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Slide Pubblicazioni Scientifiche

A new phase of life (quality) Implant-supported fixed denture

Magazine PIP • Practical implantology and implant prosthetics • May 2020

A new phase of life (quality) Implant-supported fixed denture

Dr. med. dent. Peter Randelzhofer

A restoration with a full denture requires the complete loss of all teeth. Formerly it was known as an important but often not popular restoration. On implants, the removable bridge restoration with palate-free complete denture represents an aesthetically and functionally complete restoration with fixed denture.
The 60-year-old patient came to our dental clinic with discomfort, and she no longer liked the appearance of her teeth (Fig. 1-3). After clinical and radiological diagnostics, it turned out that the remaining teeth represented a potentially “empty jaw condition”, since all teeth had to be extracted due to the periodontal and prosthetic situation (Fig. 4).

Clarification and choice of restoration

After clarifying and explaining the treatment options, especially with regard to the narrow diameter of the lower alveolar ridge, the patient was initially unsure. At first she was sceptical about a restoration with a removable bridge on an implant-supported framework. On the other hand, restoration with a non-removable bridge restoration on implants was significantly more cost-intensive and certainly not better, in terms of function or aesthetics. It was then agreed that she would first become familiar with a bridge-supported restoration on implants regarding form, function and phonetics as part of the interim restoration, and decide later. In any case, a restoration with fixed teeth was important, as the floor of the mouth was so high that a pure prosthesis would not be supportable in any way.

Planning and first surgical phase

Against the background of a compromised bone bed in the upper jaw and the narrow alveolar ridge in the lower jaw, initially eight implants in the upper and four implants in the lower jaw were planned. The purpose was an even load distribution on the prosthetic pillars (implants) in the bone. Our implant of choice was a cone-shaped, morse locking implant with a aggressive apical thread, which guarantees excellent primary stability in soft bone. The hybrid screw morse locking conical connection of the subcrestal implant (C-Tech) provides additional security against loosening of abutments, the formation of gaps or micro-movements. Before extraction of the teeth, impressions were taken, the extra-oral inclination of the condylar track and the hinge axis were determined, the occlusal position and lateral excursions were recorded, the position of the lower jaw was determined and the models were articulated in the average movement articulator. The teeth were then etched on the plaster model. A full denture was made as an interim denture. One week after extraction of the teeth, we soft relined them and put them in place.

Implant placement

After three months, the patient came to the dental clinic for implant placement (Fig. 5-7). Although the healing times of the implants in the upper and lower jaw differed with five months in the upper jaw and three months in the lower jaw, the patient had requested that the intervention should be carried out on the same day. The incision was mid-crestal with a slight displacement of the incision in the palatal/lingual direction in order to be able to gain a sufficiently large buccal flap for later augmentation (Fig. 8). Four implants were placed in the lower jaw and due to the weak bone six implants in the upper jaw (Esthetic Line, C-Tech) (Fig. 9).

According to the surgical protocol the implants were placed slightly subcrestal (Fig. 10, 11), covered with healing abutments as cover screws and optimising the bone deficits on the alveolar ridge with a-PRF (Mectron) and bone substitute material (The Graft, Regedent) (Fig. 12). After augmentation, we covered the alveolar ridge with a membrane (Ossix Volumax, Regedent) and sutured the tissue flaps primarily and tension-free over the augmentation (Fig. 13). We did the same in the lower jaw. After augmentation, covering of the graft, fixation with sutures (Fig. 14-16), a radiography was taken (Fig. 17).

Exposure and healing period

After two months, the implants were first exposed in the lower jaw and three months later in the upper jaw (Fig. 18) and restored with healing abutments. Sufficiently fixed gingiva around the implants was necessary, so we performed a vestibuloplasty. The palatal flap was split (Fig. 19), a wide bed of fixed gingiva was created using a rolling flap and sutured around the healing abutment (Fig. 20). One week later, the prostheses were fitted with a soft relining. Four weeks later, the sutures were already removed, the gain in three-dimensional volume on the alveolar ridge was analysed. The bone deficits in the lower (Fig. 21, 22) and upper jaw (Fig. 23, 24) were augmented and the jaw shape was balanced with healthy looking, sufficiently wide gingiva around the implants. The interim prosthesis was again soft relined until the final restoration was completed (Fig. 25). The patient got so used to the implant-supported bridge that she wanted to keep the removable version. The production and integration of the prosthetic restoration will follow in the first edition of the magazine pip in 2021.

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