Clinical
implant success Six of the best for
Dr Avik Dandapat BDS(Birm), MFGDP(UK),
Dip.Imp.Dent RCS(Eng) describes placing a screw-retained prosthesis based on six dental implants in a 70-year-old patient unhappy with her current denture
T
he patient initially attended in 20ıı. She was in her 70s and had recently lost the upper
retainer teeth on her partial chrome denture. She was extremely distressed with her new full upper denture and wanted a long-term solution.
History of complaint Over the last five years she had worn a partial chrome denture retained by three teeth. These teeth had progressively dete- riorated and were recently extracted by her GDP. They had added to the existing chrome denture making a very bulky and heavy upper full denture.
Medical history Apart from suffering from Bells Palsy and having a distinct lack of facial muscular function on the left side, the medical history was unremarkable.
Extra-oral examination • TMJ appeared sound and no pathology detected on examination
• Lymph nodes: clear • Muscles of mastication: appeared normal and with functional limits
• Facial muscles: exhibited atrophy on the left side and the reduced function of the following muscles: • depressor anguli oris • mentalis • zygomaticus major and minor.
The most distinct element
we observed was when the patient smiled, only the right side of the muscles used in smiling was functional. However, the patient was aware of this and under- stood that we would work in harmony with the current neuromuscular function. There was also an obvious
loss of maxillary bone and support to the soft tissues.
A decreased OVD was also present. All of these issues were, however, corrected by the use of a well-constructed full denture replacing these areas and supporting the soft tissue.
Intra-oral examination Soft tissues were clear and free from any pathological signs. Dental examination found that the lower dentition was stable, oral hygiene was good and BPE no more than one. Heavily restored molars and another eight remaining teeth present.
Patient discussion After the examination, we discussed the various forms of treatment available with the patient and potential levels of investment required. The options were as follows: ı. a complete upper denture 2. an upper denture retained by four implants and splinted with a bar
3. a screw-retained hybrid bridge on six dental implants replacing facial support and utilising prosthetic replacement of tissue support but with no grafting or sinus work
4. A full hard and soft tissue reconstruction with hip grafting and up to eight dental implants and a cement-retained bridge. After discussion, the patient
opted for the screw-retained prosthesis based on six dental implants and decided against extensive and invasive recon- structive surgery. From this point, the treatment plan could commence.
Initial tests ı. Impressions 2. face bow record 3. photographs 4. study models and new temporary denture made
Continued »
Fig 1 Six DIO SM implants placed in the upper
Fig 2
Six DIO Multi-Unit screw-retained abutments placed
Fig 3 MediMatch framework try-in
24 Ireland’s Dental magazine
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48