Full arch restoration

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Full arch restoration in dentistry refers to the comprehensive reconstruction or rehabilitation of an entire dental arch, which can include all teeth in the upper or lower jaw. [1] [2] This procedure is also known as full mouth reconstruction or full mouth rehabilitation. [3] [4]

Contents

Overview

Full arch restoration involves creating a single prosthesis to replace 10 to 14 teeth. Typically, the front areas of the jaw maintain more bone volume suitable for implants, whereas the back regions often suffer greater bone loss. This sequence occurs due to the typical loss of molars initially, followed by premolars, while the front teeth tend to remain intact for the longest duration. As time passes, there is a noticeable reduction in both the height and width of the alveolar ridge following tooth loss. [5]

Indications

The indications for full-arch restoration include:

Types

Types of implant supported restorations Types of Full Arch Dental Implants.png
Types of implant supported restorations

The two main types of full-arch restorations in dentistry are fixed implant-supported restorations and removable implant-supported overdentures. Prosthetics can be temporary or permanent.

Temporary prosthetics

Temporary prosthesis on multi-unit abutments Temporary prosthesis on multi-unit abutments.png
Temporary prosthesis on multi-unit abutments

Temporary prosthetics are essential in implant-supported full-arch restorations.

Temporary prosthetics in full arch restoration refer to provisional dental appliances that are used to replace missing teeth during the healing phase after implant surgery. These temporary prosthetics are designed to provide immediate aesthetics and function while the final permanent prosthesis is being fabricated. They are typically worn for a period of several months until the implants have fully integrated with the jawbone and the final restoration can be placed. Temporary prosthetics help maintain the patient's appearance and ability to eat and speak comfortably during the healing process.

Permanent prosthetics

Permanent prosthetics in full arch restoration are the final, long-term dental appliances used to replace missing teeth and restore function and aesthetics in patients with extensive tooth loss. These prosthetics are custom-designed and fabricated to fit precisely onto dental implants that have integrated with the jawbone. Permanent prosthetics can include fixed dental bridges, implant-supported dentures, or full-arch implant-supported prostheses. They are typically made from durable materials such as ceramic, zirconia, or metal alloys, and are designed to closely resemble natural teeth in both appearance and function. [6]

Dentures that are removable and supported by a bar

Acrylic prosthesis attached with locks Acrylic prosthesis attached with locks.png
Acrylic prosthesis attached with locks

Approaches for securing a prosthesis onto a bar:

  1. Locking mechanism: The dental prosthesis is secured to a metal structure that includes retaining components referred to as "males." These males, integrated into the framework, engage with corresponding "matrices" that snap onto the bar's "locks." The bar is permanently fixed and not intended for removal or conditional removal. Locks vary in design and configuration.
  2. Ball Attachments: They consist of a spherical component (the ball) that fits into a corresponding socket or housing on the prosthesis.
  3. Locator-Type Cylindrical Connections: type of attachment system featuring individual abutments with cylindrical connections and dedicated interface designs for securing prostheses onto a bar.

The choice of full-arch restoration depends on factors such as the patient's oral health, bone structure, budget, and treatment preferences. A thorough evaluation by a dentist or prosthodontist is necessary to determine the most suitable treatment plan for each individual case.

Implants and abutments

Internal Hex Implants Internal Hex Implants.png
Internal Hex Implants

Implants featuring a prominent threading pattern are especially important when being inserted into a socket that was recently vacated by a extracted tooth. This approach ensures initial stability, relying on 3–4 mm of the implant's tip securely fitting into the bone tissue. The size and length of these implants are chosen according to the specific clinical scenario, taking into account the patient's anatomical characteristics and the state of the bone tissue.

Multi-unit abutments for screw fixation of prosthesis Multi-unit abutments for screw fixation of prosthesis.png
Multi-unit abutments for screw fixation of prosthesis
  1. Multi-unit abutments are chosen according to the soft tissue height above the bone during implantation.
Healing cap for multi unit abutment Healing cap for multi unit abutment.png
Healing cap for multi unit abutment
  1. Healing caps are specifically made for multi-unit abutments. These caps are unique because they are meant to be connected to a multi-unit abutment, which is placed into the implant right after implantation. Afterward, the healing cap is fixed onto the abutment.
Temporary Sleeve for Multi-Unit Abutment Temporary Sleeve for Multi-Unit Abutment D-Type.png
Temporary Sleeve for Multi-Unit Abutment
  1. Temporary denture sleeves on multi-unit abutments. During the first few months after implantation, patients receive a lightweight temporary prosthesis aimed at minimizing stress on the implants. These prosthetic devices are anchored using specific sleeves inserted into them, which are then tailored to the required height by grinding at the screw shaft exit points. Afterward, the screw shafts are covered with a composite material.
  2. Sleeves designed for multi-unit abutments cater to permanent dentures, offering various modifications to suit different needs. The initial variant is 12 mm long and is altered at the screw shaft exits. The second variant comes with a yellow coating and stands at a height of 4 mm, making it perfect for scenarios where the sleeve is positioned close to the outer edge of the prosthesis.
  3. Scan abutments. First, multi-unit abutments are placed to provide support for the prosthesis. Next, scanning caps are mounted onto these abutments, after which the specialist uses an intraoral scanner to capture images. This procedure produces digital files that precisely outline the positions of both implants and abutments, allowing them to be seamlessly integrated with existing CBCT images.
  4. Digital analogues. Digital equivalents are utilized for both individual implants and those with multi-unit abutments during the fabrication of physical jaw models. To achieve accurate prosthesis development and fitting, a 3D-printed representation of the patient's jaw is employed. Within this model, replicas of the implants are placed to mimic the exact positions of the real implants within the patient's mouth.

Stages

Preparation

Axial, sagittal and coronal plane of CBCT and 3D reconstruction. CBCT image 02.png
Axial, sagittal and coronal plane of CBCT and 3D reconstruction.

The initial stage commences with the acquisition of 3D representations of the patient's jaw by merging digital data from CBCT scans with optical data gathered from an intraoral scanner. Various software platforms excel in handling this data, spanning from converting CBCT images into 3D files to creating prosthetic models. Leading software choices for these processes include Dental Wings, Shape 3D and Exocad. Additionally, documenting the soft tissue state and existing teeth is crucial, accomplished through photographic records.

Scan with scan markers Scan with scan markers.png
Scan with scan markers
A scan of the gums A scan of the gums.png
A scan of the gums

Following this, the expert needs to strategize the placement of implants and generate a preliminary model of the dentition. It's vital to position the screw shaft exits on the inner aspect of the prosthesis. Precise digital representations of implants, screws, and abutments are critical at this juncture to guarantee their accurate positioning within the digital jaw model.

Once the suitable implants have been chosen and their positions planned, the next step involves crafting a navigation template, often referred to as a surgical template. The template plays a crucial role in ensuring the precise placement of implants according to the digital blueprint and at the proper angles.

Ney Articulator with Bridge - NCP 3280 Ney Articulator with Bridge - NCP 3280.jpg
Ney Articulator with Bridge - NCP 3280

The surgical or navigation template, together with the provisional prosthesis, undergoes thorough assessment and any required adjustments using either a plaster model or a 3D-printed representation of the jaw. Both models, encompassing the restorations, need to be validated within an articulator to confirm their precision.

Installation

The procedure adapts according to the initial clinical state. For patients with a prolonged absence of teeth, the process typically follows a straightforward approach.

  1. Creating a navigation template entails making small incisions in the soft tissue at the implant sites instead of pulling back the gums, aiming to maintain gum volume.
  2. The predetermined quantity of implants is positioned utilizing the navigation template.
  3. Following implant placement, the template is removed.
  4. After attaching the provisional prosthesis to multi-unit abutments and sealing the screw shafts with composite material, the postoperative phase commences.
  5. In order to fabricate the permanent prosthesis, it is essential to gather up-to-date data utilizing an intraoral scanner. This procedure involves several stages:

Advantages and disadvantages

The benefits include:

Contraindications:

Risks

Rehabilitation treatments involving full arch dental implants may encounter complications and failures. In general, complications may be related to the patient's systemic compromise, increased functional demand, surgical technique, post-operative care, design and type of prosthesis, etc. The overall success rate for dental implants is between 90 and 100% according to the study. [12] Common prosthetic issues following the installation of an implant-supported prosthesis include mucositis, loosening or breakage of the abutment screw or prosthetic parts, and fracture of the acrylic or porcelain structure. Although most complications resolve favorably in follow-up appointments, it is essential to establish an adequate surgical and prosthetic management protocol to achieve predictable and successful long-term results. [13] [14]

Publications

Related Research Articles

<span class="mw-page-title-main">Dentures</span> Prosthetic devices constructed to replace missing teeth

Dentures are prosthetic devices constructed to replace missing teeth, supported by the surrounding soft and hard tissues of the oral cavity. Conventional dentures are removable. However, there are many denture designs, some of which rely on bonding or clasping onto teeth or dental implants. There are two main categories of dentures, the distinction being whether they fit onto the mandibular arch or on the maxillary arch.

<span class="mw-page-title-main">Bridge (dentistry)</span> Dental restoration for missing teeth

A bridge is a fixed dental restoration used to replace one or more missing teeth by joining an artificial tooth definitively to adjacent teeth or dental implants.

<span class="mw-page-title-main">Dental technician</span> Technician working on dental appliances

A dental technician is a member of the dental team who, upon prescription from a dental clinician, constructs custom-made restorative and dental appliances.

<span class="mw-page-title-main">Dental implant</span> Surgical component that interfaces with the bone of the jaw

A dental implant is a prosthesis that interfaces with the bone of the jaw or skull to support a dental prosthesis such as a crown, bridge, denture, or facial prosthesis or to act as an orthodontic anchor. The basis for modern dental implants is a biological process called osseointegration, in which materials such as titanium or zirconia form an intimate bond to the bone. The implant fixture is first placed so that it is likely to osseointegrate, then a dental prosthetic is added. A variable amount of healing time is required for osseointegration before either the dental prosthetic is attached to the implant or an abutment is placed which will hold a dental prosthetic or crown.

Osseointegration is the direct structural and functional connection between living bone and the surface of a load-bearing artificial implant. A more recent definition defines osseointegration as "functional ankylosis ", where new bone is laid down directly on the implant surface and the implant exhibits mechanical stability. Osseointegration has enhanced the science of medical bone and joint replacement techniques as well as dental implants and improving prosthetics for amputees.

Prosthodontics, also known as dental prosthetics or prosthetic dentistry, is the area of dentistry that focuses on dental prostheses. It is one of 12 dental specialties recognized by the American Dental Association (ADA), Royal College of Surgeons of England, Royal College of Surgeons of Edinburgh, Royal College of Surgeons of Ireland, Royal College of Surgeons of Glasgow, Royal College of Dentists of Canada, and Royal Australasian College of Dental Surgeons. The ADA defines it as "the dental specialty pertaining to the diagnosis, treatment planning, rehabilitation and maintenance of the oral function, comfort, appearance and health of patients with clinical conditions associated with missing or deficient teeth or oral and maxillofacial tissues using biocompatible substitutes."

<span class="mw-page-title-main">Dental extraction</span> Operation to remove a tooth

A dental extraction is the removal of teeth from the dental alveolus (socket) in the alveolar bone. Extractions are performed for a wide variety of reasons, but most commonly to remove teeth which have become unrestorable through tooth decay, periodontal disease, or dental trauma, especially when they are associated with toothache. Sometimes impacted wisdom teeth cause recurrent infections of the gum (pericoronitis), and may be removed when other conservative treatments have failed. In orthodontics, if the teeth are crowded, healthy teeth may be extracted to create space so the rest of the teeth can be straightened.

<span class="mw-page-title-main">Alveolar process</span> Region of jaw bones containing tooth sockets

The alveolar process is the portion of bone containing the tooth sockets on the jaw bones. The alveolar process is covered by gums within the mouth, terminating roughly along the line of the mandibular canal. Partially comprising compact bone, it is penetrated by many small openings for blood vessels and connective fibres.

<span class="mw-page-title-main">Toothlessness</span> Lacking teeth

Toothlessness or edentulism is the condition of having no teeth. In organisms that naturally have teeth, it is the result of tooth loss. Organisms that never possessed teeth can also be described as edentulous. Examples are the members of the former zoological classification order of Edentata, which included anteaters and sloths, as they possess no anterior teeth and no or poorly developed posterior teeth.

<span class="mw-page-title-main">Sinus lift</span> Surgery to restore bone for tooth implants

Maxillary sinus floor augmentation is a surgical procedure which aims to increase the amount of bone in the posterior maxilla, in the area of the premolar and molar teeth, by lifting the lower Schneiderian membrane and placing a bone graft.

<span class="mw-page-title-main">Crown lengthening</span> Dental procedure

Crown lengthening is a surgical procedure performed by a dentist, or more frequently a periodontist, where more tooth is exposed by removing some of the gingival margin (gum) and supporting bone. Crown lengthening can also be achieved orthodontically by extruding the tooth.

Computer-assisted surgery (CAS) represents a surgical concept and set of methods, that use computer technology for surgical planning, and for guiding or performing surgical interventions. CAS is also known as computer-aided surgery, computer-assisted intervention, image-guided surgery, digital surgery and surgical navigation, but these are terms that are more or less synonymous with CAS. CAS has been a leading factor in the development of robotic surgery.

In dentistry, an abutment is a connecting element. This is used in the context of a fixed bridge, partial removable dentures and in implants. The implant fixture is the screw-like component that is osseointegrated.

<span class="mw-page-title-main">All-on-4</span> A prosthodontics procedure

The term All-on-4, also known as All-on-Four and All-in-Four, refers to 'all' teeth being supported 'on four' dental implants, a prosthodontics procedure for total rehabilitation of the edentulous (toothless) patient, or for patients with badly broken down teeth, decayed teeth, or compromised teeth due to gum disease. It consists of the rehabilitation of either edentulous or dentate maxilla and / or mandible with fixed prosthesis by placing four implants in the anterior maxilla, where bone density is higher. The four implants support a fixed prosthesis with 10 to 14 teeth, and it is placed immediately, typically within 24 hours of surgery.

<span class="mw-page-title-main">Bite registration</span> Technique in dentistry

Bite registration is a technique carried out in dental procedures, by taking an impression of the teeth, to capture the way the teeth meet together. This is then used to accurately make restorations which will not change the position the teeth meet in.

Zygoma implants are different from conventional dental implants in that they anchor in to the zygomatic bone rather than the maxilla. They may be used when maxillary bone quality or quantity is inadequate for the placement of regular dental implants. Inadequate maxillary bone volume may be due to bone resorption as well as to pneumatization of the maxillary sinus or to a combination of both. The minimal bone height for a standard implant placement in the posterior region of the upper jaw should be about 10 mm to ensure acceptable implant survival. When there is inadequate bone available, bone grafting procedures and sinus lift procedures may be carried out to increase the volume of bone. Bone grafting procedures in the jaws have the disadvantage of prolonged treatment time, restriction of denture wear, morbidity of the donor surgical site and graft rejection.

Alveoloplasty is a surgical pre-prosthetic procedure performed to facilitate removal of teeth, and smoothen or reshape the jawbone for prosthetic and cosmetic purposes. In this procedure, the bony edges of the alveolar ridge and its surrounding structures is made smooth, redesigned or recontoured so that a well-fitting, comfortable, and esthetic prosthesis may be fabricated or implants may be surgically inserted. This pre-prosthetic surgery which may include bone grafting prepares the mouth to receive a prosthesis or implants by improving the condition and quality of the supporting structures so they can provide support, better retention and stability to the prosthesis.

A complete denture is a removable appliance used when all teeth within a jaw have been lost and need to be prosthetically replaced. In contrast to a partial denture, a complete denture is constructed when there are no more teeth left in an arch; hence, it is an exclusively tissue-supported prosthesis. A complete denture can be opposed by natural dentition, a partial or complete denture, fixed appliances or, sometimes, soft tissues.

<span class="mw-page-title-main">Overdenture</span> Removable dental prosthesis

Overdenture is any removable dental prosthesis that covers and rests on one or more remaining natural teeth, the roots of natural teeth, and/or dental implants. It is one of the most practical measures used in preventive dentistry. Overdentures can be either tooth supported or implant supported. It is found to help in the preservation of alveolar bone and delay the process of complete edentulism.

A multi-unit abutment (MUA) is an abutment most commonly used with dental implants in "All-on-Four" protocols. They are designed for screw-retained group restorations, which are often used in combination with angled dental implants and whole arch replacements, as well as screw fixation of bridges made of zirconium or metal-ceramic group restorations to the implant.

References

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  2. Lu, Xiaoya; Wang, Xiaoping; Han, Xiaohui; Hu, Lihua; Ji, Mei; Li, Shengfeng; Huang, Shengyun (25 January 2023). "Immediately loaded fixed full-arch implant-retained prosthesis: a solution to the extreme defect in zone 2—a case report". Bulletin of the National Research Centre. 47. doi: 10.1186/s42269-023-00985-3 .
  3. Kim, Hye-sung; Cho, Han-A; Kim, Young youn; Shin, Hosung (December 2018). "Implant survival and patient satisfaction in completely edentulous patients with immediate placement of implants: a retrospective study". BMC Oral Health. 18 (1): 219. doi: 10.1186/s12903-018-0669-1 . PMC   6299569 . PMID   30563482.
  4. Carossa, Massimo; Alovisi, Mario; Crupi, Armando; Ambrogio, Giulia; Pera, Francesco (1 July 2022). "Full-Arch Rehabilitation Using Trans-Mucosal Tissue-Level Implants with and without Implant-Abutment Units: A Case Report". Dentistry Journal. 10 (7): 116. doi: 10.3390/dj10070116 . PMC   9320847 . PMID   35877390.
  5. Uesugi, Takashi; Shimoo, Yoshiaki; Munakata, Motohiro; Sato, Daisuke; Yamaguchi, Kikue; Fujimaki, Michiya; Nakayama, Kazuhisa; Watanabe, Tae; Malo, Paulo (8 November 2023). "The All-on-four concept for fixed full-arch rehabilitation of the edentulous maxilla and mandible: a longitudinal study in Japanese patients with 3–17-year follow-up and analysis of risk factors for survival rate". International Journal of Implant Dentistry. 9 (1): 43. doi: 10.1186/s40729-023-00511-0 . PMC   10632321 . PMID   37938479.
  6. Kanmani, A.; Narasimman, M.; Venkatakrishnan, C. J.; Rathinavel, Pandian M.; Tamizhesai, B.; Navinbharathy, M. (2023). "Zirconia for full arch restorations". Journal of the Indian Dental Association Tamil Nadu. 14: 11. doi:10.26634/jidat.14.1.20245.
  7. Jiang, Xue; Zhu, Yanlin; Liu, Zhaoying; Tian, Zilu; Zhu, Song (2 January 2021). "Association between diabetes and dental implant complications: a systematic review and meta-analysis". Acta Odontologica Scandinavica. 79 (1): 9–18. doi:10.1080/00016357.2020.1761031. PMID   32401121 . Retrieved 15 May 2024.
  8. Choi, Yoon-Ji; Lee, Ji-Hyoun; Jhin, Min-Ju (2016). "Implant supported fixed prosthesis for complete edentulous maxilla with severe alveolar ridge resorption: A case report". The Journal of Korean Academy of Prosthodontics. 54 (2): 152. doi: 10.4047/jkap.2016.54.2.152 .
  9. Alsaggaf, Arwa; Fenlon, Michael Robert (July 2020). "A case control study to investigate the effects of denture wear on residual alveolar ridge resorption in edentulous patients". Journal of Dentistry. 98: 103373. doi:10.1016/j.jdent.2020.103373. PMID   32389732. Conclusion: Patients wearing complete dentures for more than 5 years had significantly more residual alveolar ridge resorption than was found in non-denture wearing edentulous patients.
  10. Ata-Ali, Javier; Flichy-Fernández, Antonio Juan; Alegre-Domingo, Teresa; Ata-Ali, Fadi; Palacio, Jose; Peñarrocha-Diago, Miguel (1 April 2015). "Clinical, microbiological, and immunological aspects of healthy versus peri-implantitis tissue in full arch reconstruction patients: a prospective cross-sectional study". BMC Oral Health. 15: 43. doi: 10.1186/s12903-015-0031-9 . PMC   4391105 . PMID   25888355.
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