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ePaper created 2018-04-10, 12:30:21 | version 1.38.0
| case report Fixed or removable? That is the question. Dr Alessio Casucci & Alessandro Ielasi, Italy Edentulism is considered to be a disability and a major oral health problem worldwide.1, 2 Replacing missing teeth with a well-designed and -fabricated complete denture can satisfy the patient who has both a suitable clinical condition and adaptability. However, complete dentures do not restore function in all patients, especially in the case of the rejection of a removable solution for psycho- logical reasons. Fig. 1a Fig. 1b Fig. 2 Figs. 1a & b: Intraoral photographs. Fig. 2: Dental panoramic tomogram. 24 1 2018 The increased awareness, survival, and success of im- plants and implant restorations have expanded the op- tions for restoring the edentulous mouth from conventional dentures to implant-assisted prostheses. Furthermore, numerous studies have demonstrated that restorative ap- proaches involving implants improve edentulous patients’ masticatory function, quality of life and self-esteem.3, 4 Implant restorations have to be planned properly, eval- uating different parameters to achieve long-term success. Bone resorption, aesthetics and phonetic parameters can be determinants in establishing a proper treatment plan. Several patient-related parameters such as hand ability, maintenance and other functional aspects, have to be considered before starting patient treatment. Scientific literature too has to be considered by the clinician in order to evaluate clinical protocols, especially for the mandible where the possible standard of care must be established. A consensus regarding this standard of care for the fully edentulous maxilla based on a critical appraisal and com- parison of the cost-effectiveness of different prosthodon- tic solutions has not yet been achieved.5 For the maxilla, the literature abounds with descrip- tions of technical solutions, ranging from a fixed solution retained by four axial or tilted implants and upwards to a removable solution supported by two to ten splinted or free-standing implants. It has been reported that patient expectations are higher regarding treatment with fixed restorations.6 For some patients, a removable maxillary restoration would be the best solution providing facial scaffolding and especially for patients with a wide smile and/or high smile line covering the prosthesis-tissue junction. In addition, it is beneficial to adverse ridge relations or discrepancies and gives more latitude if the palatal contour for phona- tion has to be adjusted.7 Furthermore, it can be challeng- ing to properly clean a fixed restoration in patients with se- vere maxillary resorption.8 It has been reported that fixed restorations result in phonetic disturbances in 42 % and aesthetic problems in 37 % of the treated patients.9 The case described in this paper reports on the treat- ment of an edentulous patient in whom implants were