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Maxillary prosthesis for patient with Sjogrens syndrome?

Last Updated: Mar 08, 2017

I am treatment planning a maxillary prosthesis for a patient who has had 5 implants placed in her edentuluous maxilla. They are approximately placed in the positions of both second premolars, canines and one roughly in the midline. The patient is 58 years old, her medical condition is unremarkable other than Sjogrens syndrome, which significantly affects her mouth. There is a 5-5 dental arch in the mandible.

My question revolves around what prosthesis will give the best result? I’m concerned with hygiene issues and tissue irritation with a fixed bridge or even a fixed bar to hold an overdenture. I believe in the KISS principle, and I’m leaning towards locators and a palateless maxillary overdenture. The implants are not perfectly parallel but enough that I think locators can work quite well. I know of issues regarding splinting vs non splinting implants in the maxilla, but what other suggestions do you have?

4 Comments on Maxillary prosthesis for patient with Sjogrens syndrome?

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Dorian Hatchuel

3/14/2017

Hi. Sjogrens causes dry mouth. Your concern is Hygiene. Placing locators implies full palatal coverage so that the denture is tissue and implant supported. If you leave the palate open you create a horse shoe shape and place stresses on the implants. A better example is a fixed-detachable denture. The bar is fixed and a milled Bar fits in the denture. This in turn is fixed to the bar but the patient can remove it herself. I recommend you contact Uzi at Uzi@nanomill.co.il and he will give you details. It's a little more complicated to do but we'll worth the effort. Both you and the patient will sleep better. Good luck. PS. Disclaimer: I have no financial interest in my answer. I don't work for any company.

Dennis Flanagan DDS MSc

3/14/2017

Locator support and retention can be successful if the off axial loading is controlled by the occlusal scheme. Zero degree or lingualized occlusion will OK. There needs to be a minimum of 5 implants in the maxilla, which you have. The palate can be removed. Since hygiene is an issue, a bar may be difficult to clean aa well as be unsightly. You don't want the patient to show off his bar to his friends, this is not a practice builder. See Tarnows articles on this topic. Dennis Flanagan DDS MSc

Dr. Bob

3/14/2017

The prosthesis should be planed before any implants are placed and then the implants placed to allow that prosthesis the be constructed. Implant restoration must be prosthesis driven. The Doctor and the patient should decide, before considering implants, what the final restoration will be. Some times a patient with implants in the mouth will present to the office. At this point the patient can be given options based upon the positions and sizes of the existing implants and then may evaluate the pros and cons of each reasonable option. The patient may want a fixed or a removable restoration. What is required to maintain the prosthesis may be a determining factor for the patient. Please involve the person who has to live with the restoration in these decisions.

D Sampson

3/28/2017

I don't see a problem with a fixed bridge on the five implants in a patient with Sjogrens Syndrome. We have many patients whee we have done a fixed hybrid prosthesis (All-on-4) style and they do quite well. There is minimal irritation of the soft tissues since it is completely loaded on the implants.

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