Cost Effective Treatment for Full-arch Fixed Implant bridge
I have mentioned a case in my previous blog on Medical Tourism. I am going to talk about how I provided wellness or wholistic dentistry (not holistic, please see my other previous blog about it) without costing my patient an arm and a leg.
She had 4 implants done to her lower jaw in Macedonia late last year but because of the pandemic, she was not able to travel safely back to the country to have a lower hybrid fixed bridge (all-on-4 implant prosthesis). She had been wearing a lower removable full denture but she could not eat with that because of poor fitting that causes pain to her gum tissues and constant movements during chewing.
Besides, her upper teeth are not in good conditions because of numerous cavities, excessive occlusal wear, drifting, tilting and overeruption. If a permanent (definitive) hybrid fixed bridge is done now to occlude to the upper uneven and mutilated occlusion, that bridge will not be functional and cosmetically acceptable. When the upper teeth are to be rehabilitated one day, then the lower bridge would need to be replaced.
Because she could not wear the denture without pain, she has been eating poorly with malnutrition. She was on highly processed food rich in carbohydrates that lacked the essential protein, minerals and vitamins.
After so many months of waiting for the COVID-19 travel restrictions to be lifted, which is unfortunately still in place, she finally decided to come to me for dental treatment to solve her problem with chewing and eating.
Since her upper teeth are having uneven occlusion and are buccally inclined, a permanently definitive restoration with a zirconia hybrid bridge should not be the choice before proper treatments are done to correct the issues with her top teeth. Despite of this fact, patient was given different options with the pros and cons, costs, and procedures involved for each treatment modality. We co- diagnosed and co-treatment planned for the most suitable option for her under the current difficult situation.
In order to allow her to chew her food properly without pain, have teeth that are stable to allow her to speak and smile, have confidence in her appearance, have a nice facial profile without that suck-in look without costing too much as a temporary solution. We concluded that fixing her existing temporary full denture to the 4 lower implants would be the best option while she is waiting to have the upper rehabilitated one day.
The process does require good knowledge of the type and conditions of implant system, the make, the sizes, the amount of gum tissues surrounding the implants, the inclination of the implants to each other, the conditions of the lower jaw and its relationship to the upper jaw, the existing limitations, the availability of the right types and sizes of the attachments and a good treatment planning.
Normally, freezing is not required for this chairside technique and the procedure would take about 2 hours to complete. Once the procedure is completed, the lower denture is fixed to the 4 implants with attachment screws. The denture is not in contact with gum tissues and the occlusal force is resisted by the attached 4 implants instead. There is also the consideration of proper cleaning of the implants and prevention of food debris got trapped underneath the fixed denture plate. Proper spacing was created for easy access of some special toothbrushes underneath.
While the patient can eat and smile properly with the lower fixed temporary denture, she can plan on how to look after the upper teeth without having to rush into getting unwanted and inappropriate treatments. If implants are to be placed in her upper teeth, she will have time to wait for the upper implants to be fully integrated with her jaw bone (usually take 3 to 6 months to heal) before any definitive prostheses are to be inserted.
With a fixed temporary denture made with acrylic, I can easily modify the denture to improve the occlusion (the bite), the harmony with the upper arch (remove cheek or lip biting tendency), the aesthetic of the teeth (serve as a blue print for the future definitive zirconia prosthesis, the location of the teeth (too much forward or backward), the comfort of the tongue (the arch form and location) and the facial profile (the length of the teeth). Once all the parameters just mentioned are idealized, then a permanent hybrid bridge can be fabricated based on the fixed temporary denture.