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Implant-Supported Prosthetic Therapy of an Edentulous Patient: Clinical and Technical Aspects

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Implant-Supported Prosthetic Therapy of an Edentulous Patient: Clinical and Technical Aspects Case Report Implant-Supported Prosthetic Therapy of an Edentulous Patient: Clinical and Technical Aspects Luca Ortensi 1,*, Marco Ortensi 2, Andrea Minghelli 3 and Francesco Grande 4 1 Department of Prosthodontics, University of Catania, 95124 Catania, Italy 2 CDT Private Practice, 40126 Bologna, Italy; [email protected] 3 School of Dentistry, University of Bologna, 40126 Bologna, Italy; [email protected] 4 Oral and Maxillofacial Surgery, University of Bologna, 40126 Bologna, Italy; [email protected] * Correspondence: [email protected] Received: 20 May 2020; Accepted: 23 June 2020; Published: 1 July 2020 Abstract: The purpose of this article is to show how to implement an implant-supported prosthetic overdenture using a digital workflow. Esthetic previewing using a specific software, guided-surgery, construction of the prosthesis, and the esthetic finalization are described in this article. Patients suffering from severe loss of bone and soft tissue volume could benefit from the construction of an overdenture prosthesis as a feasible therapeutic choice for functional and esthetic issues of the patient. Keywords: prosthesis; Digital Smile System; overdenture; digital prosthetic planning; atrophic patient 1. Introduction A pleasant appearance is ever more aspired to in the daily life of everyone, at any age. When adverse changes occur to a visible part of the body, the social and psychological impact can be negative for the individual [1]. Among the least well-tolerated changes is edentulism; which, in addition to causing significant functional deficits (chewing, phonetics), involves visible changes of facial esthetics, because with the loss of teeth and the resulting reabsorption of the alveolar crests, there is naturally less support for the soft tissues of the face, which takes on an unpleasant look, regardless of the person’s age. Although the total removable prosthetic is doable in a short timeframe and is economical and efficient, it is not easy to make to enhance the function and esthetics of the totally edentulous patient. These two aspects are certainly an advantage, but that is not enough to consider removable prosthesis for the ideal prosthetic therapy. In fact, not even this type of state-of-the-art prosthetic can completely restore chewing capacity and strength in some types of patients [2]. In elderly patients with atrophic maxilla, the implant-supported removable prosthesis (overdenture) is considered a feasible option in the prosthetic treatment plan [3]. When a severe loss of supporting bone structure has already happened, it would be necessary to optimize the soft tissues aspect of the lower third of the face, facilitating, at the same time, home oral hygiene procedures and patient comfort [4,5]. Stabilization of the removable prosthesis with a reduced number of implants may present multiple advantages. The biological and economic costs could be contained, the time for oral rehabilitation is shorter, and the long-term success rates are over 90%. In the mandible, two implants seem to be sufficient to obtain good stabilization of the removable prosthesis and the literature does not show statistically significant differences in terms of survival rate and comfort for the patient between insertion of two or four implants, solidified by a bar or with connections not constraining the implants (i.e., ball-attachment or other individual attachment type) [6]. On the other hand, for the upper maxilla the insertion of only two implants is not considered an ideal option if long cantilevers are expected; more predictable results could be achieved with the insertion of at least four implants connected by a metal or titanium Prosthesis 2020, 2, 140–152; doi:10.3390/prosthesis2030013 www.mdpi.com/journal/prosthesis Prosthesis 2020, 1, FOR PEER REVIEW 2 Prosthesis 2020, 2 141 connected by a metal or titanium bar, considering also the shape of the maxillary arch [7]. In this specific therapy, the prosthesis could have a limited palate, improving the patient’s comfort and flavorbar, considering perception also [8]. the shape of the maxillary arch [7]. In this specific therapy, the prosthesis could haveHowever, a limited palate,the treatment improving plan the of atrophic patient’s patients comfort is and a challenging flavor perception procedure [8]. for the clinician and also theHowever, technician. the treatment Several factors plan of should atrophic be patientsconsidered is a challengingduring the treatment procedure planning for the clinician in order and to realizealso the an technician. appropriate Several oral rehabilitation. factors should be considered during the treatment planning in order to realizeRecently an appropriate modern oralprosthetics rehabilitation. makes use of digital technologies to support both the diagnostic and theRecently therapeutic modern phases prosthetics of patient makes rehabilitati use ofon, digital facilitating technologies also the to communication support both the between diagnostic the clinicianand the therapeutic and the lab phases[9–11]. of patient rehabilitation, facilitating also the communication between the clinicianTraditional and the removable lab [9–11]. prosthetics and those supported by implants have benefitted from these innovationsTraditional both removable in virtual prosthetics planning of and clinical those supportedcases and byas implantsa support have during benefitted the construction from these phaseinnovations [12–15]. both in virtual planning of clinical cases and as a support during the construction phaseThe [12 purpose–15]. of this article is to illustrate, through detailed step-by-step description of a complex clinicalThe case, purpose the construction of this article of is toan illustrate,inferior overdenture through detailed with step-by-stepimplant support, description applying of a complexthe new digitalclinical case,technologies the construction to every of an inferiorphase overdentureof the diagnostic with implant and support,prosthetic applying therapy, the newreducing digital implementationtechnologies to every time and phase analogical of the diagnostic phases. and prosthetic therapy, reducing implementation time and analogical phases. 2. Materials and Methods 2. Materials and Methods A 70-year old patient came to the dental office complaining of diminished masticatory capacity and lossA 70-year of retention old patient of both came removable to the dental dentur officees. complaining She wanted of to diminished improve her masticatory smile and capacity facial esthetics,and loss of stating retention she ofwas both dissatisfied removable with dentures. the co Shelor wantedand poor to visibility improve herof her smile teeth, and no facial matter esthetics, how bigstating she shesmiled. was dissatisfiedThe patient with also theasked color to and avoid poor multiple-steps visibility of her therapies teeth, no and matter desired how to big have she smiled.a new prostheticThe patient solution also asked in the to avoidshorte multiple-stepsst time as possible. therapies The andpatient’s desired smile to haveseemed a new non-harmonious prosthetic solution due toin thedental shortest wear time and asthe possible. inclination The of patient’s the occlusal smile seemedplanes, non-harmoniouswhich affected her due general to dental appearance wear and (Figurethe inclination 1). The ofpatient the occlusal gave her planes, written which consent affected to herpublish general photos appearance of her clinical (Figure 1case,). The including patient photosgave her of writtenher face. consent to publish photos of her clinical case, including photos of her face. FigureFigure 1. 1.Initial Initial state state of of the the face: face: a a reduction reduction of of the the vertical vertical dimension dimension is is observed observed with with an an increase increase in perilabial wrinkles. in perilabial wrinkles. Her history did not show any pathology incompatible with dental treatment and demonstrated that sheshe waswas in in good good general general health health and classifiedand classified as ASA1. as ASA1. The facial The examination facial examination showed ashowed reduction a reductionof the vertical of the dimension, vertical dimension, with a widening with a of widening the nasolabial of the folds,nasolabial and diminished folds, and diminished tone of theperioral tone of thesoft perioral tissue, with soft atissue, generalized with a generalized deterioration deterior of all facialation estheticof all facial parameters esthetic (Figureparameters2). During (Figure the 2). Duringintraoral the clinical intraoral examination, clinical examination, incongruous incongruou prosthesiss in prosthesis both arches in both have arches been observed have been (Figure observed3). (Figure 3). Prosthesis 2020, 2 142 Prosthesis 2020, 1, FOR PEER REVIEW 3 ProsthesisProsthesis 2020 2020, 1,, 1FOR, FOR PEER PEER REVIEW REVIEW 33 Figure 2. Extraoral facial photos: lateral view. FigureFigureFigure 2. 2.2. Extraoral Extraoral facial facial photos: photos: laterallateral lateral viewview view... Figure 3. Intraoral photos of the removable dentures. FigureFigureFigure 3. 3.3. Intraoral Intraoral photos photos of of the the the removable removable removable dentures.dentures. dentures. The upperupper arch arch had had a full-removable a full-removable denture, denture, while while the lower the jawlower had jaw a fixed had prosthesis a fixed supportedprosthesis TheThe upper upper arch arch had had a a full-removable full-removable denture,denture, whilewhile thethe
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