Introduction:
Repeated case studies show a considerable difference in esthetic expectations between professionals and what the patient expects. The patient's expectations of the final prosthetic result are often centered upon a higher degree of satisfaction than professionals who judge the prosthetic rehabilitation clinically or technically concerning aspects crucial to form and function like smile line, bite, masticatory potential, and stress force assessment, etc. Hence, the operator or dental implantologist should focus on patient expectations and needs, especially regarding esthetics. This is because the satisfaction of the patient with appealing esthetics that they have been near ideally restored to proper form, contour, and function regarding the missing tooth or teeth enhances self-confidence and boosts their idea of successful treatment with the doctor. This article discusses the challenges of prosthetic rehabilitation and the phases in treatment planning in patients with multiple dental implants.
What Is Facial Analysis?
However, it is also true that clinicians should focus not just on the patient esthetics primarily but also work upon a guide to achieve long-term success rates with prosthetic rehabilitation for dental implants. This can be done by thoroughly studying the facial form analysis and considering different elements of the patients' facial profile, their needs, and the expectations desired to attain post-prosthetic fabrication.
1. Static analysis, i.e., execution of facial profile analysis anatomically.
2. Dynamic analysis, i.e., execution of functional evaluation through facial analysis. These two components contribute a vital parameter or foundation for producing the ideal fixed restoration that can be deemed esthetic by the patient. Various esthetic parameters that are also equally considered to be of clinical significance in dental implant prosthetic rehabilitation are ;
A. Facial form and soft tissue profile.
B. Lip support.
C. Smile line.
D. Facial midline.
E. Teeth dimension or vertical dimensions at rest and occlusion.
F. Gingival display.
G. Accurate centric or occlusal relationship that should be ideally established post extraction or loss of the natural tooth.
What Is the Goal of Prosthetic Rehabilitation?
The goal of prosthetic rehabilitation through dental implants involves several phases of treatment planning through a unified system of surgical and prosthetic approaches that should be done pre and post-dental implant procedure on the patient, i.e., preoperative and postoperative assessments. Complex dental implant placement procedures include ridge preservation and atraumatic extraction to bone augmentation techniques, sinus floor elevation if needed, surgical augmentation procedures, and functional concepts used for prosthetic replacement.
After dental implantation, the patient is ideally given a provisional restoration for three to six months. This is the period for the osseointegration to occur that determines the success of dental implants. Next, post the complete fusion of the dental implant to the jaw bone, the provisional restorations are replaced by permanent restoration based on functional concepts of prosthetic implant therapy. This prosthesis should ideally establish proper centric occlusal form and function. Patient evaluation can also be done using visual analog scores (VAS) based on preoperative and postoperative assessments.
What Are the Phases of Treatment Planning?
The Phase of Esthetic Analysis
In this phase, the dental surgeon or implantologist assesses the facial analysis in different expressions. For example, the patient's stern and smiling expression can be captured, and by obtaining photographs of the patient's profile, the standards of smile with a gingival display, usually standardized as 2 mm for prosthesis, are set. The ideal tooth position is also assessed to achieve an ideal outcome that is esthetically pleasing.
Cephalometric and Occlusal Phase
This is considered the planning phase of treatment by the implant surgeon, wherein the facial growth and the biotype is of primary importance. First, the saggital positions at the mandibular symphysis are assessed correctly. Next, the facial height ratio is thoroughly studied because the craniofacial morphology varies from individual to individual based on this ratio. After cephalometric assessment of the jaws, impressions are recorded usually in a hydrocolloid material, and consequently, the occlusal positions of the patient are determined by using dental wax. The casts are then mounted on the patient, and prosthetic designs can be suggested or proposed for any modifications before prosthetic fabrication. Based on this workflow, a surgical guide can be manufactured usually from transparent acrylic resins.
Surgical Phase
Hopeless teeth or teeth indicated for replacement by atraumatic extraction procedures and ridge preservation modalities can be employed by the surgeon before the surgical osteotomy preparation for the implant. The teeth can be immediately implanted post-extraction (immediate implants), or the bone graft material or sinus lift and bone augmentation procedures, if needed, can be carried out if the bone volume is low or in resorbed ridge anatomy post the healing phase. After dental implantation is complete surgically, the manual torque wrench is used to set the implant into the bone with forces ranging from a minimal 25 Ncm to a maximum of 40 Ncm .facebow transfer and articulation records are completed with the implant abutments bonded to the surgical guides.
The Phase of Provisionalisation
In this phase, the prosthetic fabrication work, or in simpler terms, the framework, is evaluated more so, especially in completely edentulous patients. Occlusal adjustments are made in this phase depending on whether the patient is entirely or partially edentulous and the number of teeth implanted and given a prosthesis. The predetermined records are matched for facial profile analysis, and the implant dentist can do a radiographic evaluation through lateral skull views. The prosthesis is delivered successfully in this phase through ceramic or zirconia crowns and implant abutment that can be screwed or cemented.
The phase of Definitive Prosthesis Evaluation
This is a final phase wherein there is a thorough reevaluation after treatment within 12 weeks of prosthetic delivery and fabrication. Then, after adjustment of the provisional restoration evaluation in 6 months, the definitive prosthesis is delivered to meet the patient's long-term functional and esthetic requirements.
Conclusion
To conclude, the phases of Prosthetic rehabilitation constitute a primary preoperative and postoperative assessment strategy by the implant dentist to restore and meet the esthetic and functional demands of the patients who undergo multiple dental implants in partially and fully edentulous situations.
