Maxillary arch rehabilitation with implant supported hybrid denture

Rehabilitation of the completely edentulous patient is a major responsibility for the dentist. Though, conventional complete dentures provide reliable service, the anatomic limitations, tissue changes underneath the denture and the psychological makeup of the patient often contribute to the poor performance of the prosthesis. A hybrid denture in such situations can provide a successful fixed prosthesis option. A hybrid denture is one that is fabricated over a metal framework and retained by screws threaded into the implants. It can be performed by using screw-retained hybrid prosthesis or screw-retained metal ceramic prosthesis.

Advantages of hybrid dentures:

• Stable and do not move like conventional dentures.
• Supported by implants and do not entirely rest on gums.
• Cannot be removed by patients, but can be removed by dentist for maintenance.
• Good aesthetics.
• Easily repairable.
• Much less expensive as compared to screw retained metal ceramic prosthesis.

Disadvantages of hybrid dentures:

• Need to clean under the bar.
• Denture teeth may require maintenance overtime but are easily replaced.

Case report

A 55yr old male patient came with an partially edentulous maxillary arch. Teeth present were 15,13,12,22,23,25 which were severely periodontally compromised. Mandibular arch was intact with full arch bridge. Patient was given option of an upper implant supported hybrid denture which he agreed.

Stage I: Implant Surgery

A total of six implants were placed immediately after extraction of remaining teeth in upper arch. The flap was closed with sutures and a prefabricated immediate denture lined with soft liner was inserted. After 1 week, the sutures were removed.

Stage 2 : Implant Surgery

After a waiting period of 5 months, implant cover screws were exposed and healing abutments were placed.

Stage 3: Prosthetic Phase

After 1 week, when the soft tissue had grown around healing abutments, the healing abutments were removed, and impression copings were connected to the implants for the impression with open-tray technique. The cast framework with trial waxed denture was obtained and tried for passive fit and occlusal adjustments. After patient’s approval, final denture was fabricated with holes for implant screw tightening. Later on these holes were filled with composite fillings.

Maintenance:

Hybrid dentures must be examined initially at interval of 3 months to evaluate the occlusal loading and oral hygiene of the patient. If the patient is cooperative and maintains good oral hygiene, the interval between checkups can be increased to 6 monthly or annually.