Goal

         Identify patient’s need for a removable or fixed prosthesis. This is critical because a patient’s need will dictate the design of the prosthesis and may affect the number of implants placed. For instance if the patient’s chief complaint is dislike of the removable aspect of the existing denture, then a fixed prosthesis must be planned.

Presurgical Needs
         1. Mounted diagnostic casts
         2. Wax trial denture set-up
         3. Surgical guide
         4. Plan for prosthesis type and design, which will determine implant placement
         5. Examination of smile line If teeth are removed and implants placed soon, there is little resorption of the vertical height of the mandible. There is a potential for metal to show due to this lack of resorption because the restoration and its components will be more superior.
         6. Radiographic needs (panoramic/ CT scan)

  Considerations
         The mandibular anterior is the most predictable region for implant success
   

Restorative Options
         1. Fixed partial denture prosthesis: fixed bone anchored partial denture,
          fixed-detachable prosthesis
            A. Number of implants
               1. Four to six implants
               2. For most clinicians, five implants evenly spaced in the Region

         2. Overdenture : mandible overdenture
            A. Two implants

       

            B. Two implants with bar and clip plus two attachments
            C. Two implants and distal attachments only, without clip
            D. Four implants
       

Example

         1. Patient I
            A. A cast gold Hader bar is used to splint two osseointegrated implants.
       

            B. The overdenture has a single retentive clip in the anterior portion. This clip is in the midline due to the position of the bar, which allows easy rotation around this bar and the prosthesis.

         1. Patient II
            A. Occlusal view of a mandible fixed detachable prosthesis shows an optimal anterior posterior spread of the osseointegrated implants. The placement of the five implants enables this patient to be restored with a cantilever that is predictable.

       

            B. Fixed prosthesis of the same patient opposing a maxillary complete denture. Notice that the metal framework is kept several millimeters above the soft tissue to allow ease of cleaning