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Implant-supported rehabilitations are undoubtedly complex surgical-prosthetic operations, aimed at restoring the
functionality of the damaged stomatognathic apparatus and at aesthetic recovery. The case illustrated below shows how current technology allows us to provide a fixed prosthesis when starting from a clinical situation without any reference line.
In Part 1, we discussed the vertical height adjustment, aesthetic trials & compromises that we acheived. In
this Part 2 of the article we will discuss & present the finalization from the techno-clinical aspect.
An edentulous 67-year-old male, had a complete removable restoration on the upper maxillae and a lower full implant supported overdenture on Straumann implant.
The patient requested for a more stable and comfortable prosthetic rehabilitation compared to the prostheses he is using since several years.
The case under consideration concerns a patient of 76 years who has a upper fixed rehabilitation on natural teeth and implants, and a partially edentulous jaw with some residual teeth periodontally compromised (Fig. 1a). In Fig. 1 the x-ray refers to a previous situation when the patient was still rehabilitate with a fixed-removable prosthesis with an implant equipped with Sphero Block abutment that had been inserted to stabilize the prosthetic rehabilitation.
The removable prosthesis with implant - mucosal support combines the aesthetic advantages of a removable
prosthesis with the stability given by the implants. The protocol for of this type of prostheses may be intricate, both for the clinician and for the dental technician. This work illustrates a simplififi ed dental protocol, which has, as its starting point, the recognition of a diagnostic prosthesis. This is used as a guide for the placement of implants and, once duplicated, for the impression for registration of the occlusal relationships and for obtaining an aesthetic prototype.
Edentulism is a condition that affects not only the masticatory function but also important aspects of the personal life of patients. The rehabilitation of an edentulous patient can currently be addressed with different prosthetic solutions; implants constitute a very effective tool from this point of view, however the implant rehabilitation pathway is often articulated and requires economic resources that not available to all patients.
After removal of the brackets and analysis of the dental axes and arches with respect to facial symmetry and lip appearance, it was necessary to lower the occlusion level on the left side. The inter maxillary space also needed to be partitioned better to reduce abutment stress in the lower jaw. The displacement of the dental midline from the middle of the face by the width of a lateral incisor and the strong tipping of dental axes
11 and 21 to the left were major problems.
Nowadays dentists have to deal with patients having more and more detailed requests.
Owing to the image of the traditional removatte prosthesis, we know that patients increasingly ask for fixed prosthesis. But not always this could e the best solution. Some factors could affect the operational decisions f the dental team such as: implant positions, vertical dimensions, the type of bone to work on, previous
prosthesis still present in the mouth and some more. It’s always important involving the patient explaining pro and cons of a given prosthetic project.
In this article we present the results of applied research TRE, started in 2006 and internationally developed by a group of independent and specialized professionals; this research has defined a complete system of procedures that involve the use of light-curing composite resins (UDMA). These procedures can completely replace cold and hot cure resins, methyl methacrylate based (PMMA) and light-curing composites (BISGMA), in all operational areas where they are used.
For patients with maxillofacial defects, both dentist and technician need to customize their treatment method according to the patient’s medical history. In the following article, the authors describe interim restoration with maxillofacial prosthetics after multiple oral and maxillofacial surgeries.
The patient, a male of 67 years old comes to the clinician attention with a circular fixed prosthesis with periodontitis. The clinician, Dr. Silvio De Simone, decided to proceed with the extraction and the subsequent insertion of six implants. We opted for
a removable denture with a two degree milled bar with threaded attachments screwed into the bar. In the incisors region two spherical attachments with head of 2.5 mm were placed and in the posterior region, having less space, we opted for two Ot Equator attachments with a low profile.
With the increase of the elderly population, we notice a larger number of edentulous patients. The social life of these patients is also affected by the impairment of chewing, phonetics, and even aesthetics. The use of osseointegrated implants can successfully manage all these inconveniences, but sometimes the implant rehabilitations can have functional, aesthetic and reliability issues. These problems are present from the very preliminary stages, and the dentist and dental technicians, in order to eliminate them, have to make an accurate analysis of the prosthetic project, the vertical dimensions and the face parameters. A large number of clinical studies emphasize the advantages of mandibular overdentures over implants. The choice of the attachment, between spherical and low-profile, is essential and cannot be accidental.
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