Full-Arch, Implant- Supported Metal- Ceramic Fixed Dentures

• Superior prosthesis fit prostheses are very similar to typical sensitive, which precludes their use for • Availability of a permanent digital ceramo-metal fixed partial dentures many patients. Perio & Implant Centers The Team for file for future reproduction of the Monterey Bay (831) 648-8800 used for replacing natural teeth. Jochen P. Pechak, DDS, MSD • Opportunity for digital fabrication A substructure is fabricated to provide Conclusion mobile app: www.GumsRusApp.com in Silicon Valley (408) 738-3423 of a prototype/replica prosthesis both the attachment to underlying web: GumsRus.com in acrylic resin for patient implants, as well as an ideal porcelain While a full-arch, implant-supported approval and adjustments thickness for long-term durability. restoration offers a predictable and • Superior biocompatibility When designed correctly with superior alternative to complete compared with metal alloys, adequate metal support for layering dentures, treating the totally edentulous PDL tm reduced plaque accumulation, and porcelain, they satisfy all requirements patient and patients facing total • Favorable soft tissue response for a prosthodontic rehabilitation. edentulism with such complete The disadvantages related to the use Definitive occlusal surfaces can be PerioDontaLetter prostheses can be a challenging task. Jochen P. Pechak, DDS, MSD, Periodontics, Implant & Laser Dentistry Winter of zirconia include the inability to created in porcelain, or alternatively Close collaboration between the repair fractures, difficulty in adjusting may be made in metal if advisable. periodontist, restorative dentist and the and polishing, and high fracture rates A metal-ceramic prosthesis is very dental laboratory is key to a successful of opposing acrylic prosthesis. esthetic, as ceramic is more life-like clinical result which is more likely to Fixed Prosthetic Treatment Moreover, the use of a minimum than acrylic resin. produce patient satisfaction in terms of From Our Office five supporting implants is However, one disadvantage of a comfort, function, phonetics, and to Yours... Options for the Completely recommended due to the high stiffness metal-ceramic prosthesis is that ceramic esthetics. and overall weight of the zirconia chipping or fracture may occur and Welcome Our New Associate Periodontist, Dr. Nikta Ghaderi, Edentulous Patient and Patients full-arch prostheses. may be difficult to repair. PDL tm The opposing occlusion should to our periodontal family. Facing Complete Edentulism invariably and scrupulously be Here are ”Five Fun Full-Arch, Implant- considered, especially if a parafunctional Facts” about Dr. Nikta istorically, the conventional life when compared with patients habit is suspected. Ghaderi: treatment for complete with a fixed prosthesis. Supported Metal- 1. Dr. Ghaderi was Moreover, six to eight implants per edentulism has been The main causes of patient Ceramic Fixed born and raised in H removable complete dentures. arch are generally recommended to Cupertino, California. dissatisfaction with complete Dentures support a PFM full-arch prostheses. 2. She was inspired However, clinical studies have dentures are lack of proper In addition, PFM full-arch prostheses to become a Periodontist as a teen shown that patients with removable mastication, inability to eat different Full-arch, implant-supported, are generally expensive, time- intern in our practice under the complete dentures have a types of food, loss of taste, impaired porcelain-fused-to-metal (PFM) consuming to fabricate, and technique beloved “angel” Dr. Rik Vanooteghem. considerably decreased quality of speech, and poor denture stability. 3. She earned her bachelor of science degree in neurobiology, physiology and behavior with honors at the University of California, Davis; her doctor of dental surgery degree from the University of the Pacific; and her master of science in Periodontology from Oregon Health and Science University. 4. She enjoys oil painting and hiking. 5. She has completed volunteeer externships in Costa Rica and Fiji, Fig. 8 Fig. 9 and hopes to volunteer next in the Philippines. We know you will be as thrilled as Figure 1. A partially edentulous patient presents with a Figure 8. Initial examination shows an unesthetic and terminal dentition. Figure 9. Both arches were we are to have Dr. “Niki” join our hopeless dentition in both the maxillary and mandibular restored with an implant-supported, hybrid complete fixed dental prosthesis. team! arches. (See Figures 2 and 3 on page 2.)

Dr Pechak is a board certified Periodontist embracing the evolution of better options with a focus on minimally-invasive techniques for gum disease, oral 21 Upper Ragsdale Drive • Monterey, CA 93940 • (831) 648-8800 • [email protected] Jochen P. Pechak, DDS, MSD surgery, dental implants, and implant-supported dentures. As a CE provider for the State of California, he lectures and hosts educational events for Dentists, 516 W. Remington Drive, Suite 5A • Sunnyvale, CA 94087 (408) 738-3423 • [email protected] dental teams and the community of Dental Hygienists. He is the Founder and Director of a chapter of the Seattle Study Club network, as well as our Hygiene Diplomate, American Board of Periodontology Study Club. Please contact us if you wish to be a part of our continuing education series, in which CEU’s are earned. mobile app: GumsRusApp.com • website: GumsRus.com • Dr. Pechak’s direct email: [email protected] All these factors lead to a decrease the patient’s desires and needs for a speech problems, and hygiene cost, and dissatisfaction with treatment supported prostheses, and is purported The use of completely monolithic in overall health and diminished removable or non removable difficulties. for both patient and clinician Moreover to solve many of the problems related to zirconia, or minimally-veneered lifestyle options. Patients tend to avoid restoration — what they want to eat Material-related problems have also patients with distal cantilevers, metal-resin and metal-ceramic zirconia with feldspathic porcelain in a nutritious protein-based diet, and need to eat — and the amount of intra- been reported, including acrylic insufficient prosthetic space, or prostheses. Implant-supported, full- the gingival region, has multiple tend to avoid activities that involve arch space deterioration over time due to water parafunctional habits report much arch zirconia prostheses are designed advantages for the clinician and interaction with other people. In addition, other clinical parameters absorption, discoloration, and higher complication rates. using computer assisted design and patient. Dental implant-supported, fixed such as lip support, high maxillary ultimately, fracture. Furthermore, the computer assisted machining (CAD/ These advantages include: prostheses offer a solution to these smile, low mandibular lip line, and the excessive porosity of acrylic decreases Full-Arch, Implant- CAM). Zirconia prostheses are known • Reduced laboratory costs because problems, and can significantly patient's greater esthetic demands clinical survival. for their high fracture resistance of the automation involved in improve the quality of life for these should be evaluated before deciding Clinical studies recommend 12 to Supported Zirconia compared to all other ceramic fabrication patients. on a prosthetic treatment plan. 14mm of restorative inner arch space Prostheses materials used in dentistry. Moreover, • Good dental and gingival One alternative to complete dentures More importantly all implant to accommodate sufficient thickness they are also known for their esthetic, esthetics is an immediately-loaded, implant- surgical planning should be of acrylic to prevent fracture. Zirconia has emerged as an alternative lifelike reproduction of natural • Superior strength, durability and supported, full-arch dental prosthesis. prosthetically, as opposed to surgically, Achieving this space, especially in prosthetic material for full-arch, implant- dentition. wear characteristics Clinical longevity and success rates driven. patients with terminal dentition, will of immediately-loaded dental almost always require surgical implants have been well documented Implant-Supported reduction of alveolar bone. as a proven and predictable treatment Hybrid prostheses have been for edentulous patients. High levels of Hybrid Prostheses conventionally fabricated with a rigid patient satisfaction in terms of metal framework and acrylic resin for esthetics, phonetics and function have Complete implant-supported, metal artificial teeth and gingiva. been reported in clinical studies. and acrylic fixed dental prostheses — This design remains a popular Three main types of implant- or hybrid prostheses — were choice because of its low fabrication supported, full-arch prostheses are introduced to address the problems cost, easier repairability, and the currently in use: caused by unstable and uncomfortable clinician’s comfort level with this 1. Metal-framework, reinforced mandibular dentures. material. acrylic hybrid prostheses Hybrid prostheses have a number of However, multiple clinical studies 2. Screw-retained, full-arch zirconia advantages over acrylic and zirconia and systematic reviews have reported Fig. 4 Fig. 5 prostheses prostheses. They reduce the impact of a high rate of fracture and wear 3. Cement or screw-retained, full-arch dynamic occlusal loads, are less of the acrylic resin, requiring porcelain-fused-to-metal prostheses expensive to fabricate, and are highly repair, replacement, and lifelong Figure 4. Initial examination reveals a fully edentulous mandible arch with a decision to proceed The primary determining factor esthetic restorations. maintenance. with a fixed, implant-supported bridge. Figure 5. After healing and integration of the implants, which must be considered before Some of the disadvantages that have This maintenance represents a restorative abutments were placed. selecting one of these restorations is been reported include: food impaction, significant inconvenience, financial

Fig. 2 Fig. 3

Fig. 6 Fig. 7

Figure 2. Implants were placed and healed in preparation for a full arch zirconia prosthesis in both Figure 6. Try-in of the metal framework. Figure 7. A fixed implant-supported, porcelain-fused-to- the maxilla and mandible. Figure 3. The final restoration is both functional and esthetic. metal prosthesis was placed.

PerioDontaLetter, Winter All these factors lead to a decrease the patient’s desires and needs for a speech problems, and hygiene cost, and dissatisfaction with treatment supported prostheses, and is purported The use of completely monolithic in overall health and diminished removable or non removable difficulties. for both patient and clinician Moreover to solve many of the problems related to zirconia, or minimally-veneered lifestyle options. Patients tend to avoid restoration — what they want to eat Material-related problems have also patients with distal cantilevers, metal-resin and metal-ceramic zirconia with feldspathic porcelain in a nutritious protein-based diet, and need to eat — and the amount of intra- been reported, including acrylic insufficient prosthetic space, or prostheses. Implant-supported, full- the gingival region, has multiple tend to avoid activities that involve arch space deterioration over time due to water parafunctional habits report much arch zirconia prostheses are designed advantages for the clinician and interaction with other people. In addition, other clinical parameters absorption, discoloration, and higher complication rates. using computer assisted design and patient. Dental implant-supported, fixed such as lip support, high maxillary ultimately, fracture. Furthermore, the computer assisted machining (CAD/ These advantages include: prostheses offer a solution to these smile, low mandibular lip line, and the excessive porosity of acrylic decreases Full-Arch, Implant- CAM). Zirconia prostheses are known • Reduced laboratory costs because problems, and can significantly patient's greater esthetic demands clinical survival. for their high fracture resistance of the automation involved in improve the quality of life for these should be evaluated before deciding Clinical studies recommend 12 to Supported Zirconia compared to all other ceramic fabrication patients. on a prosthetic treatment plan. 14mm of restorative inner arch space Prostheses materials used in dentistry. Moreover, • Good dental and gingival One alternative to complete dentures More importantly all implant to accommodate sufficient thickness they are also known for their esthetic, esthetics is an immediately-loaded, implant- surgical planning should be of acrylic to prevent fracture. Zirconia has emerged as an alternative lifelike reproduction of natural • Superior strength, durability and supported, full-arch dental prosthesis. prosthetically, as opposed to surgically, Achieving this space, especially in prosthetic material for full-arch, implant- dentition. wear characteristics Clinical longevity and success rates driven. patients with terminal dentition, will of immediately-loaded dental almost always require surgical implants have been well documented Implant-Supported reduction of alveolar bone. as a proven and predictable treatment Hybrid prostheses have been for edentulous patients. High levels of Hybrid Prostheses conventionally fabricated with a rigid patient satisfaction in terms of metal framework and acrylic resin for esthetics, phonetics and function have Complete implant-supported, metal artificial teeth and gingiva. been reported in clinical studies. and acrylic fixed dental prostheses — This design remains a popular Three main types of implant- or hybrid prostheses — were choice because of its low fabrication supported, full-arch prostheses are introduced to address the problems cost, easier repairability, and the currently in use: caused by unstable and uncomfortable clinician’s comfort level with this 1. Metal-framework, reinforced mandibular dentures. material. acrylic hybrid prostheses Hybrid prostheses have a number of However, multiple clinical studies 2. Screw-retained, full-arch zirconia advantages over acrylic and zirconia and systematic reviews have reported Fig. 4 Fig. 5 prostheses prostheses. They reduce the impact of a high rate of fracture and wear 3. Cement or screw-retained, full-arch dynamic occlusal loads, are less of the acrylic resin, requiring porcelain-fused-to-metal prostheses expensive to fabricate, and are highly repair, replacement, and lifelong Figure 4. Initial examination reveals a fully edentulous mandible arch with a decision to proceed The primary determining factor esthetic restorations. maintenance. with a fixed, implant-supported bridge. Figure 5. After healing and integration of the implants, which must be considered before Some of the disadvantages that have This maintenance represents a restorative abutments were placed. selecting one of these restorations is been reported include: food impaction, significant inconvenience, financial

Fig. 2 Fig. 3

Fig. 6 Fig. 7

PerioDontaLetter, Winter • Superior prosthesis fit prostheses are very similar to typical sensitive, which precludes their use for • Availability of a permanent digital ceramo-metal fixed partial dentures many patients. Perio & Implant Centers The Team for file for future reproduction of the Monterey Bay (831) 648-8800 used for replacing natural teeth. Jochen P. Pechak, DDS, MSD • Opportunity for digital fabrication A substructure is fabricated to provide Conclusion mobile app: www.GumsRusApp.com in Silicon Valley (408) 738-3423 of a prototype/replica prosthesis both the attachment to underlying web: GumsRus.com in acrylic resin for patient implants, as well as an ideal porcelain While a full-arch, implant-supported approval and adjustments thickness for long-term durability. restoration offers a predictable and • Superior biocompatibility When designed correctly with superior alternative to complete compared with metal alloys, adequate metal support for layering dentures, treating the totally edentulous PDL tm reduced plaque accumulation, and porcelain, they satisfy all requirements patient and patients facing total • Favorable soft tissue response for a prosthodontic rehabilitation. edentulism with such complete The disadvantages related to the use Definitive occlusal surfaces can be PerioDontaLetter prostheses can be a challenging task. Jochen P. Pechak, DDS, MSD, Periodontics, Implant & Laser Dentistry Winter of zirconia include the inability to created in porcelain, or alternatively Close collaboration between the repair fractures, difficulty in adjusting may be made in metal if advisable. periodontist, restorative dentist and the and polishing, and high fracture rates A metal-ceramic prosthesis is very dental laboratory is key to a successful of opposing acrylic prosthesis. esthetic, as ceramic is more life-like clinical result which is more likely to Fixed Prosthetic Treatment Moreover, the use of a minimum than acrylic resin. produce patient satisfaction in terms of From Our Office five supporting implants is However, one disadvantage of a comfort, function, phonetics, and to Yours... Options for the Completely recommended due to the high stiffness metal-ceramic prosthesis is that ceramic esthetics. and overall weight of the zirconia chipping or fracture may occur and Welcome Our New Associate Periodontist, Dr. Nikta Ghaderi, Edentulous Patient and Patients full-arch prostheses. may be difficult to repair. PDL tm The opposing occlusion should to our periodontal family. Facing Complete Edentulism invariably and scrupulously be Here are ”Five Fun Full-Arch, Implant- considered, especially if a parafunctional Facts” about Dr. Nikta istorically, the conventional life when compared with patients habit is suspected. Ghaderi: treatment for complete with a fixed prosthesis. Supported Metal- 1. Dr. Ghaderi was Moreover, six to eight implants per edentulism has been The main causes of patient Ceramic Fixed born and raised in H removable complete dentures. arch are generally recommended to Cupertino, California. dissatisfaction with complete Dentures support a PFM full-arch prostheses. 2. She was inspired However, clinical studies have dentures are lack of proper In addition, PFM full-arch prostheses to become a Periodontist as a teen shown that patients with removable mastication, inability to eat different Full-arch, implant-supported, are generally expensive, time- intern in our practice under the complete dentures have a types of food, loss of taste, impaired porcelain-fused-to-metal (PFM) consuming to fabricate, and technique beloved “angel” Dr. Rik Vanooteghem. considerably decreased quality of speech, and poor denture stability. 3. She earned her bachelor of science degree in neurobiology, physiology and behavior with honors at the University of California, Davis; her doctor of dental surgery degree from the University of the Pacific; and her master of science in Periodontology from Oregon Health and Science University. 4. She enjoys oil painting and hiking. 5. She has completed volunteeer externships in Costa Rica and Fiji, Fig. 8 Fig. 9 and hopes to volunteer next in the Philippines. We know you will be as thrilled as Figure 1. A partially edentulous patient presents with a Figure 8. Initial examination shows an unesthetic and terminal dentition. Figure 9. Both arches were we are to have Dr. “Niki” join our hopeless dentition in both the maxillary and mandibular restored with an implant-supported, hybrid complete fixed dental prosthesis. team! arches. (See Figures 2 and 3 on page 2.)