ABSTRACT
This article presents a bimodal procedure for a patient with an implant-supported fixed partial denture (FP2 class of Misch) where endosteal implants (EOIs) and a subperiosteal implant (SPI) were indicated in different sections of the same arch. In edentulous patients, heterogeneous bone volume and density may be encountered in different regions of the same arch. When the available bone is favorable, the use of EOIs is simpler and less time consuming. An SPI is indicated when the available bone is severely resorbed, as in the type I division C, type II divisions C and D, and type III divisions C and D. The main advantage of the described combined technique is that it offers an alternative to invasive surgeries such as iliac crest bone grafts or various surgical augmentation procedures. The second advantage is the very brief healing period after insertion of the SPI before prosthetic loading. Planning, design, laboratory construction, surgical application, and prosthetic rehabilitation for bimodal implant treatment are described. Prefabricated titanium tissue abutments are used in the fabrication of the posts of the anterior titanium SPI. Titanium tissue abutments are placed in the waxup stage of the SPI before the casting of the titanium SPI. Posterior fixtures are EOIs. An anterior SPI with 4 posts and 4 posterior EOIs provides a combination of support for the screw-retained fixed maxillary denture of Misch's FP2.
