Full-Arch Implant Rehabilitation (eBook)
120 Seiten
Quintessence Publishing Co Inc USA (Verlag)
978-0-86715-810-6 (ISBN)
Arun K. Garg, DMD, is considered one of the world's foremost authorities on bone biology, harvesting, and grafting for dental implant surgery. Alongside Dr Robert E. Marx, he pioneered the use of platelet-rich plasma (PRP). He received his dental degree from the University of Florida College of Dentistry in Gainesville, Florida, and completed his residency at the University of Miami Jackson Memorial Hospital in Miami, Florida. He went on to serve for almost two decades as Professor of Surgery in the Division of Oral and Maxillofacial Surgery and as Director of Residency Training at the University of Miami Leonard M. Miller School of Medicine, where he was frequently awarded faculty member of the year by his residents. Dr Garg has published 8 medical textbooks and over 150 journal articles is currently the president of the International Dental Implant Association. An international lecturer, he also maintains six private practices throughout southern Florida and is the founder of Implant Seminars, a leading dental continuing education company.
Arun K. Garg, DMD, is considered one of the world's foremost authorities on bone biology, harvesting, and grafting for dental implant surgery. Alongside Dr Robert E. Marx, he pioneered the use of platelet-rich plasma (PRP). He received his dental degree from the University of Florida College of Dentistry in Gainesville, Florida, and completed his residency at the University of Miami Jackson Memorial Hospital in Miami, Florida. He went on to serve for almost two decades as Professor of Surgery in the Division of Oral and Maxillofacial Surgery and as Director of Residency Training at the University of Miami Leonard M. Miller School of Medicine, where he was frequently awarded faculty member of the year by his residents. Dr Garg has published 8 medical textbooks and over 150 journal articles is currently the president of the International Dental Implant Association. An international lecturer, he also maintains six private practices throughout southern Florida and is the founder of Implant Seminars, a leading dental continuing education company.
"1. Evolution of the FAIR Protocol
2. History of Tilted Implants with an Immediate Prosthesis
3. Identifying and Evaluating Candidates
4. The FAIR Technique and Its Modifications
5. Treating the Fully Edentulous Maxilla
6. Treating the Fully Edentulous Mandible
7. Treating the Partially Edentulous Maxilla
8. Treating the Partially Edentulous Mandible
9. The Definitive Prosthesis
10. Possible Complications with FAIR"
The full-arch implant rehabilitation (FAIR) protocol is one of the newest innovations in implant therapy to treat the edentulous or nearly edentu-lous patient. Instead of single implants replacing individual missing teeth, four or five implants are spaced throughout the arch and immediately loaded with a provisional fixed prosthesis. While conventional removable dentures and bone grafting with multiple implants are other options, the latter can take several years and has commensurate high costs. Morever, a number of studies have shown that wearing conventional removable dentures can reduce patients’ quality of life, causing pain and areas of discomfort, chewing and speaking difficulties, slippage, reduced occlusal force, and poor oral sensation.
The FAIR dental prosthesis offers many advantages for the dental patient with a fully or partially edentulous arch (Table 1-1). The prosthesis is immediate, fixed, esthetically pleasing, highly functional, inexpensive, and maintainable. Importantly, the FAIR procedure and similar techniques can frequently be performed without bone grafting with exceptional success rates.1–14 Such dental systems are better designed to meet the surgical and restorative needs of more patients with edentulous or partially edentulous arches, because traditional techniques often require extensive bone grafting. The invasiveness of these procedures deters many patients, and others (particularly elderly patients and those with severe bone loss) may not be good candidates for bone grafting.
TABLE 1-1 Advantages and disadvantages of removable dentures, overdentures, and the FAIR approach
ADVANTAGES | DISADVANTAGES |
Removable dentures | ▪ Relatively inexpensive tooth and gingival replacement ▪ Provides lip support ▪ Easy to remove and clean outside of the mouth | ▪ Uncomfortable ▪ May cause sore spots on gingival tissue ▪ Makes it difficult to eat certain foods ▪ Causes accelerated bone loss ▪ Often requires relining to improve comfort as bone deteriorates ▪ May make speech difficult ▪ May require creams or adhesives to reduce mobility ▪ Approximately 10% functionality compared with natural teeth |
Removable overdenture supported by 2 or 4 implants | ▪ Improves stability and functionality to 60% compared with natural teeth ▪ Relatively inexpensive tooth and gingival replacement ▪ Provides lip support ▪ Easy to clean outside of the mouth | ▪Uncomfortable ▪ May cause sore spots on gingival tissue ▪ Denture must be removed and cleaned outside of the mouth ▪ May still move when chewing or speaking ▪ May require relining to improve fit and comfort as bone deteriorates |
FAIR approach | ▪ Improves functionality to 70% compared with natural teeth ▪ Eliminates the need for bone grafting ▪ A provisional partial denture can be provided on the day of surgery, allowing a soft food diet during healing ▪ Replaces roots and teeth ▪ Preserves bone and soft tissue ▪ No decay; 95% success rate over 30 years ▪ Natural-looking esthetics ▪ Allows patients to eat any kinds of foods ▪ Can be cleaned like natural teeth | ▪ Requires healing and restorative time ▪ Involves surgical procedure and anesthesia |
During the late 1980s and early 1990s, the success rates for immediately loaded implants improved, both for the restoration of individual teeth and the placement of short-span fixed partial dentures.15–20 These developments served to push the envelope toward full-arch replacement, both with and eventually without bone grafting. The mid to late 1990s saw the development of mandibular restoration protocols that attempted to meet the challenges of anatomical placement and a redesigned partial denture architecture in the dense bone of the mandible.21,22 Similar attempts in the softer, more porous maxillary bone were generally unsuccessful because of poor anchorage.23–28 To overcome this challenge, the threading, size, and length of implants were redesigned to condense and thicken bone during placement in soft bone and with sinus elevation and other procedures.29–32
The early 2000s saw significant improvement in the esthetics of fixed prosthodontics, particularly with the introduction of pink ceramic for the gingiva. Retrospective studies of fixed full-arch prostheses in the mandible and zygomatic implants in the maxilla showed how protocols for full-arch dental prostheses had evolved.33–37 For example, when traditional implant surgery and bone grafting for sinus elevation and other procedures are contraindicated in the maxilla due to patient age or other issues with bone density or availability, the longer, nontraditional zygomatic implants can be placed near the dense, more cortical cheek bone (ie, zygoma) in the posterior maxilla (Fig 1-1). This decreases the time needed for the procedure and increases patient comfort.38,39 By about 2010, additional advancements in implant design and protocols included techniques for extramaxillary anchorage, optimal implant angulation, optional use of cantilevers, and bone reduction (when required).40–45
Fig 1-1 Placing zygomatic implants near the dense, more cortical cheekbone in the posterior maxilla is an example of an early evolution in protocol for full-arch dental prostheses.
An earlier treatment option for edentulous patients that reflects the evolution of dental implant technology is the two- or four-implant removable overdenture.46–48 Unlike conventional removable dentures (Fig 1-2), the fixed removable overdenture improves stability and function to approximately 60% that of natural teeth (Fig 1-3) and yet is still relatively inexpensive as a replacement for teeth and gingiva. Additionally, it provides lip support and easy cleaning outside the mouth. Disadvantages include sore spots on the gingiva, some movement when the patient chews and speaks, and the possible need for frequent relining for fit and comfort because of continued bone resorption.
Fig 1-2 The conventional denture was a first step in the evolution toward the FAIR protocol.
Fig 1-3 The fixed removable overdenture improves stability and function to approximately 60% that of natural teeth.
In contrast, the FAIR prosthesis and other similar protocols have only two requirements that could be considered disadvantages: a surgical procedure and a short period afterward for healing and restoration. For these relatively minor disadvantages, the FAIR protocol (Fig 1-4) provides 70% of the functionality of natural teeth, requires minimal or no grafting before placement, and serves as a replacement for bone and teeth (preserving both bone and soft tissue). A provisional prosthesis is delivered on the day of surgery, allowing the consumption of soft foods during healing. The definitive prosthesis has a 95% success rate over 30 years with a relatively natural esthetic that also permits virtually no food restrictions.
Fig 1-4 The FAIR protocol provides approximately 70% of natural dentition functionality.
According to the Centers for Disease Control and Prevention, as of 2015, the life expectancy of the average American was almost 79 years. As a result, more patients are seeking a solution to the problem of missing teeth that is not only esthetically pleasing but also cost-effective and highly functional. Doing nothing for the edentulous patient is no longer an option because edentulism negatively impacts overall oral health as well as patient longevity.49,50 Thankfully, there is a relatively simple solution for edentulism that is far superior to traditional dentures and overdentures because an immediately loaded implant-supported full-arch prosthesis is nearly equivalent to natural teeth.51,52
With 70% masticatory function and esthetics, accompanied by very low failure rates, FAIR prostheses have almost the same occlusal force as that of natural dentition.53,54 Traditional implants are placed in the vertical position, like fence posts (Fig 1-5a), but the FAIR technique employs a distally tilted or angled implant for greater stability, like a beach umbrella angled in the sand (Fig 1-5b). Tilted implants preserve important...
Erscheint lt. Verlag | 1.10.2019 |
---|---|
Verlagsort | Batavia |
Sprache | englisch |
Themenwelt | Medizin / Pharmazie ► Zahnmedizin |
Schlagworte | FAIR • FAIR Technique • Full-arch implant rehabilitation • Fully Edentulous Mandible • Fully Edentulous Maxilla • Partially Edentulous Mandible • Partially Edentulous Maxilla • Tilted Implants |
ISBN-10 | 0-86715-810-7 / 0867158107 |
ISBN-13 | 978-0-86715-810-6 / 9780867158106 |
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