Dentist Malta - Dental & Implantology Unit Malta

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Full mouth implant rehabilitation

Mrs C. visited the Dental & 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).

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.
		Fig 2: The acrylic frame design and the final titanium frame prepared for the lower jaw reconstruction

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.

IMPLANT RETAINED OVERDENTURES
An overview

There are many patients who have lost all their teeth and are wearing dentures. A high proportion of such patients experience considerable problems with their dentures and are unable to lead a ‘normal’ life. Research has shown that problems include pain, loss of function, difficulty speaking, loss of confidence, altered aesthetics and a modified lifestyle to cope with the problems. Much of this occurs because bone is progressively lost after teeth are extracted, resulting in flat ridges (i.e. the gum that stabilises the dentures). The majority of patients have problems with the lower denture rather than the upper because there is less surface area for denture support

Implants offer a simple way of resolving these problems. Research has shown that two implants supporting an overdenture is a very successful, safe, effective and economical way of stabilising a lower denture. Success rate for this form of treatment is in the 96 to 99% region. Furthermore, many patients may be managed using an immediate or early – loading technique, namely not having to wait for four months to allow the bone to bind to the implant (osseointegration). The case described is in fact such a patient, she had enrolled into our research project on this very topic.

Maintenance of over-dentures is far easier than implant retained fixed bridges. Rather than having to floss and brush beneath the fixed bridge, the over-denture may be removed and cleaned over a sink full of water. The intra-oral bars are easy to clean with a normal toothbrush. Most breakages are easily fixed in the laboratory and if desired, the patient may have a spare set constructed for emergency use. Research has also shown that over-dentures are two and a half times cheaper to maintain over a number of years than a fixed implant bridge.

Patients who loose all their teeth in one arch but maintained the dentition in the opposing arch are normally advised to have an overdenture on four implants rather than two due to the different functional loading.