Considerations for using a removable prosthesis with attachments for a staged approach to a failing implant reconstruction

Full-arch implant reconstructions are being utilized in clinical practice today. Very often these prostheses are prosthetically driven, but not periodontally maintainable. Often the patient presents to the general practitioner with a failing implant reconstruction, where several fixtures need to be removed and others are maintainable. The article presents a case report where a removable prosthesis is used as a transitional appliance during the retreatment of the case. A removable complete overdenture prosthesis using attachments was used to establish proper occlusion and function, prevent loading on the guided bone regeneration sites, and to assist in fabrication of a stable guide for implant placement. The staged approach facilitated laser periodontal therapy on the remaining fixtures, and allowed proper oral hygiene instruction and assessment of the patient’s ability to clean the remaining fixtures properly. Although the potential to treat this case with transitional implants or immediate load fixtures was discussed, the risk versus benefit scenario favored a removable prosthesis with attachments. Success required proper communication between the surgeon, restorative dental practitioner, laboratory, and patient.