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Partially Edentulous - Case ID: 4 - Lower
Female Patient, Occupation: Medical Nurse , Age at time of surgery: 67
Female Patient, Occupation: Medical Nurse , Age at time of surgery: 67
Photograph shows the extent of the vertical bone damage relative to the gingival margin positioning of the bridge restoration. We took the Swedish approach which was to place the fixtures in primary bone, if sufficient primary bone is available, and thereby retain the over ninety-nine percent success rate in the anterior mandible. A block onlay bone graft may have enhanced the aesthetic gingival or gum line position, but risked a failure rate of up to twenty percent, usually resulting in further devastation to the site, if it failed, and risking implant failure rates in graft bone of fifteen to twenty percent also.
The lip line held in the photograph is an obvious exaggeration of normal lip posture, purely to demonstrate how low the gingival bridge margin is.
The second photograph is I believe, close to a maximum display of lower incisor teeth within the range of normal lip posture and more than satisfies any cosmetic concerns raised by the bone discrepancy.
Patient is a far-west nurse, and the only issue she raised following the cementation of the bridge, was a fax requesting further diagrammatic instruction regarding the use of superfloss i.e. a modest level of difficulty experienced in the "getting used to phase" hygiene routine, related to the depth of the restorative margin below the lip line. Should be okay with practise.
The issue raised by poor hygiene around the prosthetic connections of Brånemark System fixtures can be largely subdued by a study at the Gothenberg Clinic involving thirty five thousand implants, and only seventeen recorded failures due to peri-implantitis. This is essentially gum disease producing bone loss around dental implants. Obviously, patients are given visual hygiene instruction, as a routine requirement, and it is what is expected of them to maintain their prosthesis and supporting tissue margins in a healthy condition, in spite of the above statistics. The pontics or the teeth on the bridge, not directly supported by the implant, are the lower left two and the lower right one.
The lip line held in the photograph is an obvious exaggeration of normal lip posture, purely to demonstrate how low the gingival bridge margin is.
The second photograph is I believe, close to a maximum display of lower incisor teeth within the range of normal lip posture and more than satisfies any cosmetic concerns raised by the bone discrepancy.
Patient is a far-west nurse, and the only issue she raised following the cementation of the bridge, was a fax requesting further diagrammatic instruction regarding the use of superfloss i.e. a modest level of difficulty experienced in the "getting used to phase" hygiene routine, related to the depth of the restorative margin below the lip line. Should be okay with practise.
The issue raised by poor hygiene around the prosthetic connections of Brånemark System fixtures can be largely subdued by a study at the Gothenberg Clinic involving thirty five thousand implants, and only seventeen recorded failures due to peri-implantitis. This is essentially gum disease producing bone loss around dental implants. Obviously, patients are given visual hygiene instruction, as a routine requirement, and it is what is expected of them to maintain their prosthesis and supporting tissue margins in a healthy condition, in spite of the above statistics. The pontics or the teeth on the bridge, not directly supported by the implant, are the lower left two and the lower right one.
Images - Click To Enlarge
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