In this case presentation, David Murnaghan shares the placement of four implants with a fixed bridge using Chrome guided technology.
This 63-year-old male patient presented at the practice as a self-referral. The patient shared that he had attended the dentist annually at another local practice for the majority of his life.
The reason for his attendance on this occasion was a failed two-unit bridge that had a fractured root from the upper right canine, holding the lateral incisor.
During the discussion about his general health, the patient disclosed he had type 1 diabetes, which was well controlled. In terms of medication, he was administering a daily insulin injection, as well as taking 75mg of aspirin each day.
Clinical examination revealed recent extractions and poor oral hygiene with some plaque evident.
During the assessment it was also noted that there was pathology under the upper right incisor and left first premolar. Furthermore, there was evidence of moderate attrition, abfraction, and erosion with cupping on the lower canine.
Treatment possibilities
Two main options were presented to the patient to rectify the situation:
- Restore the existing teeth to try and keep as many as possible and then address the spaces with either denture options or implants with bridges
- As the remaining teeth were heavily restored with a guarded prognosis, a full denture or restoring a full arch with conventional six-to-eight implants with grafting or four implants with a fixed bridge.
The patient was keen to have fixed teeth, as he hated the denture he had recently been given and the thought of having to remove his teeth at night.
He was also keen on a solution that would fit with his lifestyle and finances.
On that basis, Chrome guided technology was suggested to him, as it ticked a lot of his boxes, including being faster than freehand implant placement and extremely predictable. The patient agreed that was his preferred treatment option.
To facilitate the next appointment, when implant treatment would begin, the necessary impressions and imaging were taken.
He also made an appointment with the dental hygienist, so that his oral hygiene levels could be improved to facilitate a successful treatment outcome.
The treatment process
Local anaesthetic was administered for patient comfort, followed by a try-in of the Chrome guided stent and confirmation of the shade and appearance of the provisional teeth.
A full flap was then raised in the upper arch, both buccally and palatally. Removal of all the remaining upper teeth relevant to where we were placing the implants was carried out.
This was followed by passive fitting of the Chrome guided stent for the Biohorizons guided surgical kit. Next, two 4.6mm*12mm, one 4.6mm*15mm and one 3.8mm*12mm Biohorizons implants were placed.
Following this, multi-unit abutments were fitted using the markers on the guided kit to assist with their positioning and placement.
Finally, two sets of titanium cylinders were fitted; one was to pick up the provisional teeth and the second was to pick up the Rapid appliance to assist with the final restorations.
Everything was sutured using resorbable sutures and then the PMMA bridge was fitted with slight occlusal adjustments.
The time required attaching these to the titanium cylinders was remarkably quick and easy. The centre line was slightly out but the overall result for a provisional was very good.
Post-treatment
The patient left in good spirits, having been reminded that a soft diet was necessary to keep the acrylic teeth in good condition.
Four months of healing followed and then a master impression was made, picking up the previously made Rapid appliance with new photographs and a bite. A month later, the final teeth were constructed in zirconia and fitted.
Meeting expectations
It has been 18 months since this case was completed. The patient has been diligent with attendance and hygiene maintenance. The COVID-19 pandemic meant he missed one appointment, but he is using a water flosser to good effect.
No other work apart from maintenance has been needed so far, although he now has a night guard because he is a bruxer.
The patient was very happy with the outcome, with Chrome guided surgery fulfilling his expectations and meeting his wants and needs to improve his quality of life.
From a clinical point of view, the treatment phase was simplified by using guided technology and both the form and function achieved are ideal for long-term success.
This article first appeared in Clinical Dentistry magazine. For more reads like this, you can sign up to the magazine here.
