Restorative dentistry and implantology – case

Case overview

Treatment of advanced periodontal disease — from a temporary restoration to a bar-retained upper denture and lower implant-supported bridges.

• Starting point: A 66-year-old female patient wanted treatment for highly mobile teeth. She was bothered by gaps between the teeth, bleeding gums, and the inability to bite with confidence for fear that her teeth would shift.
• Treatment plan: Her periodontal disease was already so advanced that we saw no realistic chance of saving her upper teeth. We planned a temporary complete removable denture, then after wound healing a complete removable restoration retained on a bar supported by 4 implants. Because this seats completely stably, it replaces the missing teeth while also providing proper lip support. Several lower teeth were judged salvageable, so a cemented bridge restoration could safely be made on them. After wound healing we planned screw-retained bridges on implants in place of the posterior teeth.
• Course of treatment: The full treatment took 1 year and 2 months. In the first phase we had to allow for 3–4 days of temporary edentulism while the planned upper interim denture was fabricated. After the planned lower extractions, our patient left the practice already wearing a temporary restoration. With the cemented temporary restoration we waited the necessary 2–3 months for healing, then made definitive cemented metal-free zirconia ceramic bridges. After these were cemented we began placing the implants. Three months after implant placement we reinforced the soft tissue over the implants to provide long-term protection for the artificial roots in the bone. We waited another 3 months, and after soft-tissue maturation and strengthening the upper implant-retained denture was completed, along with screw-retained bridges on the implants in the lower region. The patient tolerated the procedures well; in a few cases post-operative oedema came as a surprise.
• Treatment outcome: Our patient attends regular check-ups to preserve the result long term. She has excellent oral hygiene, so we can confidently say she will use the completed restoration with lasting satisfaction. Her smile has also become confident, and she has recommended us to many acquaintances, for which we are very grateful.