The International Journal of Periodontics & Restorative Dentistry

Treatment of Completely Edentulous

Patients with Fixed Implant-Supported
Restorations: Three Consecutive Cases
of Simultaneous Immediate Loading in
Both Maxilla and Mandible

German O. Gallucci, DMD*/Jean-Pierre Bernard, PD Dr Med, MD**/ In his 1728 book Le Chirugien
Urs C. Belser, Prof Dr Med Dent, DMD*** Dentiste, Pierre Fauchard claimed:
“The loss of teeth is very unfortu-
The aims of this article are to: (1) describe the treatment of three consecutive
nate, but art and science can replace
completely edentulous patients with implant-supported fixed restorations, includ-
them.” The beginning of the 19th
ing simultaneous same-day immediate loading with fixed provisional restorations
in both jaws; and (2) illustrate a step-by-step definitive restoration approach and
century saw the replacement of early
its reproducibility. All patients followed the same diagnostic protocol. One surgi- ivory, wood, or bone dentures with
cal intervention was performed for simultaneous implant placement in both max- a new generation of prostheses
illa and mandible. Following implant placement, all patients received a simultane- made of “incorruptible materials”
ous, same-day, complete-arch, screw-retained provisional restoration in both jaws such as ceramics.1 Consequently,
according to the “pickup technique.” After healing, final impressions were taken, complete dentures became the
and occlusion recorder devices were prepared on working casts. For the first prevalent treatment for edentulous
occlusal record, the “half-provisionals” method was used. Definitive solid abut- patients in the 20th century.2–7
ments were used for both laboratory and clinical procedures. After casting and Dental implants have proven reli-
finishing, the frameworks were tried in, and a new occlusal record was made. The able in enhancing overdenture reten-
definitive segmented restorations consisted of four fixed partial dentures in the
tion,8,9 to the extent that the 2002
maxilla and three in the mandible and were cemented with provisional cement.
McGill Consensus Statement on
All patients received a nightguard. The pickup technique facilitated simultaneous
Overdentures advised that “A con-
immediate loading in both maxilla and mandible. A complete, fixed, segmented
rehabilitation supported by six to eight anteroposterior implants is a reproducible
ventional denture should no longer
treatment for completely edentulous patients when optimal anatomic conditions be the most appropriate first choice
are present. (Int J Periodontics Restorative Dent 2005;25:xx–xx.) prosthodontic treatment”; instead,
“A two-implant overdenture should
*Lecturer, Department of Prosthodontics, School of Dental Medicine, University become the first choice of treatment
of Geneva, Switzerland. in the edentulous mandible.” 10
**Associate Professor and Head of Oral Surgery, Department of Stomatology and
Long-term studies have shown that
Oral Surgery, School of Dental Medicine, University of Geneva, Switzerland.
***Professor and Chair, Department of Prosthodontics, School of Dental Medicine, dental implants can be successfully
University of Geneva, Switzerland. used in restoring edentulous jaws
with fixed rehabilitations,11–15 but the
Correspondence to: Dr German O. Gallucci, 19 Rue Barthélemy-Menn,
provisionalization often requires dif-
Department of Prosthodontics, School of Dental Medicine, University of
Geneva, CH-1205 Geneva, Switzerland. Fax: + (41-22) 372 94 97. e-mail: ficult adjustment of the complete
german.gallucci@medecine.unige.ch denture, even when optimal

Volume 25, Number 1, 2005

4
anatomic conditions are present.
Several studies16–21 provide evidence
that immediately loaded implants
with fixed complete-arch provisional
restorations osseointegrate with a
similar success rate as delayed
loaded implants. To acomplish this,
a number of immediate provisional-
ization techniques for edentulous
jaws have been reported.22–26
Patient selection and the diag-
nostic phase play an important role
in planning a fixed implant-sup-
ported rehabilitation in completely
edentulous patients. This allows for
appraisal of the appropriate denture
teeth location and emergence pro-
file, as well as occlusion, phonetics,
lips and facial support, and esthetic
parameters—all of which will deter-
mine the treatment feasibility, and,
more important, patient approval.
Various protocols for fixed rehabili-
tation in both edentulous maxillae
and mandibles have presented
many prosthetic designs, 27–35
although none are entirely free of
complications.36–38 These protocols
can be divided into three groups:
(1) fixed, splinted rehabilitation sup-
ported by four to six anterior
implants (placed between the max-
illary sinuses or between the mental
foramina) and bilateral distal can-
tilevers31,32; (2) fixed, splinted reha-
bilitation supported by six to eight
anteroposterior implants without
bilateral cantilevers29,33,34; and (3)
complete, fixed, segmented reha-
bilitation supported by six to eight
anteroposterior implants.35 All of
these protocols describe separate
maxillary and mandibular treat-
ments. However, in the case of com-
The International Journal of Periodontics & Restorative Dentistry
pletely edentulous patients with
both maxilla and mandible requiring
rehabilitation, either a consecutive or
simultaneous approach can be
taken. Both approaches present
advantages and disadvantages that
will be addressed below.
In an effort to augment the lim-
ited information currently available,
the aims of this article are to: (1)
describe the treatment of three con-
secutive completely edentulous
patients with implant-supported
fixed rehabilitations, including simul-
taneous same-day immediate load-
ing with fixed provisional restora-
tions in both maxilla and mandible;
and (2) illustrate a step-by-step defin-
itive rehabilitation approach and its
reproducibility. [AU: Edit OK?] This
approach applies conventional fixed
prosthesis concepts in a complete-
mouth implant-supported fixed
rehabilitation, taking into considera-
tion functional, phonetic, and
esthetic parameters.
Clinical reports
Two completely edentulous patients
had originally been assigned to the
student clinic at the University of
Geneva School of Dental Medicine
for a complete denture replacement.
As their initial evaluation had
revealed optimal anatomic condi-
tions, their therapeutic proposals
included a fixed rehabilitation. The
third patient, who had also been a
complete denture wearer, directly
requested a “fixed solution.”
All three patients followed the
same diagnostic protocol, which
confirmed the feasibility of a fixed
implant-supported rehabilitation.
The available bone height was first
assessed from a panoramic radi-
ograph (Fig 1a). Diagnostic casts
were mounted in an articulator, and
a setup was carried out with
radiopaque acrylic resin denture
teeth (Ivoclar Vivadent), which were
adjusted to the cast without any wax-
ing of the vestibular flange. The
setup was later used to clinically
assess functional and esthetic para-
meters. Because of the narrowness
of some implant receptor areas,
computerized tomography (CT) scan
images were requested in one case;
here, the radiopaque diagnostic
setup was used as a guide to corre-
late the tooth positions with the dif-
ferent scanner cuts.
One surgical intervention was
performed for simultaneous implant
placement in both maxilla and
mandible (Fig 1b). All three patients
received solid-screw ITI implants
(Straumann) with a sandblasted and
acid-etched (SLA) surface. The surg-
eries were carried out under local
anesthesia, and patients were pre-
medicated with antibiotics (clin-
damycin 300 mg) and nonsteroidal
antiinflammatory drugs (ibuprofen
400 mg). The preparation axes were
controlled with both paralleling
gauges and the surgical guide in
place (between drill changes).
Wound closure was performed
around the titanium healing abut-
ments with a nonsubmerged tech-
nique with interrupted sutures.
Following implant placement,
all patients received a same-day,
immediate, fixed, complete-arch,
 5

Fig 1a Preoperative panoramic radiograph. Fig 1b Panoramic radiograph at implant placement shows implant
location and distribution: eight implants in the maxilla at fist molar,
fist premolar, canine, and central incisor positions, and six implants in
the mandible at first molar, first premolar, and canine positions.

Fig 1c Anterior view of immediately loaded provisionals in occlu- Fig 1d Radiographic checkup with screw-retained provisional
sion the day of implant placement. restoration after 4 months of functional healing.

screw-retained provisional restora-
tion in both jaws simultaneously,
according to the “pickup tech-
nique”26 (Fig 1c). After healing was
completed (Fig 1d), a fixed, com-
plete, segmented rehabilitation,
supported by eight implants in the
maxilla and six implants in the
mandible, was seated. At the 24-
month follow-up, none of the
implants or fixed partial dentures
(FPD) were lost or fractured, and all
three patients presented signs of
healthy peri-implant mucosa.
Final rehabilitation step by step
After 4 months of functional loading
and soft tissue modeling, final
impressions were taken with a per-
forated customized tray and screw-
retained impression copings (ITI den-

Volume 25, Number 1, 2005

6

Fig 2a (left) First occlusal registration:

Occlusion recorder devices (ORD) show U-
shaped acrylic resin supported by four aids
for bite registration (abr), which allow accu-
ORD
rate repositioning in both master cast and
abr mouth because of their conical connection
at the implant level.

Fig 2b (right) Anterior view of half-provi-

sional maintaining vertical dimension and
centric relation. ORDs seated on contralat-
eral side. (ORDs must not be in contact at
this stage.)

Fig 2c (left) Clinical view of ORDs of con-

tralateral side linked with acrylic resin.

Fig 2d (right) Occlusal record complet-

ed, with maxillary and mandibular ORDs
linked with acrylic resin.

Fig 2e (left) Bonded ORDs retrieved

from the mouth.

Fig 2f (right) ORDs seated in master cast

establish position for mounting in the artic-
ulator.

tal implant system). The master casts,
including the corresponding implant
analogues, were prepared, and a soft
silicone gingival mask was added to
reproduce the configuration of the
peri-implant soft tissue. Occlusion
recorder devices (ORD) were pre-
pared (Fig 2a) on both maxillary and
mandibular working casts and fixed
onto four aids for bite registration to
allow for accurate repositioning on
the cast and in the mouth. For the
first occlusal record, the complete-
arch provisional restoration was split
between the central incisors. Next,
both maxillary and mandibular ORDs
were inserted on one side of the
mouth, while “half-provisionals”
were left on the contralateral side
(Fig 2b). While both vertical dimen-
sion and centric relation were main-
tained by the half-provisionals on
one side, the ORDs were bonded
with acrylic resin (Duralay, Reliance
Dental) on the contralateral side (Fig
2c). Once the acrylic resin polymer-
ized, the remaining maxillary and
mandibular half-provisionals were
replaced by ORDs, and the vertical
dimension was now maintained by
the previously bonded ORDs. The
occlusal registration was completed
by repeating the same procedure on

The International Journal of Periodontics & Restorative Dentistry

 7

the contralateral side (Fig 2d). The

bonded ORDs were then retrieved
Table 1 Checklist of clinical and laboratory steps
and used for mounting the master Clinical (C)/
cast in the laboratory (Figs 2e and 2f). Step laboratory (L)
The abutments were selected in 1. Clinical and radiographic evaluation C
the laboratory with the aid of a diag- 2. Study casts, diagnostic setup, and setup try-in C-L
(assessment of treatment feasibility)
nostic planning kit (Straumann), tak-
3. Setup duplication for provisional splint and surgical guide L
ing into account the interocclusal 4. Implant placement (choice of prosthetic protocol) C
space and using silicone indices 5. Immediate loading (pickup technique26) C-L
taken from an irreversible hydrocol- 6. Soft tissue modeling C
7. 4-month functional healing
loid impression of the provisional
8. Final impression taking C
clinical status. All three cases later 9. Master cast and occlusion recorder device preparation L
received titanium solid abutments 10. First occlusal recording and mounting in articulator C-L
of 4 mm (three sites in the same pa- 11. Abutment selection L
tient), 5.5 mm, and 7 mm in height, 12. Functional complete waxup and try-in C-L
(assessment of occlusion, phonetics, and esthetic parameters)
respectively. 13. Silicone index and framework preparation L
The selected definitive abut- 14. Framework try-in, second occlusal recording, and remounting C-L
ments were used for both labora- in articulator
tory and clinical procedures (Table 1). 15. Porcelain veneering (stratification technique) L
16. Bisque-bake try-in (final occlusal and esthetic adjustments) C
Once solid abutments were placed 17. Glazing/polishing L
on the working casts, a functional 18. Abutment insertion and tightening to 35 Ncm C
complete waxup was performed on 19. Cementing of final restoration C
burned-out plastic copings (for 20. Follow-up and maintenance C
FPDs). The waxup consisted of four
three-unit FPDs in the maxilla, and
one six-unit and two three-unit FPDs
in the mandible, according to the
protocol chosen for the definitive
restoration.35 A complete waxup try-
in was carried out by retrieving the
screw-retained provisional restora-
tion, and then transferring the solid
abutments from the master cast into
the mouth. The waxup was seated to
clinically assess occlusion, phonetics,
facial and lip support, as well as
esthetic parameters.
Silicone indices taken from the
complete waxup after clinical assess-
ment guided the fabrication of the
frameworks (Fig 3). After casting and
finishing, the frameworks were tried
Fig 3 Silicone indices taken from complete waxup after clinical assessment. One index is
in, and the passive fit was appraised created for each segment of the definitive restoration, and adjacent abutments serve as repo-
with silicone to reveal high spots and sitioning elements to hold index in place. Fabrication of framework is guided by these indices.

Volume 25, Number 1, 2005

8

Fig 4a (left) Segmented definitive rehabilitation before cement-

ing.

Fig 4b (below left) Clinical view of definitive restoration after

cementation.

Fig 4c (below) Radiographic control of definitive fixed, segment-

ed rehabilitation represented by four three-unit FPDs in the maxil-
la, and one six-unit and two three-unit FPDs in the mandible.

pressure points (Fit Checker, GC). A
new occlusal record was made; here
again, the half-provisional method
was applied. The frameworks on one
side were first linked with a light-cur-
ing pattern resin (Visio Form, 3M/
ESPE), and this maneuver was re-
peated on the contralateral side. The
master casts were remounted in an
articulator to begin the ceramic
veneering.
The definitive segmented
restorations consisted of four FPDs in
the maxilla and three in the man-
dible (Fig 4a). Morphology, texture,
and color of the final restoration
were reproduced through a stratifi-
cation technique, and the last
occlusal and esthetic adjustments
were made during the bisque-bake
[AU: OK?] try-in. After glazing, solid
abutments were definitively trans-
ferred from the master cast to the
mouth and tightened to 35 Ncm.
The final restorations were ce-
mented with provisional cement
(Temp Bond, Kerr) (Fig 4). All
patients received a nightguard to
protect the restorations against para-
function damage and were sched-
uled for follow-up visits in 3-month
intervals.

The International Journal of Periodontics & Restorative Dentistry


Discussion
Of the three patients, only one had
requested a fixed solution, and the
remaining two asked for a new set of
complete dentures. Although most
patients today are aware of the exis-
tence of dental implants, it is impor-
tant to remember that they do not
always know what dental implants
can do for them. To achieve the opti-
mal outcome with a fixed, complete
implant-supported rehabilitation, it is
critical that clinicians: (1) recognize
the potential of edentulous or future
edentulous patients to receive a
fixed, complete-mouth rehabilita-
tion; (2) inform patients about all
therapeutic possibilities, including a
fixed solution; (3) evaluate the
patient’s chief complaints, as well as
the cost benefit of the proposed
treatment; and (4) collaborate with a
team that can meet all clinical, sur-
gical, prosthetic, and laboratory
requirements. At the same time,
dental technicians should: (1) actively
participate in the decision making
and diagnostic planning; and (2) sup-
ply technical support through knowl-
edge and expertise (especially in
immediate provisionalization tech-
niques).
The choices of prosthetic pro-
tocol and number of implants
involved in a completely edentulous
patient’s fixed rehabilitation are
directly related. Since a prosthetic
protocol is based on a specific num-
ber of implants, a reduction or
increase in implant number will
require modification of the pros-
thetic design. Brånemark et al32
assert that, “There is no argument to
9
increase the number of implants
when a minimum of four can be in-
stalled.” This protocol recommends
the use of four to six anterior im-
plants (placed between the maxil-
lary sinuses or mental foramina),
which will result in a fixed, one-piece,
metal-resin restoration including
bilateral distal cantilevers. 31,32
Nevertheless, speech problems such
as difficulties with /s/ pronunciation
(about 30% of the cases) and fracture
of resin teeth have been reported as
two main complications with this
prosthetic approach.31,36,37
Alternatively, a fixed one-piece
restoration supported by six to eight
anteroposterior implants without
bilateral cantilevers29,33,34 requires a
more exhaustive diagnosis, espe-
cially for implant placement in pos-
terior areas. Moreover, long-span
FPDs may cause difficulties in labo-
ratory procedures (eg, ceramic
veneering) and demand closely con-
trolled passive fit of the complete-
arch one-piece rehabilitation at seat-
ing.
Finally, a fixed, complete-arch
but segmented rehabilitation, sup-
ported by six to eight anteroposte-
rior implants (the prosthetic protocol
followed for all three patients pre-
sented in this study) calls for a strate-
gic implant distribution.35 Rehabili-
tating both mandible and maxilla
with short-span FPDs (four three-unit
FPDs in the maxilla, and two three-
unit FPDs and one six-unit FPD in the
mandible; Fig 4a) facilitates pros-
thetic management during labora-
tory (eg, ceramic veneering) and clin-
ical procedures and improves
marginal adaptation and passive fit
Volume 25, Number 1, 2005
10
at seating. In addition, because of
the segmentation used in this pro-
tocol, all FPDs are supported only by
two abutments, allowing for partial
reintervention should the need arise.
It should be stressed that the
choice of prosthetic protocol needs
to be corroborated with the ana-
tomic availability and desired tooth
positions, both of which will guide
surgical implant placement.
The need for an often-difficult
post–implant placement adaptation
of the provisional complete denture,
along with the promising results
reported with immediate load-
ing,16–21 has made edentulous jaws
the main indication for immediate
functional provisionalization. How-
ever, in cases of completely edentu-
lous patients with both jaws requir-
ing restoration, clinicians must
choose between consecutive and
simultaneous treatment. Consecu-
tive treatment requires two surgical
interventions, preparation of an
immediate provisional template for
the first treatment of the maxilla/
mandible, and a new complete den-
ture or adaptation of the preexisting
one for the opposing jaw. A new
diagnostic setup for the remaining
jaw should be made before the sec-
ond intervention and transformed
into a fixed immediate provisional
restoration using the same tech-
nique. In other words, the treatment
is completed by a duplication of
treatment phases.
A simultaneous approach in
both jaws, on the other hand,
although more demanding for the
patient, requires only one interven-
tion. It allows for simultaneous,
The International Journal of Periodontics & Restorative Dentistry
immediate provisionalization, since
both surgical guides and provisional
splints are duplicated from the clin-
ically assessed diagnostic setup. The
immediate loading technique used
in this study required neither intra-
surgical impressions nor fabrication
of master casts,26 which markedly
reduced the chairside time and facil-
itated the same-day delivery of com-
plete-mouth fixed implant-sup-
ported provisionals.
Occlusal recording calls for spe-
cial consideration in completely
edentulous patients because no
landmarks are easily available for ref-
erence. As the screw-retained provi-
sional restorations are the sole trace
of parameters established at the
diagnostic phase and corroborated
during the healing period, a split-
mouth occlusal record using the half-
provisional technique is extremely
effective in maintaining vertical
dimension and centric relation (Fig
2).
The same titanium solid abut-
ments were used in all laboratory
and clinical steps. Because the pro-
visional restoration is screw retained,
it can be retrieved from the mouth
(giving access to the implant shoul-
ders) and transfer the titanium abut-
ments from the cast to the mouth
and vice versa. This is possible
thanks to the segmentation ap-
proach of the definitive restoration
made on burned-out copings for
FPDs whose smooth conical inner
surfaces ensure their independence
from the abutment’s retention posi-
tion.
Defining the final features of the
fixed rehabilitation with the com-

plete waxup must involve the input
of clinicians, dental technicians, and
patients. Once all parameters have
been approved, the dental techni-
cian should reproduce them with
ceramic veneering. The use of sili-
cone indices (Fig 3) from the com-
plete waxup provides pertinent
information (spatial orientation of
prosthetic teeth) for the fabrication
of the metal framework. Frameworks
must be sufficiently rigid and pro-
vide enough space for adequate
thickness of the ceramic veneer lay-
ers to avoid fractures or cracks.39,40
Given the discrepancy between
implant abutments and prosthetic
teeth dimensions, and the fact that
it is often necessary to increase the
buccal volume of maxillary anterior
teeth, the morphology of frame-
works has to guarantee a uniform
gap of at least 1.5 mm to the silicone
index. In other words, the framework
should reproduce the dental
anatomy minus the space for the
ceramic veneer, and the whole
framework-waxing process is guided
by silicone indices taken from the
complete waxup.
During framework try-in, passive
fit and prefect seating must be
assessed. Once these two aspects
are achieved, a second occlusal reg-
istration can be carried out. The half-
provisional approach is an excellent
method for occlusal recording
because it ensures accurate re-
mounting of master casts in the artic-
ulator. Although this second occlusal
registration could be viewed as an
additional clinical/laboratory step, it
is essential for subsequent stratifi-
cation of the ceramic veneering.
Dental technicians using this tech-
nique apply ceramic strata such as
opaque, opaque dentin, body
dentin, enamel, incisal, and various
colorants to reproduce the natural
tooth characteristics (shape, texture,
shade, transparency, interdental rela-
tionships, and occlusion). This sec-
ond occlusal record allows for a pre-
cise occlusal adjustment in the
articulator, requiring only minimal
final corrections in the mouth, with-
out altering the stratified composi-
tion of the restoration.
The interdental relationships,
occlusion, emergence profile, and
esthetic integration with the soft tis-
sue are all evaluated during the
bisque-bake [AU: OK?] try-in stage.
Here again, it is important that the
clinician and dental technician be
able to jointly assess the restoration
outcome and coordinate the modi-
fications. Should this interaction not
be possible, digital images are an
invaluable tool for communicating
the modifications before final glaz-
ing/polishing.
For the seating of the final
restoration, the abutments were
definitively transferred from the mas-
ter cast into the mouth, then tight-
ened at 35 Ncm using a torque con-
trol device. The final restoration was
cemented with provisional cement
(Temp Bond). Provisional cement in
implant-supported restorations
seems to behave as semidefinitive
cement, allowing for possible rein-
tervention. After a 6-month follow-
up, definitive cementation can be
carried out using glass-ionomer
cement.
11
Conclusion
A team approach is crucial for the
treatment of completely edentulous
patients with simultaneous immedi-
ate loading and fixed implant-
supported restorations. Diagnostic
planning and patient selection deter-
mine the treatment feasibility and
provide reproductible information
during the whole prosthetically dri-
ven treatment. The pickup technique
facilitates simultaneous immediate
loading in both maxilla and man-
dible. A fixed, segmented rehabili-
tation supported by six to eight
anteroposterior implants is a repro-
ducible treatment for completely
edentulous patients when optimal
anatomic conditions are present.
Acknowledgements
The authors wish to express their gratitude to
Mr Michel Bertossa, CDT, Department of
Prosthodontics, University of Geneva, for his
expertise and invaluable contribution in all
laboratory steps described in this article; Dr
Kamel Salem, Department of Prosthodontics,
University of Geneva, for his clinical collabo-
ration; and Ms Milica Tomasevic for her input
in text editing.
Volume 25, Number 1, 2005
12
References
1. Kurdvk B. Giuseppangelo Fonzi: Industrial
fabrication promoter of porcelain pros-
thetics. J Hist Dent 1999;47:79–82.
2. Terrel WH. Fundamentals important to
good complete denture construction. J
Prosthet Dent 1958;8:740–752.
3. Sussman BA. Routine treatment by com-
plete dentures. J Prosthet Dent 1966;16:
451–457.
4. Swoope CC. Complete denture prostho-
dontics. J Prosthet Dent 1974;32:
383–390.
5. Jacobson TE, Krol AJ. A contemporary
review of the factors involved in com-
plete denture retention, stability, and sup-
port. Part I: Retention. J Prosthet Dent
1983;49:5–15.
6. Lang BR. A review of traditional thera-
pies in complete dentures. J Prosthet
Dent 1994;72:538–542.
7. Ivanhoe JR, Cibirka RM, Parr GR. Treating
the modern complete denture patient: A
review of the literature. J Prosthet Dent
2002;88:631–635.
8. Mericske-Stern R. Clinical evaluation of
overdenture restorations supported by
osseointegrated titanium implants: A ret-
rospective study. Int J Oral Maxillofac
Implants 1990;5:375–383.
9. Johns RB, Jemt T, Heath MR, et al. A mul-
ticenter study of overdentures supported
by Brånemark implants. Int J Oral
Maxillofac Implants 1992;7:513–522.
10. Feine JS, Carlsson GE, Awad MA, et al.
The McGill consensus statement on over-
dentures. Int J Prosthodont 2002;15:
413–414.
11. Zarb GA, Schmitt A. The longitudinal clin-
ical effectiveness of osseointegrated den-
tal implants: The Toronto study. Part I:
Surgical results. J Prosthet Dent 1990;63:
451–457.
12. Zarb GA, Schmitt A. The longitudinal clin-
ical effectiveness of osseointegrated den-
tal implants: The Toronto Study. Part II:
The prosthetic results. J Prosthet Dent
1990;64:53–61.
The International Journal of Periodontics & Restorative Dentistry
13. Zarb GA, Schmitt A. The longitudinal clin-
ical effectiveness of osseointegrated den-
tal implants: The Toronto study. Part III:
Problems and complications encoun-
tered. J Prosthet Dent 1990;64:185–194.
14. Adell R, Eriksson B, Lekholm U,
Brånemark P-I, Jemt T. Long-term follow-
up study of osseointegrated implants in
the treatment of totally edentulous jaws.
Int J Oral Maxillofac Implants 1990;5:
347–359.
15. Ferrigno N, Laureti M, Fanali S,
Grippaudo G. A long-term follow-up
study of non-submerged ITI implants in
the treatment of totally edentulous jaws.
Part I: Ten-year life table analysis of a
prospective multicenter study with 1286
implants. Clin Oral Implants Res 2002;13:
260–273.
16. Schnitman PA, Wohrle PS, Rubenstein JE.
Immediate fixed interim prostheses
supported by two-stage threaded
implants: Methodology and results. J Oral
Implantol 1990;16:96–105.
17. Salama H, Rose LF, Salama M, Betts NJ.
Immediate loading of bilaterally splinted
titanium root-form implants in fixed
prosthodontics—A technique reexam-
ined: Two case reports. Int J Periodontics
Restorative Dent 1995;15:344–361.
18. Balshi TJ, Wolfinger GJ. Immediate load-
ing of Brånemark implants in edentulous
mandibles: A preliminary report. Implant
Dent 1997;6:83–88.
19. Tarnow DP, Emtiaz S, Classi A. Immediate
loading of threaded implants at stage 1
surgery in edentulous arches: Ten con-
secutive case reports with 1- to 5-year
data. Int J Oral Maxillofac Implants 1997;
12:319–324.
20. Horiuchi K, Uchida H, Yamamoto K,
Sugimura M. Immediate loading of
Brånemark system implants following
placement in edentulous patients: A clin-
ical report. Int J Oral Maxillofac Implants
2000;15:824–830.
21. Jaffin RA, Kumar A, Berman CL. Im-
mediate loading of implants in partially
and fully edentulous jaws: A series of 27
case reports. J Periodontol 2000;71:
833–838.
 13

22. Ganeles J, Rosenberg MM, Holt RL, 32. Brånemark P-I, Svensson B, van
Reichman LH. Immediate loading of Steenberghe D. Ten-year survival rates
implants with fixed restorations in the of fixed prostheses on four or six implants
completely edentulous mandible: Report ad modum Brånemark in full edentulism.
of 27 patients from a private practice. Int Clin Oral Implants Res 1995;6:227–231.
J Oral Maxillofac Implants 2001;16:
33. Taylor TD. Fixed implant rehabilitation
418–426.
for the edentulous maxilla. Int J Oral
23. Cooper LF, Rahman A, Moriarty J, Maxillofac Implants 1991;6:329–337.
Chaffee N, Sacco D. Immediate mandibu-
34. Zitzmann NU, Marinello CP. Treatment
lar rehabilitation with endosseous
outcomes of fixed or removable implant-
implants: Simultaneous extraction,
supported prostheses in the edentulous
implant placement, and loading. Int J
maxilla. Part II: Clinical findings. J Prosthet
Oral Maxillofac Implants 2002;17:
Dent 2000;83:434–442.
517–525.
35. Belser U, Gallucci G, Bernard JP. Rehab-
24. Kammeyer G, Proussaefs P, Lozada J.
ilitation of edentulous jaws with fixed
Conversion of a complete denture to a
implants prostheses. [AU: Has this mate-
provisional implant-supported screw-
rial been formally accepted for publi-
retained fixed prosthesis for immediate
cation (if so, which journal?)? If not, ref-
loading of a completely edentulous arch.
erence will be changed to an in-text
J Prosthet Dent 2002;87:473–476.
citation.]
25. Balshi TJ, Wolfinger GJ. Immediate load-
36. Jemt T. Failures and complications in 391
ing of dental implants in the edentulous
consecutively inserted fixed prostheses
maxilla: Case study of a unique protocol.
supported by Brånemark implants in
Int J Periodontics Restorative Dent 2003;
edentulous jaws: A study of treatment
23:37–45.
from the time of prosthesis placement to
26. Gallucci GO, Bernard JP, Bertossa M, the first annual checkup. Int J Oral
Belser UC. Immediate loading with fixed Maxillofac Implants 1991;6:270–276.
screw-retained provisional restorations in
37. Lundqvist S, Haraldson T, Lindblad P.
edentulous jaws: The pickup technique.
Speech in connection with maxillary fixed
Int J Oral Maxillofac Implants 2004;19:
prostheses on osseointegrated implants:
524–533.
A three-year follow-up study. Clin Oral
27. Jemt T, Lindén B. Fixed implant-sup- Implants Res 1992;3:176–180.
ported prostheses with welded titanium
38. Kinsel RP, Lamb RE, Moneim A. Develop-
frameworks. Int J Periodontics Restorative
ment of gingival esthetics in the edentu-
Dent 1992;12:177–184.
lous patient with immediately loaded,
28. Zarb GA, Schmitt A. Implant prostho- single-stage, implant-supported fixed
dontic treatment options for the edentu- prostheses: A clinical report. Int J Oral
lous patient. J Oral Rehabil 1995;22: Maxillofac Implants 2002;17:866–872.
661–671.
39. Straussberg G, Katz G, Kuwata M. Design
29. Mericske-Stern RD, Taylor TD, Belser U. of gold supporting structures for fused
Management of the edentulous patient. porcelain restorations. J Prosthet Dent
Clin Oral Implants Res 2000;11:108–125. 1966;16:928–936.
30. Weingart D, ten Bruggenkate CM. Treat- 40. Stein RS, Kuwata M. A dentist and a den-
ment of fully edentulous patients with ITI tal technologist analyze current ceramo-
implants. Clin Oral Implants Res 2000;11: metal procedures. Dent Clin North Am
69–82. 1977;21:729–749.
31. Jemt T. Fixed implant-supported pros-
theses in the edentulous maxilla. A five-
year follow-up report. Clin Oral Implants
Res 1994;5:142–147.

Volume 25, Number 1, 2005