The complete supra-radicular and supra-implant removable prosthesis
INTRODUCTION :
The importance of bone resorption, the anarchy of bone remodeling, the narrowness and quality of the support surface, and the dynamics of the muscular elements, there are many problems linked to total edentulism, the use of auxiliary techniques such as the preservation of dental roots or the installation of implant fixtures associated with additional retention means, finds its full indication here.
SUPRA-RADICULAR PROSTHESES: OVERDENTURES:
Over =above
Denture =prosthesis
The overdenture is an adjunct prosthesis supported by a set consisting of: the edentulous muco-osseous crest and the treated residual roots.
Indications:
- Subtotal edentulism
- Good intrinsic and extrinsic value+++
- Sufficient prosthetic space (Mounting on articulator+++)
- In the mandible rather than the maxilla.
Contraindications:
- Very poor periodontal value
- Presence of vestibular undercut
Advantage :
- SOCIO-PSYCHOLOGICAL
- AESTHETICS
- BIO MECHANICS
- ANATOMO-PHYSIOLOGICAL
- FUNCTIONAL
Root supports: can:
- have no role in retention; apart from STABILIZATION and SUSTENATION, we speak of parabolic caps (P.MILLER 1957)
- be used for prosthetic retention and are then covered with a coping equipped with a retentive system (ATTACHMENT)
THERAPEUTIC DECISION: several factors come into play:
- CLINICAL EXAMINATION
- PANORAMIC
- ADDITIONAL X-RAYS
- PERIODONTAL ASSESSMENT
- STUDY MODELS: prosthetic space; PO; DVO
Tooth preparation:
- Endodontic treatment.
- Coronary preparation according to the principles of fixed prosthesis preparations.
- Stump imprint (preparations)
- Installation of the caps or bar.
Axial attachments
- Male part attached to the dental root
- Female part in the prosthetic intrados
Retention bar
The bar contributes to retention in addition to the effectiveness of the peripheral seal.
The complete supra-radicular and supra-implant removable prosthesis
Completed removable supra-implant prosthesis
The implant-supported prosthesis is a covering prosthesis on osteointegrated implants, retention and support are ensured by attachments or by a bar.
The principle is to place a retention system at the implant level, which will allow additional retention of the well-designed complete prosthesis. Support and stabilization will be ensured by the osteo-fibrous tissues.
The creation of a total supra-implant prosthesis requires very rigorous pre-prosthetic and pre-implant planning and analysis, as well as a surgical phase that respects not only
The requirements of the surgical procedure but also the previously defined prosthetic objectives
Main indication : Retention
🡺 Significantly improved chewing efficiency
Benefits
Chewing efficiency is greatly improved. Thanks to increased stabilization and prosthetic retention, resorption is reduced thanks to the presence of implants. On a psychological level, patients regain self-confidence;
Mandibular PACSI : principles
- Conventional PC Rules: Implants Don’t Fix Errors
- There remains a prosthesis with osteo-mucosal support
-> At the mandibular level: Possibility of piezographic impression
Preliminary production of the prosthesis with an effective joint and according to already defined inter-arch relationships
Surgical phase:
Placement of implants. Number: 2 to 3 implants
The site of choice for implants is the parasymphyseal site, due to the absence of an anatomical obstacle;
Osseointegration: 3 months minimum,
X-ray control
Postoperative
- Do not wear the prosthesis for 10 days
- Transitional phase: prosthesis relined with viscogel, hollowed out opposite the implants
- Review the patient every 15 days = Most difficult period with removable prosthesis
After osteointegration (around 3 months)
- Setting up the fixing system:
- Spherical system
- Rod
- Fixing the counterpart in the prosthesis of use
- under occlusal pressure (self-polymerizing resin)
- or after imprint, in the laboratory
CONCLUSION :
Residual roots represented a solution to promote the retention and stability of total removable prostheses until the appearance of implants, which represent a solution with its advantages and disadvantages.
It is up to the practitioner, during his discussion with his patient, to define and propose the most appropriate solution for the particular case of toothlessness.
The complete supra-radicular and supra-implant removable prosthesis
Wisdom teeth can cause infections if not removed.
Dental crowns restore the function and appearance of damaged teeth.
Swollen gums are often a sign of periodontal disease.
Orthodontic treatments can be performed at any age.
Composite fillings are discreet and durable.
Composite fillings are discreet and durable.
Interdental brushes effectively clean tight spaces.
Visiting the dentist every six months prevents dental problems.