implants - the journal of oral implantology UK Edition

30 I I clinical _ CBCT implants1_2012 and good bone quality it was decided to adopt a single stage surgical protocol, thereby plac- ing healing abutments over the implants. The site was closed using 5,0 PGA sutures and a tooth supported denture replacing the lower incisors was fitted. Careful examination of the denture was carried out to ensure there was no contact, or transfer of occlusal load onto the implants from the denture. The patient was seen seven days after surgery for suture re- moval and review. The patient healed without incident and due to the favourable lingual undercuts of the low- er teeth was able to comfortably wear the den- ture during the healing process. Due to finan- cial reasons the planned implant placement for the UR4 site was deferred until a later date. After eight weeks of healing, fixture level open tray impressions were taken in Imp- regum (3M ESPE), and 4-unit screw retained bridge was fabricated. The tooth set of the denture was duplicated on the final bridge as the patient was happy with the tooth size and shape. Due to the previous bone loss, pink por- celain was added to the bridge to improve the emergence and reduce the crown lengths of the lower incisors. The bridge was seated and torqued to 35Ncm and composite placed in the access holes, a baseline long cone periapical radio- graph was taken to serve as a baseline for bone level measurements. The occlusion was checked, with the patient exhibiting canine guidance in excursive movements. The patient was shown how to clean under the bridge us- ing super floss and tepe brushes and placed on a long term maintenance programme. _Prognosis The bridge has a good long-term prognosis as this patient is highly motivated, and exhib- its excellent oral hygiene. She is aware of the increased risk of complications, and the possi- bility of losing more teeth in the long run, but after having worn a denture for three months, she is determined to avoid becoming a long- term denture wearer. The patient will see me at six-monthly intervals and sees a hygienist every three months for maintenance._ Dr Nilesh R Parmar BDS (Lond) Msc (ProsthDent) Msc (ImpDent) Was voted Best Young Dentist in East Of England in 2009 and runner up in 2010. He is one of the few dentists to hold a University Of London degree from all three London Dental Schools and is due tostart his 3rd Msc in Orthodontics at Warwick University this year. Nilesh is an Astra Tech Clinical Coach and has his own practice in Southend on Sea, Essex. He also works as a visiting implantologist at Sparkly Smiles in BlackheathandtheLondonBridgeDentalPractice.www. drnileshparmar.com. implants_author info Fig. 9 Fig. 10 Figs 8-10_Laboratory-made screw retained porcelain bridge on Straumann Sync Octa abutments Fig 11_Appearance at fit Fig. 11