Implant supported bridges in UJ and LJ with 9 years of follow up

With use of long implants in pterygoid zone

Situation

• Patient desires: fixed solution for upper and lower jaw

• diagnosis:– UJ: dorsally insufficient bone volume– LJ: enough bone volume

• Treatment plan– UJ: 4 standard implants and 2 long implants

with pterygoid anchorage– LJ: Implant supported bridge on 5 (6) implants

Chronology• 13/02/2003: Placement implants

– Upper jaw: (4RP,2pt) – Lower jaw (6RP)

• 28/07/2003: Second stage + failure implant 32

Intake

28/01/2002: Intake

28/01/2002: Intake

Implantplanning

UJ: Planning 4 RP and 2 pterygoids

UJ: Planning 4 RP and 2 pterygoids

Implantplanning

LJ: Planning 6 RP

Implantplanning

Dimensional data about the Safe® System

Dimensional data about the Safe® System

Treatment

Stereolithographic model with planned implant positions

Stereolithographic model with SurgiGuide with Mucosal support and Safe® System

Stereolithographic model with zygoma implant Insertion Guide

Stereolithographic model with SurgiGuide with Safe® System

13/02/2003: Implant Placement in UJ and LJ

13/02/2003: Implant Placement in UJ and LJ

13/02/2003: Implant Placement in UJ and LJ

13/02/2003: Implant Placement in UJ and LJ

Rubber stop for depth control

13/02/2003: Implant Placement in UJ and LJ

Second Guide for Placement of Long Implants

13/02/2003: Implant Placement in UJ and LJ

13/02/2003: Implant Placement in UJ and LJ

13/02/2003: Implant Placement in UJ and LJ

13/02/2003: Implant Placement in UJ and LJ

13/02/2003: Implant Placement in UJ and LJ

13/02/2003: Implant Placement in UJ and LJ

13/02/2003: Implant Placement in UJ and LJ

Postoperative check

Postoperative check

Postoperative check

28/07/2003: Second stage surgery

28/07/2003: second stage for the upper jaw

X

Implant 32 was lost at second stage

Final result Upper jaw and Lower Jaw

9 years follow-up

08/02/2011

08/02/2011: 9 years follow-up

08/02/2011: 9 years follow-up

08/02/2011: 9 years follow-up

08/02/2011: 9 years follow-up

08/02/2011: 9 years follow-up

Severe bone loss in the lower jaw

08/02/2011: 9 years follow-up

With a history of several crown fractures and bridge looseningAnd gradual breakdown of the bridge

08/02/2011: 9 years follow-up

08/02/2011: 9 years follow-up

08/02/2011: 9 years follow-up

08/02/2011: 9 years follow-up

Extremely asymmetric occlusion

08/02/2011: 9 years follow-up

Extremely asymmetric occlusion

08/02/2011: 9 years follow-up

Extremely asymmetric occlusion

What to do?

• Patient wants to change from restorative dentist

• A remake of bridge in the Upper and Lower jaw is needed

• After unscrewing the bridges, all implants were found to be stable

• What advice to give to the new restorative dentist ?