title: Considerations for a staged approach in implant dentistry.
abstract: Full-arch and partial reconstruction is demanding for the clinician and a challenge for the patient. Traditionally, teeth are extracted, and implants are placed; the patient wears a provisional removable prosthesis during implant osseointegration. The patient is left to deal with a difficult transition from a fixed dentition to a removable one, albeit temporarily. This drastic alteration can generate functional, emotional, and esthetic changes for the patient, thereby making a difficult time even more challenging. Reconstructing the dentition through a staged approach has been documented and involves strategic extractions along with the placement of several implants, but leaves select abutment teeth for a fixed provisional prosthesis. This allows for the provisional prosthesis to be tooth-supported during implant integration and later converted to an implant-supported prosthesis. In this manner, the patient will benefit from a fixed provisional prosthesis throughout the treatment process. A staged approach is contingent upon a thorough periodontal and prosthetic evaluation and work-up. Success requires proper communication between the periodontist, surgeon, restorative dentist, laboratory, and patient. A team approach is necessary for success. The protocol, advantages, and disadvantages for a staged approach to a full-arch implant-supported reconstruction are discussed. The authors also present a case to show how the staged approach can be used for sextant or quadrant rehabilitation.
authors.affiliation: Department of Periodontics, University of Medicine and Dentistry, Newark, NJ 07101-1709, USA. drewhj@umdnj.edu
authors.forename: Howard J
authors.initials: HJ
authors.lastname: Drew
authors.forename: Talal
authors.initials: T
authors.lastname: Alnassar
authors.forename: Kenneth
authors.initials: K
authors.lastname: Gluck
authors.forename: James E
authors.initials: JE
authors.lastname: Rynar
mesh_terms: D000328:Adult; D000540:Alveolar Ridge Augmentation; D016025:Bone Transplantation; D003758:Dental Implantation, Endosseous / Q000379:methods*; D019094:Dental Prosthesis, Implant-Supported; D003833:Denture, Partial, Temporary; D005260:Female; D006801:Humans; D016348:Osseointegration; D010347:Patient Care Planning; D010348:Patient Care Team; D010518:Periodontitis / Q000628:therapy; D014081:Tooth Extraction