In the search for a better lifestyle and increased life expectancy, more and more elderly are seeking dental treatment. However, many of these patients present systemic compromise that could affect the success and maintenance of the proposed therapy. In such cases, simple proposals, such as partial removable prostheses (PRPs), must be used. PRPs are widely used, especially when conditions for rehabilitation with a fixed prosthesis attached to implants are not favorable.1
In one study,2 10 patients were rehabilitated with inferior PRPs supported by implants in the posterior region; results show increased satisfaction in all patients, minimal wear of the component, absence of excessive bone loss, and periodontal health after 1 year of rehabilitation.
Literature describing the combination of PPRs and implants is scarce and is based mainly on clinical reports of posterior implants for distal extension with PRPs.3,4 In this case, rehabilitation with fixed prostheses and implants was proposed to the patient, who required surgically guided bone regeneration through subantral graft or PRPs, but the patient declined both proposals. Following this, rehabilitation with implants in conjunction with PRP was planned and proposed to avoid subjecting the patient to sinus lifting surgery and to preserve the remaining tooth and the residual ridge; however, the team explained that greater load would be generated on these if they received only PRPs.
A 71-year-old male patient with controlled hypertension and presenting with dental phobia inquired about dental implants, seeking to improve both esthetics and function.
During the planning stage, the need for surgery to achieve maxillary sinus lifting was observed if rehabilitation with a fixed prosthesis on implants was chosen (Figures 1 and 2). However, following the clinical examination and according to patient history, planning was directed toward simplified rehabilitation, also involving implants, but associated with PRP. This solution rehabilitated the patient within his functional and esthetic expectations without subjecting him to greater stress.
Following initial procedures of restorative care, the surgical implantology step was initiated, during which the region of missing elements 15, 22, 24, 36, and 46 received Cone Morse implants. After 4 months, implanted regions were reopened with placement of the healings. Then the prosthetic components were selected, highlighting the region of elements 24 and 25, which received o-ring abutment (Figure 3).
The proposed therapy considered the patient's complaint, his systemic framework, and his response to invasive events, given that he reported high levels of fear and anxiety. The treatment approach was preventive, based on maintenance of blood pressure without systemic risks to the patient, by not indicating surgery for maxillary sinus lifting. The patient received 5 implants, and the top 2 retainers were PRP o-rings (Figures 4 and 5).
In rehabilitation with PRPs, viscoelastic tissue, alveolar mucosa, and teeth must be properly evaluated because they serve as support structures. When rehabilitation is associated with osseointegrated implants, which provide the support line between these pillars and edentulous areas in classes I and II of Kennedy situations, survival can be compromised by functional overload.5 However, when implants are used only to retain the PRP, the current consensus is that support, retention, and stability of PPRs are improved without overload and without the need for conventional clips.
Follow-up of 1 year shows that the impact of treatment was well absorbed by the tissues, allowing the original treatment plan to be maintained (Figures 6 and 7).
It was possible to establish a comfortable situation, both esthetically and functionally, without creating more fear and anxiety in the patient, because greater intervention, such as sinus lifting and grafting, was not required, resulting in satisfactory treatment at a lower cost with less stress and over a shorter time.