Rubén Jiménez Hernández
Bar-retained maxillary overdentures supported by four implants have shown favorable survival and consistently positive patient-reported outcomes, particularly when careful prosthetic planning and high primary stability are achieved. The case presented here illustrates the clinical application of this treatment approach as part of a full mouth rehabilitation. A 64-year-old male presented with poor esthetics and function due to multiple missing teeth in both arches and nonrestorable maxillary teeth and mandibular molars. Although the mandibular arch could be restored with a combination of fixed crowns and a removable partial denture, the remaining maxillary teeth were all deemed to have a poor prognosis. In shared decision making, the patient opted for removal of these maxillary teeth and replacement with an implant-supported bar overdenture. Following minimally traumatic extraction and partial grafting of sockets using a xenogeneic bone substitute, four bone-level implants were placed immediately in the canine-premolar positions (13, 15, 23, and 25) according to a prosthetically driven three-dimensional plan, achieving insertion torques of 40-45 Ncm. After a 5-month uneventful osseointegration period and minimally invasive uncovering surgery, straight multiunit abutments and an Ackermann-type bar (a prosthetic bar design unrelated to the Eckermann implant system) were used to support a bar-retained maxillary overdenture with bilateral balanced occlusion. At the 4- and 7-month follow-up visits, peri-implant tissues were healthy, the implants and bar remained stable, and no biological complications were detected. The patient reported improved comfort, chewing ability, and esthetics. These findings illustrate the short-term clinical feasibility of this treatment approach in this individual patient.