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ePaper created 2017-05-10, 16:12:25 | version 1.38.0
restoration of the edentulous maxilla case report | Discussion The number of implants placed for an edentulous patient should be based upon whether the design is to be implant-assisted or implant-supported. If the goal is a minimalist design utilising the soft tissue for support, two implants using Locator attachments are appropriate to retain a mandibular denture and will provide a predictable outcome. However, when more than two implants using resilient overdenture retain- ers are employed, there is not a corresponding linear increase in retention of the denture and the result may suffer. Therefore, when at least four implants are planned, the restoration should be designed as implant-supported to maximise the value of the patient’s greater investment. This article discusses just such a situation where a patient had experienced repeatedly low value from her investment of five implants. By redesigning her treatment to become implant-supported through the use of the Atlantis Conus concept, a successful result was achieved without the greater expense of a fixed hybrid. The final result was functionally com- parable to a fixed restoration while providing lip and cheek support of a removable prosthesis without complicating or obstructing oral hygiene. The telescopic design of the Atlantis Conus con- cept provides outstanding retention of the prosthesis during function as edentulous patients chew in a rel- atively flat elliptical pattern and the bridge can only be removed vertically. The abutments themselves are patient-specific and can be made for all major implant systems, allowing rescue of many frustrating results with overdentures. As long as there is sufficient interarch space (at least 12 mm), existing finished dentures can be retro- fit with Atlantis Conus Abutments, reducing patient cost while providing a stable result. Cast chrome frame reinforcement is advised for all new Atlantis Conus prostheses as the tremendous increase in strength of the bridge by the frame more than offsets the slight increase in cost and may actually reduce required inter-arch space. Fig. 19 Fig. 20 Fig. 19: Panoramic radiograph of the abutments seated on the four selected implants. Because the restoration is fully implant-supported, gradual diminution of the residual ridge will present no consequence to the patient. Fig. 20: Completed bridge in place showing flange length suitable to prevent food entrapment and support the lip and cheeks. Because the restoration remains removable, these flanges do not prevent excellent home care. The clinical procedure is relatively simple and com- parable to implant overdentures; however, because the abutments are patient-specific, tooth position must be established before the design of the abut- ments is begun. Conclusion A patient with an 11-year history of frustration with her dental implant investment was treated successfully with the Atlantis Conus concept using patient-specific abutments and SynCone caps, pro- viding an implant-supported, removable bridge with all the benefits of a fixed design and none of the lim- itations. Acknowledgements The author would like to thank Fred Senne, John Bergstresser and Sean Ferguson for their expertise and information. The author would also like to thank Tom Wiand and the talented team at Wiand Dental Laboratory for the laboratory procedures and prod- ucts described in this article._ Editorial note: A list of references is available from the publisher. contact Dr Montana graduated from the University of Southern California School of Dentistry in 1987 and completed his certificate in Advanced Prosthodontics at USC in 1989. He has maintained a full-time private practice in Tempe, Arizona, since 1989, emphasis- ing fixed, removable and implant prosthodontics. He has been a clinical instructor while attending USC and currently is a clinical instructor and lecturer in the Advanced Education of General Den- tistry program at the Arizona School of Dentistry and Oral Health. He is a member of the Dentsply Implants’ PEERS North America study club (Dentsply Sirona), the American College of Prosthodontists, the American Academy of Fixed Prosthodontics, the Pacific Coast Society for Prosthodontics, the Academy of Osseointegration and the American and Arizona Dental Associations. He has lectured extensively throughout North America on the topics of implant, fixed and removable prosthodontics. He can be contacted at: office@markmontanadds.com. CAD/CAM 2 2017 17