Treatment of the edentulous mandible with a fixed bridge supported by 4 mm short implants in the molar region – a case report

Introduction: In implant therapy of the edentulous mandible, the decision of implant position is often determined by the need for bone augmentation in the molar region. Bone augmentation requires an extra surgery and thus presents higher risks and costs. In addition, the prosthetic treatment modality of fixed versus removable prosthesis is dependent on implant position. Usually, treatment decision is made in favor of lower costs, less risks and higher patient comfort, which often results in choosing interforaminal implants and removable overdentures. Extra short implants allow for fixed implant supported bridges in the edentulous jaw. Furthermore, in patients with advanced bone loss, pre-treatment with complex bone augmentation is not necessary. Material & methods: This report describes the treatment protocol for a fixed implant-supported prosthesis in the edentulous mandible based on a patient case. Implant therapy was performed without bone augmentation procedures, and instead 4 mm short implants were inserted in the molar and 10 mm long implants were inserted in the canine region with diameters of 4.1 mm. After implant exposure in a second-stage surgery, a fixed prosthesis with CAD/CAM-fabricated framework and full porcelain veneer was cemented on individualized titanium abutments. Results: The described treatment with a fixed prosthesis supported by extra short implants in the molar, and regular long implants in the canine region resulted in full rehabilitation of masticatory function in the edentulous jaw. From the patient's perspective the achieved rehabilitation is comparable to a status with own teeth and leads to an improvement in quality of life. Conclusion: A straight forward implant placement without prior bone augmentation reduces the overall treatment time. In addition, more patients with advanced bone loss in the molar region of the lower jaw may benefit from the presented treatment protocol. From the perspective of the patient treated, the major improvement of chewing ability and the fixed character of the prosthesis made an immense positive impact. Keywords: advanced bone loss, edentulous mandible, fixed bridge, short implants