The Marius implant bridge: surgical and prosthetic rehabilitation for the completely edentulous upper jaw with moderate to severe resorption: a 5-year retrospective clinical study

Background Patients seeking replacement of their upper denture with an implant-supported restoration are most interested in a fixed restoration. Accompanying the loss of supporting alveolar structure due to resorption is the necessity for lip support, often provided by a denture flange. Attempts to provide a fixed restoration can result in compromises to oral hygiene based on designs with ridge laps. An alternative has been an overdenture prosthesis, which provides lip support but has extensions on to the palate and considerations of patient acceptance. The Marius bridge was developed as a fixed bridge alternative offering lip support that is removable by the patient for hygiene purposes, with no palatal extension beyond normal crown-alveolar contours. Purpose Implant-supported restorative treatment of completely edentulous upper jaws, as an alternative to a complete denture, is frequently an elective preference, and it requires significant patient acceptance beyond the functional improvement of chewing. Patients with moderate to severe bone resorption and thin ridges present additional challenges for adequate bone volume and soft-tissue contours. The purpose of this investigation was to develop a surgical and prosthetic implant treatment protocol for completely edentulous maxillae in which optimal lip support and phonetics is achieved in combination with substantial implant anchorage without bone grafting. Materials and methods The Marius bridge is a complete-arch, double-structure prosthesis for maxillae that is removable by the patient for oral hygiene. The first 45 consecutive patients treated by one person (YF) in one center with this concept are reported, with 245 implants followed for up to 5 years after prostheses connection. Results The cumulative fixture survival rate for this 5-year retrospective clinical study was 97%. Five fixtures failed before loading, in five different patients, and two fixtures in the same patient failed at the 3-year follow-up visit. None of the bridges failed, giving a prostheses survival rate of 100%. The complications were few and mainly prosthetic: nine incidences of attachment component complications, one mesobar fracture, and three reports of gingivitis. All complications were solved or repaired immediately, with minimal or no interruption of prostheses use. Conclusions Satisfactory medium-term results of survival and patient satisfaction show that the Marius bridge can be recommended for implant dentistry. The technique may reduce the need for grafting, because it allows for longer implants to be placed with improved bone anchorage and prostheses support. key words: clinical follow-up, complete arch, double structure, esthetics, maxilla, phonetics, tilted implants