Introduction

Dental Implantation has become very popular and important in the last years particularly for the patient who has no teeth in the posterior area either of the upper jaw or the lower jaw, because most patients refuse to wear removable dentures.

Therefore, putting implants at the posterior area is considered as an alternative to removable dentures and resolved a lot of problems which faced us in the past years.

Case No: 1

A 68 years old Emirati lady known as K.A came to our clinic on 28/12/09 and requested to put artificial teeth in the missing teeth area.

After full examination of her mouth and teeth, we found that she has some calculus and has been careless in cleaning her teeth, the upper right canine and lower left central are mobile, and missing all the teeth which are distal to the upper right canine and all upper left premolar and first molar.

In lower jaw, there are missing right first molar, central, lateral, left lateral and all left molars.

These photos of her models – because I forgot to take vital photos - explain the situation completely

   Treatment plan:

1-    On her first visit, we did scaling, cleaning of all the remaining teeth and polishing and gave the patient strict instructions to keep teeth and gum healthy by using tooth brush and mouth wash.

2-    At the same time we decided to extract her mobile right canine because it was hopeless to keep it as seen in panoramic X-ray, so we gave her local infiltration anesthesia of Lidocaine hydrochloride 2% with adrenaline 1:80000 (Lignospan special – septodont).

3-    After two days, the patient came back to our clinic and we gave her local infiltration anesthesia of Lidocaine hydrochloride 2% with adrenaline 1:80000 (Lignospan special – septodont) in the lower left central area to extract her mobile lower first central.

4-    As shown in the panoramic X-ray, the alveolar ridge at the right side is very close to the maxillary sinus and the distance between them is around 6-8 mm. Therefore, we requested the patient to take CT scan for upper jaw. .

5-    After viewing the CT scan, it was found that there was an enough space to put implant having 9.5 mm in length. Then, we gave her appointment on 21/1/10 to put two implants with platform of 4.5 mm and length 9.5 mm (type SPI contact conical design from company Thommen Medical) without gingival flap, we just did punch after clinical examination of buccolingual distance of alveolar crest after giving her local infiltration anesthesia of Lidocaine hydrochloride 2% with adrenaline 1 : 80000 ( Lignospan special – septodont ) and then completed the procedure from the first step which was using Pilot drilling/ axial angle correction 2.0 mm and then we inserted in the drilling place a depth measuring to measure the depth of place after we assured the correct depth we inserted a  Pilot drilling 2.8 mm to length of 9.5 mm after that we inserted profile drill 3.5 mm/4.5 mm to prepare the implant site to the lower edge of the depth marketing to place the machined neck above the bone crest.

6-    After finishing the preparation of implant site we installed adapter on the handpiece to fit over the implant and hold constantly and then remove it from container and transferred it to the prepared site and inserted in it by using only 50 rpm after that we completed implantation by using a torque ratchet to fix implant in its place  until reach the level of bone crest with primary stability more than 35 Ncm , after that we   covered it with healing screws as seen in the photo, and we prescribed for her antibiotic Amoxicillin   500 mg 4 times per day and analgysic Brufen 600 mg 3 times per day and B-complex 3 times per day and antiseptic mouth wash corsedyl  3 times per day . 

7-    On 26/1/10 the patient came to us to make for her a lower anterior bridge, so we prepared her canines on both sides and took impression and sent it to laboratory to fabricate a ceramic bridge consisting of six units.

8-    We made an appointment with the patient next week to put two implants in the lower jaw in the place of first molar on both sides.

9-    On 3/2/10 we put two implants having platform 4.0 mm and length 9.5 mm of the same type which we had already used in the upper left side for the company THOMMEN medical of kind contact in the place of lower first molar in both sides without any flap.

Also we gave the patient antibiotic Amoxicillin 500 mg 4 times per day and analgesic Brufen 600 mg 3 times per day in addition to B-complex - to enhance immunity and to compensate the intestinal useful bacteria which destroyed by antibiotic – and antiseptic mouth wash.

10-                       After three months of extraction of the upper right canine, we gave the patient next appointment on 22/3/10 to put three implants in the place of 13,14,15

All the first two implants were of size 4.0 mm and length 9.5 mm of contact , but the third implant which was close to maxillary sinus was 8.0 mm in length of element kind as in this photo and we have done the same procedures which we used in the left upper side and in the lower jaw.

At the same day we uncovered the two implants in the lower jaw and replaced the screw with gingival former for one week.

11-                       On 29/3/10 we took impression of lower jaw for two implants and for anterior bridge and sent it to laboratory and received the complete work after one week.

12-                       On 3/4/10 we fixed two implants in the lower jaw and cemented the anterior bridge as seen in these photos:

13-                       On 7/7/10 we uncovered the five upper implants and removed the cover screws and replaced with gingival former and left it for one week to allow the growth of gingiva and make sure that it was healthy around the implants.

14-                       On 14/7/10 we took impression for upper jaw to perform two bridges, one on the left side consisting of two abutments and one pontic in the distal side as cantilever bridge, and the right bridge also consisting of three abutments and one pontic.

15-                       On 22/7/10 two bridges became ready to fixe into the mouth of the patient.

16-                       Once we finished all the procedure, she has become very happy and felt in herself that she has become young.  She can smile confidently and eat well now.

Conclusion:

By this method of implantation we were able to provide the patient with fixed and well prosthesis instead of removable prosthesis which has become unacceptable by most of people.

Here are photos and x ray panoramic after 8 months of implantation.