Clinical
A patient-removable full arch upper fixed bridge
Dr Willie Jack describes a case of an implant supported bridge that provides a win-win-win for patient, technician and dentist
W
hen contem- p la ting replacing f ailing
upper teeth with an implant solution, patients would mostly prefer to have a bridge that is permanently fixed to implants. However, the main challenge
with this is that they often have an uphill battle to maintain good oral hygiene, especially if the bridge has good anterior lip support as this will make flossing almost impossible. On many occasions, I have
had to opt for a full upper removable denture, retained using Locator abutments as the lip support required was too great to be accommodated within a bridge which resulted in effective oral hygiene prac- tices (in addition, some of these full arch permanently fixed bridges have challenges with phonetics for months after completing a case). I have made dentures which
are neater than a conventional full upper denture as they omit the palate, but this is quite complicated as it needs to be reinforced with chrome cobalt; relines often being impossible. They do work well, but, of course, although retention is improved with the Locators, the denture is still tissue borne. My ideal restoration would
be a fixed bridge that is wholly implant borne, gives full lip
support and is removable so the patient can maintain good oral hygiene. I have tried several designs but, until recently, all have been a compromise. In most cases, there are two
reasons why I prefer to use Straumann SLActive implants: ı. The SLActive surface is bio- active and allows for rapid osseo-integration. 2. Tissue level implants have a built in ‘collar’ of titanium so that the prosthetic connection is positioned away from the bone crest. These two factors help to
achieve a high level of inte- gration with bone that is then maintained over the long term. I have used many other dental implant systems over 20 years but have returned to using Straumann due to the systems’ predictability and reliability.
Treatment plan The patients’ posterior teeth had been adversely affected by periodontal disease (Figs ı and 2) and had been extracted previously; the patient was then left with the six upper anterior teeth only, all of which had some degree of mobility (Fig 3). She wanted to avoid a remov-
able denture at all costs and was willing to function without any posterior teeth during the duration of the treatment. Eight weeks after the posterior teeth were extracted, six implants
“The patient wanted to avoid a removable denture at all cost”
Fig 1 Pre-op retracted
were placed at upper 542/245; both upper lateral incisors were extracted and immediate implants placed (Fig 4). The premolar sites were
of reduced bone height and volume due to bone loss from previous periodontal disease and, especially on the upper left side required guided bone regeneration using BioOss and BioGide (Geistlich Pharma AG). All implants were closed with closure screws for a two-stage closed healing protocol.
SUMMARY Case selection
ascertaining tissue loss and lip support required identifying adequate bone quantity & quality
Treatment planning • deciding when teeth need to be extracted • is it possible to avoid a denture during the provisional stage?
• one or two stage approach • osseo-integration timescale
Implant predictability and reliability Straumann SLActive implants – tissue level
Bridge accuracy and design
Dentsply Implants Atlantis ISUS 2in1 primary and secondary bridge
Fig 2 Pre-op smile If I had placed four implants
rather than six, this would have reduced the cost, but I wanted to have a full arch bridge and I knew I had enough bone volume for two implants on each side distal to the canines. Placing six implants will reduce the load on each of the implants and give a greater safety margin in case an implant was to fail (with only three implants the case would be unrestorable). Just prior to placing the
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Scottish Dental magazine 55
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