Maxillary implant-supported overdenture to replace a failed, fixed restoration

A 68-year-old female patient was referred wearing an implant-supported restoration in the upper jaw associated with a very high mobility of the implants due to periimplantitis. The restoration had only been delivered 10 months earlier and was causing severe discomfort and pain, not allowing the patient to follow the routine oral hygiene instructions.

The patient's main wish was to solve the mobility problem of the existing prosthesis, ease the pain during mastication and provide her with a restoration that would allow for a good oral hygiene maintenance and also improve the esthetic outcome.

The main goal of this treatment was to remove the existing implants and prosthesis in the maxilla, successfully treat the periodontal symptoms and improve the patient's general oral health. The overall treatment plan for this patient consisted in the placement of new implants and fabrication of a new prosthesis to re-establish function and esthetics and provide overall comfort.

Complete edentulism is associated with a reduced masticatory efficiency, unfavorable esthetic and psychological changes due to the loss of support for the facial muscles, loss of vertical dimension and speech impairment. The conventional method for treating edentulous patients has been to rehabilitate them with a complete removable denture. Nowadays, several fixed or removable dental prostheses can be fabricated to restore the edentulous jaws with implants. However, the treatment choice between a fixed dental prosthesis, an implant-assisted or an implant-supported overdenture depends on a number of combined factors, including the degree of bone resorption and its related superficialization of deep anatomic structures such as the inferior alveolar nerve, the amount of keratinized attached mucosa, the patient dexterity and compliance, the esthetic needs (lip and soft tissue support) and last but not least cost and psychologic demands of the patient.