Case histories

Case Study 1

34-year-old female was referred by her general dental practitioner for an implant retained crown to replace the missing upper right central incisor.

The natural tooth had been damaged as a child and had subsequently been root-filled and crowned. Unfortunately, the tooth became infected and had to be removed. 22 years post-injury and presented at Torrington Clinic 6 weeks following extraction.

A Straumann Bone Level implant was placed under local anaesthesia 8 weeks after extraction. A temporary adhesive bridge was while the implant integrated with the bone. A prototype crown was then placed on the implant after a period of 2 months to allow the gum to develop around the crown.

Following maturation of the soft tissues, a final impression was taken and an all-ceramic crown constructed on top of the implant.

Case Study 2

26 year old male who lost his front tooth through a traumatic accident with a bottle. The patient had worn a denture for a few years following the accident, but was unhappy with the difficulties in eating and speaking.

Following consultation and treatment planning the tooth was replaced with an implant retained crown. He is now able to eat whatever he likes, and feels that he has finally got his own tooth back again.

Case Study 3

41 year old lady who had previously lost her upper front tooth. This had initially been replaced with an adhesive bridge but the patient was unhappy with the appearance of the bridge.

There had been a considerable loss of bone following extraction of the tooth, and a bone graft was required prior to implant treatment. The upper left central incisor was finally restored with a zirconia crown supported on a Straumann implant. Treatment took almost 12 months, but the patient was delighted with the final result and felt that it had all been worthwhile in the end.

Case Study 4

A 50 year old female presented with a missing premolar tooth on the upper left which had been recently. The patient was very conscious of the gap, and had been unable to tolerate wearing a denture.

The patient was keen to have the tooth replaced with ‘something permanent’, and an implant retained crown was considered to be the best option.

A single Straumann implant was inserted, and a crown subsequently placed on the implant. The patient was delighted with the result, and can now smile confidently.

Case Study 5

51 year old male referred for replacement of his missing upper left first molar tooth. The patient was very conscious of the gap and was keen to have a dental implant to replace the tooth.

There was limited bone height available due to the position of the maxillary sinus. It was, therefore, necessary to carry out a procedure known as a sinus floor elevation, whereby the lining of the sinus is lifted and then ‘tented up’ by the implant. New bone subsequently heals around the tip of the implant, and a crown is then fitted.

The space has now been restored, and the patient is eating normally, and delighted with the result.

Case Study 6

A 37 year old male presented with a missing front tooth, and another which was failing and required extraction. A denture was initially worn with limited success, and then an adhesive bridge as a short term solution.

The patient was very keen to have the best treatment possible to replace the two missing teeth, and two implant retained crowns were recommended. There was a reduced width of bone available in which to place the implants, but this was overcome by using slightly narrower implants and expanding the existing ridge of bone.

Case Study 7

A 58-year-old female was referred by her dentist for implant treatment to address her failing upper bridge. Unfortunately, the 4-tooth bridge had failed catastrophically and a replacement bride was not a viable option.

The patient did not wish to consider wearing a denture as a long term solution and as she had previous experience of dental implants, was keen to have an implant retained bridge.

The situation was deemed suitable for immediate placement (implants placed at the time of tooth extraction) and Straumann Bone Level implants were subsequently placed in the extraction sockets of the upper lateral incisors (UR2 / UL2). A temporary acrylic denture was worn during the initial healing period over the top of the implants.

The implants were left undisturbed for a period of two months to allow the bone to fuse onto the titanium surface. A prototype bridge was initially constructed before a final bridge was fitted. The patient was delighted with the final result.

Case Study 8

49 year old lady required removal of her four front teeth due to gum disease. The patient did not want a denture and a bridge supported on her natural teeth was not a feasible option.

The teeth were replaced with a bridge supported on two dental implants resulting in a marked improvement in the appearance and function of her teeth. She is now able to eat whatever she likes, and smile confidently.

Case Study 9

A 57 year old female presented following loss of her four front teeth due to gum disease. The patient did not want a denture and a bridge supported on her natural teeth was not a feasible option.

The teeth were replaced with a bridge supported on two dental implants resulting in a marked improvement in the appearance and function of her teeth. She is now able to eat whatever she likes, and smile confidently.

Case Study 10

A 47 year old female was referred for implant treatment to address the problems she was experiencing with her loose upper teeth. The remaining upper teeth needed to be removed due to advanced gum disease but the patient did not want to wear a denture at any stage of treatment.

The patient underwent extensive gum treatment and oral hygiene instruction to stabilise the situation prior to implant treatment as this can be a significant risk in implant failure.

A staged approach to treatment was undertaken which involved construction of temporary bridgework, extractions and immediate implant placement, then temporary implant bridgework and further extractions, before the final 12 tooth implant retained bridge was constructed and fitted. Treatment took almost twelve months but it was not necessary for the patient to wear a denture at any stage, and she now has a fixed bridge which allows her to eat, speak and function completely normally.





Implant retained dentures

Difficulty in wearing complete dentures can have a significant impact on the quality of life for many patients. A poorly retentive denture can result in considerable problems both socially and professionally with profound consequences for the individual.

Dental implants can be used to secure complete or partial dentures by using various attachments. This provides excellent retention for the denture and can be a relatively simple and straightforward approach to helping patients who have difficulties in adapting to denture wearing.

We most commonly use the “Locator” attachment which provides a very simple yet effect means of retaining a denture. A small metal housing is placed in the denture with an internal silicone insert within it. This silicone insert attaches to the Locator abutment and it can be easily changed to adjust the retentive force applied. In the lower jaw we would commonly use 2 implants (Figure 1) and in the upper jaw 4 implants (Figure 2).

An alternative approach would be to use a Dolder bar which can either be cast or milled and secured on 2 implants (lower) or 4 (upper). (Figure 3) In such a design the prosthesis is viewed as being implant supported and can offer some additional denture stability. The denture is attached to the bar by means of small plastic clips (Hader clips) which are easily changed at chair side.

Case Study 11

An 81 year old male was referred by his own dentist due to significant problems with retention of his lower denture. The denture was extremely loose and the patient was unable to eat, speak or carry out many every day functions.

Various options considered, but agreed 2 implants with Locator attachments would offer adequate retention.

Two Straumann implants were placed in the canine region and used to support Locator attachments. A new denture was constructed which allowed the plate to be securely clipped to the implant Locators. The patient was delighted with the result and can now eat and function normally with a secure and stable denture.

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