The number of edentulous patients is on the rise. As a group they are becoming increasingly important to every dentist.
Demographic data indicates that the number of edentulous patients will continue to grow in the years to come, and in a world full of readily available digital information, patients’ expectations — as well as their awareness of available treatment options — are increasing at the same time.
Taking each patient’s clinical situation, expectations, available time, and financial situation into account, the dental team has to decide first and foremost on the most appropriate treatment protocols and materials to recommend.
Then they must communicate the benefits of competing treatment alternatives and explain the availability of low-cost, yet high-quality, restorative options such as titanium frameworks with acrylic veneering, denture teeth or treatment concepts such as All-on-4, which uses four implants to support an immediately loaded full-arch prosthesis.
Overdentures for patients with little hard and soft tissue
Edentulous patients commonly present extensive loss of hard and soft tissue, which can be attributed to a variety of factors, ranging from severe periodontal breakdown to external trauma. Making matters worse, the longtime use of full-arch dentures leads inevitably to atrophy of the alveolar ridges.
While many additive techniques for the reconstruction of missing anatomic morphology are employed on a routine basis today, surgical intervention may not always lead to the desired outcome. Physiologically, some patients may be poor candidates for extensive grafting, or they may simply decline such treatment on emotional or financial grounds.
In these situations, treatment concepts that make it possible to provide reliable bone-anchored support in minimal volumes of hard tissue become especially relevant, as does the use of soft tissue-colored resin or porcelain in the final restoration.
One promising and fast growing treatment concept is based on the use of bar-retained overdentures (often called, “fixed-removable”). Overdentures allow for the proper support of extra-oral tissue, which restores facial appearance and esthetics, and provide complete functional stability at the same time. They also allow for easy, fast and simple hygiene maintenance by the patient. This characteristic is recognized as one of the most critical predictors for the long-term survival and success of any implant restoration.
Loading dental implants immediately
The loading protocol also needs to be taken into consideration. While staging implant therapy over time is a highly predictable option, the extraction of remaining teeth and roots, simultaneous or delayed implant placement, and immediate provisionalization also represent protocols that are routinely performed with good success.
Loading dental implants immediately after their placement has tremendous advantages for both the dentist and the patient. The protocol results in minimized trauma and immediate esthetics, adequate function, and preservation of hard and soft tissue contours.
The positive psychological benefit for the patient—who is not left with a transitional, mostly unacceptable denture—can be very substantial indeed.
In this context, the All-on-4 concept—whose reliability has been substantiated by extensive long-term documentation and scientific evidence—provides not only an immediate provisionalization protocol, but also a definitive treatment solution.
Advantages of CAD
No matter which clinical protocol is selected, the manufacturing and quality of the definitive restoration is of fundamental importance for longevity, as functional forces acting on the prostheses are extensive.
When combined with aligned centralized milling strategies, computer-aided design (CAD) offers many advantages over conventional manual laboratory manufacturing techniques. Among these advantages are fit, material quality and reliability. The NobelProcera System provides custom-design options for frameworks made of titanium or zirconia.
The extent of atrophy, the amount and quality of bone and soft tissue available, and the inter-occlusal distance are all factors that need to be taken into consideration when choosing between a fixed and removable implant-retained restoration—as are the anticipated number and position of implants and the clinical protocol preferred by the restoring dentist.
Whether the restorative team decides to proceed with superstructures made from zirconia and ceramic veneering on a large span or in multiple sections, or a cost-saving NobelProcera Implant Bridge made of titanium—finished with composite resin or conventional denture teeth—, they can be sure they are working with the best possible quality.
Thanks to these products and services from Nobel Biocare, poor fitting frameworks and the need for chair-side sectioning and soldering are a thing of the past!
Optimal function and esthetics require comprehensive treatment planning. Criteria for esthetically pleasing, long-lasting, and well-functioning implant reconstructions are:
- Meticulous examination, diagnosis, and treatment planning with a full-contour wax-up, following basic esthetic principles, function, and phonetics.
- A properly planned and appropriately fabricated CAD/CAM framework adhering to biomechanical principles and providing passive fit.
- An easy-to-handle restoration to expedite treatment and facilitate hygiene.