Treatment of Complete Secondary Adentia with the Help of Alpha Dent Implants in 84-year-old Patient

	Spiridonov Anton Mikhailovich – the 1st class maxillofacial surgeon, the Master of Medicine, Department of Maxillofacial Surgery and Stomatology of 1472nd Naval Clinical Hospital of the Black Sea Fleet of the Russian Federation named after N.I. Pirogov, Sevastopol.
	Yefimenko Konstantin Viktorovich – an orthopedist-stomatologist, Department of Maxillofacial Surgery and Stomatology of 1472nd Naval Clinical Hospital of the Black Sea Fleet of the Russian Federation named after N.I. Pirogov, Sevastopol.

The laboratory stage was performed on the basis of dental laboratory “Dental Art” by a dental mechanic Sergei Shabalin, Simferopol.

The patient K., b. 1927, turned to the clinic of 1472nd Naval Clinical Hospital of the Black Sea Fleet of the Russian Federation named after N.I. Pirogov to settle the questions of her rational dental prosthetics (Photo 1). A complete removable laminar dental prosthesis being used before was functionally insufficient. Two-stage placement of four maxillary Alpha Dent Active Implants followed by delayed tooth replacement were proposed after the general somatic examination and specification of local status.

Two Alpha Dent Active Implants [4.2 x 11.5 mm] and two Alpha Dent Active Implants [3.75 x 11.5 mm] were placed during the surgery with a sufficient primary fixation in the region of the 14th, 12th, 22nd and 24th teeth (Photo 2). .

Taking into consideration the undesirability of osteoplasty carrying out in so elderly patient, when placement of implants, the doctors focused on the maximal usage of available bone volume having stipulated a certain nonparallelism of intraosseous elements (Photo 3).


Photo 1. Initial clinical situation	Photo 2. Placement of Alpha Dent Implants in the region of the 14th, 12th, 22nd and 24th teeth.	Photo 3. Control orthopantomogram.

The healing period took its normal course.

A new provisory maxillary complete removable laminar dental prosthesis was made in a fortnight after the surgery. This prosthesis made it possible not only to restore the patient’s chewing function but also presented the approximate data necessary to make her final prosthesis.

The data aforementioned are as follows:

determination of the interalveolar space;
visualization of supposed aesthetical result;
check of patient’s possible adaptation to the new orthopedic construction;
preliminary selection of construction and system of fixation.

The second surgical stage of implantation was carried out in six months. The formers of gingival cuff were placed after finding and removal of the plugs (Photo 4). Then the process of rebasing a removable prosthesis in the region of protruding formers of gingival cuff (with Mucopren soft, an A-silicone denture reline material from Kettenbach) was carried out. This type of approach made it possible to increase the load exerted on the implants on a gradual basis. The surgical sutures were removed on the seventh day after surgery.

Orthopedic stage.

An impression of the maxilla was obtained after final formation of the soft-tissue contour with the help of a close tray transfers. A supplementary impression of mandible was taken with the help of standard tray.

The dental laboratory stage commences from manufacturing of working models of the maxillary individual tray.

The second clinical stage lies in obtainment of impression with the help of individual tray and transfers for an open technique. The impression was made of polyester impression material (Impregum 3M ESPE). The central correlation of mandible and maxilla was determined after manufacture of the working model and bite torus.

The placement of teeth and final selection of fixation system were carried out with the account taken of data obtained when manufacture of provisory prosthesis.

Alpha Dent Aesthetic Abutments were used for the dental prosthetics. The deviation of implants relative to each other was equilibrated when modeling and manufacture of the beam-type elements (Photo 5).


Photo 4.	Photo 5. Alpha Dent Straight Aesthetic Abutments. The deviation of implants relative to each other was equilibrated when modeling and manufacture of the beam-type elements.	Photo 6. Construction of removable prosthesis.

The basic supporting elements were represented by two beams fixed on the abutments with the help of long orthopedic screws.

The retention function was executed by two special locking fasteners locating in the center of each beam.

The tertiary construction consisted of chromium-cobalt carcass coated with plastic. (Photo 6).

The aesthetic result was obtained with the help of set plastic teeth from Ivoclar Vivadent AG.

Conclusions:

The removable prosthesis abutting upon the beams fixed on the dental implants assured optimal comfort comparable with a fixed dental prosthesis (Photo 7). Notwithstanding of the manufacturing technical complications and relatively high cost of beam-abutting prosthesis the value of this technique is proved by high stability and simplicity of care being especially topical for the patients of elderly age groups.

Treatment of Complete Secondary Adentia with the Help of Alpha Dent Implants in 84-year-old Patient