Terminal Dentition Case Study

Terminal Dentition Case Study

Immediate functional loading in full arch restoration is a preferred treatment option for those patients with a failing dentition or those patients who wish to replace loose, troublesome dentures for both upper and lower jaws. This may be achieved from either the conventional implant approach or using the new, revolutionary option of CT scans and guided surgery.

As more and more patients seek advice for treatment options for failing, periodontally involved teeth and failing bridgework. We created this technique to offer an alternative option to traditional denture options or conventional implant treatment, when implants are placed, left for 4-6 months before lading them with teeth. Immediate functional loaded full arch restoration involves removing all failing teeth, placing 4-6 implants and providing an immediate, provisional functional bridge that is usually replaced 6 months later.


Presentation

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Sandra came to see me for some treatment options for her upper and lower failing teeth. All her upper teeth were mobile and needed to be removed although she was keen to avoid any dentures.

A treatment plan involved a removing all her remaining teeth, placing 4 upper and 4 lower implants and providing her immediate full arch provisional bridges. These would be replaced 4-6 months later, depending on soft tissue healing.


Stage 1- Implant treatment

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A denture setup is constructed to use as a surgical guide and treatment involved using distally angled implants and low profile abutments to ensure an adequate anterior-posterior spread was achieved.

During planning it was seen that there was no requirement for an artificial gingivae for the upper arch whereas the lower arch treatment involved flattening the ridge and providing some “pink” for both the provisional and final bridgework.


Stage 2- 4 months later

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4 months after implant treatment satisfactory healing was observed and final impressions were taken. Even though the distal implants were intentionally distally placed, low profile abutments allow the implants to be uprighted and allow ease of restoration.

As seen, the upper bridge was constructed with no artificial gum whereas due to the remodelling of bone prior to implant placement, composite was used as part of the bridge for the mandible. At no stage did our patient ever have to wear dentures


Treatment summary

Treating the terminal dentition is a very challenging prospect to any dentist. Using strict immediate loading protocols allows patients to not only enjoy an immediate solution to their problem but also to improve their smile, bite and function. The concept is possible because of materials used, low profile abutments to upright implants, length of implants and cross arch stabilisation.

Presentation

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Final bridges

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Before & After smile

As seen from this case, we can offer an laternative treatment to either failing teeth or dentures. 4-6 implants are generally used to support full arch bridgework.