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Prosthodontic Implant Bridge Design

Treatment Plan Choices for Maxillary Bone Loss

Bone loss can occur for a variety of reasons, some that are natural or normal, depending upon a patient's history of treatment choices or perhaps a factor that is more recent,such as trauma or gum disease.

Broken Failed Bridge
Bridge Failure caused by Leakage
Loss of ALL Anchor Teeth
For this patient, considerable loss of tissue (bone and anchor tooth structures) occurred as a result of extreme leakage on all of the anchor teeth.

The patient had a "significant" sweet tooth that, unfortunately, wasn't matched with an aggressive oral hygiene regimen.

Implant Bridgework vs Cemented Bridgework

Bridgework, both implant retained and non implant retained, does require a level of oral hygiene maintenance of the anchor supports. Bacteria and debris can accumulate at implant sites just as it does with natural teeth that are prepped to serve as anchor teeth.

Missing teeth deep maxillary bone loss
Implant Placements - View #1
Of course, infection can occur with both anchoring methods, but when natural tooth structures are used as anchors, there is the significant danger of the bacteria and debris destroying the natural tooth structures, once leakage begins.

As can be seen in our first photograph, there has been wholesale destruction of all anchor teeth that also involved peridontal and bone tissue loss.

Reconstruction Choices

Tooth replacement choices are usually numerous for most patients. One primary factor is a consideration of what type and level of reconstruction is desired.

Missing teeth deep maxillary bone loss
Implant Placements Closeup View #2
A younger patient is likely, as an example, to select treatments that restores as much bone and supportive tissues as possible while a senior citizen may choose to focus on retaining the best function possible with the least invasive surgeries, minimal healing time and best value for the dollar.

Implants with Minimal Bone Grafting

An implant supported bridge was deemed as the best treatment choice for this patient. Although special bone grafting treatments could be used to recreate a width and height of bone tissue that was lost, the use of custom implants and a unique bridge design was suggested that would minimize the need for additional bone graft surgeries.

Missing teeth deep maxillary bone loss
Five Unit Bridge
Abutment Design
For this patient, the extraction sites were prepared for implant devices that designed for use in bone areas where height and width are variable.

As reflected in the adjacent photos, a healthy, plump ridge of bone and gum tissue was created to serve as a solid foundation for a custom implant bridge.

Custom Titanium Milling

Missing teeth deep maxillary bone loss
Titanium Bridge Framework
Try In
Using a stone model of the patient's jaw structures and remaining bite characteristics, a prototype of the patient's recommended bridge was placed into the implant configuration for final assessment and adjustments.

Notice how there is a "reach" or extension of titanium used to compensate for more bone loss on end end of the bridge (central incisor area) as compared to the opposite end.

Fine Tuning Occlusal Adjustments

Additional bite analysis with the bridge prototype mounted enabled a series of final adjustments along the entire bridge to assure the proper relationships with the opposing teeth in the patient's lower jaw.

Porcelain Implant Bridge
Porcelain Bridge
Mirrored View
Based on the diagnostic waxup models used, the uppermost areas along the top of the bridge are tinted with a gingival color that matches the patient's actual tissues and creates a harmonious gingival arching effect that is symmetrical with the patient's existing teeth.

Porcelain Bridge Restoration

The intermediate use of a temporary bridge (acrylic composition) provides for attention to detail and patient input during the final bridge design phase. Cosmetic values for the final porcelain bridge product (shading, translucency) are baked-in during the fabrication process and cannot be revised afterwards.

Prosthodontist Arch Reconstruction
Prosthodontic Maxillary Arch Rehab
Mirrored View

Occlusal Confirmation

With the final porcelain restoration in place, bite characteristics are assessed for each pair of opposing tooth structures that assures proper alignment and biting pressure that complements the overall bite dynamics between the upper and lower jaw.

Final Abutment Adjustment

When using dental implants, the attachment of the bridge prosthesis can be screw retained or cemented, based on patient preference and any special considerations for achieving optimal endurance.

Abutments are adjusted as needed to create the best fit.

Prosthodontic Progession to Cosmetic Outcome

Prosthodontist Arch Reconstruction
Cosmetic - Functional Smile Reconstruction
The overall approach of a Prosthodontic specialist is frequently different from a dentist who practices Cosmetic Dentistry.

Unwanted surprises in comprehensive dentistry are more easily avoided when a specific rehabilitative protocol is followed that focuses on function primarily, with ample opportunity to create the best cosmetic match, as defined by the patient.

Editorial Staff

Material provided by:
Christopher McFarland, DMD
Atlanta Prosthodontist - Periodontist
2530 Lawrenceville Highway
Decatur - Duluth - Atlanta, GA
(770) 492-0256

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