The TORONTO PROSTHESIS, an appealing method for restoring patients candidates for hybrid overdentures: A case report

Abstract

The implant is a therapeutic resource in constant evolution, and the different types of implants and techniques have been increasingly used in cases of both fully or partially edentulous patients. In some cases they provide more conservative treatment, and in others better stability, retention, and function. To achieve a satisfactory result, there are several factors that should be taken into account: the type and quality of the bone, bone density, the placement location of implants, retrievability of restorations, the patient’s motivation, and economic issues. Trainees should be aware of the limitations of the techniques that can be used for successful prosthetic rehabilitation. This work describes the prosthetic rehabilitation of a fully edentulous mandible treated with dental implants using the ‘Toronto Bridge” technique for restoring both function and aesthetics. This type of prosthesis is a screwed-in mesostructure with milled abutments for the cementation of single or multiple suprastructures. This device could also be named “abutment-hybrid overdenture” The main advantages and disadvantages of this protocol are discussed. Key words:Implant-supported restorations, dental implants.

Complete-arch fixed reconstruction by means of guided surgery and immediate loading: a retrospective clinical study on 12 patients with 1 year of follow-up

“…Most of the studies in the literature, in fact, refer to the immediate loading of hybrid prostheses (such as Toronto Bridges, "all-on-four," and "all-on-six" dentures), characterized by the presence of a bar connecting the implants and, more relevant, artificial gum [22][23][24][25][26]. It is obvious how such prosthetic rehabilitations differ so thoroughly from a full-arch fixed prosthesis, which is characterized by the absence of artificial gum and much more delicately manageable for the clinician, from an aesthetic point of view [28][29][30][31].…”

“…There is no doubt that even in this context, guided implant surgery offers advantages, such as more precise implant placement, especially with respect to the screw holes, and the availability to pre-fabricate a milled provisional for same-(or next-) day delivery [14-16, 20, 22-25]. However, these types of implant-supported dentures, although easier to manage for clinicians, cannot represent the maximum of aesthetics, precisely because of the presence of the artificial gum [26,27]. Moreover, the correct maintenance of daily oral hygiene can be much more difficult for the patient with such types of prosthetic rehabilitation [26,27].…”

“…However, these types of implant-supported dentures, although easier to manage for clinicians, cannot represent the maximum of aesthetics, precisely because of the presence of the artificial gum [26,27]. Moreover, the correct maintenance of daily oral hygiene can be much more difficult for the patient with such types of prosthetic rehabilitation [26,27].…”

Multidisciplinary rehabilitation of eosinophilic granuloma with bone graft surgery and a modified implant‐supported hybrid prosthesis: A case report with a 6‐year follow‐up

“…Montero et al described a prosthesis called “Toronto Bridge,” which has a design that is similar to that of the one in the present case. It was composed of a metal mesostructure screwed onto the implants for the cementation of single or multiple crown parts.…”

“…In this report, a modified hybrid prosthesis that combines the advantages of screw‐ and cement‐retained prostheses was described. This design allows the achievement of a correct axis if the inserted implants are not parallel . Moreover, if a fracture occurs in the veneering porcelain on the crown part of the prosthesis, a novel crown may be produced without extracting the whole prosthesis, and a provisional restoration might be utilized during this period …”