Minimally Invasive Treatment of Edentulous Maxillae with Overdenture Fully Supported by a Cad/Cam Titanium Bar with a Low-Profile Attachment Screwed on Four or Six Implants: A Case Series

Abstract

Rehabilitation of atrophic maxilla still remains a challenge. Fixed implant-supported restorations have become more predictable in the last years; nevertheless, technical and biological complications still occur. Removable overdenture fully supported by a CAD/CAM titanium bar seems to be a viable treatment option for the rehabilitation of completely edentulous patients with a high degree of bone resorption. In these clinical cases, the soft tissues of the lower third of the face need to be respected, and a fixed-removable solution is the only option to have good hygiene control. Nevertheless, there is no consensus about the optimal number and position of the implants. A total of six adult patients were recruited and treated with an overdenture fully supported by a CAD/CAM titanium bar and low-profile attachment, screwed on four or six implants. A detailed step-by-step description of the procedures was presented. Overall, all the patients were successful treated with no relevant complications. With the limitations of this case series, maxillary implant overdenture fully supported by four or six implants seems to be a safer treatment option for the minimally invasive rehabilitation of atrophic maxillae, regardless of the number of implants.

Hybrid Polyetheretherketone (PEEK)–Acrylic Resin Prostheses and the All-on-4 Concept: A Full-Arch Implant-Supported Fixed Solution with 3 Years of Follow-Up

“…The present study reports the three-year outcome of a restoration solution for full-arch edentulism comprised of a fixed hybrid polymer-acrylic prosthesis with CAD/CAM infrastructure, as an alternative to other recent CAD/CAM solutions [49].…”

Four narrow dental implants and conventionally cast bar‐supported removable hybrid acrylic complete denture as a therapeutic modality for terminal dentition

“…There is a paucity of long‐term randomized clinical trials involving a large sample size to determine a proper treatment protocol for the potentially edentulous maxilla 8 . However, a maxillary denture without palatal coverage, supported by 4‐6 implants, were shown to be successful 8,19 . A collective 10‐year survival rate of 99.3% was reported for 4‐6 splinted implant‐retained RCD compared to 85.7% for two independent implant‐retained RCD 20 .…”

“…A bar‐splinted, implant‐retained RCD has long‐term reliability concerning the preservation of bone 25 . Some studies reported the bar's fabrication using CAD/CAM technology 19,22,26 . A CAD/CAM technology reduces the chance of casting errors, and using a titanium bar reduces the weight; however, the cost is usually on the higher side 26 .…”

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

“…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 flavor perception [8].…”

“…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 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 flavor perception [8].…”