Dentaltown April 2015 - (Page 54)

prosthodontics feature Treatment Planning for Implants in the Maxillary Edentulous Patient by John Nosti, DMD, FAGD, FACE, FICOI R ecent research has discussed techniques to improve a practitioner's predictability, proﬁciency and aesthetic outcomes in removable complete dentures.1-3 More than 60 million people in the United States alone have dentures.4 In a recent survey, a signiﬁcant number of denture wearers reported household incomes of more than six ﬁgures.5 Patients' desire to no longer have a removable prosthetic, along with the public's increased knowledge of implants, means that more patients are electing implant-retained prosthetics over conventional denture counterparts. For a patient, the psychological effect of missing maxillary teeth is extremely powerful. On several occasions, patients have disclosed to me that their biggest fear was that they may require a lifesaving surgery where intubation was necessary. They mentioned that they would "rather die" than remove their teeth in the presence of other people. It is not uncommon for patients to request after-hours appointments or secluded operatories so that they would have limited contact with staff. Many of these patients seek out practitioners who not only have advanced training in implant prosthetics, but can also demonstrate, with prior-case documentation, the psychologically beneﬁcial cosmetic appearance they desire. Where to start Several options are available for the completely edentulous patient, including a complete removable 54 APRIL 2015 // dentaltown.com denture, an implant-supported removable overdenture, a ﬁxed hybrid, or a ﬁxed prosthesis. Once it is determined that the patient has adequate bone to support any of these prostheses, or the ability to undergo augmentation to achieve the necessary bone-level foundation, the determining factor between these options comes down to patient ﬁnances. Fees will be discussed later. "In a 20-year review of the literature compiled by Dr. Charles J. Goodacre and his colleagues, restorations associated with the edentulous maxilla have the highest early loading implant failure rate compared with any other dental prostheses."6-7 In light of this research, it is extremely important to have a clear understanding of implant prosthetics and treatment options available for the edentulous maxillary arch. Although guidelines exist for the surgical aspect of implantology, few standards exist for the prosthetics. "A review of the literature indicates that full maxillary ﬁ xed-implant-supported prostheses may be fabricated on four to six standard-diameter implants with posterior molar cantilevers. An average of four to six implants also is used to support bar overdentures. Yet the edentulous maxilla has the lowest implant survival for either ﬁ xed or removable implant restorations compared with mandibular prostheses with this treatment approach."6-17 These studies indicate that many dentists are choosing to restore a ﬁ xed prosthesis in the http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown April 2015

On Dentaltown.com
HOWARD SPEAKS: When Staff Members Lose Hope
PROFESSIONAL COURTESY: Recommendations Refl ect You
Continuing Education Update
Industry News
Poll
Lateral Incisor Placement with CEREC
Oral Cancer: Stop Assuming and Start Screening
CE: Removal of Hemangioma, Fibroma and Performing a Frenectomy
Braces V. Aligners: As Technology Evolves So Do Patient Choices
Malpractice: Changing the Way We Practice
Treatment Planning for Implants in the Maxillary Edentulous Patient
You Should Know: Molar Media Mount
Collecting Trauma Pictures for a Lecture
A Progressive Treatment for the Over-Flared, Over-Prepared Endodontically Treated Tooth
New Products
Creating a Safe, Effective X-ray Practice
SmartBox: Marketing Prodigy Masters Patient Attraction
Facebook Updates and the Impact on Your Dental Practice
Improve a Dental Practice’s Fiscal Health by Proactively Managing A/R Days
Pennsylvania Doc Balances Professionalism and Humor
Ad Index
Product Profile: Ivoclar Vivadent
Perspectives: Being a Female Dentist in Yemen
Products in Practice: DENTSPLY
ULTRASONICS SHOWCASE
Ready, Set, Know: Making the Most of Your Dentrix Investment
Dentally Incorrect

Dentaltown April 2015