Full-Arch Implant Restoration by Dr. Arun K. Garg with Drs. Renato Rossi Jr. and Maria del Pilar Rios

Dentaltown Magazine

by Dr. Arun K. Garg with Drs. Renato Rossi Jr. and Maria del Pilar Rios

The full-arch implant rehabilitation technique (FAIR) uses multiple implants to treat edentulism, avoiding the morbidity associated with bone grafting. FAIR is derived from the successful four-implant, full-arch restoration treatment concept pioneered by Malo and colleagues.1–5 Its importance to the clinician, as evidenced in this case report, is that it is one of many sister protocols6–10 developed over the past decade that attempt to duplicate the success of the full-arch restoration treatment concept via less standardized and less costly commercial products and processes.

For a rapidly aging American demographic, the need for solutions for missing teeth is growing, and so should alternative methods for addressing these solutions, especially cost-effective solutions.11,12 The FAIR option employed in this case represents a relatively simple alternative to traditional dentures or overdentures, with much more effective results for patients.13,14 The implant-fixed bridge techniques demonstrated in this case are the culmination of decades of implant-based restorations for single teeth,15 which have made possible the multi-implant restorations accomplished for entire arches today, with their extraordinary success rates.16–19

This case demonstrates the many advantages of full-arch implant restoration. Not only does the case show the immediate, fixed and visually appealing result of the provisional prosthesis, but it also presages the highly functional, cost-effective and hygienically simple care the patient will enjoy for years when the final restoration is placed. FAIR and its sister protocols make these outcomes possible for edentulous patients who formerly were bound to overdentures or traditional dentures.

Case description
A healthy 52-year-old Caucasian male presented with a completely edentulous mandible (Class I). He wore a complete lower denture and an upper removable partial denture. His chief complaint was lower denture instability during function and a diminished social life. His primary desire was to find a solution for the lower arch via fixed prosthesis.

An extensive clinical and radiographic evaluation (including panoramic radiograph and cone beam CT scan) was performed to facilitate case planning, which resulted in the decision to provide the patient with an upper removable denture and a lower full-arch solution via full-arch implant restoration on four implants.

In preparation for mandibular surgery, the clinician ordered functional impressions, which were mounted in a semiadjustable articulator with occlusal registration and a vertical dimension of occlusion set for this patient. Next, measurements were taken to ensure enough interocclusal space (15–17?mm) for the multiunit abutments, framework, teeth, freeway space while speaking, and proper biomechanics ratio for such a FAIR case, following the color selection and wax-up. Smile and laugh lines were evaluated as well as the anterior-posterior spread of the implant design placement to minimize any cantilever.

The lower denture was duplicated in transparent acrylic and prepared for the surgery to ensure apical-to-occlusal visibility of the residual ridge. The buccal flank had the minimum 15mm distance from the incisal edge of the tooth to the apical border of the flange. To ensure buccal-to-lingual visibility of the residual ridge, a window was required to view the lingual aspect of the surgical stent to allow enough space to observe the entire ridge.

Before surgery began, the case was completely reviewed, the dentures were checked in place for a proper occlusion, the middle line and vertical dimension of occlusion were registered, and a bite registration was taken and used as a guide once the denture had been converted into a provisional fixed-screw prosthetic.

With the patient under local and infiltrative anesthesia (lidocaine 2 percent), a mid-crestal incision was performed with a 15C blade from first molar to first molar, and a flap was reflected with a midline incision, making sure that the mental foramen was identified. The lingual flap was sutured to ensure more visibility. The surgical guide was placed in position, and it was determined that 2–3mm of bone reduction was required, which was effected by a round acrylic bur at 40,000 rpm (Implant Vision Motor) with saline solution irrigation.

Four conical implants, wide-pitch and self-taping, with RBM surface and internal hex (Implant Vision) were placed through the surgical stent, with a 20:1 reduction and 1,200 rpm (Implant Vision) and external irrigation. The clinician followed the drilling protocol for wide-pitch implants, where undersizing the osteotomy is mandatory. Two straight implants (3.7 diameter by 13mm in position of laterals) were placed perpendicular to the bone ridge, and two implants tilted 30 degrees (4.2 diameter by 16mm in position) were placed between the first and second premolars, with the clinician making sure to avoid the mental loop and foramen (Fig. 1).

A countersink bur, or bone profile bur, was used to flare the distal part of the osteotomy to avoid threat exposure and to allow for a full seating of the multiunit abutments. Before the implants were placed, all the mountings were loose, and the implants were driven manually into the osteotomy site, each sunk with 45Ncm of torque. Before suturing, the clinician used a snap-in guide director/indicator to determine the angulation of the multiunit abutment to be used (Fig.?2A). Once the abutments were selected (0 degrees for the two anterior and 30 degrees for the two posterior, Fig.?2B), they were ratcheted to 25Ncm (Fig. 3, p.?68), then sutured with a 3.0 violet suture in an interrupted fashion, starting from the middle releasing incision.

Upon completion of suturing, the dentures were placed in the patient’s mouth with the bite registration, making sure that the lower denture contained a fast-set polyvinyl siloxane to make an imprint of the multiunit abutments at occlusion to facilitate transfer of the implant position to the denture (Figs. 4A and 4B); thereafter, windows were opened to pick up the provisional abutment and start the prosthetic conversion.

At this point, the provisional metal multiunit abutments were attached and properly hand-screwed into the multiunit implants, ensuring no visual gap between them. The lower denture was seated, and the provisional abutments thus stood through the windows made in the denture. The height of those abutments was adjusted until occlusion was achieved (Figs. 5A and 5B, p.?70). Once this try-in process was completed, the provisional abutments’ chimneys were filled with Gingi Mask; then, a rubber dam in a U-shape arch was placed over the provisional abutments to prevent the acrylic from moving into any undercut.

For the denture reline, pink acrylic was placed in the inner part of the denture, the MucoHard was injected around the provisional abutments, and the denture was placed in position. After the acrylic was set, the Gingi Mask was removed from the chimneys with an explorer, and the denture was unscrewed from the patient’s mouth. The length of the provisional abutments was adjusted with a carbide disk, removing the metal spurs to allow access for the final screw. Buccal and lingual denture flanges were cut and shaped for proper cleaning, and all voids were filled with MucoHard. The cantilever allowed for this particular FAIR procedure is 5mm distal to the terminal abutment. Next, the prosthesis was polished with rubber and photo-cure glazed (Fig.?6A, p. 71).

The FAIR provisional prosthesis was screwed in the patient’s mouth in a zigzag manner and torqued to 25Ncm. Teflon was engaged inside the chimney, and Cavit was used as provisional sealer. Balanced occlusion was desired and achieved in this case (Fig.?6B, p. 71). Amoxicillin and clavulanic acid (875mg) were prescribed every 12 hours for 7 days, as well as sodium diclofenac (50mg) every 8 hours for 3 days, along with a liquid-to-soft diet.

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Fig. 1: Bone reduction and parallel pins to check the future implants’ angulation for a FAIR case.
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Fig. 2A: The snap-in guide director/indicator helps determine the angulation of the multiunit abutment to fit in the surgical guide.
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Fig. 2B: A silver 0-degree and blue 30-degree snap-in guide director were chosen to determine abutment angulation and the cuff.
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Fig. 3: Abutments were selected (0 degrees for the two anterior and 30 degrees for the two posterior). All of the abutments fit inside the guide and are parallel.
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Fig. 4A: The lower denture contained a fast polyvinyl silicone to make an imprint of the multiunit abutments.
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Fig. 4B: Windows were opened to pick up the provisional abutment and start the prosthetic conversion.
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Fig. 5A: Provisional abutments placed.
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Fig. 5B: The height of the abutments was adjusted until occlusion was achieved.
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Fig. 6A: The prosthesis was polished with rubber and photo-cure glazed.
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Fig. 6B: Provisional FAIR was delivered.

Discussion
This case history demonstrates how the full-arch implant rehabilitation approach for using multiple implants to treat edentulous or nearly edentulous patients is one of the more recent solutions to a specific dental concern faced by millions of patients around the world.20 The procedure requires no bone grafting, and its success rates are outstanding, as evidenced by FAIR’s sister protocols,6–10 all of which are derived from the four-implant, full-arch restoration treatment concept pioneered by Malo and colleagues.1–5

According to the Centers for Disease Control, the life expectancy for Americans in 2014 was nearly 79 years. As a result, more patients are seeking solutions for missing teeth, a condition often accompanying aging. These patients seek dental alternatives that are not only aesthetically pleasing but also cost-effective and highly functional. Dental clinicians clearly must act to address the growing number of edentulous patients because edentulism negatively impacts not only overall oral health but also patient longevity.11,12 Thankfully, FAIR and other multi-implant, full-arch restoration treatment options represented in this case offer a relatively simple treatment of edentulism instead of traditional dentures or overdentures. FAIR’s immediate-loaded, implant-supported, full-arch prosthesis is nearly equivalent (90 percent) to natural teeth in function and appearance21,22 and complemented by very low failure rates.23,24

Conventional dentures have been the most common solution for edentulism until relatively recently. However, studies show that wearing dentures can reduce patients’ quality of life, with pain and areas of discomfort, difficulties chewing and speaking, denture slippage, a clear reduction in bite force, as well as poor oral sensation.13,14 Such conditions result from tridimensional alveolar bone atrophy as well as reduced musculature attachment to the edentulous ridge, the shape of the arches, and occlusal relationship between arches.25–27 Therefore, the development of new techniques and protocols to offer solutions to these conditions became necessary—and even urgent—to meet optimal patient satisfaction. As a result, expectations grew for an improved quality of life not only regarding patient dental function but also physical appearance and overall psychological health.28,29

The success rates for immediate-load implants improved significantly in the late 1980s and early 1990s, for individual teeth rehabilitation as well as for partial-arch rehabilitation via the placement of minor bridges.30–37 The two-implant and four-implant removable denture represented initial treatment options for edentulous patients, reflecting dental implant technology’s evolution.38–43 Such implant-supported solutions approximated (60 percent) the stability and function of natural teeth and, like conventional dentures, were relatively inexpensive replacements for teeth and gingiva. Lip support and easy cleaning outside of the mouth were also accomplished by these implant-supported solutions. However, a number of disadvantages accompanied these procedures, such as sore gums, unwanted movement during chewing and speaking, and eventual relining of the device to maintain fit and comfort because of persistent reduction in alveolar bone volume and shape over time. Also, overdentures could be properly cleaned only by removing them from the patient’s mouth.

Nevertheless, evolving protocols such as the two-implant and four-implant removable denture presaged the development of full-arch replacement, complemented at first by alveolar bone enhancement and then without it. In the mid- to late 1990s, arch restoration protocols for the bone-dense mandible attempted to meet these implant challenges via improved anatomical placement and bridge architecture redesigns.44,45 Similar implantation attempts in less accommodating maxillary bone were not as promising because of poor anchorage.46–51 As a result, the threading, size and length of implants had to undergo redesign in attempts to condense/thicken bone during placement for sinus-lift and other procedures.52–55

In the early 2000s, important advancements were made providing realistic soft-

tissue and ceramic or acrylic teeth for artificial bridges. A number of retrospective studies described the evolution of mandibular full-arch dental prostheses and zygomatic implants for the maxilla in sinus lift and other cases that contraindicated traditional implant placement and bone grafting.56–63 Additional implant design evolution took place near the end of the 2000s and during the first few years of the 2010s, including extramaxillary anchorage,64 optimal implant angulation,65 optional cantilevers,66–68 and bone reduction.69

The FAIR techniques described in this case have leveraged the success of implant restoration for single teeth,15 making possible the success of multi-implant restoration of whole arches via placing implants throughout the edentulous region and immediately loading them with a provisional fixed prosthesis.18 Though such multi-implant protocols have minor disadvantages—surgery and necessary healing/restoration time—the implant-fixed bridges that result provide 90 percent of the functionality of natural teeth, no bone grafting, bridge temporization on surgery day, soft-food diet during healing, preservation of bone and soft tissue, a 95 percent success rate, and a patient hygiene-maintenance regimen virtually the same as natural teeth.

The FAIR surgical and restoration techniques described in this case are accomplished in a single visit, via placement of two axial implants anteriorly and two tilted implants posteriorly, supporting a provisional, fixed, immediately loaded, full-arch prosthesis with survival rates between 92 and 100 percent.16,17,19,70–72 Anatomical structures are preserved via the longer tilted implants, providing exemplary cortical bone anchorage and increasing the space between implants while lessening cantilever length and often eliminating any need for bone augmentation.55,73–76

Conclusion
The edentulous patient described in this case report discovered the many advantages of receiving the full-arch implant restoration dental prosthesis: an immediate, fixed, visually appealing, highly functional, low-cost and hygienically simple dental device. FAIR and its sister protocols can address such patients’ surgical and restorative needs as never before—even when, as in this case, some older technologies complement the FAIR solution. By comparison, the previous generation of overdentures (which often required bone grafting, bone reconstruction, and placement of six to eight implants) left many potential patients untreatable because of age/morbidity concerns or systemic conditions such as osteoporosis, and those qualifying patients who did receive these treatments were often unsatisfied. Additionally, FAIR helps to eliminate the range of dental and systematic drawbacks resulting from prolonged use of traditional dentures.


References
1. Malo P, Rangert B, Dvarsater L. Immediate function of Branemark implants in the esthetic zone: a retrospective clinical study with 6 months to 4 years of follow-up. Clin Implant Dent Relat Res. 2000;2:138-46.
2. Malo P, Rangert B, Nobre M. “All-on-Four” immediate-function concept with Branemark System implants for completely edentulous mandibles: a retrospective clinical study. Clin Implant Dent Relat Res. 2003;5:2-9.
3. Malo P, Friberg B, Polizzi G, Gualini F, Vighagen T, Rangert B. Immediate and early function of Branemark System implants placed in the esthetic zone: a 1-year prospective clinical multicenter study. Clin Implant Dent Relat Res. 2003;5:37-46.
4. Malo P, de Araujo Nobre M, Lopes A, Moss SM, Molina GJ. A longitudinal study of the survival of All-on-4 implants in the mandible with up to 10 years of follow-up. J Am Dent Assoc. 2011;142:310-20.
5. Malo P, de Araujo Nobre M, Lopes A, Francischone C, Rigolizzo M. “All-on-4” immediate-function concept: a clinical report on the medium (3 years) and long-term (5 years) outcomes. Clin Implant Dent Relat Res. 2012;14:e139-50.
6. Misch CE, Degidi M. Five-year prospective study of immediate/early loading of fixed prostheses in completely edentulous jaws with a bone quality-based implant system. Clin Implant Dent Relat Res. 2003;5(1):17-28.
7. Barbosa GA, Bernardes SR, de França DG, das Neves FD, de Mattos Mda G, Ribeiro RF. Stress over implants of one-piece cast frameworks made with different materials. J Craniofac Surg. 2016 Jan;27(1):238-41. doi:10.1097/SCS.0000000000002175.
8. Motta M, Monsano R, Velloso GR, de Oliveira Silva JC, Luvizuto ER, Margonar R, Queiroz TP. Guided surgery in esthetic region. J Craniofac Surg. 2016 May;27(3):e262-5. doi: 10.1097/SCS.0000000000002493.
9. Uhlendorf Y, Sartori IA, Melo AC, Uhlendorf J. Changes in lip profile of edentulous patients after placement of maxillary implant-supported fixed prosthesis: Is a wax try-in a reliable diagnostic tool? Int J Oral Maxillofac Implants. 2016. Oct 5. doi: 10.11607/jomi.4967.
10. Zoidis P. The all-on-4 modified polyetheretherketone treatment approach: A clinical report. J Prosthet Dent. 2017 Jul 11. pii: S0022-3913(17)30308-6. doi:10.1016/j.prosdent.2017.04.020.
11. Emami E, de Souza RF, Kabawat M, Feine JS. The impact of edentulism on oral and general health. Int J Dent. 2013;2013:498305. doi: 10.1155/2013/498305. Epub 2013 May 8.
12. Gil-Montoya JA, de Mello AL, Barrios R, Gonzalez-Moles MA, Bravo M. Oral health in the elderly patient and its impact on general well-being: a nonsystematic review. Clin Interv Aging. 2015 Feb 11;10:461-7. doi:10.2147/CIA.S54630. eCollection 2015. Review.
13. Janeva N, Kovacevska G, Janev E. Complete Dentures Fabricated with CAD/CAM Technology and a Traditional Clinical Recording Method. Open Access Maced J Med Sci. 2017 Oct 6;5(6):785-789. doi: 10.3889/oamjms.2017.169. eCollection 2017 Oct 15.
14. McLaughlin JB, Ramos V Jr, Dickinson DP. Comparison of Fit of Dentures Fabricated by Traditional Techniques Versus CAD/CAM Technology. J Prosthodont. 2017 Nov 14. doi: 10.1111/jopr.12604.
15. Moraschini V, Poubel LA, Ferreira VF, Barboza Edos S. Evaluation of survival and success rates of dental implants reported in longitudinal studies with a follow-up period of at least 10 years: a systematic review. Int J Oral Maxillofac Surg. 2015 Mar;44(3):377-88. doi: 10.1016/j.ijom.2014.10.023. Epub 2014 Nov 20. Review.
16. Lopes A, Maló P, de Araújo Nobre M, Sánchez-Fernández E, Gravito I. The NobelGuide(®) All-on-4(®) Treatment Concept for Rehabilitation of Edentulous Jaws: A Retrospective Report on the 7-Years Clinical and 5-Years Radiographic Outcomes. Clin Implant Dent Relat Res. 2017 Apr;19(2):233-244. doi:10.1111/cid.12456. Epub 2016 Oct 18.
17. Testori T, Galli F, Fumagalli L, Capelli M, Zuffetti F, Deflorian M, Parenti A, Del Fabbro M. Assessment of Long-Term Survival of Immediately Loaded Tilted Implants Supporting a Maxillary Full-Arch Fixed Prosthesis. Int J Oral Maxillofac Implants. 2017 Jul/Aug;32(4):904-911. doi: 10.11607/jomi.5578.
18. Sugiura T, Yamamoto K, Horita S, Murakami K, Tsutsumi S, Kirita T. Effects of implant tilting and the loading direction on the displacement and micromotion of immediately loaded implants: an in vitro experiment and finite element analysis. J Periodontal Implant Sci. 2017 Aug;47(4):251-262. doi:10.5051/jpis.2017.47.4.251.
19. Ayub KV, Ayub EA, Lins do Valle A, Bonfante G, Pegoraro T, Fernando L. Seven-Year Follow-up of Full-Arch Prostheses Supported by Four Implants: A Prospective Study. Int J Oral Maxillofac Implants. 2017 Nov/Dec;32(6):1351-1358. doi: 10.11607/jomi.5312.
20. Petersen PE, Yamamoto T. Improving the oral health of older people: the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol. 2005 Apr;33(2):81-92.
21. Rosenbaum N. Full-arch implant-retained prosthetics in general dental practice. Dent Update. 2012 Mar;39(2):108-10, 112, 114-6.
22. Dellavia C, Rosati R, Del Fabbro M, Pellegrini G. Functional jaw muscle assessment in patients with a full fixed prosthesis on a limited number of implants: a review of the literature. Eur J Oral Implantol. 2014 Summer;7 Suppl 2:S155-69. Review.
23. Balshi TJ, Wolfinger GJ, Slauch RW, Balshi SF. A retrospective analysis of 800 Brånemark System implants following the All-on-Four™ protocol. J Prosthodont. 2014 Feb;23(2):83-8. doi: 10.1111/jopr.12089. Epub 2013 Jul 25.
24. Papaspyridakos P, Chen CJ, Chuang SK, Weber HP. Implant loading protocols for edentulous patients with fixed prostheses: a systematic review and meta-analysis. Int J Oral Maxillofac Implants. 2014;29 Suppl:256-70. oi:10.11607/jomi.2014suppl.g4.3. Review.
25. Koshino H, Hirai T, Ishijima T, Ikeda Y. Tongue motor skills and masticatory performance in adult dentates, elderly dentates, and complete denture wearers. J Prosthet Dent. 1997 Feb;77(2):147-52.
26. Sadowsky SJ. The implant-supported prosthesis for the edentulous arch: design considerations. J Prosthet Dent. 1997 Jul;78(1):28-33. Review.
27. Bedrossian E, Sullivan RM, Fortin Y, Malo P, Indresano T. Fixed-prosthetic implant restoration of the edentulous maxilla: a systematic pretreatment evaluation method. J Oral Maxillofac Surg. 2008 Jan;66(1):112-22.
28. Abu Hantash RO, Al-Omiri MK, Al-Wahadni AM. Psychological impact on implant patients’ oral health-related quality of life. Clin Oral Implants Res. 2006 Apr;17(2):116-23.
29. Agliardi E, Clericò M, Ciancio P, Massironi D. Immediate loading of full-arch fixed prostheses supported by axial and tilted implants for the treatment of edentulous atrophic mandibles. Quintessence Int. 2010 Apr;41(4):285-93.
30. Buser DA, Schroeder A, Sutter F, Lang NP. The new concept of ITI hollow-cylinder and hollow-screw implants: Part 2. Clinical aspects, indications, and early clinical results. Int J Oral Maxillofac Implants. 1988 Fall;3(3):173-81.
31. Piattelli A, Ruggeri A, Franchi M, Romasco N, Trisi P. An histologic and histomorphometric study of bone reactions to unloaded and loaded non-submerged single implants in monkeys: a pilot study. J Oral Implantol. 1993;19(4):314-20.
32. Henry P, Rosenberg I. Single-stage surgery for rehabilitation of the edentulous mandible: preliminary results. Pract Periodontics Aesthet Dent. 1994 Nov-Dec;6(9):15-22.
33. Spiekermann H, Jansen VK, Richter EJ. A 10-year follow-up study of IMZ and TPS implants in the edentulous mandible using bar-retained overdentures. Int J Oral Maxillofac Implants. 1995 Mar-Apr;10(2):231-43.
34. Salama H, Rose LF, Salama M, Betts NJ. Immediate loading of bilaterally splinted titanium root-form implants in fixed prosthodontics--a technique reexamined: two case reports. Int J Periodontics Restorative Dent. 1995Aug;15(4):344-61.
35. Biglani M., Lozada J.L. Immediately loaded dental implants – influence of early functional contacts on implant stability, bone level integrity and soft tissue quality: a retrospective 3 and 6 year analysis. Int J Oral Maxillofac Implants. 1996;11:126–127.
36. Attard NJ, Zarb GA. Immediate and early implant loading protocols: a literature review of clinical studies. J Prosthet Dent. 2005 Sep;94(3):242-58. Review.
37. Romanos G, Froum S, Hery C, Cho SC, Tarnow D. Survival rate of immediately vs delayed loaded implants: analysis of the current literature. J Oral Implantol. 2010;36(4):315-24. doi: 10.1563/AAID-JOI-D-09-00060. Review.
38. Galindo DF. The implant-supported milled-bar mandibular overdenture. J Prosthodont. 2001 Mar;10(1):46-51.
39. Feine JS, Carlsson GE, Awad MA, Chehade A, Duncan WJ, Gizani S, Head T, Heydecke G, Lund JP, MacEntee M, Mericske-Stern R, Mojon P, Morais JA, Naert I, Payne AG, Penrod J, Stoker GT, Tawse-Smith A, Taylor TD, Thomason JM, Thomson WM, Wismeijer D. The McGill consensus statement on overdentures. Mandibular two-implant overdentures as first choice standard of care for edentulous patients. Gerodontology. 2002 Jul;19(1):3-4. Review.
40. Chee WW. Treatment planning: implant-supported partial overdentures. J Calif Dent Assoc. 2005 Apr;33(4):313-6.
41. Ikebe K, Matsuda K, Morii K, Furuya-Yoshinaka M, Nokubi T, Renner RP. Association of masticatory performance with age, posterior occlusal contacts, occlusal force, and salivary flow in older adults. Int J Prosthodont. 2006 Sep-Oct;19(5):475-81.
42. Turkyilmaz I, Company AM, McGlumphy EA. Should edentulous patients be constrained to removable complete dentures? The use of dental implants to improve the quality of life for edentulous patients. Gerodontology. 2010 Mar;27(1):3-10. doi: 10.1111/j.1741-2358.2009.00294.x. Epub 2009 Mar 8. Review.
43. Shetty PP, Gangaiah M, Chowdhary R. Hidden Overdenture Bar in Fixed Implant-retained Hybrid Prosthesis: Report of a Novel Technique. J Contemp Dent Pract. 2016 Sep 1;17(9):780-782.
44. Balshi TJ, Wolfinger GJ. Immediate loading of Brånemark implants in edentulous mandibles: a preliminary report. Implant Dent. 1997 Summer;6(2):83-8.
45. Brånemark PI, Engstrand P, Ohrnell LO, Gröndahl K, Nilsson P, Hagberg K, Darle C, Lekholm U. Brånemark Novum: a new treatment concept for rehabilitation of the edentulous mandible. Preliminary results from a prospective clinical follow-up study. Clin Implant Dent Relat Res. 1999;1(1):2-16.
46. Jemt T, Lekholm U. Implant treatment in edentulous maxillae: a 5-year follow-up report on patients with different degrees of jaw resorption. Int J Oral Maxillofac Implants. 1995 May-Jun;10(3):303-11.
47. LoCascio SJ, Salinas TJ. Rehabilitation of an edentulous mandible with an implant-supported prosthesis. Pract Periodontics Aesthet Dent. 1997 Apr;9(3):357-68.
48. Scortecci G. Immediate function of cortically anchored disk-design implants without bone augmentation in moderately to severely resorbed completely edentulous maxillae. J Oral Implantol. 1999;25(2):70-9.
49. Mattsson T, Köndell PA, Gynther GW, Fredholm U, Bolin A. Implant treatment without bone grafting in severely resorbed edentulous maxillae. J Oral Maxillofac Surg. 1999 Mar;57(3):281-7.
50. Bohsali K, Simon H, Kan JY, Redd M. Modular transitional implants to support the interim maxillary overdenture. Compend Contin Educ Dent. 1999 Oct;20(10):975-8, 980, 982-3.
51. Ivanoff CJ, Gröndahl K, Bergström C, Lekholm U, Brånemark PI. Influence of bicortical or monocortical anchorage on maxillary implant stability: a 15-year retrospective study of Brånemark System implants. Int J Oral Maxillofac Implants. 2000 Jan-Feb;15(1):103-10.
52. Wennstrom J, Zurdo J, Karlsson S, Ekestubbe A, Grondahl K, Lindhe J. Bone level change at implant-supported fixed partial dentures with and without cantilever extensions after 5 years in function. J Clin Periodontol 2004; 31: 1077-1083.
53. Cannizzaro G, Felice P, Leone M, Viola P, Esposito M. Early loading of implants in the atrophic posterior maxilla: lateral sinus lift with autogenous bone and Bio-Oss versus crestal mini sinus lift and 8-mm hydroxyapatite-coated implants. A randomised controlled clinical trial. Eur J Oral Implantol. 2009 Spring;2(1):25-38.
54. Balevi B. Implant-supported cantilevered fixed partial dentures. Evid Based Dent. 2010;11(2):48-9. doi: 10.1038/sj.ebd.6400721.
55. Maló P, Nobre Md, Lopes A. Immediate loading of ‘All-on-4’ maxillary prostheses using trans-sinus tilted implants without sinus bone grafting: a retrospective study reporting the 3-year outcome. Eur J Oral Implantol. 2013 Autumn;6(3):273-83.
56. Rocci A, Martignoni M, Gottlow J. Immediate loading in the maxilla using flapless surgery, implants placed in predetermined positions, and prefabricated provisional restorations: a retrospective 3-year clinical study. Clin Implant Dent Relat Res. 2003;5 Suppl 1:29-36.
57. Kinsel RP, Liss M. Retrospective analysis of 56 edentulous dental arches restored with 344 single-stage implants using an immediate loading fixed provisional protocol: statistical predictors of implant failure. Int J Oral Maxillofac Implants. 2007 Sep-Oct;22(5):823-30.
58. Eliasson A, Blomqvist F, Wennerberg A, Johansson A. A retrospective analysis of early and delayed loading of full-arch mandibular prostheses using three different implant systems: clinical results with up to 5 years of loading. Clin Implant Dent Relat Res. 2009 Jun;11(2):134-48. doi:10.1111/j.1708-8208.2008.00099.x. Epub 2008 Apr 1.
59. Pi Urgell J, Revilla Gutiérrez V, Gay Escoda CG. Rehabilitation of atrophic maxilla: a review of 101 zygomatic implants. Med Oral Patol Oral Cir Bucal. 2008 Jun 1;13(6):E363-70.
60. Chow J, Wat P, Hui E, Lee P, Li W. A new method to eliminate the risk of maxillary sinusitis with zygomatic implants. Int J Oral Maxillofac Implants. 2010 Nov-Dec;25(6):1233-40.
61. Fortin Y, Sullivan RM. Terminal Posterior Tilted Implants Planned as a Sinus Graft Alternative for Fixed Full-Arch Implant-Supported Maxillary Restoration: A Case Series with 10- to 19-Year Results on 44 Consecutive Patients Presenting for Routine Maintenance. Clin Implant Dent Relat Res. 2017 Feb;19(1):56-68. doi:10.1111/cid.12433. Epub 2016 Jun 22.
62. Atalay B, Doganay Ö, Saraçoglu BK, Bultan Ö, Hafiz G. Clinical Evaluation of Zygomatic Implant-Supported Fixed and Removable Prosthesis. J Craniofac Surg. 2017 Jan;28(1):185-189. doi: 10.1097/SCS.0000000000003204.
63. Fortin Y. Placement of Zygomatic Implants into the Malar Prominence of the Maxillary Bone for Apical Fixation: A Clinical Report of 5 to 13 Years. Int J Oral Maxillofac Implants. 2017 May/Jun;32(3):633-641. doi: 10.11607/jomi.5230.
64. Lifshitz AB, Muñoz M. Evaluation of the stability of self-drilling mini-implants for maxillary anchorage under immediate loading. World J Orthod. 2010 Winter;11(4):352-6.
65. Harirforoush R, Arzanpour S, Chehroudi B. The effects of implant angulation on the resonance frequency of a dental implant. Med Eng Phys. 2014 Aug;36(8):1024-32. doi: 10.1016/j.medengphy.2014.05.007. Epub 2014 Jun 20.
66. Romanos GE, Gupta B, Gaertner K, Nentwig GH. Distal cantilever in full-arch prostheses and immediate loading: a retrospective clinical study. Int J Oral Maxillofac Implants. 2014 Mar-Apr;29(2):427-31. doi: 10.11607/jomi.3243.
67. Alencar SM, Nogueira LB, Leal de Moura W, Rubo JH, Saymo de Oliveira Silva T, Martins GA, Moura CD. FEA of Peri-Implant Stresses in Fixed Partial Denture Prostheses with Cantilevers. J Prosthodont. 2017 Feb;26(2):150-155. doi:10.1111/jopr.12384. Epub 2015 Nov 20.
68. Sheridan RA, Decker AM, Plonka AB, Wang HL. The Role of Occlusion in Implant Therapy: A Comprehensive Updated Review. Implant Dent. 2016 Dec;25(6):829-838. Review.
69. Tischler M, Ganz SD, Patch C. An ideal full-arch tooth replacement option: CAD/CAM zirconia screw-retained implant bridge. Dent Today. 2013 May;32(5):98-102.
70. Kwon T, Bain PA, Levin L. Systematic review of short- (5-10 years) and long-term (10 years or more) survival and success of full-arch fixed dental hybrid prostheses and supporting implants. J Dent. 2014 Oct;42(10):1228-41. doi: 10.1016/j.jdent.2014.05.016. Epub 2014 Jun 26. Review.
71. Francetti L, Rodolfi A, Barbaro B, Taschieri S, Cavalli N, Corbella S. Implant success rates in full-arch rehabilitations supported by upright and tilted implants: a retrospective investigation with up to five years of follow-up. J Periodontal Implant Sci. 2015 Dec;45(6):210-5. doi: 10.5051/jpis.2015.45.6.210. Epub 2015 Dec 28.
72. Krennmair S, Weinländer M, Malek M, Forstner T, Krennmair G, Stimmelmayr M. Mandibular Full-Arch Fixed Prostheses Supported on 4 Implants with Either Axial Or Tilted Distal Implants: A 3-Year Prospective Study. Clin Implant Dent Relat Res. 2016 Dec;18(6):1119-1133. doi: 10.1111/cid.12419. Epub 2016 Apr 28.
73. Malhotra AO, Padmanabhan TV, Mohamed K, Natarajan S, Elavia U. Load transfer in tilted implants with varying cantilever lengths in an all-on-four situation. Aust Dent J. 2012 Dec;57(4):440-5. doi: 10.1111/adj.12002. Epub 2012 Nov 5.
74. Krennmair G, Seemann R, Weinländer M, Krennmair S, Piehslinger E. Clinical outcome and peri-implant findings of four-implant-supported distal cantilevered fixed mandibular prostheses: five-year results. Int J Oral Maxillofac Implants. 2013 May-Jun;28(3):831-40. doi: 10.11607/jomi.3024.
75. Spinelli D, Ottria L, DE Vico G, Bollero R, Barlattani A, Bollero P. Full rehabilitation with nobel clinician(®) and procera implant bridge(®): case report. Oral Implantol (Rome). 2013 Oct 15;6(2):25-36.
76. Drago C. Frequency and Type of Prosthetic Complications Associated with Interim, Immediately Loaded Full-Arch Prostheses: A 2-Year Retrospective Chart Review. J Prosthodont. 2016 Aug;25(6):433-9. doi: 10.1111/jopr.12343. Epub 2015 Sep 15.


Author Bio
Author Arun K. Garg, DMD, is a clinician, researcher, author and national lecturer who in his more than 25 years in dentistry and education has transformed the lives of thousands of doctors and patients alike. He is also the founder and owner of six private practices throughout South Florida and Greater Miami. In the last several decades platelet-rich plasma and its derivatives have given rise to what is today a $40 billion industry. Because of Garg’s pioneering work, PRP has become instrumental in a host of dental and other surgeries, including socket grafting, injection site wound healing and facial rejuvenation. Garg is a graduate of the University of Florida College of Dentistry and Jackson Memorial Hospital/University of Miami School of Medicine. Before founding Implant Seminars, a dental continuing education provider and its affiliated companies, Garg was a professor of surgery in the division of oral/maxillofacial surgery at the University of Miami.
 
Author Dr .Renato Rossi Jr.
 
Author Dr. Maria del Pilar Rios
 
 

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