1. Introduction & Objective
XXIII International SIO Congress “How to optimize and simplify the implant-prosthetic rehabilitation in totally edentulous patient ”
Milan, February
Reducing the number of implants in the prosthetic rehabilitation of edentulous patients: Presentation of two cases
LANZA A1, SCOGNAMIGLIO F 2(*).
1 Second University of Naples, Naples, Italy.
2 University of Naples Federico II, Graduate school of oral surgery. .
Introduction & Objective
One of the primary objectives in oral implantology is to restore function and aesthetics of the oral cavity lost. Secondary objectives include the resolution of the case in short periods of time, with a reduced number of surgeries and  simple treatment protocols . In totally edentoulus patients this is possible by reducing the number of implants inserted.  The literature shows that at the level of the maxilla is possible to rehabilitate the patient with a fixed prosthesis supported by a minimum of six plants (2). For the mandible is possible to reduce the number of implantsat 4.  In totally edentulous patients literature demonstrates large percentage of success and survival also for implant-retained overdentures  (2).  Particularly, maxillary overdentures with ≥4 implants and splinted (bar) anchorage show high implant and overdenture survival rate (both > 95% per year) (3). In the mandibula   the union of implants through the bar does not seem to affect outcomes (4). We present a case of edentulous maxilla and mandible rehabilitated with fixed prostheses on implants and a case of edentulous maxilla rehabilitated with overdenture on dolder bar stabilized by 4 implants.
Case Report N Materials & Methods
Edentulous maxilla and mandible rehabilitated with implant fixed prosthesis
A male patient of 58 years non-smoker comes to our attention with multiple edentulous areas in maxilla and mandible. After careful clinical and radiographic examination we decide to extract the elements periodontally compromised, wait a healing period of 4 weeks and then insert n. 6 implants at the maxillary arch and n. 4 implants at mandibular arch (OsseoSpeed ​​™ Astra Tech AB, Mölndal, Sweden) (fig.1). After the osseointegration period (5 months) we proceed to the prosthetic phase(fig.2 e 3). Fig.4 shows the radiographic control at one year of follow-up
Figure 1. Implant surgery
Figure 3. Prostethic rehabilitation (a ) (b). Clinical aspect of the prosthetic rehabilitation (c) (d).
Figure 3. Prostethic rehabilitation (a ) (b). Clinical aspect of the prosthetic rehabilitation (c) (d). a b c d
Figure 2. Prostethic phase. Healing cup and clinical aspect of the transmucosal tissue 5 months after surgery (a ) (b). Transfers splinted (c) Clinical aspect of the abutments and the mesostructure (d). c a b d e
Figure 4. Radiographic control after 1 year from loading
F-TiO c d a b e
Case Report N.2
Edentulous maxilla rehabilitated with overdenture on 4 implants and splinted (bar) anchorage
Figure 1 Clinical aspect after osseointegration period. Transmucosal tissue (a). Transfers splinted at the time of the impression (b)
A male patient of seventytwo years, no smoker comes to our observation to be rehabilitated with oral implants. A complete denture without palate has been linked to four endosseous maxillary implants (OsseoSpeed ​​™ Astra Tech AB, Mölndal, Sweden)  using an innovative anchoring system. The connection is represented by a titanium bar  including in its own structure also abutments, designed and built with dedicated software . So there are no welds that join the bar to dental implant abutments but the whole is represented by a single block of titanium obtained by milling. Welds are eliminated, thereby greatly reduced the shrinkage stress between implant and abutment in titanium. The result is an anchoring system with a high degree of liability and thus durability. a b
Figure 3. Clinical aspect of the bar and the internal surface of the prosthesis. Occlusal view of th bar (a). Frontal view of the bar (b). Internal aspect of the prosthesis (c).
Figure 2. c a b
Figure 4. Clinical aspect of the prosthesis. Frontal (a) lateral (b) and occlusal view of the prosthesis (c).
Figure 5. Radiographic control after 1 year from loading c a b d
Result and Conclusion
No bone loss around implants was registrated at one year from loading. No prosthetic or biological complication were recorded.
The clinical aspect (fig.3) and radiographic outcome at one year after delivery (fig.4-5) demonstrate how we can achieve a successful outcome with a minimum number of implants at both jaws. The reduction in the number of implants along with the need not to make bone regeneration and thus increase the surgical time, costs and morbidity of the patient made ​​it possible to solve both cases after a period of time content with clear satisfaction of the operators and the patient.
References
1 Mericske-Stern R., Worni, A. Optimal number of oral implants for fixed reconstructions: A review of the literature. Eur J Oral Implantol. 2014: 7:
2 Wennerberg A. , Albrektsson T. Current challenges in successful rehabilitation with oral implants. Journal of oral rehabilitation 2011; 38:
3 Raghoebar GM, Mejer HJ, Slot W, Slater JJ, Vissink A. A systematic review of implant- supported overdentures in the edentulous maxilla, compared to the mandible: how many implants? Eur J Oral Imlantol. 2014; 7 Suppl 2 :
4 Roccuzzo M, Bonino F, Gaudioso L, Zwahlen M, Meijer HJA. What is the optimal number of implants for removable reconstructions? A systematic review on implant-supported overdentures. Clin. Oral Implants Res. 23(Suppl. 6), 2012, 229–237