Indication 5, Case 1

Edentulous mandible

Surgeon:
Dr. Tom Wilson
Restorative Dentists:
Dr. Frank Higginbottom

An 80-year-old female patient presented in my office with a new set of full dentures and complained that she could not eat comfortably. She in fact could not wear the new lower denture for any period of time without very severe pain. She had a very atrophic resorbed mandible and the soft tissues that were very fragile. It appeared that the only way that the patient could eat comfortable would be to stabilize the lower denture and to take the load off the soft tissues. It was felt that implants would be the best option for the patient. The next dilemma was how to get the patient through the healing period. It was decided that the implants would not do well under a removable appliance. The patient would not be improved and here problems corrected until the implants were actually loaded. It was decided to load the implants immediately with a tissue bar fabricated in the first 72 hours after placement.

	1 Patient's pre-operative appearance showing very thin non-keratinized mucosa with very little residual ridge. The mental nerves were positioned at the ridge crest, and provide little room for implant application in the posterior.

	2 Panoramic radiograph showing the severe atrophy due to long term denture wear.

	3 Since the patient's denture was new and was judged to be satisfactory it was duplicated to serve as a surgical guide.

	4 Pre-operative cast.

	5 Surgical placement of four ITI 4.1 and 4.8mm solid screw implants. There were four standard octabutments placed at the time of surgery and torqued to 35 Ncm.

	6 The day following the implant placement the patient came to the restorative dentist's office to initiate the restorative procedure. Four repositionable transfer copings were placed on the implants over the octabutments.

	7 The patient's denture was modified to be used as an impression tray and used as a reference base to transfer jaw relation records.

	8 A polyvinyl impression was taken with the patient in centric relation at the existing occluding vertical demension. The impression was removed from the mouth and the impression copings recovered. The laboratory analogs were attached to the impression coping and the analogs placed in the impression.

	9 The impression was boxed using irreversible hydrocolloid impression material.

	10 The master cast was poured and prior to separating the model the denture/impression and jaw relation transfer was articulated against the patient's upper denture. The impression was then separated and a four unit bar fabricated. The patient's lower denture was relined over the bar and retentive clips incorporated in the reline.

	11 The tissue bar was seated three hours after making of the impression. The bar was found to be passive and the occlusal screws torqued to 35 Ncm.

	12 The modified denture ready for seating.

	13 The patient's immediate load denture seated.

	14 The tissue bar secure and the healing at 12 weeks.

	15 Final facial view of a happy and comfortable patient.

	16 Final panoramic radiograph

Conclusions Our edentulous patients can have their lives improved so much with dental implants. It is easy to add two, three, or four implants to an existing prosthesis. This is not a new concept. The ITI has been doing this since 1974.