Requrements for total prosthetic maxillary rehabilitation according to Strategic implant technology in immediate loading protocol

(case series report)

Abstract

Summary. Strategic Implant technology, which involves the installation of bicortical implants in the cortical and resorption-free areas of the upper and lower jaws with their immediate functional loading, is a modern and well-documented technique. However, the restoration of a single dental arch, performed when the patient has his own teeth, crowns or bridges on the opposite jaw, removable plate dentures requires a careful approach to diagnosis and treatment planning. Thus, extruded, intruded, dystopian or even strongly inclined teeth in the opposite arch must be aligned or removed. Existing interdental spaces should be closed, and removable dentures should be replaced with fixed orthopedic structures to achieve stable harmonious contacts and successful implantation on the opposite jaw. Often existing crowns and bridges must be adjusted relative to the opposite arch or even replaced to align the occlusal plane and adjust the jaw, which has natural teeth, to the opposite jaw, where the implants will be placed.

This article lists a number of criteria that should be taken into account when deciding on the total rehabilitation of the upper jaw with the use of bicortical implants in the protocol of immediate loading, and substantiates the feasibility of supporting interventions on the opposite jaw in accordance with the requirements of Strategic Implant technology.

The aim of the study – to formulate requirements for total prosthetics of the upper jaw in the presence of fully / partially preserved dentition on the lower jaw on the basis of the analysis of professional literature and a series of clinical cases.

Materials and Methods. 4 cases of total rehabilitation of the upper jaw with the use of bicortical implants in the protocol of immediate loading with the substantiation of corrective interventions on the lower jaw are described and analyzed.

Results and Discussion. Based on the analysis of the professional literature, own experience and clinical examples, 7 main requirements for prosthetics on bicortical implants are formulated in the protocol of immediate loading, given the possibility of achieving optimal occlusal relationship:

– The same length of the masticatory plane on both sides;

– The same width of the masticatory plane on both sides (about 8 mm);

– Avoid contact between the front teeth of the upper and lower jaws during occlusion and chewing;

– Symmetrical Spee curve on both sides;

– Identical functional chewing angle of Planas on both sides (this aspect includes the length and position of the tubercles that direct the chewing movement);

– Parallelism or proximity of the masticatory plane to the Camper’s horizontal;

– Removal of all wisdom teeth.

The expediency of corrective operations / manipulations on the mandible in the case of manufacturing a maxillary circular bridge structure on cortical implants in the protocol of immediate loading is substantiated.

Conclusions. Unlike prosthetics on traditional two-stage osseointegrated implants, the requirements for total prosthetic rehabilitation of the jaws on bicortical implants according to the concept of Strategic Implant are much stricter. On the other hand, these requirements are now understandable, acceptable, logical and clearly defined. The long-term success of rehabilitation depends not only on careful adherence to the surgical protocol of bicortical implantation, but also on adequate prosthetics, taking into account the dental status of the antagonizing jaw.