UNIVERSIDADE ESTADUAL PAULISTA
“JÚLIO DE MESQUITA FILHO”
Instituto de Ciência e Tecnologia
Campus de São José dos Campos
ORIGINAL ARTICLE DOI: https://doi.org/10.4322/bds.2024.e4293
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Braz Dent Sci 2024 Apr/June;27 (2): e4293
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
Rehabilitation of a Full-Arch Patient with Cemented Metal-Ceramic
Multiple Prostheses on Implants: A Case Report
Reabilitação de paciente de arco completo com Próteses Múltiplas Metalocerâmicas Cimentadas sobre Implantes – relato de caso
Adérico Santana GUILHERME1 , Yasmin Milhomens MOREIRA2 , Rhadija Victoria Mendonça MARTINS2 ,
Bárbara Lima de AGUIAR2
1 - Universidade Federal de Goiás, Faculdade de Odontologia, Departamento de Prevenção e Reabilitação Oral. Goiânia, GO, Brazil.
2 - Universidade Federal de Goiás, Faculdade de Odontologia, Curso de Graduação em Odontologia. Goiânia, GO, Brazil.
How to cite: Guilherme AS, Moreira YM, Martins RVM, Aguiar BL. Rehabilitation of full-arch patient with Cemented Metal-Ceramic
Multiple Prostheses on Implants - case report. Braz Dent Sci. 2024;27(2):e4293. https://doi.org/10.4322/bds.2024.e4293
ABSTRACT
Objective: To report a clinical case of a female patient rehabilitated with Cemented Metal-Ceramic Multiple
Prostheses on Implants in the upper arch. Materials and Methods: A multidisciplinary approach was employed,
utilizing various clinical skills to achieve satisfactory outcomes in the rehabilitation of a fully edentulous patient.
The treatment plan involved the use of cemented metal-ceramic prostheses, with a focus on optimizing the
positioning of the crown margins to ensure periodontal health. Results: The use of cemented metal-ceramic
multiple prostheses effectively addressed the patient’s aesthetic concerns by eliminating screw access holes and
ensuring the continuity of the ceramic material. The supragingival positioning of the crown margins prevented
excess cement in the peri-implant sulcus, promoting periodontal health. The nal prostheses provided excellent
aesthetics and functionality, leading to enhanced patient satisfaction. Conclusion: The choice of cemented
implant-supported prostheses represents a highly effective approach for treating edentulism. This method offers
clinical benets, such as increased retention and improved esthetic outcomes, while also positively impacting
the patient’s quality of life.
KEYWORDS
Dental implants; Dental implant-supported prosthesis; Fixed partial prosthesis; Prostheses and implants; Oral
rehabilitation.
RESUMO
Objetivo: Relatar um caso clínico de uma paciente feminina reabilitada com Próteses Metálicas-Cerâmicas
Cimentadas em Implantes na arcada superior. Materiais e Métodos: Foi empregada uma abordagem multidisciplinar,
utilizando várias habilidades clínicas para alcançar resultados satisfatórios na reabilitação de um paciente
totalmente edêntulo. O plano de tratamento envolveu o uso de próteses metálicas-cerâmicas cimentadas, com
foco na otimização do posicionamento das margens das coroas para garantir a saúde periodontal. Resultados: O
uso de próteses metálicas-cerâmicas cimentadas abordou efetivamente as preocupações estéticas da paciente ao
eliminar os orifícios de acesso para parafusos e garantir a continuidade do material cerâmico. O posicionamento
supragengival das margens das coroas preveniu o excesso de cimento no sulco peri-implantar, promovendo a
saúde periodontal. As próteses nais proporcionaram excelente estética e funcionalidade, resultando em maior
satisfação do paciente. Conclusão: A escolha de próteses suportadas por implantes cimentadas representa uma
abordagem altamente ecaz para o tratamento da edentulismo. Este método oferece benefícios clínicos, como
maior retenção e melhores resultados estéticos, além de impactar positivamente a qualidade de vida do paciente..
PALAVRAS-CHAVE
Implantes dentários; Prótese dentária xada por implante; Prótese parcial xa; Próteses e implantes; Reabilitação oral.
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Braz Dent Sci 2024 Apr/June;27 (2): e4293
Guilherme AS et al.
Rehabilitation of full-arch patient with Cemented Metal-Ceramic Multiple Prostheses on Implants - case report
Guilherme AS et al. Rehabilitation of full-arch patient with Cemented Metal-Ceramic
Multiple Prostheses on Implants - case report
INTRODUCTION
The options available for rehabilitating fully
edentulous patients with implant-supported
prostheses vary based on the number and
positioning of implants, as well as the type
of retention—either removable or fixed [1].
The selection of these options depends on several
factors, including the patient’s clinical conditions,
technical feasibility, personal preferences, and
nancial considerations [2]. Oral rehabilitation
through the replacement of missing teeth is
crucial for restoring masticatory function, occlusal
stability, the maintenance of support structures,
phonetics, and aesthetics. Additionally, it aims to
provide comfort to the patient and restore balance
to the stomatognathic system [3].
Implant-supported rehabilitations are a
reliable choice for replacing single or multiple
missing teeth, signicantly contributing to the
restoration of masticatory function and overall
quality of life [4]. There are different philosophies
regarding the type of nal connection used in
implant-supported prosthetic rehabilitations,
namely screw-retained and cement-retained [5].
Generally, this choice is based on the clinical
situation encountered and the preference of the
professional for one system over the other. These
systems can be applied in unitary, partial, or full-
arch rehabilitations [6].
Literature highlights the advantages
and disadvantages associated with each type
of prosthetic connection. Cement-retained
prostheses differ from screw-retained primarily
in their retention method, where cement-retained
prostheses are xed using provisional or denitive
cement, whereas screw-retained prostheses rely
solely on the mechanical retention of the screw
within the implant or prosthetic abutment [7].
The fabrication of cement-retained
prostheses on implants follows the principles of
conventional xed dental prostheses, requiring
less technical complexity and therefore being
more cost-effective compared to screw-retained
alternatives [7]. Among the advantages of
cemented retention is its ability to compensate
for discrepancies in implant positioning, achieve
passive t during seating, enhance aesthetics by
eliminating screw access holes, and facilitate
occlusal adjustments [8]. However, a notable
drawback is the challenge of removing excess
cement from subgingival areas, which can lead
to the development of periodontal diseases like
peri-implantitis and mucositis, posing additional
risks to treatment outcomes [8].
The use of cement-retained prostheses
is recommended in cases where prosthetic
connections are mechanically stable, such as with
Cone Morse implants, or when poorly positioned
implants make screw retention difcult via the
occlusal or cingulum aspects [9]. Both retention
types have their advantages and limitations,
underscoring the importance for clinicians to
carefully select the most suitable method for
each patient. Understanding the success rates
and potential clinical complications associated
with each retention system is crucial in making
informed decisions and optimizing the success of
rehabilitation treatments.
Based on these considerations, this article
aims to present a clinical case report on Cemented
Metal-Ceramic Multiple Prostheses on Implants,
conducted as part of a specialization course in
dental prosthetics with a focus on implantology
at the Faculty of Dentistry, Federal University of
Goiás.
MATERIAL AND METHODS
A 65-year-old female patient, partially
edentulous in both the upper and lower arches,
was presented to the specialization course
in dental prosthetics with an emphasis on
implantology at the Federal University of Goiás-
School of Dentistry seeking oral rehabilitation.
In the upper arch, the patient had complete
rehabilitation using single-unit implant-
supported prostheses screwed onto metal-resin
abutments. The prostheses were supported by
eight external hexagon (HE) type implants,
each with a platform diameter (abutment) of
4.1 mm (Figures 1A and B). The clinical and
radiographic examination indicated satisfactory
osseointegration with favorable spacing and
parallelism between the implants. However,
the prostheses became unstable due to screw
loosening, and the esthetics were compromised
by resin deterioration in color and wear, leading
to changes in tooth shape. Additionally, the
screw access holes, especially in the anterior
region, were located on the vestibular surfaces,
affecting the esthetics and posing difculties in
screw access, complicating the removal of the
prosthesis (Figures 2A and B).