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I C.E. article_ fixed and removable implant restorations implants 2_2016 08 I This article qualifies for C.E. credit.TotaketheC.E.quiz,log on to www.dtstudyclub. com. Click on ‘C.E. articles’ and search for the edition this arti- cle first appeared in (Implants C.E. Magazine — 2/2016). If you are not registered with the site, you will be asked to do so beforetakingthequiz.Youmay also access the quiz by using the QR code below. _c.e. credit part II _When a patient presents with an edentulous arch or terminal dentition, implant treatment can be provided that improves not only form and func- tion but also quality of life. For patients desiring better chewing capability, stability, esthetics and comfort than a traditional denture can offer, both removable and fixed implant restorations are su- perior alternatives.1 While the appropriate implant solution can vary depending on the patient’s oral health, anatomy, quality and quantity of bone, and financial resources, full-arch prosthetics have pro- gressed to the point where virtually every patient can be restored. Althoughfixed,implant-supportedrestorations offer the highest levels of stability, function and patient satisfaction, removable overdentures are a dramatic improvement over conventional com- plete dentures as well.2 Both treatment options effectivelymitigatetheboneresorptionthatoccurs following the loss of teeth, helping to preserve the oral and facial structures and, by extension, the self-confidence of the fully edentulous patient. Determiningwhichsolutionisappropriaterequires a careful evaluation of the individual patient’s circumstances and desires. Even when an implant overdentureisdelivered,theprosthesiscaneventu- ally be converted to a fixed restoration. As evidenced by the case that follows, in which one arch is restored with an implant overdenture and the other with a BruxZir® Full-Arch Implant Prosthesis, practitioners today have a great deal of clinical flexibility. Whatever prosthetic approach is adopted, immediate, life-changing relief can be provided to patients suffering from terminal dentition or an uncomfortable, poorly function- ing traditional denture. Further, the dramatic overhaul of this patient’s oral health demonstrates the life-changing capabilities of implant therapy, which helped him overcome severe functional and esthetic challenges that were impacting practically every facet of his life prior to treatment. _Case presentation A 47-year-old male presented with terminal dentition in both arches resulting from periodontal disease and severe caries (Figs. 1a–1c). The patient had already lost many of his teeth, and the denti- tion that remained had been rendered unstable by his periodontal condition (Fig. 2). He had saved up enough money for a fixed implant restoration for his upper arch, for which he desired the most func- tional,lifelikeprosthesispossible.Whilehecouldn’t affordsucharestorationforbotharches,hewanted a retentive appliance for his mandible, with the op- tion of later upgrading to a fixed prosthesis. The patient accepted a treatment plan in which his maxilla would be restored with a BruxZir Full- Arch Implant Prosthesis and his mandible with an Inclusive® Locator Implant Overdenture. Fabricat- inghismaxillaryrestorationfrommonolithiczirco- nia would ensure maximum long-term durability. This was important provided the relatively young age of the patient, who would not have to worry about his upper prosthesis succumbing to frac- tures, chips or stains. His lower appliance would be held in place by connecting to the implants via Locator® attach- ments (Zest Anchors; Escondido, Calif.), which are an economical means of improving prosthetic retention and stability. The overdenture caps that connect to the Locator attachments would be incorporated in the prosthesis chairside, though it should be noted that many clinicians elect to have the laboratory handle this step. Thesurgicalphaseoftreatmentcalledfortheex- Fixed and removable implant restorations: A solution for every arch Author_Paresh B. Patel, DDS