This patient was referred for comprehensive management involving: missing dentition, failing dentition due to periodontitis and parafunction. While a few teeth still carry a guarded to fair prognosis, however from a full mouth perspective, it would make more sense to carry out full mouth clearance with replacement to achieve an optimal aesthetic and functional outcome that is more cost-effective while carries a good long-term prognosis. The patient is happy with this approach. Full mouth replacement options were thoroughly discussed including: conventional removable full dentures, implants retained removable dentures and implants supported fixed bridges.
During the assessment period, he has demonstrated significant improvement in oral hygiene with excellent compliance. He is very motivated and is young at heart. He prefers to have a fixed option for best mastication, intra-oral comfort and not to feel “old”. He is rational and is most aware that patients with a history of periodontitis carries a higher risk of peri-implantitis and management of parafunction is most important to achieve long-term success. With this in mind, we have decided to replace maxillary and mandibular missing teeth using fixed implants-supported and screw-retained full arch bridges.
3 months after dental clearance, 6 dental implants were placed in each jaw. A number of implant sites required simultaneous guided bone regeneration and bilateral sinus lift via lateral window to achieve the necessary bone volume.
During the healing phase, the patient continued to demonstrate excellent oral hygiene and compliance.
Once all dental implants have confirmed to have reached successful osseointegration, we have taken full arch splinted implant level impressions and constructed the final fixed implant bridge prosthesis.
Great care was made to ensure all intaglio surfaces are convex in nature with access grooves present to allow easy access of interdental tooth brushes under the bridge.
Upon review, the patient has continued to demonstrate excellent oral hygiene and compliance with his occlusal splint (for the management of parafunction). The soft tissue response is excellent and the patient feels younger than before. He is now able to smile confidently, eat anything he wants and no longer feeling embarrassed with his teeth.