Combined Implant Prosthesis: Combination of a 15-year Implant and Modern Two-stage Alpha Dent System in Case of Fully Edentulous Maxilla
|Polyakov P.V., dentist, surgeon of the highest qualification category, State dental clinic №1, Bobruisk, Belarus
||Bobko S.N., dentist, podiatrist of the first qualification category, the institution State dental clinic №1, Bobruisk, Belarus
||Lazakovich S.E., dental technician of the highest qualification category, the institution State dental clinic №1, Bobruisk, Belarus
Usually there are no modern methods of restoring the integrity of the dentition for the rehabilitation of patients with complete or partial edentulous without the use of dental implants. A clinical example of a long period of treatment (over 15 years) with the use of dental implants in the upper jaw was considered
As a rule modern methods of restoring the integrity of the dentition for the rehabilitation of patients with complete or partial edentulous are not possible without the use of dental implants.
Patient P., 49 years old is being treated at KM «Bobruisk City Dental Clinic No 1» in 1998.
More than 15 years ago, 22.02.1999 dental implants were placed in maxilla region 1.5; 1.3; 1.1; 2.4 – 2.6 cylindrical implant was united with plate implant (see Fig. 1, 2).
|Photo 1.Initial orthopantomogram before treatment (1999)
|| Photo 2.Control orthopantomogram 2013
||Photo 3.Control orthopantomogram after removal of the unusable implant on the left upper jaw
The period of operation of the construction lasted 13 years, after what the bridges that stood on the implants and natural teeth on the maxilla were broken down. In 2013 the plate implant was removed and a fracture of the body of implants 1.3; 1.1, 1.5 and abutments were diagnosed. Available endosseous implant part 1.5 is stable, immobile, with no signs of inflammation of the surrounding bone and mucosa (see Fig. 3)
Taking into account the negative experience of the removable dentures laminar use, there was recommended to install two-stage implants in the upper jaw in area of the missing 1.6; 1.3; 1.2; 2.1; 2.3; 2.5 teeth with the inclusion of a prosthetic construction a cylindrical implant which was set 15 years ago.
In 08.01.2014 the patient were made surgery. In 1.6; 1.3; 1.2; 2.1; 2.3; 2.5 were set Alpha Dent implants 10-13-16 mm length and a diameter of 3.75 – 4.2 mm. Implant 1.2 was installed by passing method between the remaining portions of the previously installed (1999) implants. All implants Alpha Dent were established in «bloodless» way by using tissue punch, without sutures. The postoperative period was uneventful. For rehabilitation period of patient P. made a temporary removable denture in upper jaw was made, which she used for the entire treatment period (from surgery to manufacturing a permanent prosthesis). There was a 5 months period of using a temporary removable prosthesis.
In 02.05.2014 the second stage of rehabilitation was made. Revealed endosseous part 6 Alpha Dent implants in the upper jaw were opened, gums conditioners installed and restored abutment of 15-years old implant in 1.5 using titanium cap. The success rate of implantation in the rehabilitation of patient P. with edentulous maxilla reached 100% (see Fig. 4, 5).
|Photo 4.Installed Alpha-Dent conditioners of gingival cuff. In the area of 15-year-old implant a 1.5% recovery of titanium 2 made.
||Photo 5.Condition after Healing Caps setting.
Maxilla prosthetics for patient P. with fabrication of cermet bridge held as follows:
– Removal of impressions (molds) using an Open Tray Transfer;
– Making a personal tray with perforations. For the manufacture of the cast elastomeric material is applied (polyvinylsiloxane or polyester rubber). After curing impression material positional screws loosened and removed from the mold of the oral cavity.
|Photo 6.Prints removing
||Photo 7.Fitting the abutments in the mouth.
– Determination of the position of central occlusion;
– Production of a working model;
– Modeling of wax denture with metal base;
– Repeated cast of the prosthesis metal base;
– Fitting the metal base of the prosthesis on the working model and in the oral cavity;
– Re-determination of the position of central occlusion with metal denture base;
– Definition of the color of the veneering ceramic prosthesis;
– Production of ceramic tiles and fitting the prosthesis in the mouth;
– Fixation of the prosthesis in the mouth on non evgenolyc polymeric cement Alpha-Sem;
– Monitoring and correction of the position of central occlusion and articulation movements of the lower jaw.
The next step will be setting of dental implants in the mandible.
|Photo 8.Fitting the abutments on the working model
||Photo 9.Ready cermet bridge of the maxilla
||Photo 10.Fitting the cermet bridge in the mouth
With the accumulation of clinical experience, with increasing of observing the results of the treatment for more than 20 years formed the criteria for selecting different methods prosthetic dentition with implants.
During the functioning of bridges with reliance on dental implants some problems which arise can be solved by carrying out reimplantation – the establishment of additional implants. Often it is possible by combining of a single orthopedic design previously established stable implants and advanced two-stage systems.