Replacement of an existing maxillary anterior fixed dental prosthesis, redo another fixed dental prosthesis, or convert to implants.

Abstract

The purpose of this article is to discuss the considerations that need to be evaluated when considering the replacement of an existing maxillary anterior fixed dental prosthesis (FDP) with another FDP, or when to consider converting to implants and individual crowns on the previous abutment teeth. The need to replace unesthetic or failing maxillary anterior FDPs is something all restorative dentists will be faced with multiple times in their careers. Given the emphasis over the past few decades on utilizing implants for tooth replacement as opposed to a tooth supported FDP, the question becomes when is converting the existing FDP to implants and single crowns an appropriate choice, as opposed to redoing a new FDP. This article will focus on the risks of choosing to convert to an implant solution, and the risks of redoing the tooth supported FDP. Multiple systematic reviews on each approach will be used to aid in the decision process. The most significant risks for both approaches will be identified, and a chart of the key parameters to assess will be presented, along with their impact. The statistical outcomes at 5 and 10 years of tooth supported FDPs, and Implant based restorations are very similar if certain clinical parameters are met, namely vital healthy abutment teeth for the FDP, and adequate bone and soft tissue for the implant-based restoration. If one abutment tooth is compromised the long-term prognosis drops significantly and converting to an implant-based restoration may be more predictable. Similarly, if adequate bone and soft tissue cannot be obtained through surgical augmentation procedures, using a connective tissue graft for the ridge, and redoing the FDP may obtain a more acceptable esthetic result. A significant number of maxillary anterior FDPs exist that will need replacement in the future. Given the desire of many dentists to utilize implants when possible, there can be a tendency to automatically treatment plan an implant-based approach for replacement of the existing FDP. Certainly, most clinicians would favor an implant-based tooth replacement rather than preparing unrestored teeth to place an FDP, but when an existing FDP exists, the teeth have already been prepared for full coverage in most instances. In addition, for most long term existing FDPs, there is a significant change in the vertical and horizontal dimension of the bone and soft tissue that can make getting an acceptable esthetic result with an implant challenging. This article provides a systematic approach to identifying when redoing the FDP may be preferable, or when converting to an implant-based approach is a better choice.