Maintenance of implant hybrid prostheses: clinical and laboratory procedures

Fixed implant hybrid prostheses have been used for the last 40+ years in the treatment of edentulous patients. These prostheses have provided long-term masticatory function for thousands of patients. The original treatment protocol included fabrication of cast metal frameworks that fit accurately on the restorative platforms or abutments and/or endosseous implants. Frameworks were designed to splint implants together; they also provided retention and support for the functional and esthetic portions of the fixed hybrid prostheses. Initially, edentulous patients were treated with maxillary complete dentures and mandibular fixed, hybrid prostheses. Denture teeth were used in both prostheses. Over the span of many years, occlusal surfaces of the denture teeth in the mandibular prostheses exhibited signs of occlusal abrasion and wear, sometimes completely abrading the teeth and denture bases, resulting in framework exposures. Ultimately, this resulted in decreased chewing efficiency and loss of vertical facial height. Patients would then return to clinicians and ask for retreatment. In certain instances, the underlying frameworks would have to be remade. This involved replicating the original series of appointments and significant additional expense to patients and clinicians alike. The protocol presented in this article avoids having to remake the most expensive portion of fixed implant prostheses--the frameworks. The protocol identifies the clinical and laboratory procedures involved in using existing frameworks and replacing preexisting denture bases and denture teeth, with minimal inconvenience to patients.