dental practice July 2009
Implantology Update www.dental-practice.org
Restoration of a uni-lateral
posterior maxilla with an implant-
retained bridge
Harry Shiers presents a further case report in his bi-monthly series
T
HE patient was a 53-year-old seen. Figure 3 shows a digital peri-
male, a non-smoker and with apical image of the upper right second
no significant medical history. molar and upper right second pre-
He was an engineer by profession. molar, where the extent of the decay in
He had lost his right 1st maxillary the maxillary second molar is seen
molar (RHS) around five years more clearly.
previously. Subsequently, he developed The prospective treatment options
a large carious cavity in the maxillary were offered to the patient. They
second molar (RHS) and was referred included extraction and to live with the
to an endodontist for treatment. space or restore the space with a
The endodontist felt this tooth removable or fixed prosthesis. The FIG 1 FIG 3
would be unrestorable and advised patient wished to have a fixed
that it be extracted. Faced with the prosthesis and therefore an implant-
prospect of a large gap in the posterior retained bridge was chosen.
quadrant, the patient was referred to Studying the RHS maxillary sinus,
the practice in January 2005 for there appeared to be adequate bone
consultation regarding the upper right mesially and distally to the largest
quadrant. expansion of the sinus, which was
On examination, the patient primarily centred above the maxillary
demonstrated a fairly heavily restored 1st molar site.
dentition with one metal ceramic The implant positions were planned
FIG 2
crown and five amalgam restorations in either side of this dip in an effort to
the maxilla, and four gold crowns (two avoid a sinus elevation.
periotomes and luxators. The patient FIG 3a
of these teeth root-treated) and three Impressions were made, a face bow
was reviewed one week later and
further restorations in the mandible recorded and the laboratory asked to
healing had been uneventful. A two-stage surgical procedure was
(Figure 1). create a wax-up of three teeth and a
A pre-operative appointment was planned; surgical placement of the
The most extensive restorative work surgical stent.
made for the end of March when two implants was carried out at the
was in the posterior segments and Because of the bruxing habit, we
further peri-apical radiographs were beginning of April 2009 and the
there was evidence on the teeth of a requested the wax-up and the final
taken prior to the selection of the second stage surgery was performed
bruxing habit. teeth to have a reduced occlusal table
implants (Figure 3a). two-and-a-half months after implant
Figure 2 shows the DPT of the and be of pre-molar dimensions.
Two Astra Osseospeed implants placement. Head of implant
patient at presentation: the peri-apical At the start of February 2005, the
were selected, a 5.0mm diameter for impressions followed three weeks later.
radio-lucency associated with the right maxillary second molar was
the most posterior site and a 4.0mm Figure 5 shows the impression
mesio-buccal and palatal roots may be sectioned and carefully extracted using
diameter for the anterior site. copings in situ. Once the model had
FIG 6
FIG 8 FIG 10
FIG 4
FIG 5 FIG 7 FIG 9 FIG 11
14
DP July 09 8, 10, 12-20, 22.indd14 14 24/6/09 13:15:52
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