A perfect fit (full arch implant-supported prosthesis)

Fixed, permanent solution

The options discussed during the initial consultation included remaking the dentures, securing them with locators or an implant-supported full-arch prosthesis. As he wanted a fixed, permanent solution, the patient chose the latter. 

At the first appointment, 2D orthopantomogram and 3D cone beam CT images were taken to confirm the amount of resorption that had occurred and the density of the remaining bone [Figure 2]. Primary impressions were prepared to enable the manufacture of a lower full arch wax try-in denture by Ceramic Designs Laboratory. The wax denture was cast up with laboratory analogues, allowed to set and then trimmed. A verification jig and a try-in, with plastic reinforcement running through it, were manufactured. The try-in allowed the patient to see the colour and shape of the planned prosthesis. Occlusion vertical dimension, tooth position, centre-line, horizontal and vertical axes, and bite registration were all checked. 

The simple, predictable laboratory process

Once the patient was happy to proceed, a 3D design was created and forwarded to Anthogyr for the fabrication of the titanium bar. The model and try-in were also posted to the company’s production team to be scanned in, allowing the bar design to be placed within the prosthetic envelope. The plan was sent back to the laboratory to be reviewed, using a 3D viewer, to confirm gaps and spaces were accurately reproduced within tolerances, giving the required aesthetics. Once verification had taken place, the milling process began. 

A few days later, the bar was delivered and a silicone key of the original try-in was attached. This was sent to the surgeon to try in, immediately prior to implant placement. When the surgeon and patient had signed off the prosthesis, it was returned to the laboratory for processing, finishing, and characterisation. 

Laboratory analogues were attached to the impression copings and a soft tissue mask was created before the first pour [Figure 3]. Prior to working up the prosthesis in acrylic, temporary cylinders were accurately positioned, to ensure the screw access holes were ideally located [Figures 4 and 5]. 

The junction between the bridge and tissue was fairly even, making it easy to clean [Figure 6]. Once the implants had been placed, a flat fit surface was manufactured and polished to aid good healing [Figure 7]. 

This was a simple prosthesis to produce. Delayed load implant cases are easier and more predictable, as the conversion is not on the same day. Anthogyr’s production team provided a prompt service that worked well with the laboratory workflow timescales.

Management of bone resorption

Once the prosthesis had been checked and returned to the laboratory for finishing, the patient was given intravenous sedation and six Axiom^®TL narrow implants with inLink^® connections were placed in the lower jaw [Figure 8]. Tissue level implants were chosen, as there had already been some resorption of the jaw bone. Given the large frame of the patient, and the forces expected to be exerted on the prosthesis, it was decided that six implants would provide better stability than four. Once the implants were placed, the flap was closed with sutures [Figure 9].  Guide pins were fitted to enable an open tray impression to be taken for the manufacture of the fitting surface of the lower prosthesis [Figures 10 and 11]. 

Balanced occlusion

After two days, the patient returned to have both a removable upper full denture and the fixed lower full arch bridge placed.  Soft tissue healing was progressing well [Figure 12] and the fit was perfect – very accurate and stable – with balanced occlusion.  The inLink^®connections made attaching the prosthesis quick and simple [Figure 13].  With one-piece implants, there are less moving parts and maintenance is easier.

Confidence boost

The patient was extremely happy with the outcome. It changed his life overnight and gave him a major confidence boost, along with the ability to enjoy the food he had not been able to eat for some time [Figure 14]. He has attended regularly for post-surgery follow-up appointments and, at his recent six-month check, the prosthesis remained stable. The long-term plan is to replace the upper denture with another implant-supported prosthesis.

Dr. Werner Slabbert BChD (Stell), MClinDent Oral Surgery (Lond) DipImpDent (UWC) DipSed (Kings), MJDF RCS (Eng)

Dr. Werner Slabbert has a passion for advanced dentistry and in particular implantology, oral surgery, and sedation.  He has extensive experience in difficult extractions and implants, and regularly accepts referrals from other dentists. He has completed oral surgery training to specialist level.

Sussex Implant Centre
Hazel Cottage, Warren Road
Woodingdean, Brighton  BN2 6DA
Tel: 01273 698045
Email
www.susseximplantcentre.com