Dental Asia May/Jun 2018

58 DENTAL ASIA MAY / JUNE 2018 Introduction Gradually, more edentulous patients are specifically asking clinicians for a fixed prosthesis. Mostly in the lower jaw, the implant prosthetic treatment presents no high technical difficulties. However, in the upper arch, there are a number of variables that are essential to keep in mind during the commencement of the treatment plan. If these elements are undervalued, potential failure may easily occur. The shape of the jawbone and soft tissues can hold the patient back during cleansingof the prosthesis that, toooften, is fabricated trying tomeet only the aesthetic requirements, ignoring the importance of hygiene and basic requirement for the long-term success of the treatment 1,2 . For these reasons, prosthesis with implants should be designed prior to their placement where insertion must be “guided” by the prosthesis itself 3 . Additionally, in the upper arch, more than in the inferior, the shape and the position of the lip strongly contribute to the aesthetics; indeed the perioral tissuesmust be correctly supported in order to restore facial harmony and the phonetics 4 . As mentioned above, the removable prosthesis with implant and mucosal support Ƥnds its application in dentistry. This type of prosthesis is called “hybrid”: on one hand the implants performa supporting function (like a Toronto Bridge), and not only as retention (for overdenture), while the prosthesis remains removable from the patient. The Anglo-Saxon definition is often “milled bar overdenture” or “fixed - removable overdenture”. In particular, according to the classiƤcation of Misch, we speak of removable prosthesis “RP-4” when the prosthesis is completely implant supported and removable prosthesis “RP-5” when the prosthesis is implant and mucosal supported 5 . The latter type and the subject of this work, is indicated when simultaneously 1) the patient requests for an implant-supported and 2) there is a need for a good support for the lips with a ƪange. In fact, a vestibular Ƥxed ƪangewill impede the patient’s ability to maintain a proper hygiene, causing the loss of the implants. Combining the use of implants and of a removable prosthesis, the clinician is able to o ơ er the patient a stable, aesthetic and easily hygienic prosthesis without the palate ƪange. The purpose of this article is to provide a simpliƤed technical protocol, compared to the classical one, with the intention to 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 this type of prostheses may be intricate, both for the clinician and for the dental technician. This work illustrates a simplified dental protocol with, at its starting point, the recognition of a diagnostic prosthesis. This is used as a guide for the placement of implants and, once duplicated, for impression registration of occlusal relationships and for obtaining an aesthetic prototype. Also, the management of milled bar becomes simplified, thanks to the use of attachments with reduced dimensions, and the superstructure, made of PEEK (Polyether ether ketone - thermoplastic composite polymer). By following what is illustrated in the article, it is possible to provide the patient with an aesthetic prosthesis which is stable and easily maintainable from a hygiene point of view. Simplified Dental Protocol for the Construction of Removable Prosthesis WITH IMPLANT AND MUCOSAL SUPPORT By Dr. Maurizio Sedda and Mr. Simone Fedi Behind the Scenes