Full mouth implant rehabilitation
04 September 2015
Mrs C. visited the Dental and Implantology Unit in 2004 after being referred by her doctor. Her main problem was gum disease. She had already lost many teeth in both jaws due to tooth loosening and was wearing partial dentures which she found to be very uncomfortable. It was her wish to restore her dentition completely.
 
She was initially seen by both the Prosthodontist and the oral surgeon. Examination revealed advanced gum disease with mobile teeth in both jaws. The earlier loss of teeth had lead to drifting of her remaining teeth. This altered her bite significantly in such a way that her remaining upper right teeth were over-erupted. Mrs C. had learnt how to control her smile so as not to show her teeth and had also stopped going out with friends as she was embarrassed.
 
 
Fig 1: Pre-treatment
 
Radiographs confirmed the advanced state of her gum disease but also showed that she had adequate bone for implant treatment. Once the treatment plan was drawn up and accepted by the patient, she was seen by the prosthodontist to prepare temporary fixed full mouth restorations.
 
In two separate sessions, both under local anaesthesia and intravenous sedation, she had one jaw treated at a time. Teeth were removed, an alveoplasty (re-shaping of the underlying bone) performed and implants were inserted. In this case, Replace implants (Nobel Biocare AB, Gothenburg, Sweden) were inserted into both jaws. Four implants were placed, following what has been termed the ‘All-On-Four’ approach. The upper jaw required bone grafting to maintain the bone anatomy. Scrapings of her own bone were harvested from the same site and inserted into the sockets and defects. The bone graft was protected with a membrane (a process termed Guided Tissue Regeneration).
 
 
 Fig 2: The acrylic frame design and the final titanium frame prepared for the lower jaw reconstruction
 
Temporary fixed bridges were used during the healing period. After six months, the prosthodontist took over her care. Impressions were taken, the final bridgework was designed and approved by the patient. Only then was the framework designed. This was sent over to Sweden and the framework was scanned and laser cut from a single block of titanium.
 
Once completed, both the upper and lower jaw bridges were fitted and checked. The patient has been followed up regularly without any problems. She reports that the treatment has changed her outlook on life and is socialising normally.
 
 
Fig 3: Final X-ray showing four implants in either jaw.
 
 
Fig 4: End result.
 
Related Material
Crowns and conventional bridges or dentures need not be your only options when replacing missing teeth. For some people, dental implants offer a smile that looks and feels very natural.
Single-tooth implants can be used in people who are missing one or more teeth. An implant is surgically placed in an opening that your dentist makes in the jawbone.
When all teeth are missing or in such condition that they need to be replaced, dental implants are the best permanent solution.