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You have a patient with terminal dentition and they are looking to you, their dentist, for solutions.
The options for treatment include:
- Extraction and conventional denture treatment
- Conventional dentistry
- Fixed hybrid options
What do you tell that patient?
A fixed hybrid prosthesis is a good option for patients who have multiple missing teeth and whose remaining teeth are heavily repaired. Compared to other fixed options, the fixed hybrid is a more cost effective treatment and more predictable in the long term than conventional dentistry.
Conventional dentures are inexpensive, but the function they offer compared to natural teeth or a fixed hybrid is dramatically lower, especially in the lower arch. Removable options are also generally less pleasing than a fixed option, causing more stress on the abutment teeth and often leading to early failure.
And, while crown and bridge, root canals and removable prostheses can be considered, the cost is high, the predictability is low and long term success rate does not match a fixed hybrid.
The fixed hybrid option requires 4 – 6 implants per arch. It usually requires minimal grafting and rarely calls for the graft to heal before implants can be placed.
The implants are placed to avoid the maxillary sinuses in the upper jaw and avoid the inferior alveolar nerve in the mandible. Osteotomy is performed that allows for inter-arch space and generally allows for more bone width after bone reduction is carried out.
Not all patients are candidates for a fixed hybrid prosthesis.
There are two indications for an overdenture prosthesis. One is when the transition line cannot be hidden on animated smile. The other is when the patient requires the labial flange of an overdenture for lip support. Evaluation to determine if a patient is a candidate for a fixed hybrid includes assessment of medical history, evaluation of tooth display, smile line, occlusion and a cone beam CT scan.
The procedure is carried out under either IV sedation or general anesthetic. The fixed hybrid cannot always be delivered the day of the procedure. If the implants do not have high primary stability, the patient may have to wear a temporary denture for several months before the hybrid can be converted. Patients will be on a very soft diet the first six weeks after the procedure while initial healing takes place.
Regular visits are required to ensure proper maintenance of the prosthesis.
A fixed hybrid prosthesis is not only a highly successful option, it allows patients to eat normally and feel good about how their teeth look.
Dr. David W. Todd, DMD, MD, has been active in his profession. He has authored 18 articles in various publications and made numerous presentations at state, regional, and national meetings. For Dr. Todd’s full bio click here.
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