Upper arch rehabilitation using dental implants
Case study: Teeth in a day with New Life Teeth
Words: Dr Mark Tarpey (BDS (QUBz) DipImpDent (Adv Cert) RCS (Eng)
The literature on immediate loading with fixed full-arch prostheses in the maxilla shows that a successful outcome can be expected if adequate criteria are used to evaluate the patient, choose the implant and perform the surgical and prosthetic treatment1.
New Life Teeth dental clinics (Belfast, Dublin, Edinburgh and Glasgow) have been providing teeth-in-a-day treatments for seven years, and have done more than 2,000 full arch surgeries and restorations.
Here, a recent case is presented to outline the workflow and protocols used in the clinics.
The patient
Fit and healthy 59-year-old. Non-smoker. High blood pressure, well controlled by medication.
Initial presentation
The patient presented with terminal upper dentition. There were multiple areas of apical pathology and she was wearing a removable denture. Oral hygiene was adequate. At the time of the initial consultation, she reported a loss of function and a lack of confidence in her teeth and in herself.
Treatment plan
Pre-operative planning
As part of the process both CBCT and intra-oral scans were taken. The CBCT allows for 3D bone imaging, volume assessment and the identification of vital structures. Intra-oral scans are accurate, reproducible and with no physical models there is no need for physical storage of models and the risk of losing or breaking models is eliminated.
With these scans in the arsenal, Smile Design with Zirkonzahn is the next step.
Terminal upper dentition; multiple areas of apical pathology; removable denture; loss of function and confidence 
Terminal upper dentition; multiple areas of apical pathology; removable denture; loss of function and confidence 
CBCT – 3D bone imaging; Bone volume assessment; Identification of vital structures 
Intra-Oral Scans – Accurate; reproducible; no storage; no risk of losing/breaking models 
Extraction of all remaining upper teeth 
Partially guided placement of six Southern Implants dental implants; 12-tooth immediately loaded milled acrylic bridge with welded bar 
External hex connection, reduced risk of implant fracture, machined surface collar, reduced risk of peri-implantitis, co-axis for tilted implants, reduction in required prosthetic space, reduced alveoplasty, higher torque of straight MUA compared with angled 
iMetric and Intra-Oral Scans 
Highest level of accuracy; Fewer restorative phases; Improved patient comfort 
Soft tissue condition is excellent after 12 weeks’ healing 
Milled PMMA trial bridge: allows for assessment of occlusion, aesthetics, passivity, speech 
CADCAM Prettau Zirconia Bridge is constructed by Teeth Forever Lab 
Implant surgery
During surgery, all the remaining upper teeth were extracted, and six Southern Implants External Hex implants were placed using a partially guided protocol.
The external hex connection is the preference due to the reduced risk of implant fracture2 as well as the wider range of co-axis angulation being available (12, 24 and 36 degrees). The MSc implant, which has a machined surface coronally to help reduce the risk of peri-implantitis3, was chosen for this case. Co-axis implants are excellent for reducing the required prosthetic space4, leading to reduced alveoplasty, and a higher torque of a straight multi-unit abutment compared with angled abutments5. In this case, two 24-degree co-axis implants were placed along with four straight implants.
The implants were loaded with a 12-tooth milled acrylic bridge with a welded bar. The post-surgery workflow is as follows:
- Week 1: Review
- Week 2: Suture Removal
- Week 6: Secondary review and OH check. A Waterpik was prescribed.
- Week 12: Osseointegration check and restorative phase
Restorative phase
During the restoration phase, both iMetric and Intra-Oral Scans are taken, as this assures the highest level of accuracy, and also reduces the restorative phases. Improved patient comfort is also a consideration.
In this case, the soft tissue condition is excellent after 12 weeks’ healing.
The milled PMMA trial bridge allows the assessment of occlusion, aesthetics, passivity of the fit and the patient’s speech before the definitive CADCAM Prettau Zirconia Bridge is constructed by Teeth Forever Lab, NewLife Teeth’s in-house laboratory.
More information
Southern Implants UK & Ireland: www.southernimplants.co.uk
New Life Teeth: www.newlifeteeth.co.uk
NLT Mission Statement: Achieving dental excellence every day. We provide world-class dental and cosmetic care underpinned by three core elements: leading-edge technology, professional expertise, and unrivalled skill.
References
- Peñarrocha-Oltra D, Covani U, Peñarrocha-Diago M, Peñarrocha-Diago M. Immediate loading with fixed full-arch prostheses in the maxilla: review of the literature. Med Oral Patol Oral Cir Bucal. 2014 Sep 1;19(5):e512-7. doi: 10.4317/medoral.19664. PMID: 24880445; PMCID: PMC4192577.
- Data on file: Southern Implants fatigue testing. info@southernimplants.com
- Wennerberg A, Albrektsson T, Chrcanovic B. Long-term clinical outcome of implants with different surface modifications. Eur J oral Implantol 2018; 11 (Suppl1):S123-136
- Malaguti, G, Esposito A, Nicoli G, Pellitteri G, Consolo U. Implant-supported restorations of edentulous arches with immediate loading and intra- and extraoral welding. Retrospective study with 3 years of follow-up. Eur J oral Implantol 2013; 6 (Suppl: S9-s82.
- Van Weehaeghe M, De Bruyn H, Vandeweghe S. A prospective split-mouth study comparing tilted implants with angulated connections versus conventional implants angulated abutment. Clin Implant Dent Relat Res 2017; 1-8.
Tags: arch, Life, new, rehabilitation
