Implant Rehabilitation Planning Protocol for the Edentulous Patient According to Denture Space, Lip Support, and Smile Line

Abstract

Rehabilitation with implants is a challenge. Having previous evaluation criteria is key to establishing the best treatment for the patient. In addition to clinical and radiological aspects, the prosthetic parameters must be taken into account in the initial workup, since they allow discrimination between fixed and removable rehabilitation. We present a study protocol that analyzes three basic prosthetic aspects. First, denture space defines the need to replace teeth, tissue, or both. Second, lip support focuses on whether or not to include a flange. Third, the smile line warns of potential risks in esthetic rehabilitation. Combining these parameters allows us to make a decision as to the most suitable type of prosthesis. The proposed protocol is useful for assessing the prosthetic parameters that influence decision making as to the best-suited type of restoration. From this point of view, we think it is appropriate for the initial approach to the patient. In any case, other considerations of study may amend the proposal.

Protocols in classification of partially edentulous patients

“…The main idea Figure 1. Recommended therapy in combination of three prosthetic parameters [14] of the classification was the possibility to help practitioners to define appropriate treatments to be recommended to partially edentulous patients. The system uses four basic criteria and their diversity to divide all partially edentulous patients in four classes, where Class I includes simple while Class IV exceptionally complicated clinical cases of partial edentulism.…”

“…While considering characteristics of the residual ridge, the following should be determined on the OPT image: height, that should be ≥ 21mm when measured on the lowest position on the mandible, width and shape of the ridge if implant treatment is planned. Implantation procedure should be agreed with the surgeon with previous 3D diagnosis of jaw bone quality and other measurements on the jaws (proximity of sinus cavities and the mandibular canal) [14,27,28,29].…”

“…On the other hand, certain areas, such as esthetic dentistry and oral implantology, offer protocols adopted on consensus conferences, as well as recommendations of the professional associations. It is important to mention some of them, without which, contemporary practice would not be rationally sustainable: recommendations related to clinical procedures based on which esthetic rules related to placement of implants are defined [11], conditions and significance of immediate implantation [12], protocols in application of cemented and screwed implants [13], recommendations on management of edentulous patients determined by different parameters [14] as well as similar recommendations with longitudinal evidence based data [15][16][17][18][19][20][21] (Figure 1).…”

Full‐Arch Implant‐Supported Rehabilitation Guided by a Predicted Lateral Profile of Soft Tissue

“…In the anterior part of full‐arch restorations, treatment plans can be designed using digital smile design to obtain esthetic results; however, the 3D lip profile cannot be changed accordingly in current digital design methods with modifications of tooth shape and arrangement . For patients with edentulous arches, the complete denture serves as a diagnostic treatment plan tool, which helps to evaluate soft tissue profile . In full‐arch implant‐supported rehabilitation of patients with severe periodontitis, communication with patients about lateral facial profile with modified dental position remains a challenge, especially for patients with protruded anterior teeth.…”

“…3 For patients with edentulous arches, the complete denture serves as a diagnostic treatment plan tool, which helps to evaluate soft tissue profile. 4 In full-arch implant-supported rehabilitation of patients with severe periodontitis, communication with patients about lateral facial profile with modified dental position remains a challenge, especially for patients with protruded anterior teeth. Dolphin Imaging offers patient education modules including an orthodontic, dental, and surgical preview, so patients can see the results of treatments.…”