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Day Gates III, DDS, M. This article provides support in the literature for these rules and illustrates their application in the treatment of mandibular edentulism. The treatment of mandibular edentulism using dental implants is now well established as a biologically sound treatment option. More than 40 years after Swedish orthopedic surgeon Per-Ingvar Brånemark introduced the process of transforming oral function in the edentulous patient using endosseous dental implants, a picture of success has emerged that is recognized worldwide. The use of one or two implants to retain a mandibular overdenture and the use of four or more implants to support and retain a fixed dental prosthesis is widely known to provide improved function and increased satisfaction in the edentulous patient when compared to conventional denture therapy.
The contemporary literature demonstrates a high degree of survival over the 10- to 20-year time horizon when implants are placed in the parasymphyseal mandible and restored with an IRO or with an ISFP. These studies invoke inclusion and exclusion criteria that favor success, benefit from the local factors of mandibular bone quality and quantity, and commonly employ the use of an opposing maxillary denture. However, all the studies indicate high and lasting rates of implant survival. Less well documented and perhaps equally significant is the quality of the prosthesis, its longevity and maintenance requirements, and the related issues of patient-perceived satisfaction. There is also a history of common limitations associated with dental implant therapy for the edentulous mandible.
These materials serve as the functional substrate and esthetic foundation of the implant-based prostheses for the edentulous mandible. The functional stresses — impact and imposed bending — endured by the esthetic veneer must be supported by and transmitted through the framework and the components to the supporting implants. The materials, designs and techniques used in the production of implant-supported prostheses for the treatment of mandibular edentulism require further consideration. One hypothesis to explain the prosthetic failures and complications associated with the IRO and ISFP is that the mechanical environment established by implant placement is inadequate to permit proper construction of a robust and resilient IRO or ISFP prosthesis. One is the magnitude of forces — specifically, bending moments, which are dependent on the magnitude of the load and the length of any cantilever.