Full Arch Oral Rehabilitation

Treatment Choices

1.Fixed Multiple Implant Supported Bridge

2. All-On-Four Fixed Implant Supported Prosthesis

3. Removable Implant Supported Bar-Overdenture

4. Removable Implant Attachment Retained Overdenture

5. Complete Dentures only

1. Fixed Multiple Implant Supported Bridge

The ideal choice for patients that need to have all teeth in an arch replaced.

The final bridge is the closest that can be achieved to mimic the aesthetics & function of the natural dentition.    

Benefits

• The bridge is fixed in your mouth but can be removed by a dentist with training in implant dentistry
• Proven technique & 'gold standard' choice in long-term rehabilitative implant dentistry research
• Feels closest to having your natural teeth
• Exhibits 90% of the strength of your natural teeth
• The technique aims at conserving the volume and height of your jaw bone during implant placement. This allows for a biological fail safe or contingency plan should any complication arise in the future. 
• Custom-designed teeth and gums which is first trialled in your mouth prior to fabrication of your final prosthesis
• The final prosthesis gains its strength with a framework (or superstructure) that is precision milled using either titanium, cobalt-chrome (a metal alloy), or zirconia (a white metal). The material will be decided upon depending on your clinical situation and needs. 
• Porcelain is hand-layered and fused over the superstructure to replicate the appearance of your entire natural dentition (based on your trial smile).     

Considerations

• Depending on your clinical situation, a minimum of 4 dental implants are needed. 
• The more implants used for support, the more stable the final prosthesis (bridge)
• May not be a viable option if there is little bone height in the molar region of the jaw. 
• Usually needs 3 months implant integration before a permanent bridge is loaded
• A provisional removable denture is commonly needed during the healing period
• In some cases, a provisional plastic bridge may be immediately loaded onto the implants (usually requiring 6 implants)

11. All-On-Four Fixed Implant Supported Prosthesis

All-On-Four is a treatment concept where an acrylic prosthesis is secured onto 4 implants immediately after they are placed. The two back implants are tilted at 45 degree angles to avoid bone grafting in jaws with bone deficiencies in those regions. 

Benefits

• Hopeless teeth can be replaced by a temporary acrylic (plastic) set of teeth immediately (or several days) after the 4 implants are placed (this acrylic prosthesis is usually converted from an existing denture)
• Pink acrylic (fake gum) can be used to hide the transition line between the teeth and gums for patients who have a high lip line (I.e. "a gummy smile")

Considerations

• Immediate loading of implants carry a higher risk of bone loss around the implant which may lead its failure
• This technique usually requires the removal of extra bone to allow a level of thickness for the acrylic prosthesis, where otherwise it would be too weak to withstand the normal loads of chewing. This extra bone removal is irreversible and in the rare event of implant failure in the future, patients may have sufficient bone for re-implantation.   
• The gums beneath the temporary prosthesis will shrink over 3 months. A new prosthesis will be needed within 3 years. This prosthesis can be remade with either an acrylic bridge (supported by a rigid metal bar), a porcelain-metal bridge, or a porcelain-zirconia bridge.       

111. Removable Implant Supported Bar Overdenture

Benefits

• The implant-prosthesis of choice for patients in need of additional lip support by way of a denture flange
• Offers almost the same amount of rigidity as a fixed bridge supported by implants
• Patients with existing dentures may prefer this option as it offers the ability to be removed for cleaning; once the overdenture is attached to the bar, there is sufficient rigidity and strength needed for everyday eating

Considerations

• A minimum of 4 implants will be needed
• When the overdenture is not worn, a titanium bar that is suported by the implants will be visible in the mouth

1v. Removable Implant Attachment Retained Overdenture (Lower Jaw)

Benefits

• Simple minimally-invasive procedure
• Allows for extra retention for existing denture wearers looking for more comfort and function
• The overdenture can be converted from an existing denture
• The overdenture can be removed for cleaning

Considerations

• 2 implants are needed in the lower jaw 
• The overdenture remains 'gum' supported; the implants offer retention only to reduce the likelihood of the denture moving around in the lower jaw
• Rubber inserts around implant attachments will require replacement every 1-2 years.

Gallery

Case Study 1 - Fixed implant supported ceramic-metal bridge

Case Study 2 - Removable Implant-Bar Supported Overdenture

Case Study 3 - Removable Implant-Attachment Retained Overdenture (Lower Jaw)