Clinical
Fig 11 Implants in situ
Fig 12 Final smile
Fig 13 Retracted view
Continued » Fig 14
bridge. You can see from the photographs that the inside of the bridge is a perfect fit for the bar. In fact, when I was trying everything out chair-side, I put the primary and secondary together to check the fit and I had quite a task to separate them again! (Figs 5 to ı0) At the fit appointment, I
removed the provisional screw- retained bridge and the healing caps from the most distal two implants. With some trepida- tion, I picked up the bar and fitted it to the six implants. I needn’t have worried as the fit was perfect. You can see from the photo-
graphs that the bar fits perfectly on the soft tissues and this high degree of accuracy can be confirmed from the X-rays. Likewise, the bridge fitted evenly and snugly over the bar, with no sign of blanching or rubbing of the tissues. What did require adjustment
was the pins and the amount of acrylic around them. Patients do require a degree of dexterity to manipulate these and so,
Stuart Smith at WSDL made up a couple of tools to push out the pins from the palatal. After a demonstration, the patient quickly got the idea of the angle and force required to push the pins out. I prefer to use acrylic teeth for a bridge such as this as it will be easier to adjust and maintain in the future. Like all Dentsply Implants
products, the bar is very well milled and, being made in ı00 per cent titanium, the tissue response is positive as can be seen from the photo of all six fixture heads (Fig ı2) – this was one month after the fit. Patients do have to be shown
how to clean underneath the bar using toothbrushing and flossing, but if there are any problems, the bar can easily be unscrewed from the fixtures if adjustments are required to allow floss to pass easily underneath. This case was the second of four similar cases with others in the planning stages. All round a win-win-win situation for patient-technician-dentist (Figs ı2 to ı4).
Bibliography Belser, UC, et al (2004) Inter- national Journal of Oral & Maxillofacial Implants, ı9 Suppl, 30-42. Buser, D, et al (ı997) Clinical
Oral Implants Research, 8, ı6ı-72.
Buser, D, et al (2004) Inter-
national Journal of Oral & Maxillofacial Implants, ı9 Suppl, 43-6ı. Esposito, M, et al (2007)
Cochrane Database of System- atic Reviews, CD006697. Fischer, K et al (2004) Inter-
national Journal of Oral & Maxillofacial Implants, ı9, 374-8ı.
Garber DA, et al (ı995)
Compend Contin Educ Dent. Aug;ı6(8):796, 798-802, 804. Hammerle, CH, et al.
(ı998) Clinical Oral Implants Research, 9, ı5ı-62. Schultes, G et al. (200ı)
Oral Surgery Oral Medi- cine Oral Pathology Oral Radiology & Endodontics, 92, ı7-22. Schwartz-Arad, et al (2000)
Journal of Periodontology, 7ı, 923-8.
ABOUT THE AUTHOR
Dr Willie Jack BDS (Univ Ed), DGDP (RSC Eng), MGDS (RCS Ed), MMedSci Oral Implantology & Biomaterials (Univ Sheff), qualified from Edinburgh in 1983, initially working as a community paediatric dentist for Lothian Health Board. He moved to Wales in 1985 to established an NHS practice, going private in 1990.
He has been placing implants since 1991 and in that time has placed over 3,000 implants in more than 1,000 patients.
He currently splits his time between Ludlow in the West Midlands and Edinburgh at Stafford Street Dental Care.
willie@williejack.com www.williejack.com
GDC No 57620 Scottish Dental magazine 59
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