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Implant Number and Prosthetic Material
Posted on 9/23/2021 by Greg Kammeyer
How important is Implant Number and Prosthetic Material in Maxillary Fixed Full Arch Prosthesis

Biomechanical problems are common in full arch implant supported prosthesis. A study by Tiosssi et al, Clin Implant Dent Relat Res, 2017 showed that with All-on-4 in the maxillae both monolithic zirconia and titanium supported prosthetics had similar strain characteristics.
With All-on-6 however the monolithic zirconia had significantly higher strain than did the titanium framework. With 6 maxillary implants with a zirconia surface on the prosthetic, individual zirconia crowns on a titanium bar should be considered from a strain point of view than monolithic zirconia.

My Comment: I strongly favor 5-6 implants with full arch maxillary prosthesis (6 with men), apposing implant prosthesis or parafunction) and I’ve seen that the titanium bar with individual zirconia crowns is narrower buccal-lingually and hence easier to clean.

Implant length in Mandibular Full Arch Fixed Prosthesis?
A recent study using 5 interforamina implants, compared 6mm short and 11mm long implants to support a fixed full arch prosthesis by Guida et al, Clin Oral Implants Res, 2020.

At 3 years no implant of the 140 followed failed nor was any prosthetic with a distal cantilever lost. No significant difference in bone loss was noted between the 2 groups as well.
My Comment: The 5 short implants goes against the conventional wisdom of 40mm of implant in bone for this prosthesis. This does coincide with the growing data base showing 8mm implants perform similarly to 10mm implants and in many studies, 6mm implants have a higher failure rate, yet this was not shown here.
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