Mode of Retention of Fixed Implant Prosthesis

Fixed dental implant-supported prostheses may be either cement-retained or screw-retained. Screw-retained prostheses (Figure 6) are retrievable and require lesser vertical restorative space compared to cement-retained prostheses.^58,59 Retrievability enables better hygiene maintenance of the prosthesis, the implants, and the surrounding mucosa⁶⁰ and easier management of the restorations in case of complications. Screw loosening, the requirement of sectioning and soldering procedures, increased costs, greater complexity of components and laboratory procedures, increased chairside time, and compromised esthetics, occlusion and porcelain strength are the major disadvantages associated with screw-retained prostheses.^58-61 It is also difficult to place a screw-retained restoration in a patient’s mouth with a limited oral opening as it may be challenging to insert the screwdriver in the oral cavity.⁶²

Figure 6. Screw-retained prosthesis.

Figure 6. Screw-retained prosthesis.

Cement-retained implant prostheses (Figure 7) offer superior stability,⁶³ occlusion, esthetics, stronger implant prosthetic connection, and improved force transmission compared to screw-retained implant prostheses.^58,59 Extrusion of the excess cement into the peri-implant sulcus (which may be difficult to recognize and remove) is one of the major drawbacks of a cement-retained prosthesis.^58,64 Several techniques have been reported that aid in preventing/decreasing the flow of cement into the subgingival sulcus.^64-67

Figure 7. Cement-retained prosthesis.

Figure 7. Cement-retained prosthesis.

Picture courtesy of Dr. Wicks

The Locator FIXED attachment system (attachment system for fixed implant-supported prostheses) (Figure 8) has been recently introduced by Zest Dental Solutions as a solution to the disadvantages of both screw and cement retention.⁶⁸ The Locator FIXED attachment system eliminates the use of screw access holes, cement, and several difficult intraoral procedures.^23,68 It permits the fabrication and placement of a fixed full arch implant prosthesis using the conventional Locator attachments in conjunction with the proprietary fixed inserts. It also permits the transition from removable to fixed implant restorations using the same Locator attachments with proprietary fixed inserts. The Locator Fixed Denture Attachment Housings (DAHs) are picked up in the prosthesis via a chairside pick-up procedure similar to that used for the conventional locator attachment system.⁶⁸ The Locator FIXED inserts can accommodate implants with up to 20° of divergence, however, this system is not indicated for long cantilevers.

Figure 8. Locator FIXED attachment system used to retain a full-arch implant restoration.

Figure 8. Locator FIXED attachment system used to retain a full-arch implant restoration.

Picture courtesy of Dr. Massad