Cement-retained implant crowns
Our patient, a lady in her sixties presented to our clinic with the following complaints:
- She was looking to have her old upper bridges replaced for aesthetic reasons.
- She desired to have her missing teeth replaced restoring both masticatory function and appearance
- With her old replacement teeth her phonation had changed, which made her feel ill at ease.
First treatment (3 workdays):
Our patient came with a previously recorded panoramic radiograph directly to the first consultation. During the first examination it was borne out that her teeth beneath the old bridges were in a state of disrepair, ridden with inflammations and periodontal disease (dental foci) despite no complaints presenting themselves. (More often than not patients go complaint-free despite there being irreversible inflammations around the root canal tip. For this very reason patients are advised to undergo regular check-ups in order to reveal and remedy hidden issues before a major intervention is required.)
Teeth had to be removed from beneath the bridge. At the first encounter a CBCT (Cone beam computed tomography) was performed for a 3 dimensional examination of residual bone mass prior to implant surgery since we were looking to have the patient’s lower arch edentulism restored with implants. The CT scan demonstrated adequate bone mass for installing implants in the area of lower molars. 2 implants were therefore directly installed in the left and right quadrant each, in the site of the missing molars. The surgical areas were sealed with sutures (both the tooth extraction sites and the implanted areas) which had to be removed in 7 to 10 days. The patient was given a provisional denture to provide teeth for the 3 month-long healing period, so that she could smile and eat and her self-esteem and quality of life were not compromised.
It is important to minimise the wearing time of the provisional removable denture following bone graft and/or the installation of the implant. Patients are advised to only wear their provisional dentures at work or at places where they are required to talk or smile. When at home, please immediately remove the denture. Also make sure you keep your denture and mouth clean, that no pressure is exerted on the denture/implanted area and that the denture does not “wiggle” on the implants. Undue pressure exerted by the denture restricts blood circulation, hinders healing and may cause cracking or infection, or worst of all, the rejection of the implant, however successful the implant surgery may have been. This is crucial from the point of view of healing.
Panoramic radiograph of the initial condition
Second treatment (3 workdays)
Following 3 months’ healing a new CBCT (Cone beam computed tomography) was performed in order to examine bone mass in 3 dimensions. The CT scan demonstrated that the upper tooth extraction sites healed completely and implants were ready to be installed. 4 implants were inserted in each quadrant. The provisional removable denture was relined to fit the altered anatomical relationships and ensure comfortable wear.
Implant-borne tooth replacements require as much, if not more care and follow-up as natural tooth-borne varieties. You are advised to report for a short check-up twice a year and have a tartar removal performed. There is a very close relationship between tartar build-up and the long-term success of implants. Patients are advised to have a bite-check performed on a regular basis as a less than perfect fit may overload the denture and the ceramic may break on a traumatic occlusion or an inflammation may develop around the implants (periimplantitis).
Third treatment (10 workdays)
After 6 months’ healing we set about fabricating the permanent metal-ceramic crowns for the implants. On our patient’s request no crowns were placed on her natural teeth which proved sound and required no treatment. She said she wanted to preserve them in their natural condition since they have become, as it were, a hallmark of her personality and she was not disturbed by there being a small gap between her first two teeth.
Precision impressions are taken of the implants with closed tray impression copings. Several test fittings follow impression taking while the dental technician is proceeding with the preparation of the crowns. The frame test fitting allows us to verify the accuracy of the impressions and the trueness of the frame of the tooth replacement since all tooth replacements must seamlessly fit the master cast. This is also when the length of the frame and the teeth are verified, as well as the central position of the 2 central incisors and the appropriate rearward curve of the denture are checked. At the preliminary test fitting the crowns are almost finished, the ceramic is already sintered onto the frame (with a matte finish) and the patient’s bite (function), the shape and colour of the crowns, the middle line (aesthetics) and smile line can be verified with even better accuracy. Although several days elapse between the different test fittings, the dental technicians are working at full tilt in the meantime.
Upper left implant abutments for cement-retention on a gypsum cast.
Upper left metal-ceramic crowns borne by implant abutments with pink artificial gums for a seamless and comfortable fit on natural gums.
Upper implant abutments for cement retention with the screw driver used for securing the implants and pink artificial gums on a gypsum cast.
Upper right implant abutments for cement retention on a gypsum cast.
Implant-borne tooth replacements require as much, if not more care and follow-up as natural tooth-borne varieties. There is a very close relationship between quality and quantity of tartar build-up and the long-term success of implants. To this end, you are requested to observe the following instructions:
- Annual follow-up examinations (Warranty condition)
- Professional tartar removal is recommended on a minimum of 1 or 2 occasions yearly.
- The use of Super floss or an appropriately sized interdental brush at least once a day.
- Thorough brushing twice a day (preferably with a soft bristle brush).
Please feel free to address any queries to our colleagues. We shall also happily be at your service when choosing tooth care products.