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Frontal view of the sectioned mesostructure with multiple individual abutments before and after the ceramization in pink to mimic the soft tissues.
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The implant is a therapeutic resource in constant evolution, and the different types of implants and techniques have been increasingly used in cases of both fully or partially edentulous patients. In some cases they provide more conservative treatment, and in others better stability, retention, and function. To achieve a satisfactory result, there...
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Context 1
... the pick- up technique and a test for occlusion and aesthetic com- position was performed on a wax-up, to simulate the final restoration. Then, a sectioned mesostructure with multiple individual abutments was made by casting, and after a clinically acceptable passive fit had been confir- med multiple individual crowns of metal-ceramic were made (Fig. 1). The mesostructure was ceramicized in pink to mimic the soft tissues ( Fig. 1) and the crowns were provisionally cemented after the glazed ceramic crowns had been inserted (Fig. 2). The "Toronto prosthesis" comprised 12 teeth made of porcelain fused to metal, supported by 7 implants dis- tributed along the jaw in three sections (Fig. ...Context 2
... performed on a wax-up, to simulate the final restoration. Then, a sectioned mesostructure with multiple individual abutments was made by casting, and after a clinically acceptable passive fit had been confir- med multiple individual crowns of metal-ceramic were made (Fig. 1). The mesostructure was ceramicized in pink to mimic the soft tissues ( Fig. 1) and the crowns were provisionally cemented after the glazed ceramic crowns had been inserted (Fig. 2). The "Toronto prosthesis" comprised 12 teeth made of porcelain fused to metal, supported by 7 implants dis- tributed along the jaw in three sections (Fig. 3), so that the occlusal forces would not compromise the implants. The crowns ...Context 3
... implant dentistry it is important that professionals should understand the effects of the me- chanism of anchorage when choosing the type of reten- tion of the prosthesis: screwed or cemented. The factors influencing the different anchoring methods are: 1) Ease of manufacture and cost; 2) the passivity of the fit; 3) Retention; 4) Occlusion; 5) Aesthetics; 6) prosthesis re- trievability, and 7) implant ubication (1-3). However, the challenge of combining the advantages of both types of attachment encouraged authors to combined screw-and cement-retained prosthesis in implant prosthodontics (5), as the method report in this case. ...Similar publications
Fixed prostheses are appropriate treatment solutions for edentulous patients. In fxed prostheses,
following “All on four”, titanium frameworks are commonly used to support the implants. However,
the limitations of titanium have prompted researchers to search for alternative materials (e.g.
polymers). This study applied fnite element investigatio...
The article describes the medical and dental procedures for four treatment sessions with the Digital Denture Professional (DDP) system. First, conventional preliminary dental impressions of the full arch are taken to achieve accurate jaw positioning records. The study models and patient data are digitalised using a laboratory scanner. The dental la...
Citations
... It also involves the osseointegration of implants that are PROSTHETIC AND IMPLANT DENTISTRY Official Publication of Indian Prosthodontic Society Kerala State Branch placed in an ideal position for the fabrication of prostheses 5 . Nowadays the most pleasing smiles which have vanished due to the loss of teeth, supporting alveolar bone, and muscle are created by prosthetic materials 6,7 . The use of implantretained fixed bridges ranging from limited span to complete arch restoration has become a popular mode of treatment in recent years 8,9 . ...
Rehabilitation of patients with a deep bite is restored either with a tooth-supported fixed prosthesis, implant prosthesis, or by a combination of both. Implant-retained fixed bridges range from limited span to complete arch for dentulous and edentulous jaws. The desire to achieve expected results has in the long-run involved several issues concerning the materials, techniques, and anchorages used. Concerning the types of connection between the implant and restoration, these can be screwed, cemented, or a technique combining both can be implemented. The purpose of this article is to describe an impression technique and its various procedures for the rehabilitation of a patient with a deep bite using a tooth and implant-supported prosthesis. Key words: deep bite, full arch rehabilitation with implant and tooth-supported prosthesis, esthetic smile, castable abutments, and screw-retained implant prosthesis.
... In this case, a conventional fixed bridge would not fulfill the patient's requests for esthetics, phonetics, hygiene maintenance and comfort. Furthermore, pink porcelain has less naturallooking and it mostly demands more baking cycles that increase the possibility of porcelain fracture [4] . ...
... Some mechanical and biological complications may occur as a result of the exposure to high stresses that lead to loosening of the screw and component fracture, bone resorption, and detachment of the veneering material from the underlying framework [4,8] . ...
... Furthermore, retrievability, passive casting, proper hygiene, simple maintenance and reduced fatigue, fracture or distortion of components are some of the characteristics of the hybrid restorations. [9][10][11][12] The purpose of this study was to present two cases referred to our department who had received iliac graft after an ameloblastoma resection and partial mandibulectomy. Due to the increased interocclusal space and patients demands, it was decided to use fixed hybrid implant-supported prostheses in order to benefit from both advantages of cement-retained and screw-retained restorations. ...
... It was shown that the implant-supported fixed prostheses provide more comfort and efficient in the mandible reconstruction, Also, considering that the removable prosthesis could increase the risk of bone graft resorption, the hybrid Prosthesis was chosen in the present cases. 11,13 F I G U R E 5 Adding pink porcelain to framework F I G U R E 6 Crowns were cemented on framework ...
... 14 However, the corresponding laboratory costs are higher than other options such as an acrylic hybrid overdenture or multiple implant-supported bridges, and some of the technical procedures like adjusting contact points are time consuming, more complex, and more expensive compared to the conventional rehabilitations. 11 In addition, some criteria such as type of the bone, position of implants, and design of superstructures affect the success rate of implants. 15 In order to assess the survival rate of implants, prevent continuous pain and peri-implantitis, the mobility and radiolucency should be taken into account. ...
Ameloblastoma is an invasive odontogenic tumor, and for reconstruction, iliac graft and dental implants play an important role. This article evaluates the application of hybrid prostheses, clinical steps, and complications related to this treatment. image
... With the advent of computer-aided design and computer-aided manufacturing (CAD-CAM) technology, various alternative designs have become possible for implant-supported fixed prosthesis, including Toronto hybrid prosthesis, monolithic zirconia, and porcelain veneered zirconia prosthesis. The Toronto bridge includes the cementation of full veneer restorations on milled titanium or zirconia substructure [8]. As a result, long-term prognosis has been yielded due to superior aesthetics and biomechanics, in addition to the ease of hygienic care [9][10][11][12]. ...
The long-term success of dental implants is greatly influenced by the use of appropriate materials while applying the “All-on-4” concept in the edentulous jaw. This study aims to evaluate the stress distribution in the “All-on-4” prosthesis across different material combinations using three-dimensional finite element analysis (FEA) and to evaluate which opposing arch material has destructive effects on which prosthetic material while offering certain recommendations to clinicians accordingly. Acrylic and ceramic-based hybrid prosthesis have been modelled on a rehabilitated maxilla using the “All-on-4” protocol. Using different materials and different supports in the opposing arch (natural tooth, and implant/ceramic, and acrylic), a multi-vectorial load has been applied. To measure stresses in bone, maximum and minimum principal stress values were calculated, while Von Mises stress values were obtained for prosthetic materials. Within a single group, the use of an acrylic implant-supported prosthesis as an antagonist to a full arch implant-supported prosthesis yielded lower maximum (Pmax) and minimum (Pmin) principal stresses in cortical bone. Between different groups, maxillary prosthesis with polyetheretherketone as framework material showed the lowest stress values among other maxillary prostheses. The use of rigid materials with higher moduli of elasticity may transfer higher stresses to the peri implant bone. Thus, the use of more flexible materials such as acrylic and polyetheretherketone could result in lower stresses, especially upon atrophic bones.
... Fixed prostheses for the restoration of a fully edentulous arch with four implants could be either made of metal-resin (hybrid) or porcelain-metal structures. The Toronto prosthesis is usually used when the inter-arch space is too much to be restored with a conventional fixed implant-supported prosthesis (8). Malo et al. (2011) described the protocol for the insertion of implants following standard procedures, except that under-preparation was used to achieve an insertion torque of at least 35 Ncm before final seating of the implant. ...
The "All-on-Four" concept is based on the placement of four implants in the anterior part of fully edentulous jaws to support a provisional, fixed, and immediately loaded full-arch prosthesis. Typically, full arch reconstruction of edentulous ridges requires five to 10 dental implants; however, some patients demanding fixed implant-supported prostheses are not able to medically or economically afford complex bone grafts and/or a greater number of implants. These situations could pivot the treatment plan toward the All-on-4 protocol. Combining tilted and straight implants for supporting fixed prostheses can be considered a viable treatment modality resulting in a simpler and less time consuming procedure, in significantly less morbidity, in decreased financial costs and a more comfortable postsurgical period for the patients. In this article, a case report with mandibular implant supported prosthesis with all-on-4 concept is discussed.
... Drawbacks include complex and expensive fabrication as compared to the conventional prosthesis. 8 This case report presents the first-ever unique case where three techniques, i.e., autogenous bone augmentation in posttrauma partially atrophic anterior maxilla followed by implant placement using osseodensification technique and prosthetic rehabilitation with Toronto prosthesis, were instituted with a successful outcome. ...
... 21 In the present case, prosthetic rehabilitation was done with the Toronto bridge technique or abutment-hybrid technique. 8,22 It was first described by Rajan and Gunaseelan for fabrication of retrievable combined cement-and screw-retained prosthesis for the single-tooth implant-supported prosthesis. 23 As it is a combination of screw-and cement-retained prosthesis, it allows easy retrievability of abutment and removal of prosthesis for cleaning of excess cement. ...
... Increased crown inclination and lengthening are avoided. [10] This design has also several advantages over conventional fixed hybrid prostheses such as easy crown repair and better esthetic result by tolerating undesirable screw access hole positions. [5] Production of a titanium framework with the CAD/ CAM system allows proper adaptation to the abutment system. ...
... However, despite these advantages, the process is laborious and expensive, since adapting the contact points of the individual crowns makes the technical stage particularly difficult. [10] Maxillary anterior reconstruction with an autogenous iliac bone graft and Malo Bridge design prosthesis can be a useful therapeutic option in patients with advanced alveolar ridge atrophy. In the present case, the patient was highly satisfied with the esthetic outcome, phonation and function, although long-term follow-up is now required. ...
Alveolar bone loss subsequent to long-term edentulism and trauma may be severe and treatment plan is always an esthetic and functional challenge. Implant supported hybrid prosthesis is widely regarded as an effective treatment option for patients with excessive and irregular bone loss. However, implant placement is occasionally impossible without surgical procedures in such cases. This case report presents rehabilitation of 19-year-old maxillary anterior edentulous male patient with maxillary anterior bone defect and excessive cross-bite anterior closure with multidisciplinary approach. The patient was rehabilitated with implant supported hybrid prosthesis with Malo Bridge design following autogeneous iliac bone augmentation, teeth leveling with orthodontic treatment, and surgical placement of three implants. Esthetics, pleasing phonetics and function were achieved as desired with this treatment option and no complications were observed.
... The following treatment plan was agreed on; Maxilla: extraction of the remaining teeth with alveolar segmental reduction along with a bilateral sinus floor elevation, followed by a maxillary rehabilitation by means of a Toronto prosthesis [10] retained by 6 implants also known as abutment-hybrid overdenture. ...
... (i) Ease of retrievability [10] of the concerned parts in case of maintenance in an event of a repair of chipped ceramic while avoiding compromising the framework, provided that the crowns are cemented with a temporary cement, and the underlying mesostructure is screw-retained (ii) Achievability of desired esthetics of the individual crowns regardless of the screw access openings situated in the underlying screw-retained framework [17] (iii) Improved metal framework fitting over the implants, related to the reduced number of repeated porcelain firing over the framework itself, which is responsible for metal shrinkage and a further misfit [18] Speaking about the drawbacks of the whole procedure: First, concerning the surgical part, authors agree on the fact that the volume of the obtained bone following sinus floor elevation was hardly sufficient, except the areas where the xenogenic material was inserted, precisely and exclusively in the posterior part of the left maxillary sinus. This clearly reflects the inferiority of the autologous alveolar process grafted into the sinuses in terms of volume stability, an evidence barely reported in the literature [19]. ...
The aim of this paper is to report a suggested approach for the management of excessive maxillary gingival display with terminal dentition. A segmental osteotomy of the maxillary process was performed, and the latter used as grafting material for lateral sinus augmentation that was performed simultaneously. Following the graft maturation period, implants were inserted and rehabilitated with a fixed dentogingival prosthesis. Consequently, the mandible was prosthetically restored following the new occlusal plane dictated by the rehabilitated maxilla. Clinically, the procedure showed a drastic improvement in the patient's appearance, eliminating the excessive gingival display. Radiologically, it led to a vertical translation of the maxillary process level in an apical direction. Nevertheless, the resected process used as grafting material was noticed to have a suboptimal behavior as long as it showed increased intrasinusal resorption, barely sufficient for a regular implant accommodation. The described therapy concept seems to be a plausible approach when it comes to manage excessive maxillary gingival displays in edentulous patients or those presenting a terminal dentition. However, at the time of sinus augmentation, authors recommend to graft a mixture of resected maxillary process and a bone substitute material, in order to get more stable results.
... Single or multiple-cemented structures on the milling abutment and screwed frameworks are known as the "Malo Bridge". [5][6][7] The Malo Bridge allows not only for the reconstruction of teeth, but also the rehabilitation of soft tissues, gums, and all of the masticatory system. [7] Case Report A 15-year-old male patient with a history of aggressive periodontitis was referred [ Figure 1] to the clinic. ...
... The production of the Cr-Co framework with CAD/CAM by milling eliminates shrinkage or deformation of the metal during the casting process in the lost wax technique. [6] In this case, the Cr-Co framework was preferred for purely economic reasons. ...
It is possible to rehabilitate fully edentulous patients with implantsupported fixed or removable prostheses; however, implantsupported fixed prostheses are the gold standard for patients who not prefer to use removable dentures. This case report, prosthetic rehabilitation of a completely edentulous young patient with an implantsupported fixed hybrid prosthesis using the "Malo Bridge" technique is described. A 18 years old male patient was referred to the clinic with complaints of tooth loss, aesthetics, function, and phonetic. A total of 5 implants were placed in both the jaws. Considering that screw holes may cause aesthetic problems due to the Class III occlusion, these problems have been solved with the implant-supported hybrid prosthesis called Malo bridge. With the Malo Bridge design, the patient's aesthetic, functional and phonetic loss was eliminated, patient comfort and quality of life were improved, and patient expectations were met. It is a viable treatment option to rehabilitate completely edentulous jaws with a cross relationship and increase interarch distance using Malo Bridge to support a fixed prosthesis.
... Elderly patients seek replacement of lost teeth with the primary sole aim of chewing food followed by esthetics that gets altered due to lost teeth, supporting alveolar bone and muscles. [1] Treatment options may range from the use of removable conventional denture to the creation of fixed implant-supported restorations and to implant-supported dentures. The treatment choice depends on the patient's anatomical limitations and personal preferences such as cost including the acceptance of extensive surgical procedures to restore the alveolar bone and/or soft tissue. ...
... In addition, excess of cervical porcelain looks unnatural and also requires more baking cycles, which increases the risk of porcelain fracture. [1] Such complications can be resolved by fabricating hybrid prosthesis that can easily replace the soft tissue; on concerning their shock-absorbing properties, it can reduce the mechanical and biological problems, i.e., component fracture, screw loosening, and bone resorption. [3] Hybrid prostheses' advantages include decrease in impact force of dynamic occlusal loads, cost-effectiveness, and highly esthetic restorations. ...
Difficulty in eating and speaking, ill-fitting denture, and sore mouth syndrome has been life longing among the elderly using dentures. The evolution from conventional denture to implant-supported prosthesis provides these patients normal healthy life with functional and esthetic benefits. An elderly man reported to the Department of Prosthodontics and Oral Implantology of ITS Dental College, Hospital and Research Centre, Greater Noida, with the chief complaint of mobility of upper and lower teeth. After diagnosis and treatment planning, it was decided for immediate implant placement to fabricate a full-mouth implant-supported hybrid prosthesis.
