The functionally fixed restoration can meet the needs of patients in many clinical situations in which the fixed and/orremovable modalities cannot be used. The functionally fixed restoration can provide the proper esthetics and comfortfor a patient with a lack of severe alveolar support coupled with a high smile line.
If needed, it can provide profileenhancement. It can also create palateless restorations when there is not enough natural tooth and/or implantsupport for a fixed restoration. The functionally fixed restoration is the ultimate unilateral or bilateral distal extensionprosthesis. With the functionally fixed restoration, there is no need for palatal coverage or a lingual bar and it isextremely effective in combining implants and natural teeth into one restoration.The functionally fixed restoration is the perfect solution to salvaging a prosthetic restoration where implants werepreviously placed in unrestorable positions. Furthermore, this restoration can mediate the problem of poor implant-to-crown ratios.The functionally fixed tooth and tissue replacement restoration with removable ponis bar retained, yet tissuesupported.
The restoration has a fixed as well as a functionally fixed component (Figure 3). The pontics areabsolutely immobile, and do not rise from tissue resilience, nor depress from the forces of occlusion (Figure 4). Theforces from occlusion are directed perpendicularly and equally to all ridge areas. Only a direct, deliberate, preciseaction removes the pontics from the fixed permanent section containing the specialized bar. For all intent andpurposes, the removable section is functionally fixed.
It acts as a fixed restoration from a phonetic, esthetic, andmasticatory prospective. The only difference between a fixed and a functionally fixed restoration is that with the latter,the pontics can be removed by the patient for hygienic reasons.The functionally fixed restoration incorporates the use of Andrews bars and sleeves.
These attachments can be usedas a single bar and sleeve, as well as a double bar with a corresponding sleeve (Figure 5). The bar is attached to thefixed fixed prosthesis. These curved bars and sleeves are made of a special stainless-steel material that is mated totolerances of 1:2,000 of an inch. They are cut from three different sized concentric rings. The curvature of the barsand sleeves allows the covered ridge to be under constant pressure from occlusion, as well as provide the retention. Amolecular "stickiness" is created when the two pieces move against each other. Small grooves along the length of thebar prevents full metal contact, which prohibits the creation of too much retention.The attachments also allow for a quick increase in retention by crimping the bar very slightly with three-prongedpliers. The key point is that these restorations are bar-retained, yet tissue-supported.The sleeve should be set 1 mm above the bar as the acrylic comes into contact with the tissue. The attachment doesnot bottom out. The saddle and flange areas aid with the retention of the restoration, as well as help distribute theocclusal forces over the entire edentulous area. This protects the abutments from undue occlusal pressure.