses was accomplished.
Concerns with the biocompatibility and optical properties of metal ceramic restorations provoked the shift to all ceramic restoration placement. Zirconia fixed prostheses can be considered reliable products in both the anterior and posterior fields with survival rates comparable to traditional metal ceramic prosthesis. In addition to excellent esthetic characteristics, the mechanical strength of zirconia is suitable to withstand masticatory loads in the posterior area of the oral cavity. Zirconia can theoretically overcome crack propagation through a process called “transformation toughening” which allows the material to partially increase in volume discouraging development of cracks.
Conclusion: A comprehensive understanding of the range of prosthetic components is essential for this type of treatment. Hence, a thorough understanding of the surgical, material and prosthodontic components for this type of treatment is essential.
1. Mericske-Stern, R.D., T.D. Taylor, and U. Belser, Management of the edentulous patient. Clin Oral Implants Res, 2000. 11 Suppl 1: p. 108-25.
2. Gargari, M., et al., Strength of zirconia fixed partial dentures: review of the literature. Oral Implantol (Rome), 2010. 3(4): p. 15-24.