[Place of implantology in the treatment plan: apropos of some clinical situations].

Abstract

The advent of osseointegrated implants has considerably influenced the treatment of the edentulism. The Brånemark's protocol allows a high enough degree of predictability for a wide variety of clinical applications. A selection of the most typical indications attempts to focus on the benefit of implant supported prosthesis, regarding the conventional prosthetic treatment. The relative indications concern single-tooth replacement and Kennedy class III situations where classical tooth supported bridge is not easily feasible. The resort to osseointegration treatment enhances the possibilities of prosthetic rehabilitation in unfavorable conditions. The greater part of the indications is represented by Kennedy class I and class II situations. Clinical examples selected show the different combinations related to the fixtures position in the maxilla where bone availability is reduced. When just one fixture can be installed, connection with adjacent tooth must be carefully indicated. With two fixtures, a bridge must be designed with a posterior cantilever. But the opposite dentition can also dictate a fixture installation in the posterior region for a good occlusal stabilization: a specific modality of fixture installation in the pterygoid region has provided a seductive alternative. The last part concerns the prosthetic rehabilitation of advanced cases involving evolutive periodontal disease. The current trends determine a flexible approach with strategic extractions and progressive fixtures installation during stabilized periods of the disease activity. This management of the treatment planning reduces the psychogenic stress related to the complete edentulism and allows a easier transition from partial implant supported-prosthesis to fully bone anchored-prosthesis.