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Longevity of implant-supported fixed partial dentures (ISFPDs) may be associated with multiple clinical complications, irrespective of whether retention is achieved via screws or cement. While use of screws ensures ease of prosthesis retrievability and elimination of the inherently risky cementation process, more mechanical strains are induced in this design. A combined screw-retrievable and cement-retained ISFPD is designed to achieve the best passive fit and strain reduction while allowing complete excess cement removal and maintaining ease of retrievability. Moreover, this approach suggests better protection of the cement layer from oral environment degradation and offers scope for an alternative retention protocol. This paper outlines aspects of the clinical indications and fabrication of a screw-retrievable, cement-retained ISFPD. A diagnostic assessment method that provides tactile resistance guidance for selection is also proposed.

Logical categorization of implant-supported fixed partial dentures (ISFPDs) based on implant angulation, abutment type, and screw access channel (SAC) design for screw-retained restoration is not available in the literature. This article proposes a simple classification system to describe implant angulations and prosthesis design affecting abutment selection (engaging or nonengaging) for ISFPDs. An additional classification that addresses screw access channel designs is also introduced. These classifications provide clear interpretation of clinical scenarios for ISFPD design consideration and a basis for categorization of future complications. The angulation-based and prosthetic-based classifications simplify communication regarding implant angulation and prosthesis design type for ISFPDs. The SAC classification assists in prosthetic design, factoring in function and esthetics when designing the screw access.

Implant-supported fixed complete dentures, often referred to as hybrid prostheses, have been associated with high implant survival rates but also with a high incidence of mechanical prosthetic complications. The most frequent of these complications have been fracture and wear of the veneering material. The proposed design concept incorporates the occlusal surfaces of the posterior teeth as part of a digital milled metal framework by designing the posterior first molars in full contour as part of the framework. The framework can be designed, scanned, and milled from a titanium blank using a milling machine. Acrylic resin teeth can then be placed on the framework by conventional protocol. The metal occlusal surfaces of the titanium-countered molars will be at centric occlusion. It is hypothesized that metal occlusal surfaces in the posterior region may reduce occlusal wear in these types of prostheses. When the proposed design protocol is followed, the connection between the metal frame and the cantilever part of the prosthesis is reinforced, which may lead to fewer fractures of the metal framework.

Implant-supported fixed complete dental prostheses have been associated with a high implant success rate in long-term studies. However, they have also been associated with a high frequency of prosthetic complications. The most frequent and primary prosthetic complication has been the fracture or wear of the occlusal surface of acrylic resin teeth that are typically attached to a metal framework. The design of the framework in this clinical report involved the incorporation of metal occlusal surfaces for the posterior first molars to the framework. The titanium framework was fabricated with computer-aided design and computer-aided manufacturing (CAD-CAM) technology. The remaining teeth were restored in a conventional manner with acrylic resin denture teeth bonded to the titanium framework. This was expected to maintain the occlusal vertical dimension and also reduce the frequency of the primary complications associated with these prostheses., (Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)