Full-Arch Implant Rehabilitation

By Arun Garg

The full-arch implant rehabilitation (FAIR) protocol is one of the newest implant therapy innovations to treat the edentulous or nearly edentulous patient. The FAIR prosthesis is immediate, fixed, esthetically pleasing, highly functional, inexpensive, and maintainable, and it can frequently be installed without bone grafting. This book describes how the FAIR protocol works, who it should be used for, and methods to implement it successfully for different patients. The system can be used in both arches and in patients with total or near-total edentulism. Several chapters are devoted to describing step-by-step treatment with detailed clinical photographs documenting every step from initial assessment to prosthesis delivery. Even those new to fixed denture systems will find the procedures easy to follow and can begin implementing the FAIR approach for their patients.

• Language: English
• Publisher: Quintessence Publishing Co, Inc
• Release date: Oct 1, 2019
• ISBN: 9780867158106

Book preview

The full-arch implant rehabilitation (FAIR) protocol is one of the newest implant therapy innovations to treat the edentulous or nearly edentulous patient. The FAIR prosthesis is immediate, fi xed, esthetically pleasing, highly functional, inexpensive, and maintainable, and it can frequently be installed without bone grafting. This book describes how the FAIR protocol works, who it should be used for, and methods to implement it successfully for different patients. The system can be used in both arches and in patients with total or near-total edentulism. Several chapters are devoted to describing step-by-step treatment with detailed clinical photographs documenting every stage from initial assessment to prosthesis delivery. Even those new to fi xed denture systems will fi nd the procedures easy to follow and can begin implementing the FAIR approach for their patients.

Full-Arch Implant Rehabilitation

Library of Congress Cataloging-in-Publication Data

Names: Garg, Arun K., 1960-author.

Title: Full-arch implant rehabilitation / Arun K. Garg.

Description: Berlin ; Chicago : Quintessence Publishing, [2019] |

Includes bibliographical references.

Identifiers: LCCN 2019022458| ISBN 9780867158090 (paperback) | ISBN 9780867158106 (ebook)

Subjects: | MESH: Dental Implantation--methods | Jaw, Edentulous--surgery | Dental Implants | Dental Arch

Classification: LCC RK667.I45 | NLM WU 640 | DDC 617.6/93--dc23

LC record available at https://lccn.loc.gov/2019022458

© 2019 Quintessence Publishing Co, Inc

Quintessence Publishing Co, Inc

411 N Raddant Road

Batavia, IL 60510

www.quintpub.com

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All rights reserved. This book or any part thereof may not be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, or otherwise, without prior written permission of the publisher.

Editor: Marieke Zaffron

Design: Sue Zubek

Production: Kaye Clemens and Christine Cianciosi

Printed in China

Preface

1Evolution of the FAIR Protocol

The FAIR Difference

2History of Tilted Implants with an Immediate Prosthesis

Tilted Implants and FAIR

Factors Guiding Successful Outcomes

Tilted Implants and Restoration of the Edentulous Maxilla.

Position and Angulation of Tilted Implants

3Identifying and Evaluating Candidates

Evaluating the FAIR Patient

Treatment Planning

4The FAIR Technique and Its Modifications

Surgical Guidelines for Edentulous Arches

FAIR Surgical Guide and Immediate Denture

The FAIR Surgery

Immediate Provisionalization

5Treating the Fully Edentulous Maxilla

The FAIR Vision

Preoperative Procedure

FAIR Surgical Procedure

6Treating the Fully Edentulous Mandible

FAIR in the Mandible

Preoperative Procedure

FAIR Surgical Procedure

7Treating the Partially Edentulous Maxilla

The FAIR Vision

Preoperative Procedure

FAIR Surgical Procedure

8Treating the Partially Edentulous Mandible

FAIR in the Mandible: Special Considerations for Partial Edentulism

Preoperative Procedure

FAIR Surgical Procedure

9FAIR Prosthetics

Biomechanical Factors

The Provisional Prosthesis

The Definitive Prosthesis

10 Possible Complications

Complications Unrelated to Prosthesis Fracture

Complications Related to Prosthesis Fracture

The purpose of this book is to explain and illustrate how to treat the edentulous or nearly edentulous patient via a full-arch implant rehabilitation (FAIR) protocol. FAIR is one of the newer innovations in implant therapy to relieve the functional and esthetic misery of a growing worldwide demographic of edentulous patients numbering in the millions.

The FAIR protocol offers full-arch prostheses that are immediate, fixed, loaded, esthetically pleasing, highly functional, inexpensive, maintainable, and very reliable. The protocol’s low-morbidity surgical and provisional restoration techniques are accomplished in a single visit with usually only four or five implants, including posterior tilted implants that take advantage of the patient’s available bone, often eliminating the need for bone grafting.

The book begins with a two-chapter history of the tremendous progress in dental implantology treatment over the last 40 years, due in large part to advances in digital imaging and materials technology for both implants and prostheses. Subsequent chapters describe the specific methods for choosing and treating patients to restore their full-arch function and esthetics.

The text provides a clear, succinct, and authoritative guide to full-arch rehabilitation and as such is ideal for any clinicians incorporating or expanding full-arch restoration modalities into their practice. The case-by-case methodology adds to the uniqueness of the text. A patient-focused approach covers surgical templates and techniques, sterilization, pharmacology, bone biology, complications, and more. Dozens of vivid, digitally mastered artist renderings as well as maxillofacial photography of real patients further enhance the depictions of treatment procedures. Informative tables and charts are also included, many of which depict essential procedural elements for treatment. I hope that the readers also take time to explore the dozens of scholarly resources assembled to support the claims of the text. My further hope is that this text becomes a welcomed companion for any dentists eager to expand their implant knowledge and skills and to advance their careers.

My inspiration for writing stems, as always, from my decades-long service as a full-time professor of surgery in the Division of Oral and Maxillofacial Surgery and as director of residency training at the University of Miami Leonard M. Miller School of Medicine. I see FAIR as one of the next logical steps in my career-long focus on bone biology, harvesting, and grafting for dental implant surgery. My humble hope is that this book will have the same global success as several other texts that I’ve written on bone grafting and dental implantology to benefit dental clinicians and patients around the world.

Acknowledgments

For their invaluable assistance and work on the patient cases described in this book, I would like to offer special thanks to Renato Rossi, Jr, DMD, MSc, PhD; Maria Del Pilar Rios, DDS, MScD, PhD; and Rosa Ysabel Rios, implant prosthetic specialist.

The full-arch implant rehabilitation (FAIR) protocol is one of the newest innovations in implant therapy to treat the edentulous or nearly edentu-lous patient. Instead of single implants replacing individual missing teeth, four or five implants are spaced throughout the arch and immediately loaded with a provisional fixed prosthesis. While conventional removable dentures and bone grafting with multiple implants are other options, the latter can take several years and has commensurate high costs. Morever, a number of studies have shown that wearing conventional removable dentures can reduce patients’ quality of life, causing pain and areas of discomfort, chewing and speaking difficulties, slippage, reduced occlusal force, and poor oral sensation.

The FAIR dental prosthesis offers many advantages for the dental patient with a fully or partially edentulous arch (Table 1-1). The prosthesis is immediate, fixed, esthetically pleasing, highly functional, inexpensive, and maintainable. Importantly, the FAIR procedure and similar techniques can frequently be performed without bone grafting with exceptional success rates.1–14 Such dental systems are better designed to meet the surgical and restorative needs of more patients with edentulous or partially edentulous arches, because traditional techniques often require extensive bone grafting. The invasiveness of these procedures deters many patients, and others (particularly elderly patients and those with severe bone loss) may not be good candidates for bone grafting.

TABLE 1-1 Advantages and disadvantages of removable dentures, overdentures, and the FAIR approach

During the late 1980s and early 1990s, the success rates for immediately loaded implants improved, both for the restoration of individual teeth and the placement of short-span fixed partial dentures.15–20 These developments served to push the envelope toward full-arch replacement, both with and eventually without bone grafting. The mid to late 1990s saw the development of mandibular restoration protocols that attempted to meet the challenges of anatomical placement and a redesigned partial denture architecture in the dense bone of the mandible.21,22 Similar attempts in the softer, more porous maxillary bone were generally unsuccessful because of poor anchorage.23–28 To overcome this challenge, the threading, size, and length of implants were redesigned to condense and thicken bone during placement in soft bone and with sinus elevation and other procedures.29–32

The early 2000s saw significant improvement in the esthetics of fixed prosthodontics, particularly with the introduction of pink ceramic for the gingiva. Retrospective studies of fixed full-arch prostheses in the mandible and zygomatic implants in the maxilla showed how protocols for full-arch dental prostheses had evolved.33–37 For example, when traditional implant surgery and bone grafting for sinus elevation and other procedures are contraindicated in the maxilla due to patient age or other issues with bone density or availability, the longer, nontraditional zygomatic implants can be placed near the dense, more cortical cheek bone (ie, zygoma) in the posterior maxilla (Fig 1-1). This decreases the time needed for the procedure and increases patient comfort.38,39 By about 2010, additional advancements in implant design and protocols included techniques for extramaxillary anchorage, optimal implant angulation, optional use of cantilevers, and bone reduction (when required).40–45

Fig 1-1 Placing zygomatic implants near the dense, more cortical cheekbone in the posterior maxilla is an example of an early evolution in protocol for full-arch dental prostheses.

An earlier treatment option for edentulous patients that reflects the evolution of dental implant technology is the two- or four-implant removable overdenture.46–48 Unlike conventional removable dentures (Fig 1-2), the fixed removable overdenture improves stability and function to approximately 60% that of natural teeth (Fig 1-3) and yet is still relatively inexpensive as a replacement for teeth and gingiva. Additionally, it provides lip support and easy cleaning outside the mouth. Disadvantages include sore spots on the gingiva, some movement when the patient chews and speaks, and the possible need for frequent relining for fit and comfort because of continued bone resorption.

Fig 1-2 The conventional denture was a first step in the evolution toward the FAIR protocol.

Fig 1-3 The fixed removable overdenture improves stability and function to approximately 60% that of natural teeth.

The FAIR Difference

In contrast, the FAIR prosthesis and other similar protocols have only two requirements that could be considered disadvantages: a surgical procedure and a short period afterward for healing and restoration. For these relatively minor disadvantages, the FAIR protocol (Fig 1-4) provides 70% of the functionality of natural teeth, requires minimal or no grafting before placement, and serves as a replacement for bone and teeth (preserving both bone and soft tissue). A provisional prosthesis is delivered on the day of surgery, allowing the consumption of soft foods during healing. The definitive prosthesis has a 95% success rate over 30 years with a relatively natural esthetic that also permits