Outcome Analysis for Fixed Hybrid Prostheses

Have you thought about your technique to achieve a reasonable understanding of a patient's expectations for dental treatment? Certainly, as we learn and grow over time as clinicians we develop a style or a process that we may not be able to outline in a written or “how-to” format. Social acceptability, the ability to chew food, or perhaps an oral environment free from pain would be examples of expectations. Many times the expectations are not verbalized by a patient in a  clear and concise fashion and it takes a little extra effort to gain a full understanding of what it is that the patient is looking for. How about a restoration like this – a fixed hybrid prostheses for an edentulous patients – what are our patients' expectations as a result of going through this type of treatment?

Clinical success with fixed hybrid prostheses is directly related to meeting or exceeding our patients' expectations.

Outcome data is becoming increasingly important in measuring effectiveness of our dental related treatment.  Certainly it’s one thing if a tooth chips and can be easily fixed at the next recall appointment versus a scenario where a patient has to drive out of their way and take time off during a work day to fix an upper front tooth that may have come out completely. Dhima reported on findings from the Mayo dental clinic in Rochester, MN where they followed dental implant supported fixed hybrid prostheses over time to evaluate the outcome of the restorative treatment process.  The findings are interesting:

• Patients experienced 3.8 times more prosthetic events than biologic events
•  15 percent of prostheses survived free of any event
•  9 percent implant failures
•  86 percent of prostheses survived 20 years
•  92 percent survived free of implant failure

The Conclusion About Fixed Hybrid Prostheses

“Prosthodontic care for missing teeth ought to be thought in a “chronic condition” context, recognizing that long-term outcome monitoring to provide realistic care expectations is important for demonstrating care value in oral health promotion!!” How true for anything we do in dentistry. Think about the patients that were studied – patients that presented for treatment between 1983 and 1991.  While the article was written in 2014, the patients that present for this type of treatment today are very different.  It is becoming more common for a patient to elect removal of all remaining teeth as opposed to restoration of the remaining dentition purely for cost reasons. Dental implants placed in the mandible for a fixed hybrid (fixed detachable) restoration were intended for “mal-adaptive” denture patients with significant alveolar atrophy.  There was likely an appropriate amount of room (12-15mm from the platform of the fixture to the planned incisal edge position) for a durable restoration when working with advanced alveolar ridge resorption in the mandible. Creating a “mal-adaptive” denture patient today by removing bone to allow space for restorative materials is a challenge both to the surgeon and to the restorative dentist.  New materials provide options to decrease the amount of room required for restorative material, however, the challenge created involves managing the transition between the prosthesis and the lip position in a spontaneous smile. How do you discuss the expected outcomes for a restoration that is compromised in terms of overall thickness of the biomaterial whether for fixed hybrid prostheses or full coverage restorations cemented to a natural tooth? Reference: Practice-Based Evidence from 29-Year Outcome Analysis of Management of the Edentulous Jaw Using Osseointegrated Dental Implants.  Dhima, et. al. Journal Of Prosthodontics 23:173-181;2014. Douglas G. Benting, DDS, MS, FACP, Spear Visiting Faculty and Contributing Author. [ www.drbenting.com ]