While implants have the mechanical availability to attach many different prosthetic options, many factors must be taken into consideration before a final prosthetic choice is made for the patient. The decision amongst the prosthetic choices available to attach to a implant is based upon treatment planning.
This month’s Implants Today topic is dental implant prosthetic options. This is a broad topic in the field of dental implants, one where we find that there are now many treatment choices for the patient. While dental implants have the mechanical availability to attach many different prosthetic options, many factors must be taken into consideration before a final prosthetic choice is made for the patient. The decision amongst the prosthetic choices available to attach to an implant is based upon treatment planning.
One of the first questions I ask patients is if they are open to wearing a removable implant-supported option. While a removable implant-supported prosthesis can be a more affordable than a fixed option, there are disadvantages to consider. The main disadvantage to a removable implant-supported prosthesis is that this choice is less like natural teeth than fixed options. Removable implant-supported options that are partially tissue-supported also are susceptible to bone loss in the tissue-supported areas and the inherent problems associated with any bone loss. Unless finances are the determining factor, in my experience I have found that most patients would rather have a fixed implant-supported option.
From a fixed prosthetic standpoint, it seems that fewer screw-retained acrylic hybrid options are now being chosen and utilized as a treatment option. The success rate of zirconia as a screw-retained option has increased the use of zirconia for full-arch implant-supported prostheses. Zirconia, especially as a monolithic option, reduces and virtually eliminates the problems of porcelain chipping and the loss of teeth from the prosthesis. While there might be slightly higher laboratory costs associated with the fabrication of a full-arch screw-retained zirconia prosthesis, these costs should be compared to the financial impact (and stress) for the clinician and patient that can result from fractured teeth seen often with acrylic and metal hybrids. There are other clinical benefits of zirconia versus acrylic. Zirconia, having the highest modulus of elasticity of any product available in dentistry along with its inherent low porosity and susceptibility to attract debris, allows for the observed high success rate with this prosthetic option. In addition to the cost of repairs, there is often a loss of patient confidence seen with hybrid acrylic bridges that can negatively affect the dental practice. Some thoughts when choosing among the different treatment options for a patient.
This month, we have 2 excellent articles in our Implants Today section. Dr. Edward Kusek presents an article showing the resurrection of a failing implant case using the latest technologies and clinical expertise, and Dr. Tim Kosinski discusses proper preparation for prosthetically driven implants and demonstrates the ways in which the latest technology, implant design, and techniques, can help the clinician manage a challenging case.
If you have any questions or comments about this topic, or any other subject presented in Implants Today, feel free to contact Dr. Tischler at mt@tischlerdental.com.
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