Fabrication of implant-retained bar dentures Treatment phase III (Case presentation) (65)

2020. október 12

Our male patient, aged 57, reported to our clinic with the following complaints and requests:

Antecedents:

His teeth were removed at the first session due to chronic uncontrolled periodontal disease.
He was given an immediate denture over the 3 months of healing.
A total of 4 implants were installed into the lower and upper arch 3 months after the tooth extractions.

Before

After

Third treatment phase: The fabrication of permanent tooth restorations (10 workdays)

Following six months’ healing time the final and lengthiest treatment phase could ensue. Thanks to gingiva formers (healing abutments) precision impression taking can be performed in a simple and almost painless way. Following the removal of the gingiva formers, so-called impression copings are screwed in, which give the dental technician exact information as to the location and axial position of the dental implant installed. A follow-up panoramic radiograph is made to verify the seamless fit of the impression copings in the implants.

Follow-up panoramic radiograph of the open tray impression copings screwed into the upper implants

Photograph of the open tray impression copings screwed into the upper implants, giving the dental technician exact information as to the exact location and axial position of the dental implants installed.

Open tray impression copings on the master cast placed into a custom-moulded tray with a view to achieving the perfect precision of the impression

The custom-moulded tray prepared specifically for the present instance by the dental technician for precision impression taking

The finished upper precision impression taken with the custom-moulded tray

Following impression taking a gnathological treatment (viz. an instrument-aided bite registration) is due for the technician to see the exact position of the jawbones in the articulator to ensure the correct position of the temporomandibular joint on occlusion.

Articulator: a dental instrument reproducing the movement of the mandible and the maxilla in the correct position of the temporomandibular joint. The movements of the articulator are as follows:

opening-closing movements
lateral movements
forward (propulsion) + backward movements

Gnathological treatment, facebow transfer

The placement of the upper plaster cast into the articulator for the dental technician to see the precise position of the maxillary arch in relation to the temporomandibular joint

With dentures, not to mention bar dentures, several crucial trial fittings are performed for the dentures to seamlessly fit and to achieve perfect aesthetics. During the trial fittings of the framework and bar the finished bar is screwed into the implants to verify the trueness of the framework of the tooth restoration. The trial fitting of the teeth focuses on aesthetics and correct occlusion. During the trial fitting of the teeth, aesthetics can be improved in the event of individual requests as to the position and shape of the teeth.

At handover, the bars are screwed onto the implants with the appropriate torque on which the new denture will seamlessly sit.

The bipartite bar intended for 4 upper implants on the master cast:

Intraoral view of the bipartite bar intended for 4 upper implants

Bar supported by 4 lower implants on the master cast

Intraoral view of the bar supported by 4 lower implants

Upper bar denture on the master cast:

Bars offer such a degree of stability that dentures sit firmly even without the support of the roof of the mouth, making it an ideal solution for those unable to wear palate-supported dentures.

Bottom view of the finished bar-retained denture featuring dolder bars

Lower bar denture on the master cast:

Bar mounted on 4 lower implants on the master cast

Bar mounted on 4 lower implants on the master cast and bottom view of the finished lower bar denture featuring dolder bars

Intraoral view of the finished bar dentures following handover

Follow-up panoramic radiograph of the lower and upper bars following handover in which the seamless fit of the bars can be verified

A few weeks on, the patient’s ability to eat, speak and smile would be perfectly restored and his self-confidence regained, and he would feel free to mingle with people. The first 8 days following hand-over of the finished work is a difficult period during which the patient should read out aloud, talk and eat so that the natural function of the muscles, tongue and the temporomandibular joint is restored as soon as possible. This process usually lasts two months.

Our patient was content with the treatments and comes for regular check-ups, oral hygiene treatments and professional tartar removal, which constitutes a condition for warranty.

It is supremely important to keep the denture clean. Patients are advised to remove it after each meal and clean it thoroughly with a denture brush. The implants and the bar must also be cleaned thoroughly with a tooth brush, toothpaste, and beneath the bar, with Super Floss and an interdental brush.