Progress report on full implant dentures

Abstract

vv ORKING on prosthetic structures in the oral cavity leads the clinician to the realization that all patients have to be treated as unique entities with individual problems, especially in the occlusion, anatomic configuration, and systemic reaction ; that no set rationale is universally applicable ; and that, aside from basic surgical principles, each candidate for implant dentures must be carefully studied, and individual plans must be made for prosthesis. It is for this reason that implant development has been accompanied by a constantly growing change in technique and rationale. These changes have been made for the purpose of meeting the exigencies that the particular patient presented. This is illustrated in the reports of Goldberg and Gershkoff,’ Lew,’ Berman,’ and Ogus.’ Changes in the design of a lower implant were effected : (1) to avoid placing screws in the mandibular canal with the resulting parasthesia, a method of implantation has been developed which uses natural anatomic undercuts in the mandible, and temporary splinting for superstructures ; (2) to avoid impingement on nerve tissue and blood vessels in the mental foramen, lower implants have been designed to circumscribe these areas by extending the design to the lingual in that region ; (3) to eliminate postoperative impingement on the mucoperiosteum in case the implant should settle, the design of the abutments has been altered to avoid sharp platforms and protruding angles. To overcome the edentulous period, to facilitate primary healing, to minimize postoperative swelling and the accompanying wound opening and loss of sutures, the immediate splint technique has been developed and used with gratifying results. This technique has made it possible to make implants effectively on ambulatory patients with little fear of postoperative sequelae. The upper implant has been changed in design from that of the early archshape of Ogus,’ to the palatal implant of Lew.’ It has been changed to the present full palatal implant which we find necessary in order to effect greater rigidity. Screws or circumferential wiring can be eliminated in the lower implant, where rigidity is obtained by the utilization of undercuts, boxings, and immediate denture splints. But because of the very transient nature of the alveolar bone in the maxilla, maximum fixation must be obtained for upper implants by screws in the mid-torus area, and by the extension of the palatal portion of the implant as far anteriorly and posteriorly as possible.