Rationale

Dental implants have become the first treatment option for most edentulous patients and in particular for partial restorations. This is due to the favorable long-term results and the opportunity to deliver a prosthetic restoration with minimal risk, compared to a conventional approach.

Nevertheless, some controversies remain concerning the overall prosthetic decision: distribution of implants, cantilevers, implant/natural tooth connection, and screw-retained or cemented restorations.

The general prosthetic goal is to create an overall reliable structure consistent with a comfortable function (biomechanics), acceptable esthetics, and with minimum morbidity and cost.

Opinions based on conventional prosthetic treatments experience are not always reliable, as implant-supported denture concepts follow specific rules, mainly related to the osseointegration process.

Advantages

Compared to most conventional restorations, implant-supported FPD represents a less invasive prosthetic treatment with a reduction of the overall risk (Pjetursson and Lang, 2008) (Table 27.1). This is partially due to the possibility of increasing the number of abutments.

Table 27.1 Survival rate of prosthetic fixed partial dentures (Pjetursson and Lang, 2008)

FPD, fixed partial denture.

Disadvantages

Financial costs and anatomical limits can represent barriers which are not easy to overcome, and conventional restorations can then be considered.

Indications

Implant-supported FPD, when possible, is the treatment of choice for partially edentulous patients in the following situations:

• healthy adjacent teeth
• intact adjacent tooth restoration
• posterior reduced arch
• extended edentulous segments.

Implant Distribution (Figs 27.1–27.4)

The number of implants depends on th/>