Delivering an implant-supported, removable full arch solution
Featured Products Promotional FeaturesPosted by: Dental Design 5th June 2022
Dr Andrew Henderson from Goodwin & Associates Dental Practice in Cumbria presents a case utilising the Axiom® Multi Level® implant system from Anthogyr, a Straumann Group brand.
A patient presented having lost all his upper teeth several years ago. He was generally fit and health with a clear medical history. A full clinical assessment was conducted, identifying a Class III skeletal pattern and a retained lower 4-5 (shortened dental arch). Lower posterior support had been lost entirely.
The patient had already tried and failed to adapt to multiple removable upper and lower dentures. He had eventually resorted to chewing soft food against his gums because he just couldn’t tolerate the dentures. He was in desperate need of a fixed solution to first and foremost improve his dental functional, in turn enhancing his nutrition, aesthetics and self-confidence.
Treatment planning
We decided early on that due to the underlying Class III skeletal pattern – which was further exaggerated by buccal resorption – that a fixed prosthesis without significant bone grafting would be unsuitable. The patient also expressed a preference for a removable prosthesis that could be taken out of the mouth for easy cleaning.
Due to the significant resorption but reasonable clearance, a bar overdenture was chosen as the most appropriate restorative option. The treatment was described to the patient in detail, including the benefits and limitations. The patient’s own role in long-term oral health maintenance was also reiterated, ensuring he was able and motivated to
Treatment
The patient was also keen to avoid bone grafting so given the significant resorption present, placement of dental implants would be fairly limited. We therefore planned to use multi-unit abutments/bar and locators to correct any divergence. The bar was, therefore, designed to allow the denture to compensate for the loss of bone and soft tissue in the anterior region, creating a Class 1 occlusion.
Conventional impressions were sent to the laboratory for fabrication of the bar – as I prefer this impressioning method for fully edentulous cases. The bar was created by John Foster of Private Prosthetics in Newcastle.
During the surgical appointment, a crestal incision was made and a flap raised. Four Anthogyr Axiom® BL 3.4x10mm implants were placed – two distally and as far back as the sinus location allowed, with the two anterior implants evenly spaced. The surgical sites were closed with no tension in the soft tissue and left to heal for three months with a temporary denture in place.
Outcome
The patient was delighted with the final outcome, both in terms of the aesthetics and function achieved. He was once again able to eat most foods for the first time in a decade. His wife was even happier – he told us she thinks we should be up for an OBE!
Discussion
The most challenging aspect of this case was the exaggerated Class III skeletal pattern we were presented with. Both the bar and denture had to be designed to compensate for this. We did run into some problems initially, with the denture uncoupling from the posterior locators in function. This was corrected by re-seating the locator inserts chairside, adjusting the occlusal contacts slightly and providing a little extra posterior support. In the end, an excellent result was achieved and, mostly importantly, the patient was very happy with the outcome.
I chose to use the Axiom® dental implant from Anthogyr because it is a simple, effective and predictable implant system which I have developed complete faith in over the years. As such, I would certainly recommend it to colleagues looking for a solution to deliver a stable and predictable implant solution to a wide range of patients.
Images
Figure 1 – Internal fitting surface of the denture and also the bar mounted on the cast
Figure 2 – Abutments in situ.
Figure 3 – Bar mounted on the abutments in situ
Figure 4a – Denture in situ
Figure 4b – Denture in situ
Figure 5a – Denture in the cast
Figure 5b – Denture in the cast
For more information and to book your Anthogyr Test Drive, visit www.anthogyr-uk.co/testdrive
Author:
Mr Andrew Henderson BDS Associate Dentist Andrew qualified from Newcastle in 2001. Andrew carries out all aspects of general dental practice, but has a special interest in implants. He has extensive intra oral dental implants experience, and has been successfully placing implants here as the practice since 2010. Andrew accepts implant referrals from other Dental Practices. Andrew also provides tooth straightening treatment using the Invisalign tooth straightening system, and offers other private and cosmetic treatments GDC Number: 79406 Date of registration 2001
