Dental Tribune United Kingdom Edition

21ClinicalJanuary 24-30, 2011United Kingdom Edition For instance, two implants with ball attachments, placed around the canine positions of the mandible, can dramatically improve the retention (resist- ance to vertical movements) as well as the stability (resistance to horizontal movements). This intervention can put in place the “wild” lower denture over the flat ridge and restore the patient’s confidence (Figs 1-3). In case of high expectations with regard to reduced func- tionality, four implants would support an over-denture which improves retention and sta- bility, almost functioning as a bridge or as a conventional bridge, depending on budget. For the maxilla, a minimum of four implants splinted with a cast or milled bar, bearing ball attachments will provide a se- cure highly retentive platform for an over-denture. Addition- ally, the use of Cr-Co reinforce- ment can allow the freeing of extensive palatal coverage. Take the case of a healthy 50-year old male with edentulous maxilla. Due to ad- vancedchronic periodontitis,the patient’s upper teeth were in- evitably removed. Her conse- quently developed social avoid- ance and an eating disorder with devastating knock-on ef- fects. The solution we offered, which was highly beneficial to the patient, is as follows. Without additional complex surgery and utilizing the an- teriorly available bone, we placed four implants and a bar to support his Cr-Co over-den- ture. The extremely retentive and stable prosthesis has restored the previously lost Fig 1. Note the completely flat ridge which has been resorbed to the level of the genial tubercle. What appears to be a ridge anteriorly is just soft tissue. Two ball attachments would provide adequate retention for the prosthesis. Fig 2. The base of the denture with the adjustable housings to secure a retentive connection over the ball attachments. Fig 3. The denture in-situ. The difference is made by the fact that it does not move over the flat ridge. Fig 4. Figs 4&5. Edentulous maxilla and view of the mandible, restored with a partial well fitted Valplast denture. Bite registration and try-in (see figure 7-9) of the denture in wax stage to confirm aesthetics and phonetics.. Fig 6 Fig 7 Fig 8 page 22DTà Fig 10 Figs 11-13The radiographic guide as well as few of the CBCT images (figure 11-13) which demonstrate adequate volume of bone for the implants. In an interactive way the implants can be placed with an angle to relate to the tooth position Fig 11 Fig 12 Fig 13 Fig 14 Fig 15 Fig 16 Fig 17 Fig 18 Fig 19 Figs 15-19 Surgical guide and surgery (figures 15-19) for the placement of four implants to correspond with teeth at posi- tions UR2,4 and UL2,4 respectively. Fig 20 Fig 21 Figs 20&21. Impression taken at first stage surgery, immediately before the wound closure. Fig 22 Fig 23 Figs 22&23. MediMatch Dental Laboratory built the bar to connect with the implants, ready for try-in. Note the three ball attach- ments on the top of the bar. Fig 24 Fig 25