A male patient, Mike, in his thirties presented with multiple fractured teeth and several with chronic infection. Most of the remaining upper teeth had to be removed but UR3, UL3 and UL4 were retained to help hold a removable temporary partial denture (fig 1).
Fig 1: UR3, UL3 and UL4 retained to hold a removable temporary partial denture.
After about six months, once the tissues had fully healed, I discussed the treatment options with the patient. His preference was to have the denture replaced with an implant-supported fixed bridge. If at all possible, he wanted the implant placement and prosthetics completed at the same time – teeth in a day.
The new SmartFix concept for Ankylos implants has helped practitioners to provide screw-retained prostheses for their patients. The need for sinus augmentation can be avoided by placing the distal implant at an angle. The correct vertical alignment is achieved by use of the new 30 degree angled balance base abutment.
Prior to the patient’s first treatment appointment, study model impressions, bite registrations and facebow records were taken. This enabled the face height and initial set-up to be established. ExpertEase software was used to help plan how the implants would be placed (figs 2 and 3).
Fig 2: ExpertEase software was used to plan implant placement.
Fig 3.
The implant treatment had to start at 8am, to allow time for the new prosthesis to be constructed on the same day. After administering local anaesthetic, I removed the three remaining teeth. Using the sockets as a reference, the two distal implants (Ankylos A14) were placed at an angle, planned to avoid the maxillary sinus. The two front implants (Ankylos A14) were then placed in the UL2 and UR2 regions (fig 4).
Fig 4: The two distal implants were placed at an angle to avoid the maxillary sinus.
Using the lower teeth as a reference, the abutments were tried in. Thirty degree and 15 degree abutments were used for the distal and anterior implants respectively (figs 5). These were then screwed into place. The angles were corrected with the second component located on the top of the abutment carrier.
Fig 5: Ankylos angled balance base abutments were tried in.
Copings were attached (fig 6) and an open tray impression taken using silicone putty (fig 7). Analogues were attached to the abutments and bite records were taken (fig 8). By late morning, the next stage of the laboratory work was delivered, allowing a try-in of the initial set up. Once approved by the patient, this was returned to the technician for a planned delivery at around 4pm.
Fig 6. Impression copings were attached.
Fig 7: An open tray impression was taken using silicone putty.
Fig 8: Analogues were attached to the abutments and bite records were taken.
During the afternoon, the provisional bridge was made from heat-cured acrylic and Ivoclar Vivodent PE teeth, incorporating a screw-retained retentive coping. Finally, this was tried in and screwed into place (fig 9). The patient was instructed to follow a soft diet for six weeks to allow initial bone healing. He returned two weeks later for a follow-up appointment, and he said that he was delighted with the provisional bridge (fig 10).
Fig 9: Provisional bridge.
Fig 10: Two week review.
Four months later, the patient returned and, following several visits, a metal-bonded-to-acrylic bridge was fitted (fig 11). He was delighted with the final look and feel of the teeth and is looking forward to having treatment on his lower arch in the future. As a clinician I am completely sold on this technique. SmartFix enables me to provide cost effective fixed teeth in a day for my patients using the Ankylos implant system.
Fig 11: Final restoration with a metal-bonded-to-acrylic bridge.
At Advance Implant Clinic we accept referrals from dentists anywhere in the UK to provide patients with same-day-teeth using Ankylos implants and the SmartFix concept. We work in partnership with the referring dentist to treat edentulous patients and those who need their remaining teeth removed. The patient’s own dentist completes the final bridge, after four to six months for healing and implant integration.