In a recent issue of Dental Economics, Pat Sullivan,of Nobel Biocare, argued that due to certain advances in technology, the market for implant-supported fixed bridges is on the verge of a major transformation.
Specifically, Pat Sullivan states:
“Many dentists assume that the main or only application for dental implants for the edentulous patient is to retain overdentures. The coexisting market for fixed bridges on dental implants currently is quite small….To take a human being with failing dentition or existing dentures and provide him or her with a fixed bridge approximating an arch of natural teeth is a dramatic development in science and clinical practice. Those dentists who do have experience with both overdentures and implant-supported fixed bridges usually find that overdentures often don’t offer patients all the benefits available from fixed bridges. There are thus huge opportunities for dentists to take advantage of fixed-restoration treatment on behalf of their current and future patients.”
What are your thoughts on this development in implant dentistry? Is this truly something patients will demand? Is it worth the investment? What are the potential complications?
Implant supported bridges have ben and will remain a big part of my regular work in patients or several reasons, mainly that are cheaper for the patient than an implant per tooth approach and much nicer for them than overdentures. Also with the use of full ceramic bridges now, we can obtain really good cosmetic-function ratios, and for a long time now I place implants where need them and not where I can so in the end I get really good results with bridges when they are needed.
Patients do ask for them , there is no real extra investment.
In terms of complications you have to consider if you want to go cemented or screwed in. The screw in way has the complication of the masking of the access hole and the occlusion in that zone(it demands extra work but it is doable) but as a plus, the retrievability is really easy(repairs and stuff). The cemeted way is easier to finish and to adjust (oclussally) but as for the retrievability, not that great, you have to use temporary cements which will dissolve in time leading to bacterial colonization and to patients maybe ending with your bridge in their hands at the worst time. If you use a permanent cement that wont happen, but if at any time one screw of an abutment gets loose you will loose the suprstructure… your call , I usually go with screwed in bridges.
Cheers
On the contrary, when Branemark and his team introduced “tissue-supported osseointegrated prosthesis”, they were all based on fixed concepts.
Over the years, their recommendations have been found to be expensive, unaesthetic and full of potential complications that would cost both the patients and the dentists time and money.
That overdentures have many advantages don’t need to be reinterated here.
I have done several implant retained bridges and all the patients have been very pleased. The one lesson that I have learned (the hard way, I might add) is when dealing with the posterior areas I will always go with screw retained abutments. Anteriors depend on the angulation of the implants and the esthetics. Chances of the anterior implants unscrewing are pretty low.
The one thing I like about screw-retained bridges is that I can always inspect the tissue at the implant level anytime I want.
Implant retained bridges in the edentulous maxilla or implant retained dentures, that is the question.
The pro of fixed bridges are the (psychologic) comfort of the patients: No (removable) dentures.
The con’s of fixed bridges with the resorbed maxilla are the lack of support of the midfacial soft-tissues. This is always very hard to explain to the patient who wants to get rid of their prosthesis. In order to get the best facial esthetic results with fixed bridges a Le Fort I osteotomy is mostly needed!
Another solution might be fixed dentures on implants like the all-on-4 concept. The major problem here is the difficulties with oral hygiene.
how can i choose the best type of implant-suported fixed partial denture?