Amit Patel shares his recent case, where he provided full-arch rehabilitation for a patient.
A 62-year-old patient was considering a fixed solution as an alternative to the maxillary denture that she had worn for a while. Due to her dentures moving around in her mouth, she was experiencing pain when chewing, as well as difficulties speaking. This made her feel embarrassment and affected her confidence when eating and communicating with others.
After a thorough medical history and clinical assessment, it was concluded that the patient was otherwise in a state of good health. She did not smoke and took good care of her remaining teeth.
The treatment options were presented to the patient; no treatment, a replacement denture, a removable implant-retained denture or a fixed implant-retained full arch prosthesis. After giving the patient a comprehensive overview of each individual option, she stuck with her original preference for the fixed implant-retained prosthesis. This was due to its improved stability and comfort compared to removable options, as well as the achievable aesthetics.
Treatment planning
A radiograph and a CBCT scan were taken to assess the bone and whether it was of sufficient height and density. There were no pathologies present and the patient had adequate bone for implant placement, with no need to perform a bone graft. An intraoral scan of the upper and lower jaws was also taken which was then used to fabricate a 3D study model. This allowed me to evaluate certain factors such as the maxillomandibular relationships.
The intraoral examination also revealed that the patient had a high smile line. To ensure that the transition line was invisible, an alveoloplasty was planned to take into account the restorative space present and to hide the transition line. A FP3 prosthesis would also be created.
A treatment plan was then devised and shared with the patient, noting the timeframe of the treatment, the costs and any potential risks or complications. After answering the patient’s queries, I emphasised her role in the maintenance of her oral health both during and after the treatment. As the patient already had an adequate comprehension of how to maintain good oral hygiene, she demonstrated her understanding of the extra precautions she must employ to ensure the implants remain healthy and long-lasting. Fully-informed consent was then obtained.
Surgery
Six Straumann® BLX 3.75 diameter implants were selected as they are developed for optimal stability in all bone types due their thread design. Plus, the SLActive® surface is beneficial for reducing the healing and integration period.
The surgery was performed under local anaesthesia. Once the incision was made in the maxilla, the alveoloplasty was performed. The sites were prepared with the Straumann® BLX, two implants were placed in the anterior region with two more placed at an angle in the premolar region. A further two were placed in the second molar site to achieve maximum anterior-posterior spread of the implants. The soft tissue was sutured with a tension-free closure, to ensure successful healing and aesthetics.
The patient was provided with a full denture to wear during the healing period so she was able to perform basic functions, such as eating and speaking. She was reminded that there may be some swelling, minor bleeding and some pain at the implant sites, and she was given all normal post-operative oral hygiene instructions.
Post-op
After three months the patient returned. The implants had integrated successfully, radiographs were taken to assess the bone levels around the implants, and multi-unit abutments were then placed. The prosthetic metal frame was tried on the study model with composite teeth to assess the bite registration. The final prosthesis was then fitted in the mouth and the patient was very satisfied with the final outcome.
Three months post placement of implants with milti unit abutments
Dental implants have become an increasingly viable option for partially- or fully- edentulous patients, improving their quality of life due to the stability, aesthetics and longevity of treatment. However, with all in things in dentistry good treatment planning is vastly important to ensure the patient receives the best possible outcome and a restoration that can be easily maintained by the patient. Radiographs are taken on a yearly basis alongside periodontal probing of the implant abutments to assess any changes in the peri-implant tissues.
For more information visit https://www.straumann.com/en/dental-professionals.html