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ePaper created 2017-12-06, 12:03:50 | version 1.38.0
| industry Rehabilitation of edentulous arches The Double FiRe Bridge Authors: Dr Marco Montanari, Claudio Sassatelli & Davide Nadalini, Italy Implantology allows the restoration of missing or lost teeth by supporting fixed prostheses or anchor- ing removable prostheses. This has considerably ex- panded the possibilities of treatment and has allowed the patient to gain functional and psychological ben- efits and improved comfort, especially compared with conventional removable prostheses.1 Every prosthetic rehabilitation aims to restore the stomato- gnathic apparatus, achieve satisfactory aesthetics— in harmony with the patient’s face—and support soft tissue or compensate for loss.2–4 In this situation, it is of great importance to choose the type of prosthesis (fixed or removable) and the means of realising it.5, 6 The support of perioral tissue, lip mobility and the smile line are important parameters to take into account, because they affect the choice of the most appropriate prosthesis for the patient. Specifically, the relationship between the tooth profile and the volume of hard- and soft-tissue, which the prostheses must compensate for, gains particular significance in devel- oping a treatment plan.2, 5 For this reason, a complete patient analysis, which is not limited to intraoral ex- amination, but includes extraoral (frontal and profile) aspects, such as the smile line, perioral tissue, muscu- loskeletal conformation, phonetics and hygiene hab- its, is of fundamental importance. In cases of high crestal bone and gingival resorp- tion, an implant-supported removable prosthesis is the obvious solution, since lost volumes can be sup- ported by a prosthetic flange. This kind of prosthesis has the advantage of facilitating the patient’s home oral hygiene, both of the framework and of the re- movable prosthesis itself, and gives the patient the feeling of wearing a fixed prosthesis.7 However, in cases in which there is good maintenance of hard- and soft-tissue and the profile appears correct, with good support of perioral tissue, a fixed prosthesis appears to be the best option.2, 5 Loss of hard tissue can be due to trauma, but it is more often due to periodontal problems that may lead to spontaneous tooth loss. Periodontitis is an in- fectious pathology that causes progressive resorp- tion of the dental supporting structures (alveolar bone, periodontal ligament and root cementum), re- sulting in recession, deep periodontal pockets, tooth mobility, spontaneous gingival bleeding or bleeding on probing, and apical abscesses, ultimately resulting Fig. 1a: Dental panoramic tomogram showing periodontal problems on both arches. Fig. 1b: Intraoral photograph showing signs of generalised chronic periodontitis. Fig. 1a Fig. 1b 20 implants 4 2017