Stephen Parel: Prosthetic complications

Hybrid restorations are an excellent restorative procedure in combination with the All-on-4® treatment concept. Dr Parel reviews some of the main complications which can occure when implementing this concept and how to solve them, e.g. management of the transition line in patients with vertical maxillary excess (VME) showing a considerable amount of gingival display and situations with limited posterior space for prosthetic options. Comparative data suggest that implant failure and loss with immediate loading on 4 implants seems to be significantly more frequent in the maxilla than in the mandible. Rescue options for the failed implants are reviewed. Dr Parel develops an implant failure profiling on the contributing factors to such implant losses and identifies a subset of patients where an adaptation of treatment planning might be needed. Main contributing factors seem to be opposing natural dentition, bruxism, poor bone density and male gender, in such cases placement of 5, 6 or more implants has to be considered to provide more stability. Dr Parel concludes that 4 implant restorations offer advantages such as graftless and low invasive approach, good patient acceptance and good success rates in most cases, but there are patients who need more then 4 implants in the maxillary arch.