Dr. Pranay Sharma is a specialist in prosthodontics and a senior clinical teacher at the Eastman Dental Institute. A frequent lecturer, he practices dentistry on Harley Street in London. In this article, he presents a clinical case highlighting the use of an array of our products adapted specifically to meet the functional and esthetic needs of the patient.
Implant dentistry has advanced rapidly over the years and the needs and demands of patients are also constantly changing. To meet patient expectations today, I need to work with an implant company that can deliver the technology, techniques and support that allow me to manage a complete range of clinical situations with confidence, and without limitations.
I rely on a system that can provide me with complete surgical and restorative flexibility to cater for all clinical scenarios. The following case report underlines the versatility and displays the functional and esthetic outcome that can be achieved with our portfolio.
A male patient in his sixties was referred by his general dental practitioner for management of a failing maxillary dentition. The patient requested a fixed replacement. Management was somewhat complicated as the patient had a severe “gag-reflex” and was not willing to consider any form of removable prosthesis at any stage throughout treatment.
Following full clinical and radiographic assessment and complete diagnostic work-up, the following treatment plan was agreed upon with the patient: Removal of all the remaining anterior teeth in the upper arch and immediate placement of implants in the maxilla. The implants were restored on the same day with a provisional acrylic bridge at an increased occlusal vertical dimension.
Following a four-month healing period to allow for osseointegration of the implants, the provisional restoration was subsequently replaced with a definitive NobelProcera titanium implant bridge veneered with customized denture teeth. Mandibular posterior partial reconstruction with dental implants was also planned to provide posterior stability.
Following removal of the remaining maxillary anterior teeth, six NobelReplace Conical Connection implants were placed. The drilling protocol is very straightforward, quick and efficient, a significant advantage when placing multiple implants.
All the implants displayed excellent initial stability with insertion torque values in the region of 45Ncm. Residual bony defects were managed with guided bone regeneration techniques (GBR). Nobel Biocare Multi-unit Abutments (MUA) were located on five of the implants, and an immediate provisional acrylic bridge was fitted on the same day.
The provisional restoration was subsequently replaced with a definitive NobelProcera titanium implant bridge veneered with customized denture teeth. From a technical perspective the chemical bond between titanium and acrylic is relatively easy to achieve, and there is plenty of literature to corroborate its durability in clinical use.
In the above media carousel you can see the NobelProcera milled titanium framework displaying excellent fit on the verified working cast. Optimally designed, it accommodates both material support and retention after veneering.
Other images show the intra-oral view of the definitive maxillary restoration, veneered with conventional denture teeth. The esthetic result has been further enhanced and customized by manually layering composite resin that has been added following cut-back of the denture teeth and gingival acrylic. The mandibular partial posterior implant reconstruction has also been completed to provide posterior support.
This case demonstrates how the functional and esthetic demands of the patient can be managed utilizing treatment solutions based on sound fundamentals.
In order to manage the expectations of our patients, we must have complete confidence in the products, back-up and support offered by the implant system being used. For me, Nobel Biocare provides that.