The Partial-Arch Implant Prosthesis: When, Why and How (1 CEU)
When your partially edentulous patient presents with an edentulous span of five units or more, the partial-arch implant restoration is an excellent option that can fully restore form and function. The challenge in designing this type of restoration is typically related to the volume and type of tissue that must be replaced. According to the Misch classification, there are three types of fixed prostheses: FP-1, FP-2 and FP-3.1 The FP-1 is an implant restoration that replaces only the crown portion of the missing teeth. An FP-2 prosthesis restores the crown as well as portions of the root, resulting in teeth that are usually longer than normal. The FP-3 restoration includes a gingiva-colored portion, replacing areas of the soft tissue in addition to the missing teeth.
FP-1: Replaces teeth with anatomy similar to natural crowns
FP-2: Replaces crown and portions of the root, resulting in elongated teeth
FP-3: Replaces crowns and soft-tissue areas
For the purposes of this article, we will focus on cases where the patient has experienced hard- and soft-tissue loss in the edentulous area, requiring an FP-3 implant prosthesis.
After determining that the FP-3 prosthesis is the optimal solution, the clinician must work with the patient in deciding whether to preserve the remaining teeth. The health and long-term prognosis of the remaining teeth must be considered as well as whether the patient is happy with the appearance of their teeth. If there is periodontal disease or caries involving the remaining teeth, or the patient prefers the uniform esthetics of a full-arch restoration, extraction followed by full-arch implant treatment may be the best way forward. Conversely, if the remaining teeth are healthy, preserving the dentition is a conservative approach to treatment that some patients prefer and also makes it easier to maintain the vertical dimension of occlusion (VDO).
Edentulous spans of 5 units or more
Cases where an FP-3 prosthesis is indicated due to hard- and soft-tissue loss
Partially edentulous patients with healthy dentition adjacent to implant sites
Patients who are happy with the esthetics of their remaining natural teeth
Cases where the prognosis of the remaining teeth is very good
Due to its exceptional strength and stunning esthetics, the BruxZir® Esthetic Implant Prosthesis (Glidewell; Irvine, Calif.) has become my restoration of choice in these situations. In this case report, I’ll show an example of a patient for whom this restorative solution is recommended. The case involves a longstanding patient who had been wearing a removable partial denture spanning teeth #4–11 for over two decades, and decided she wanted a fixed restoration to improve her oral health, comfort and quality of life. She expressed a strong desire to keep her remaining maxillary teeth, which were healthy and showed no signs of caries or periodontal disease. The patient accepted a treatment plan in which four implants would be placed to support a partial-arch restoration fabricated from BruxZir Esthetic Zirconia — a process eased by Glidewell’s streamlined restorative protocol.
Figure 11: The lab scanned the provisional to capture the occlusal adjustments in the final restoration design, and the partial-arch implant prosthesis was milled from BruxZir Esthetic. Fabricated from 870 MPa monolithic zirconia, this new formulation of the BruxZir Implant Prosthesis is warrantied for life and combines premium esthetics with exceptional durability, avoiding the chipping and fractures of the porcelain or acrylic used in other types of premium FP-3 prostheses.
Figures 13a, 13b: Before-and-after images illustrate the dramatic transformation we were able to provide for the patient through implant dentistry and the use of BruxZir Esthetic Zirconia.
The partial-arch implant prosthesis is a viable solution for patients who desire a fixed implant restoration and have healthy teeth adjacent to a long edentulous span. This solution allows for a conservative approach to treatment and avoids the problems associated with removable partial dentures. And by fabricating the restoration from BruxZir Esthetic Zirconia, we can provide patients with beautiful restorations they can depend on for life.
For more information about the BruxZir Implant Prosthesis, visit glidewelldental.com/bip.