ISSN: 2581-5989

PubMed - National Library of Medicine - ID: 101738774

International Journal of Dental Science and Innovative Research (IJDSIR)

IJDSIR : Dental Publication Service
Available Online at: www.ijdsir.com
Volume – 2, Issue – 6, November - December - 2019, Page No. : 518 - 523
Malo Implant Bridge- Refurbishing The Prosthetic Precision
1
Dr. Meenakshi. T M.D.S., Professor and Head, Department of Prosthodontics, Pacific Dental College & Hospital, Debari,
Rajasthan 313024, India.
2
Dr. Ishita Parekh, M.D.S., Post Graduate Student, Department of Prosthodontics, Pacific Dental College & Hospital,
Debari, Rajasthan 313024, India.
3
Dr. Vanshree Katarya, M.D.S., Post Graduate Student, Department of Prosthodontics, Pacific Dental College & Hospital,
Debari, Rajasthan 313024, India.
4
Dr. Priyanka Jha, M.D.S., Post Graduate Student, Department of Prosthodontics, Pacific Dental College & Hospital,
Debari, Rajasthan 313024, India
Corresponding Author: Dr. Meenakshi. T M.D.S., Professor and Head, Department of Prosthodontics, Pacific Dental
College & Hospital, Debari, Rajasthan 313024, India.
Type of Publication: Case Report
Conflicts of Interest: Nil
Abstract begins. Multiple prosthetic options exist for rehabilitating
Oral implants have become the most helpful therapeutic partial and total edentulous arches with implants. The
option to overcome functional and aesthetic deficiency. treatment options should be carefully evaluated early in
Replacement of missing teeth in the anterior esthetic zone the planning process. Introduction of CAD/CAM
is a challenging task. Specifically, when there is a technology and the availability of versatile dental
deficient soft and hard tissue. Clinical circumstances with materials, dental implantology have reached an era where
the compromised architecture of the supporting tissues oral implant therapy has become a part of routine
would require surgical augmentation to enhance the dentistry. But till today successful implant therapy is
configuration for implant surgery. This clinical report questionable. The most challenging part of oral implant
presents the successful application of Malo implant bridge therapy being the prosthetic phase. Multiple prosthetic
protocol in rehabilitating maxillary anterior region with options exist for rehabilitating partial and total edentulous
compromised supporting tissue architecture. The arches with implants using different loading protocol.
prosthetic treatment enabled to restore esthetics and In 1999, Randow et al., [2] advocated the “Nordiac
function without additional surgical reconstruction of the Bridge” concept for early loading of Branemark system
deficient supporting foundation. implants within 20 days of insertion. The prosthesis
Keywords: Ridge defect, Esthetic zone, Malo Implant consisted of bilateral cantilevers corresponding to 2
Bridge, CAD/CAM, Fixed Prosthesis premolars and superstructures fabricated in porcelain
Introduction fused to gold alloy.
Carl Misch [1] stated the fundamental axiom in implant Chow et al., in 2001 [3] proposed “Hong Kong Bridge”
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dentistry is to identify the end result before the task concept in which the patients were provided with the

Corresponding Author: Dr. Meenakshi. T M.D.S., ijdsir Volume - 2 Issue - 6, Page No. 518 - 523
Dr. Meenakshi. T M.D.S., et al. International Journal of Dental Science and Innovative Research (IJDSIR)

provisional fixed prosthesis, over immediately loaded Extra oral examination showed no gross facial asymmetry
Branemark system implants. or any other abnormality. Intra-oral examination revealed
Marius implant bridge was explained by Fortin Y et al., in partially edentulous maxillary arch with missing 12, 11
2002 [4]. The prosthesis involved a combination of the and 21 and dentulous mandibular arch (Fig.1). Edentulous
fixed bridge and the overdenture for edentulous maxillae. region examination presented Siebert’s class II-ridge
Later Branemark et al., [5] in 2003 described “Branemark defect [7] having compromised vertical bone dimension
Novum Bridge” concept in this technique on the day of resulting in increased crown height space with respect to
fixture placement 67% of the patients received Novum missing teeth region. Orthopantomography revealed 3
prosthesis. The fixtures were immediately splinted with a implants fixtures placed in 12, 11 and 21 regions (Fig. 2).
prefabricated substructure and fixed prosthesis extending Implants were well osseointegrated no pathology was
from first molar to first molar with cantilevers of 9-22mm. evident. Clinical examination of the edentulous region
In 2003 Malo et al., [6] reported prosthetic rehabilitation revealed excessive mesiodistal width and apicocoronal
of “All- On - 4” concept with Malo implant bridge. The height.
prosthetic design included either metal-ceramic implant- Misch [1] proposed 3 prosthetic options for implant
supported fixed prosthesis with a titanium framework and supported fixed prosthesis (FP) as FP-1 to 3. The FP-3
all-ceramic crowns, or metal-acrylic resin, implant- prosthetic design includes a hybrid restoration of metal
supported fixed prosthesis with titanium framework and substructure denture teeth or a porcelain-metal restoration.
acrylic resin prosthetic teeth. Malo Implant prosthesis successfully justifies the Misch
The following case report reveals the detailed description proposal to restore the missing teeth crowns, deficient soft
of surgical and prosthetic phases including the strategic and hard tissues. Hence Malo implant prosthesis was
treatment planning of restoring an esthetic zone having planned to rehabilitate compromised supporting tissues.
defective supporting tissues using Malo implant bridge. Prosthetic phase
The role of Malo implant prosthesis for achieving Implant level impression was planned using custom-made
optimum prosthetic needs and patient satisfaction has been open tray technique. Wax spacer (Fig. 2) was adapted and
described. custom-made tray fabricated (Fig. 3). Gingival formers
Case Report were removed and impression posts were attached and
A 20 years old male patient reported to the department of radiographically evaluated (Fig. 4). Definitive impression
prosthodontics for the prosthetic phase of implant placed was made using mono phase addition silicone impression
in upper front region. The chief complaint was missing material (Aquasil Ultra Monophase- Dentsply, India). Lab
teeth in the upper front teeth region. The patient gave a analogs were attached to impression posts (Fig. 5).
history of exfoliation of 12, 11 and 21, due to trauma Gingival mask placed and cast poured. Verification jig
during road traffic accident 6 months back. And was received from the lab and evaluated in patient’s
underwent implant therapy concerning above region 8 mouth. Inaccuracy was found between jig with relation to
months ago. He was wearing a removable dental 11 and 21 regions. Hence, jig was sectioned (Fig. 6) and
519

prosthesis and he was dissatisfied because of poor accurate fit was ensured followed by which jig was
aesthetics, phonetics and compromised function. splinted using composite resin material (Fig.7) and new
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Dr. Meenakshi. T M.D.S., et al. International Journal of Dental Science and Innovative Research (IJDSIR)

impression was made for further lab work. Designing The clinical condition of the current case report belongs to
(Fig.8) and milling (Fig.9) of Titanium framework was FP-3 option due to compromised edentulous in maxillary
fabricated by using CAD/CAM technology and milled anterior esthetic zone. Malo implant bridge allowed
Titanium framework having gingival area fused with correction of ridge defect without any additional surgical
acrylic resin was tried-in patient mouth (Fig.10) and invasion for ridge correction. Paulo Malo et al., [8] in
implant framework interface was verified with radiograph 2011 reported longitudinal study with 10 years follow up
(Fig.11). Shade selection was done for three individual including 245 patients and 980 immediate function
porcelain fused to metal crowns. Metal ceramic crowns implants treated with Malo prosthesis concluded high
were tried on Titanium framework (12). This final prosthetic survival rate with his invention.
prosthesis was tried in patient’s mouth. Occlusal The bone defect was successfully corrected with
interferences were evaluated and eliminated. Titanium CAD/CAM designed Titanium framework and this screw
framework was screw retained over implant and retained framework makes it easy to retrieve for further
individual PFM crowns were cemented using zinc oxide evaluation and corrections with minimal complications.
eugenol cement following standard clinical protocol. Prosthesis with individual PFM crowns enhanced the
Later, screw access openings were concealed with esthetics. Use of Titanium framework provided splinting
composite resin material (Fig. 13). mechanism, more precision fit and uniform stress
Patients esthetic concern was highly satisfied. Patient was distribution. So, fulfilling the biomechanical requirements
recalled for periodic follow up. Clinical and radiographic of prosthesis with reliable success rate.
examination of one year follow up showed no signs of Conclusion
inflammation and mobility (Fig. 14) or bone loss. Once Osseo integration has been achieved, the clinical
Discussion fate of the prosthesis primarily relates to the precise fitting
In this case report, due to trauma, there was a deficient of the prosthetic superstructure on the implant fixtures that
bone in relation to 12, 11 and 21 region resulting in will determine the patient satisfaction and overall
Seibert’s class II ridge defect. Depending on hard and soft treatment success. This precision was achieved by
tissues architecture in 1991 Misch [1] suggested 3 strategic treatment planning of Malo implant prosthesis
prosthodontic options for fixed prostheses as FP-1, FP-2 making it a novel concept for prosthetic rehabilitation.
and FP-3. FP-3 is the option that replaces the missing References
tooth, gingiva and portion of the ridge tissues. The 1. Misch, CE, ‘Prosthodontic options in implant
restorative material of choice for FP-3 is a hybrid dentistry’, Int J Oral Implantol, vol. 7, no. 2, 1991, p.
restoration of denture teeth acrylic and metal substructure 17-21.
or a porcelain-metal restoration. Prosthetic treatment plan 2. Randow k, Ericsson I, Nilner K, Petersson A, Glantz
of the present case intended to restore the excessive crown PO, ‘Immediate functional loading of Branemark
height space by fabricating small titanium framework to dental implants. An 18-month clinical follow-up
support the 3-porcelain fused to metal crowns along with study’, Clin Oral Implants Res, vol. 10, no. 1, 1999, p.
520

the esthetic replacement of soft tissue. 8-15.

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Dr. Meenakshi. T M.D.S., et al. International Journal of Dental Science and Innovative Research (IJDSIR)

3. Chow J, Hui E, Liu J, Li D, Wat P, Li W et al., ‘The Legends Figures

Hong Kong bridge protocol. Immediate loading of
mandibular Branemark fixtures using a fixed
provisional prosthesis: preliminary results’, Clin
Implant Dent Relat Res, vol. 3, no.3, 2001, p. 166–
174.
4. Fortin Y, Sullivan RM, Rangert BR, ‘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’ Clin Implant Dent Relat Res, vol. 4, no.
Fig. 1: Siebert’s class III-ridge defect with respect to 11,
2, 2002, p. 17-21.
12 & 21 region.
5. Branemark PI, Engstrand P, Ohrnell LO, Grondahl K,
Nils- son P, Hagberg K et al., ‘Branemark Novum: a
new treatment concept for rehabilitation of the
edentulous mandible. Preliminary results from a
prospective clinical follow-up study’, Clin Implant
Dent Relat Res, vol. 1, no. 1, 1999, p. 2–16.
6. Malo P, Rangert B, Nobre M, ‘All-On-Four
immediate-function concept with Branemark system
implants for completely edentulous mandibles: A
Retrospective clinical study’, Clin Implant Dent Relat
Res, vol.5, no. 1, 2003, p. 2-9. Fig. 2: Wax spacer

7. Seibert JS, ‘Reconstruction of deformed, partially

edentulous ridges, using full thickness onlay grafts.
Part I. Technique and wound healing’ Compend
Contin Educ Dent, vol. 4, no. 5, 1983, p. 437-53.
8. Malo P, Nobre M, Lopes A, Moss SM, Molina GJ, ‘A
longitudinal study of the survival of All-on-4 implants
in the mandible with up to 10 years of follow-up’ J
Am Dent Assoc, vol. 142, no. 3, 2011, p. 310-20.

Fig. 3: Open Impression Tray

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Dr. Meenakshi. T M.D.S., et al. International Journal of Dental Science and Innovative Research (IJDSIR)

Fig. 4: Periapical radiograph of Impression post Fig. 7: Acrylic jig splinted with composite resin

Fig. 5: Final Impression with lab analogues Fig. 8: CAD-CAM design for Titanium framework

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Fig. 6: Acrylic Jig sectioned Fig. 9: CAD-CAM designed Titanium framework

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Dr. Meenakshi. T M.D.S., et al. International Journal of Dental Science and Innovative Research (IJDSIR)

Fig. 10:Titanium framework try- in Fig.13: Screw access openings covered with composite
resin material

Fig.11: Periapical radiograph of framework implant

Fig. 14: One-year post-operative periapical radiograph
interface

Fig.12: PFM crowns and Titanium framework

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