Implant-supported fixed prostheses in the edentulous maxilla can be difficult because of anatomic limitations and high esthetic demand. The choice between cement and screw retention depends on factors such as esthetics, occlusion, retrievability, and passivity. The choice is also often governed by the ability to manage technical or biologic complications. In the edentulous maxilla, because of the bone trajectory and resorption pattern, unfavorable implant angulations may be encountered. In such situations, a conventional screw-retained prosthesis is difficult to design. This article describes the restoration of edentulous maxillae for a series of patients with different complete-arch fixed prosthesis designs. The clinical guidelines, including indications, advantages, and limitations of each design, were discussed.
Postextraction immediate implant placement in the esthetic zone is a common treatment modality. Immediate fixed interim restoration following immediate implant placement may provide excellent esthetic results to the patients and boost the clinicians' confidence. This paper demonstrates a series of six different techniques used to fabricate the customized screw-retained interim restorations following immediate implant placement with partial extraction therapy in the maxillary anterior esthetic zone. The techniques have utilized a putty index, polycarbonate shell crown, patients' existing crowns (prosthetic or natural), or laminate veneer, or fabricated in the laboratory based on the specific clinical situation. Advantages and limitations of each technique including alternative techniques or materials have been discussed. Excellent esthetic results were obtained with all six techniques using the screw-retained immediate interim restorations following partial extraction therapy and immediate implant placement.