ORIGINAL ARTICLE
Transition From Hopeless Dentition to Full-Arch Fixed-Implant–Supported Rehabilitation by a Staged Extraction Approach: Rationale and Technique Eitan Mijiritsky, DMD,* Ziv Mazor, MD, Adi Lorean, MD, Carmen Mortellaro, MD,† Ofer Mardinger, MD,‡ and Liran Levin, MD§∥ Abstract: Transition from a hopeless dentition to a fixed-implant– supported full-arch reconstruction can be difficult for patients if wearing a transitional removable denture is involved. In addition, an increased risk for trauma to bone augmentation areas and to the implant-bone interface exists when using a removable transitional complete denture during the implant healing period; such risk can compromise implant success or increase crestal bone loss around implants before the final restoration. This article describes a treatment approach that allows replacement of the hopeless dentition with an osseointegrated fixed prosthesis, without rendering the patient totally edentulous before the delivery of the final implantsupported prosthesis. A staged approach using a few hopeless teeth to support a provisional fixed restoration during the healing process can help avoid discomfort and improve implants’ outcome. A treatment plan for a maxillary arch reconstruction is used to illustrate the staged approach protocol. This protocol addresses patients’ psychologic need to remain dentate during partial or full-mouth rehabilitation, while providing good esthetics and function during restoration of a dental arch. Key Words: Dental implants, staged approach, serial extractions, hopeless teeth, staged extraction (J Craniofac Surg 2014;25: 847–850)
O
sseointegrated implants have become the preferred treatment option when the replacement of abutment teeth is considered.1 High implant success rates in the treatment of edentulous arches have been achieved, offering new treatment options for dentitions From the *Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel-Aviv University, TelAviv, Israel; †Department of Medical Science, Faculty of Medicine, University of Eastern Piedmont, Novara, Italy; ‡Department of Maxillofacial Surgery, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel; §Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus, Haifa, Israel; and ∥Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. Received September 3, 2013. Accepted for publication February 8, 2014. Address correspondence and reprint requests to Eitan Mijiritsky, DMD, Department of Oral Rehabilitation, School of Dental Medicine, Tel-Aviv University, Ehud street n. 12, Tel-Aviv 69351, Israel; E-mail: [email protected] Ziv Mazor is in private practice in Ra’anana, Israel, and Adi Lorean is in private practice in Tiberius, Israel. The authors report no conflicts of interest. Copyright © 2014 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000000861
with a poor prognosis or when multiple teeth have to be extracted.2–5 When the treatment plan calls for the extraction of all remaining teeth, different treatment options can be applied and sequenced, and the patient can be rehabilitated with an implant-supported fixed restoration.6–9 Treatment options can be selected according to timing of implant placement in relation to tooth extraction, timing of implant loading, and the use of removable versus fixed provisional restorations. In this context, treatment sequence may both determine patients’ comfort level during treatment and impact the efficiency of the clinician’s work. A common approach that helps avoid using a removable provisional restoration after the extraction of remaining teeth in the arch is the immediate implant loading approach.10–15 Immediate loading and prosthetic restoration overcome many of the disadvantages involved in the provisional removable prosthetic treatment often used during the implant healing period. These disadvantages include interference with masticatory function, impaired speaking ability, and possible adverse effects on esthetics.16 Furthermore, the implant failure rate is higher in patients undergoing implant treatment for an edentulous maxilla compared with patients with partially edentulous maxillae. One explanation is that pressure effect on soft tissues caused by wearing removable prostheses impacts implant healing.17 Implant immediate loading is technique sensitive and can be applied only in selected patients. A thorough evaluation of the patient’s dental and general medical history before implant planning is important to rule out risk factors.13 Moreover, several aspects specific to the immediate loading of implants in the edentulous mandible or maxilla should be considered, specifically, the minimum requirement for the sizes and number of implants. Among several factors found to predict treatment outcomes for immediately loaded implants is adequate primary stability.10,11 Threaded implants with a roughened surface are preferred because they usually achieve high primary stability. Avoiding parafunctional loading and restorations with posterior cantilevers is also recommended.13 The success of the treatment might also be related to patient compliance and adherence to a strict soft diet for the first 6 to 8 weeks of implant healing.18 A treatment approach for patients with failing dentition is described here. The protocol avoids the use of removable provisional prostheses by staged extraction of teeth and placement of dental implants. A treatment plan for a maxillary arch reconstruction is used to illustrate a staged approach protocol. This methodology could also apply to a mandibular prosthesis.
STAGED APPROACH TREATMENT PROTOCOL The suggested steps of the staged approach treatment protocol procedure are described in Table 1. The overall suggested protocol involves a thorough diagnostic phase with careful documentation and preparation followed by
The Journal of Craniofacial Surgery • Volume 25, Number 3, May 2014
Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
847
Mijiritsky et al
The Journal of Craniofacial Surgery • Volume 25, Number 3, May 2014
TABLE 1. Suggested Steps of the Staged Approach Treatment Protocol Procedure
wax-up or setup. The treatment plan should be performed keeping in mind where the final implants are planned and which teeth could be preserved in the meantime and support the provisional restoration. The cause-related initial preparation should not be skipped or underestimated in those patients. Active periodontal disease needs to be addressed before implant placement and prosthetic treatment
848
are started, even though the dentition has a guarded prognosis. This is critical because correct soft tissue healing and postextraction placement of implants cannot be safely accomplished in the presence of active lesions.19,20 Later on, the preprosthetic surgery is divided into 2 phases, with a final definitive restorations stage that follows (Table 1). © 2014 Mutaz B. Habal, MD
Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
The Journal of Craniofacial Surgery • Volume 25, Number 3, May 2014
FIGURE 1. Preoperative anterior intraoral view.
FIGURE 2. Preoperative panoramic radiograph illustrates advanced periodontitis and failing restorations in the maxillary arch.
The following treatment plan for a maxillary arch reconstruction illustrates the staged approach protocol. A 63-year-old female patient presented with advanced periodontitis, caries, and an unesthetic maxillary fixed denture (Figs. 1–3). The treatment plan called for the following: (1) staged maxillary teeth extraction with a bilateral sinus augmentation (2) preparation of hopeless teeth to support a provisional fixed partial denture during the healing phase of the first batch of implants placed (Figs. 4–6) (3) use of the already integrated implants after extraction of the remaining hopeless teeth to support a provisional fixed partial denture during the healing phase of the second batch of implants (4) delivery of an implant-supported permanent fixed restoration in the maxilla (Figs. 7, 8)
DISCUSSION Loss of dentition can occur as a result of extensive caries, severe periodontitis, injury, or some combination of the above. Different treatment options can be followed when the treatment plan calls for the extraction of remaining teeth and an implant-supported fixed restoration.6–9 There are 4 basic interim approaches that can be used to transition a patient from a dentition with guarded prognosis to a reconstructed arch as follows: (1) use of a provisional removable denture21 (2) placement of transitional mini-implants to support a fixed provisional prosthesis22
Fixed Rehabilitation by a Staged Extraction Approach
FIGURE 5. A, Clinical view of the remaining 5 strategic maxillary teeth abutments after extraction of the remaining dentition. B, Clinical view of the provisional restoration supported by strategic teeth.
FIGURE 6. Panoramic radiograph of maxillary implants and bilateral sinus floor elevation with cross-arch provisional restoration supported by 5 strategic teeth.
(3) immediate loading of inserted dental implants with a provisional fixed partial denture23 (4) staged extraction of teeth and coordinated placement of dental implants18,21,24–29
The serial extraction protocol accommodates the patient’s psychologic need to remain dentate during partial- or full-mouth rehabilitation and can provide good esthetics and function during the interim restoration phases. Placement of implants in the extraction sites immediately or a few weeks after the extractions results in easier implant placement.30 Alveolar bone width and height are also preserved because of immediate or only slightly delayed placement of the implants.7,30 Soft tissue management around the definitive prosthetic elements is now possible.31 The implants may osseointegrate with no pressure caused by a removable prosthesis while normal function and esthetics may be maintained throughout the treatment period. The limitations of this approach include the need for multiple surgical procedures, the prolonged treatment time, the need for more than 1 provisional restoration, and/or several adjustments of the initial provisional restoration. In a staged approach, the choice of implant position is based on the residual bone volume and on the capacity of temporarily retained abutment teeth to support the provisional restoration.27 Moreover, in patients with advanced periodontal disease at the time of implant placement, there is the risk for contamination of the implant site with periodontal pathogens.19,20 Extensive preimplantation treatment of active periodontal pockets of the residual teeth is thus mandatory to avoid this problem.
FIGURE 3. Clinical occlusal view of the maxillary hopeless dentition.
FIGURE 7. Clinical occlusal view of stage 2 surgery of 8 osseointegrated implants, after the extraction of hopeless strategic teeth.
FIGURE 4. Occlusal view of maxillary cast metal-reinforced processed acrylic resin provisional restoration.
FIGURE 8. A, Anterior clinical view of final restoration. B, Radiographic view of final restoration.
© 2014 Mutaz B. Habal, MD
Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
849
The Journal of Craniofacial Surgery • Volume 25, Number 3, May 2014
Mijiritsky et al
In general, serial extraction protocols take longer than the more direct approach of extracting all the teeth and having a patient wear a removable denture while the sockets and the subsequent implants heal. Therefore, clinicians using a serial extraction protocol need to allow additional time to treat patients in this manner. When calculating fees for an arch restoration, practitioners need to consider time, repairs of provisional restorations, and other factors into the cost of the treatment. ACKNOWLEDGMENTS This article is dedicated to our beloved colleague and coauthor Ofer Mardinger, MD.
REFERENCES 1. Nevins M. Periodontal prosthesis reconsidered. Int J Prosthodont 1993;6:209–217 2. Balshi TJ. Converting patients with periodontally hopeless teeth to osseointegration prostheses. Int J Periodontics Restorative Dent 1988;8:8–33 3. Nevins M, Langer B. The successful use of osseointegrated implants for the treatment of the recalcitrant periodontal patient. J Periodontol 1995;66:150–157 4. Lewis S. Treatment planning: teeth versus implants. Int J Periodontics Restorative Dent 1996;16:366–377 5. Adell R, Eriksson B, Lekholm U, et al. Long-term follow-up study of osseointegrated implants in the treatment of totally edentulous jaws. Int J Oral Maxillofac Implants 1990;5:347–359 6. Shnitman PA, Wohrle PS, Rubenstein JE, et al. Ten-year results for Branemark implants immediately loaded with fixed prosthesis at implant placement. Int J Oral Maxillofac Implants 1997;12:495–503 7. Schwartz-arad D, Gulayev N, Chaushu G. Immediate versus non-immediate implantation for full-arch fixed reconstruction following extraction of all residual teeth: a retrospectivecomparative study. J Periodontol 2000;71:923–928 8. Wolfinger GJ, Balshi TJ, Rangert B. Immediate functional loading of Branemark system implants in edentulous mandibles: clinical report of the results of developmental and simplified protocols. Int J Oral Maxillofac Implants 2003;18:250–257 9. Grunder U. Immediate functional loading of immediate implants in edentulous arches: two-year results. Int J Periodontics Restorative Dent 2001;21:545–551 10. Smukler-Moncler S, Piattelli A, Favero GA, et al. Considerations preliminary to the application of early and immediate loading protocols in dental implantology. Clin Oral Implants Res 2000;11:12–25 11. Esposito M, Grusovin MG, Willings M, et al. The effectiveness of immediate, early and conventional loading of dental implants: a Cochrane systematic review of randomized controlled clinical retrials. Int J Oral Maxillofac Implants 2007;17(suppl 2):19–34 12. Nkenke E, Fenner M. Indications for immediate loading of implants and implant success. Clin Oral Implants Res 2006;17(suppl 2):19–34 13. Mish CE, Hahn J, Judy KW, et al. Workshop guidelines on immediate loading in implant dentistry. J Oral Implantol 2004;30:283–288
850
14. Garber DA, Salama H, Salama MA. Two-stage versus one-stage—is there really a controversy? J Periodontol 2001;72:417–421 15. Gallucci GO, Morton D, Weber HP. Loading protocols for dental implants in edentulous patients. Int J Oral Maxillofac Implants 2009;24(suppl):132–146 16. Degidi M, Piattelli A. Immediate functional and non-functional loading of dental implants: a 2–60 month follow-up study of 646 titanium implants. J Periodontol 2003;74:225–241 17. Raghoebar GM, Timmenga NM, Reintsema H, et al. Maxillary bone grafting for insertion of endosseous implants: results after 12–14 months. Clin Oral Implants Res 2001;12:279–286 18. Jivraj S, Chee W. Transitioning patients from teeth to implants. Br Dent J 2006;201:699–708 19. Gouvoussis J, Sindhusake D, Yeung S. Cross-infection from periodontitis sites to failing implant sites in the same mouth. Int J Oral Maxillofac Implants 1997;12:666–673 20. Polizzi G, Grunder U, Goene R, et al. Immediate and delayed implant placement into extraction sockets: a 5-year report. Clin Implant Dent Relat Res 2000;2:93–99 21. Cavallaro JS Jr, Greenstein G, Greenstein B. Serial extraction protocol for partial arches in implant dentistry: principles and clinical methodology. Gen Dent 2010;58:378–386 22. De Almeida EO, Filho HG, Goiatto MC. The use of transitional implants to support provisional prostheses during the healing phase: a literature review. Quintessence Int 2011;42:19–24 23. Cooper L, De Kok IJ, Reside GJ, et al. Immediate fixed restoration of the edentulous maxilla after implant placement. J Oral Maxillofac Surg 2005;63(suppl 2):97–110 24. Cordaro L, Torsello F, Ribeiro CA. Transition from a failing dentition to a removable implant-supported prosthesis: a staged approach. Quintessence Int 2010;41:371–378 25. Waliszewski M, Janakievski J. Sequencing patients to implant-supported full-mouth reconstructions: a case report. Pract Proced Aesthet Dent 2005;17:267–272 26. Mercurio RJ. Treatment planning to retain hopeless teeth as support for transitional appliances: three case reports. J Oral Implantol 2002;28:15–18 27. Cordaro L, Torsello F, Ercoli C, et al. Transition from failing dentition to a fixed implant-supported restoration: a staged approach. Int J Periodontics Restorative Dent 2007;27:481–487 28. Cavallaro J. The classification and clinical application of the serial extraction protocol for full- and partial-arch fixed prostheses. Pract Proced Aesthet Dent 2008;20:377–382 29. Greenstein G, Cavallaro J. Serial extraction protocol: transitioning a hopeless dentition to a full-arch reconstruction. Compendium 2008;29:526–535 30. Lazzara RJ. Immediate implant placement into extraction sites: surgical and restorative advantages. Int J Periodontics Restorative Dent 1989;9:332–343 31. Kinsel RP, Lamb RE. Development of gingival esthetics in the terminal dentition patient prior to dental implant placement using a full arch transitional fixed prosthesis: a case report. Int J Oral Maxillofac Implants 2001;16:583–589
© 2014 Mutaz B. Habal, MD
Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
Transition From Hopeless Dentition to Full-Arch Fixed-Implant–Supported Rehabilitation by a Staged Extraction Approach: Rationale and Technique Eitan Mijiritsky, DMD,* Ziv Mazor, MD, Adi Lorean, MD, Carmen Mortellaro, MD,† Ofer Mardinger, MD,‡ and Liran Levin, MD§∥ Abstract: Transition from a hopeless dentition to a fixed-implant– supported full-arch reconstruction can be difficult for patients if wearing a transitional removable denture is involved. In addition, an increased risk for trauma to bone augmentation areas and to the implant-bone interface exists when using a removable transitional complete denture during the implant healing period; such risk can compromise implant success or increase crestal bone loss around implants before the final restoration. This article describes a treatment approach that allows replacement of the hopeless dentition with an osseointegrated fixed prosthesis, without rendering the patient totally edentulous before the delivery of the final implantsupported prosthesis. A staged approach using a few hopeless teeth to support a provisional fixed restoration during the healing process can help avoid discomfort and improve implants’ outcome. A treatment plan for a maxillary arch reconstruction is used to illustrate the staged approach protocol. This protocol addresses patients’ psychologic need to remain dentate during partial or full-mouth rehabilitation, while providing good esthetics and function during restoration of a dental arch. Key Words: Dental implants, staged approach, serial extractions, hopeless teeth, staged extraction (J Craniofac Surg 2014;25: 847–850)
O
sseointegrated implants have become the preferred treatment option when the replacement of abutment teeth is considered.1 High implant success rates in the treatment of edentulous arches have been achieved, offering new treatment options for dentitions From the *Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel-Aviv University, TelAviv, Israel; †Department of Medical Science, Faculty of Medicine, University of Eastern Piedmont, Novara, Italy; ‡Department of Maxillofacial Surgery, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel; §Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus, Haifa, Israel; and ∥Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. Received September 3, 2013. Accepted for publication February 8, 2014. Address correspondence and reprint requests to Eitan Mijiritsky, DMD, Department of Oral Rehabilitation, School of Dental Medicine, Tel-Aviv University, Ehud street n. 12, Tel-Aviv 69351, Israel; E-mail: [email protected] Ziv Mazor is in private practice in Ra’anana, Israel, and Adi Lorean is in private practice in Tiberius, Israel. The authors report no conflicts of interest. Copyright © 2014 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000000861
with a poor prognosis or when multiple teeth have to be extracted.2–5 When the treatment plan calls for the extraction of all remaining teeth, different treatment options can be applied and sequenced, and the patient can be rehabilitated with an implant-supported fixed restoration.6–9 Treatment options can be selected according to timing of implant placement in relation to tooth extraction, timing of implant loading, and the use of removable versus fixed provisional restorations. In this context, treatment sequence may both determine patients’ comfort level during treatment and impact the efficiency of the clinician’s work. A common approach that helps avoid using a removable provisional restoration after the extraction of remaining teeth in the arch is the immediate implant loading approach.10–15 Immediate loading and prosthetic restoration overcome many of the disadvantages involved in the provisional removable prosthetic treatment often used during the implant healing period. These disadvantages include interference with masticatory function, impaired speaking ability, and possible adverse effects on esthetics.16 Furthermore, the implant failure rate is higher in patients undergoing implant treatment for an edentulous maxilla compared with patients with partially edentulous maxillae. One explanation is that pressure effect on soft tissues caused by wearing removable prostheses impacts implant healing.17 Implant immediate loading is technique sensitive and can be applied only in selected patients. A thorough evaluation of the patient’s dental and general medical history before implant planning is important to rule out risk factors.13 Moreover, several aspects specific to the immediate loading of implants in the edentulous mandible or maxilla should be considered, specifically, the minimum requirement for the sizes and number of implants. Among several factors found to predict treatment outcomes for immediately loaded implants is adequate primary stability.10,11 Threaded implants with a roughened surface are preferred because they usually achieve high primary stability. Avoiding parafunctional loading and restorations with posterior cantilevers is also recommended.13 The success of the treatment might also be related to patient compliance and adherence to a strict soft diet for the first 6 to 8 weeks of implant healing.18 A treatment approach for patients with failing dentition is described here. The protocol avoids the use of removable provisional prostheses by staged extraction of teeth and placement of dental implants. A treatment plan for a maxillary arch reconstruction is used to illustrate a staged approach protocol. This methodology could also apply to a mandibular prosthesis.
STAGED APPROACH TREATMENT PROTOCOL The suggested steps of the staged approach treatment protocol procedure are described in Table 1. The overall suggested protocol involves a thorough diagnostic phase with careful documentation and preparation followed by
The Journal of Craniofacial Surgery • Volume 25, Number 3, May 2014
Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
847
Mijiritsky et al
The Journal of Craniofacial Surgery • Volume 25, Number 3, May 2014
TABLE 1. Suggested Steps of the Staged Approach Treatment Protocol Procedure
wax-up or setup. The treatment plan should be performed keeping in mind where the final implants are planned and which teeth could be preserved in the meantime and support the provisional restoration. The cause-related initial preparation should not be skipped or underestimated in those patients. Active periodontal disease needs to be addressed before implant placement and prosthetic treatment
848
are started, even though the dentition has a guarded prognosis. This is critical because correct soft tissue healing and postextraction placement of implants cannot be safely accomplished in the presence of active lesions.19,20 Later on, the preprosthetic surgery is divided into 2 phases, with a final definitive restorations stage that follows (Table 1). © 2014 Mutaz B. Habal, MD
Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
The Journal of Craniofacial Surgery • Volume 25, Number 3, May 2014
FIGURE 1. Preoperative anterior intraoral view.
FIGURE 2. Preoperative panoramic radiograph illustrates advanced periodontitis and failing restorations in the maxillary arch.
The following treatment plan for a maxillary arch reconstruction illustrates the staged approach protocol. A 63-year-old female patient presented with advanced periodontitis, caries, and an unesthetic maxillary fixed denture (Figs. 1–3). The treatment plan called for the following: (1) staged maxillary teeth extraction with a bilateral sinus augmentation (2) preparation of hopeless teeth to support a provisional fixed partial denture during the healing phase of the first batch of implants placed (Figs. 4–6) (3) use of the already integrated implants after extraction of the remaining hopeless teeth to support a provisional fixed partial denture during the healing phase of the second batch of implants (4) delivery of an implant-supported permanent fixed restoration in the maxilla (Figs. 7, 8)
DISCUSSION Loss of dentition can occur as a result of extensive caries, severe periodontitis, injury, or some combination of the above. Different treatment options can be followed when the treatment plan calls for the extraction of remaining teeth and an implant-supported fixed restoration.6–9 There are 4 basic interim approaches that can be used to transition a patient from a dentition with guarded prognosis to a reconstructed arch as follows: (1) use of a provisional removable denture21 (2) placement of transitional mini-implants to support a fixed provisional prosthesis22
Fixed Rehabilitation by a Staged Extraction Approach
FIGURE 5. A, Clinical view of the remaining 5 strategic maxillary teeth abutments after extraction of the remaining dentition. B, Clinical view of the provisional restoration supported by strategic teeth.
FIGURE 6. Panoramic radiograph of maxillary implants and bilateral sinus floor elevation with cross-arch provisional restoration supported by 5 strategic teeth.
(3) immediate loading of inserted dental implants with a provisional fixed partial denture23 (4) staged extraction of teeth and coordinated placement of dental implants18,21,24–29
The serial extraction protocol accommodates the patient’s psychologic need to remain dentate during partial- or full-mouth rehabilitation and can provide good esthetics and function during the interim restoration phases. Placement of implants in the extraction sites immediately or a few weeks after the extractions results in easier implant placement.30 Alveolar bone width and height are also preserved because of immediate or only slightly delayed placement of the implants.7,30 Soft tissue management around the definitive prosthetic elements is now possible.31 The implants may osseointegrate with no pressure caused by a removable prosthesis while normal function and esthetics may be maintained throughout the treatment period. The limitations of this approach include the need for multiple surgical procedures, the prolonged treatment time, the need for more than 1 provisional restoration, and/or several adjustments of the initial provisional restoration. In a staged approach, the choice of implant position is based on the residual bone volume and on the capacity of temporarily retained abutment teeth to support the provisional restoration.27 Moreover, in patients with advanced periodontal disease at the time of implant placement, there is the risk for contamination of the implant site with periodontal pathogens.19,20 Extensive preimplantation treatment of active periodontal pockets of the residual teeth is thus mandatory to avoid this problem.
FIGURE 3. Clinical occlusal view of the maxillary hopeless dentition.
FIGURE 7. Clinical occlusal view of stage 2 surgery of 8 osseointegrated implants, after the extraction of hopeless strategic teeth.
FIGURE 4. Occlusal view of maxillary cast metal-reinforced processed acrylic resin provisional restoration.
FIGURE 8. A, Anterior clinical view of final restoration. B, Radiographic view of final restoration.
© 2014 Mutaz B. Habal, MD
Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
849
The Journal of Craniofacial Surgery • Volume 25, Number 3, May 2014
Mijiritsky et al
In general, serial extraction protocols take longer than the more direct approach of extracting all the teeth and having a patient wear a removable denture while the sockets and the subsequent implants heal. Therefore, clinicians using a serial extraction protocol need to allow additional time to treat patients in this manner. When calculating fees for an arch restoration, practitioners need to consider time, repairs of provisional restorations, and other factors into the cost of the treatment. ACKNOWLEDGMENTS This article is dedicated to our beloved colleague and coauthor Ofer Mardinger, MD.
REFERENCES 1. Nevins M. Periodontal prosthesis reconsidered. Int J Prosthodont 1993;6:209–217 2. Balshi TJ. Converting patients with periodontally hopeless teeth to osseointegration prostheses. Int J Periodontics Restorative Dent 1988;8:8–33 3. Nevins M, Langer B. The successful use of osseointegrated implants for the treatment of the recalcitrant periodontal patient. J Periodontol 1995;66:150–157 4. Lewis S. Treatment planning: teeth versus implants. Int J Periodontics Restorative Dent 1996;16:366–377 5. Adell R, Eriksson B, Lekholm U, et al. Long-term follow-up study of osseointegrated implants in the treatment of totally edentulous jaws. Int J Oral Maxillofac Implants 1990;5:347–359 6. Shnitman PA, Wohrle PS, Rubenstein JE, et al. Ten-year results for Branemark implants immediately loaded with fixed prosthesis at implant placement. Int J Oral Maxillofac Implants 1997;12:495–503 7. Schwartz-arad D, Gulayev N, Chaushu G. Immediate versus non-immediate implantation for full-arch fixed reconstruction following extraction of all residual teeth: a retrospectivecomparative study. J Periodontol 2000;71:923–928 8. Wolfinger GJ, Balshi TJ, Rangert B. Immediate functional loading of Branemark system implants in edentulous mandibles: clinical report of the results of developmental and simplified protocols. Int J Oral Maxillofac Implants 2003;18:250–257 9. Grunder U. Immediate functional loading of immediate implants in edentulous arches: two-year results. Int J Periodontics Restorative Dent 2001;21:545–551 10. Smukler-Moncler S, Piattelli A, Favero GA, et al. Considerations preliminary to the application of early and immediate loading protocols in dental implantology. Clin Oral Implants Res 2000;11:12–25 11. Esposito M, Grusovin MG, Willings M, et al. The effectiveness of immediate, early and conventional loading of dental implants: a Cochrane systematic review of randomized controlled clinical retrials. Int J Oral Maxillofac Implants 2007;17(suppl 2):19–34 12. Nkenke E, Fenner M. Indications for immediate loading of implants and implant success. Clin Oral Implants Res 2006;17(suppl 2):19–34 13. Mish CE, Hahn J, Judy KW, et al. Workshop guidelines on immediate loading in implant dentistry. J Oral Implantol 2004;30:283–288
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14. Garber DA, Salama H, Salama MA. Two-stage versus one-stage—is there really a controversy? J Periodontol 2001;72:417–421 15. Gallucci GO, Morton D, Weber HP. Loading protocols for dental implants in edentulous patients. Int J Oral Maxillofac Implants 2009;24(suppl):132–146 16. Degidi M, Piattelli A. Immediate functional and non-functional loading of dental implants: a 2–60 month follow-up study of 646 titanium implants. J Periodontol 2003;74:225–241 17. Raghoebar GM, Timmenga NM, Reintsema H, et al. Maxillary bone grafting for insertion of endosseous implants: results after 12–14 months. Clin Oral Implants Res 2001;12:279–286 18. Jivraj S, Chee W. Transitioning patients from teeth to implants. Br Dent J 2006;201:699–708 19. Gouvoussis J, Sindhusake D, Yeung S. Cross-infection from periodontitis sites to failing implant sites in the same mouth. Int J Oral Maxillofac Implants 1997;12:666–673 20. Polizzi G, Grunder U, Goene R, et al. Immediate and delayed implant placement into extraction sockets: a 5-year report. Clin Implant Dent Relat Res 2000;2:93–99 21. Cavallaro JS Jr, Greenstein G, Greenstein B. Serial extraction protocol for partial arches in implant dentistry: principles and clinical methodology. Gen Dent 2010;58:378–386 22. De Almeida EO, Filho HG, Goiatto MC. The use of transitional implants to support provisional prostheses during the healing phase: a literature review. Quintessence Int 2011;42:19–24 23. Cooper L, De Kok IJ, Reside GJ, et al. Immediate fixed restoration of the edentulous maxilla after implant placement. J Oral Maxillofac Surg 2005;63(suppl 2):97–110 24. Cordaro L, Torsello F, Ribeiro CA. Transition from a failing dentition to a removable implant-supported prosthesis: a staged approach. Quintessence Int 2010;41:371–378 25. Waliszewski M, Janakievski J. Sequencing patients to implant-supported full-mouth reconstructions: a case report. Pract Proced Aesthet Dent 2005;17:267–272 26. Mercurio RJ. Treatment planning to retain hopeless teeth as support for transitional appliances: three case reports. J Oral Implantol 2002;28:15–18 27. Cordaro L, Torsello F, Ercoli C, et al. Transition from failing dentition to a fixed implant-supported restoration: a staged approach. Int J Periodontics Restorative Dent 2007;27:481–487 28. Cavallaro J. The classification and clinical application of the serial extraction protocol for full- and partial-arch fixed prostheses. Pract Proced Aesthet Dent 2008;20:377–382 29. Greenstein G, Cavallaro J. Serial extraction protocol: transitioning a hopeless dentition to a full-arch reconstruction. Compendium 2008;29:526–535 30. Lazzara RJ. Immediate implant placement into extraction sites: surgical and restorative advantages. Int J Periodontics Restorative Dent 1989;9:332–343 31. Kinsel RP, Lamb RE. Development of gingival esthetics in the terminal dentition patient prior to dental implant placement using a full arch transitional fixed prosthesis: a case report. Int J Oral Maxillofac Implants 2001;16:583–589
© 2014 Mutaz B. Habal, MD
Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
