dental case studies

Broken Bridge to Implant-Supported Bridge . . . with No Dentures in Between By Andrei Mark, D.D.S., Board Certified Oral and Maxillofacial Surgeon

By using the multi-step, interdisciplinary approach a patient can successfully transition from a broken bridge to an implant-sup- ported bridge, without interim dentures. A noteworthy example is the case of Ms. W., a patient in sound health in her mid- 50s. This patient was referred to me by her general dentist and she and I collaborated on this case. The patient arrived for her initial consulta- PHOTOGRAPHY BY JACQUELINE WINTER, D.D.S. tion with a loose anterior maxillary 10-unit, Restorative dentistry by Jacqueline Winter, cantilevered bridge from 4 through 13 with D.D.S. teeth numbers 6 through 11 as abutments. These abutments were decayed and deemed periodontally and restoratively unsalvage- retention on numbers 4, 5, 12 and 13 and able. A panoramic X-ray of the patient was (Top:) Pre-op panoramic. light vertical rests on the healing screws of (Bottom:) Post-op panoramic taken before beginning the procedure. This teeth numbers 6 through 11. The restoring case occurred just prior to my acquisition of dentist adjusted the bridge and the occlusion an i-CAT cone beam 3-D imaging system. placed Lifecore dental implants in position of and the patient was dismissed for another My protocol today is to take both preopera- teeth numbers 4, 5, 12 and 13, respectively. three months. tive and postoperative CT scans. The CT This case was temporized by re-cement- At the six-month point, the patient re- scans provide me with images that project ing the existing bridge on the six anterior turned to my office where we removed the the shape and density of the bone with a abutments. At this point, a roundhouse temporary bridge, temporary abutments true three-dimensional rendering and in- temporary shell was prepared to be used as and healing screws and took an implant-level dicate if any bone grafting is necessary due a temporary, after removing the six anterior impression. Then everything was replaced to resorption. teeth and placing six anterior implants. We and the final impression was sent to Angel Given today’s dental treatment options, waited three months to allow for healing and Dental Studio. The case was completed by the obvious solution to her problem was osseointegration to take place. the restoring dentist by placing custom abut- dental implants. Dental implants provide Three months later at the second surgical ments and porcelain fused to metal bridge the patient with a permanent, stabile solu- visit, the patient arrived for extractions of from teeth numbers 4 through 13. tion that will satisfy both her functional and teeth number 6 through 11 and immediate One could say we envisioned the end re- emotional needs, without compromising placement of implants on teeth numbers sult from the very beginning and it served speech, taste, aesthetics or mastication. 6 through 11 using BioLok Silhouette im- as our guide through the initial steps. True The patient had a couple of concerns. plants. These implants were solid and treated harmony was ultimately achieved because First, she did not want a sinus bone graft. in a single-stage fashion, by placing healing the oral surgeon, the restorative dentist and Second, she did not want to wear an interim abutments at the same visit. At the same the lab were in constant communication denture during the implant treatment under time, the four previously placed implants, throughout the entire process. any circumstances. Unsure if immediate numbers 4, 5, 12 and 13, were exposed and The patient was very satisfied with her load could work on this particular case, we temporary crown and bridge abutments results and happy that she never had to wear opted not to do all the implants at once and were placed to support the new temporary an interim denture. elected to go with a two-stage approach. bridge from numbers 4 through 13. The Contact Dr. Andrei Mark at Central Park At the first surgical visit the loose bridge bridge was then relined with cold-cured Oral Surgery, [email protected] or by phone was removed. Using the bridge as a guide, I acrylic and was temporarily cemented with at (212) 813-0707. ■

NEW YORK CITY DOCTOR OF DENTISTRY MARCH/APRIL 2007 | 3