Spear Education, Scottsdale, Arizona, USA.
Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Washington, USA.
J Esthet Restor Dent. 2022 Jan;34(1):81-91. doi: 10.1111/jerd.12852. Epub 2021 Dec 6.
The purpose of this article is to discuss the considerations that need to be evaluated when considering the replacement of an existing maxillary anterior fixed dental prosthesis (FDP) with another FDP, or when to consider converting to implants and individual crowns on the previous abutment teeth.
The need to replace unesthetic or failing maxillary anterior FDPs is something all restorative dentists will be faced with multiple times in their careers. Given the emphasis over the past few decades on utilizing implants for tooth replacement as opposed to a tooth supported FDP, the question becomes when is converting the existing FDP to implants and single crowns an appropriate choice, as opposed to redoing a new FDP. This article will focus on the risks of choosing to convert to an implant solution, and the risks of redoing the tooth supported FDP. Multiple systematic reviews on each approach will be used to aid in the decision process. The most significant risks for both approaches will be identified, and a chart of the key parameters to assess will be presented, along with their impact.
The statistical outcomes at 5 and 10 years of tooth supported FDPs, and Implant based restorations are very similar if certain clinical parameters are met, namely vital healthy abutment teeth for the FDP, and adequate bone and soft tissue for the implant-based restoration. If one abutment tooth is compromised the long-term prognosis drops significantly and converting to an implant-based restoration may be more predictable. Similarly, if adequate bone and soft tissue cannot be obtained through surgical augmentation procedures, using a connective tissue graft for the ridge, and redoing the FDP may obtain a more acceptable esthetic result.
A significant number of maxillary anterior FDPs exist that will need replacement in the future. Given the desire of many dentists to utilize implants when possible, there can be a tendency to automatically treatment plan an implant-based approach for replacement of the existing FDP. Certainly, most clinicians would favor an implant-based tooth replacement rather than preparing unrestored teeth to place an FDP, but when an existing FDP exists, the teeth have already been prepared for full coverage in most instances. In addition, for most long term existing FDPs, there is a significant change in the vertical and horizontal dimension of the bone and soft tissue that can make getting an acceptable esthetic result with an implant challenging. This article provides a systematic approach to identifying when redoing the FDP may be preferable, or when converting to an implant-based approach is a better choice.
本文旨在讨论在考虑用另一个固定义齿修复体（FDP）替代现有的上颌前牙 FDP 时，或者在考虑将先前基牙转换为种植体和单冠时需要评估的注意事项。
修复牙医在职业生涯中多次需要更换不美观或失败的上颌前牙 FDP。考虑到过去几十年强调使用种植体代替牙支持的 FDP 进行牙齿替代，问题变成了何时将现有的 FDP 转换为种植体和单冠是合适的选择，而不是重做一个新的 FDP。本文将重点讨论选择转为种植体解决方案的风险，以及重做牙支持 FDP 的风险。将使用多项关于每种方法的系统评价来帮助决策过程。将确定两种方法的最大风险，并提出评估关键参数的图表及其影响。
如果满足某些临床参数，即 FDP 的基牙健康有活力，以及种植体修复的骨量和软组织充足，那么牙支持 FDP 和基于种植体的修复体在 5 年和 10 年的统计学结果非常相似。如果一个基牙受损，长期预后会显著下降，转为种植体修复可能更具可预测性。同样，如果无法通过外科增强手术获得足够的骨量和软组织，则使用结缔组织移植物进行牙槽嵴重建，并重新制作 FDP，可能会获得更可接受的美观效果。
大量的上颌前牙 FDP 需要在未来更换。由于许多牙医希望在可能的情况下使用种植体，因此可能会倾向于自动计划为现有 FDP 进行基于种植体的治疗。当然，大多数临床医生会赞成基于种植体的牙齿替代，而不是预备未修复的牙齿以放置 FDP，但当存在现有 FDP 时，在大多数情况下，牙齿已经为全冠预备。此外，对于大多数长期存在的 FDP，骨和软组织的垂直和水平维度会发生显著变化，这使得用种植体获得可接受的美观效果具有挑战性。本文提供了一种系统的方法来确定何时重新制作 FDP 可能更可取，或者何时转为基于种植体的方法是更好的选择。
