A Digital and Conventional Approach to the Rehabilitation of Complete Edentulous with a Toronto Infrastructure-Designed Hybrid Prosthesis: a Case Report
Abstract
This case describes the prosthetic treatment of a completely edentulous patient treated with the "Toronto Bridge" technique, an implant-supported (all-on-four/all-on-five) hybrid prosthesis.
A 42-year-old male patient applied to our clinic for aesthetic and functional problems. After clinical and radiographic examination, the all-on-five treatment concept for the edentulous maxilla and an all-on-four treatment concept for the edentulous mandible were planned. In the maxilla, two distal implants were placed at 30-45° angles, and three straight implants were placed in the anterior region. In the mandible, two distal implants were positioned at the anterior to mental foramina at an angle of 30-45°and two straight implants were placed in the anterior region. The digital impressions were taken, and the infrastructures and veneers were designed according to the "Toronto Bridge" protocol. The infrastructures and veneers were fabricated by milling zirconium blocks and cemented. The occlusion was rechecked for any interferences.
This case report showed successful results for the all-on-four/five treatment concept "Toronto Bridge" prostheses at a six-month follow-up, and no complications were observed. This case report suggests that the implant-supported prosthetic treatment of a completely edentulous patient treated with the "Toronto Bridge" treatment technique provides esthetics, phonetics, oral hygiene, and oral comfort, which may be an alternative to an acrylic resin or porcelain fused metal fixed restorations.
Keywords
Edentulism, Implant-supported prosthesis, Hybrid prosthesis, Toronto bridge
References
- Misch CE. Dental implant prosthetics. St Louis: Elsevier Mosby; 2005.p. 224-49.
- Özdoğan A, İncesu A. Implant supported hybrıd prosthesıs. Atatürk Üniv Diş Hek Fak Derg. 2016;26:366-9.
- Patzelt SB, Bahat O, Reynolds MA, Strub JR. The all-on-four treatment concept: a systematic review. Clin Implant Dent Relat Res. 2014;16:836-55.
- Agliardi EL, Romeo D, Panigatti S, de Araujo Nobre M, Malo P. Immediate full-arch rehabilitation of the severely atrophic maxilla supported by zygomatic implants: a prospective clinical study with minimum follow-up of 6 years. Int J Oral Maxillofac Surg. 2017;46:1592-9.
- Asawa N, Bulbule N, Kakade D, Shah R. Angulated implants: an alternative to bone augmentation and sinus lift procedure: systematic review. J Clin Diagn Res. 2015;9:10-3.
- Maló P, Rangert B, Nobre M. "All-on-Four" immediate function concept with Brånemark System implants for completely edentulous mandibles: a retrospective clinical study. Clin Implant Dent Relat Res. 2003;5:2-9.
- Maló P, Rangert B, Nobre M. All-on-4 immediate-function concept with Brånemark System implants for completely edentulous maxillae: a 1-year retrospective clinical study. Clin Implant Dent Relat Res. 2005;7:88-94.
- Goodacre CJ, Bernal G, Rungcharassaeng K, Kan J.Y.K. Clinical complications with implants and implant prostheses. J Prosthet Dent. 2003;90(02):121–32.
- Attard NJ, Zarb GA. Long-term treatment outcomes in edentulous patients with implant-fixed prostheses: the Toronto study. Int J Prosthodont. 2004;17:417-24.
- Real-Osuna J, Almendros-Marques N, Gay-Escoda C. Prevalence of complications after the oral rehabilitation with implant-supported hybrid prostheses. Med Oral Patol Oral Cir Bucal. 2012;17:e116-21.