Treatment planning: implant-supported fixed partial denture
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.
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.
|5 years (%)||10 years (%)|
|Conventional tooth-supported FPD||93.8||89.2|
|Combined tooth-implant FPD||95.5||77.8|
|Implant-supported single crown||94.5||89.4|
FPD, fixed partial denture.
Financial costs and anatomical limits can represent barriers which are not easy to overcome, and conventional restorations can then be considered.
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/>