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Rehabilitation of partial and total edentulism with Toronto Bridge Prostheses; 3 case reports
While treatment planning of partially or completely edentulous patients, selecting a particular prosthesis design requires consideration of factors such as the amount of crown height, the relationship between the maxillary and mandibular crests, the number and location of implants and patient demand. In cases where it is desired to support soft tissue and lip as well as hard tissue, Toronto systems can provide aesthetic and functional advantages. Toronto Systems are hybrid prostheses with cement-retained crowns on screwed framework , which are generally used in cases where the crown height is high. The aim of this article is to describe the rehabilitation with Toronto bridge prostheses of 3 different cases that could not be rehabilitated with conventional fixed prostheses due to aesthetic and biomechanical limitations. Material Method: Case 1: 38-year- old female patient with maxillary central and lateral teeth loss and Class 3 jaw relationship was restored with Toronto Bridge Prosthesis after 2 implants were placed in the maxillary areas 12-22 by implant surgery. The reason why the Toronto bridge prosthesis was preferred in this case was to increase the soft tissue support in the upper jaw and to reach a more aesthetic solution. Case2: 49 year old female patient with total edentulous mandible and posterior maxillary teeth loss was treated with 4 implants and hybrid all-on-four Toronto bridge prosthesis in the lower jaw due to the excessive bone loss and 5 implant and cement-retained prostheses in the posterior regions of the upper jaw. Due to the vertical dimension loss, the crown heights of the upper anterior teeth were increased with fiber posts and fixed bridge prosthesis was made. Case 3: Iliac graft was applied to a 52-year-old female patient with excessive bone resorption in her upper jaw. Following the healing process; 4 implants and all-on-four Toronto Bridge Prosthesis in mandibula, 6 implants and all-on-six Toronto Bridge Prosthesis in maxilla were planned and restored since the angulation and distance between the total edentulous lower and upper jaws is more than the ideal vertical dimension and the crown height will exceed the ideal ratio when cement-retained prostheses are made. Results: After the treatments, the patients have healthy and happy smiles. They are called twice a year to get information about their prostheses. Conclusion: Toronto Bridge Prostheses can be considered as a hybrid prosthesis treatment option in cases where cement-retained or screw-retained fixed prostheses are not expected to meet aesthetics and function.