32 I I clinical _ implant retained crowns implants1_2012 Case study: Implant retained crowns Author_ Dr Shushil Dattani _Treatment summary: Patient complaint and expectations The patient, who had a clear medical his- tory, presented with a dull ache that appeared to be associated with a bridge in the upper left quadrant which felt “loose and spongy”. Be- cause of the existing problems with the bridge, the patient was reluctant to have a new bridge placed but wanted a long term solution. She was adamant that dentures were not an ac- ceptable option due to her strong gag reflex. Her oral hygiene was excellent. _Clinical examination No abnormalities were detected during ex- tra-oral examination but the intra-oral clinical examination revealed: UL4-6 VMK bridge present with the UL5 missing. UL4 had an 8mm pocket distally. UR4 also has 8mm pocket mesially. All the other teeth were healthy and her oral hygiene excel- lent. She was seeing the hygienist on a regular basis and her BPE score were 404/000. There was pocketing of 8mms UL4 MP, Midpoint and DB. There was also pocketing 8mms UR4 MP, Midpoint and DB. The patient had a class I incisor relationship on a skeletal I base with an anterior open bite from the UL2 UR2. Her guidance presented as canine on both left and right sides. There ap- peared to be no parafunctional habits. There were no other findings with the occlusion. _Radiographic and photographic examination: This confirmed that there was vertical bone loss mesially UR4 and distally UL5 of around 10mms. There seemed to be adequate bone height of 14mm from the sinus wall to mesial aspect of UL4, and the UL5 space had a height of 10mms from the alveolar crest to sinus wall, and UL4 14mms, (calculated from radiographic calibration using space of UL5 to calibrate). The ridge width was assessed by clinical palpation and ridge mapping which seemed adequate. _Assessment of case There was a distal bone defect around the UL4. The implant could be positioned to the mesial aspect and not follow the path of the extracted socket. This would give an increased bone height availability. The options of implant length could be a 13mm or a 16mm (and inter- nally raise the sinus by 2mms) (Nobel Biocare). With the UL5 an 8mm implant or a 10mm im- Fig. 1_Left Lateral Fig 2_Upper Occlusal Fig a_Rotational Tomogram: Note – Distal loss of bone UL4 and mesial UR4. Sinus in a favourable position. Internal Lifting necessary in the UL4 area if considering 16mm implant. See PAs for calculations. Bone density: good. Fig b+c_Confirmation of bone loss mesially UL4 and distally UR4. Sinus position noted UL5 and need for tenting. Sinus at 10mms from crest. Bone density: good. Fig.1 Fig. 2 Fig. a Fig. b Fig. c