CASE REPORT

Australian Dental Journal 2001;46:(3):216-219

Salvage of a blade-implant bridge

David H Thomson*
Ideally the implants, or at least implants 22 and 23, should have been removed and tooth 11 retreated with surgical endodontic procedures. However, this would have resulted in loss of more maxillary bone and a large defect that would have required augmentation or restoration with an obturator type appliance. The patient understood that ongoing retention of her implants might result in further compromise and, at the time of eventual failure, a significant prosthetic problem. Despite this, the patient refused any type of surgery and requested only a more aesthetic and functional bridge. After considering several treatment options with the patient and the laboratory technician, the following treatment was provided.

Abstract This paper describes an aesthetic and functional treatment for the replacement of a failing bridge supported by blade implants where the patient refused further surgery.
Key words: Blade implants, aesthetic, metal ceramic crowns.

(Received for publication February 2000. Revised March 2000. Accepted April 2000.)

INTRODUCTION The design of contemporary osseointegrated implant components makes the replacement of the aesthetic prosthesis relatively easy should this be required after the initial placement of the abutments and crowns or bridgework. The same cannot be said for the replacement of crowns or bridgework on the older-type blade implants, particularly when there has been hard and soft tissue loss around the blade implant structure. CA S E R E P O RT A 57 year old female patient presented requesting, for aesthetic reasons, the replacement of a maxillary anterior bridge that was supported on implants (Fig 1). The implants and prosthesis had been placed at least 15 years previously. Clinically, there were five splinted metal ceramic crowns from the right maxillary lateral incisor (12) to the left maxillary canine (23) (Fig 2). These were supported by blade type implants in the region of 12, 21, 22 and 23. Due to gingival recession, an extensive labial restoration had been placed at the gingival aspect of the crown on tooth 11. As seen in Fig 3, there had been substantial loss of hard and soft tissues in the region of 22 and 23, resulting in the exposure of the shaft of these implants. The prosthesis was slightly mobile on the left and probing of the tissues in this region caused pain. Radiographs (Fig 4a, 4b) showed there were four blade type implants in the region of 12, 21, 22 and 23 and an endodontic implant in tooth 11. There was bone loss around the blade implants, most noticeably in the 23 region.
*Prosthodontist, Brisbane.
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Fig 1. Patient at presentation.

Fig 2. Old maxillary bridge 12-23.

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Fig 3. Labial defect and implant exposure.

At the initial appointment, the existing bridgework was removed by sectioning the individual units (Fig 5). The 23 implant was very mobile and the 21 and 22 implants only slightly mobile (Fig 6). The preparation on tooth 11 was refined, leaving the existing resin core that was placed around the coronal aspect of the endodontic implant. Because of the mobility and alignment of the implant, it was decided to section the coronal post part of the 23 implant and to cantilever the 23 tooth in the final prosthesis. There was minor modification to the other implant posts to facilitate the placement of the final castings. Using Protemp Garant* for the teeth with the addition of a labial gingival flange of Triad material, a temporary bridge was constructed (Fig 7).

Fig 4b. Occlusal radiograph.

*ESPE, Germany. Dentsply International Inc, USA.

At the next appointment, an impression was taken after placing retraction to enable the recording of as much detail of the implant structure as possible. The various components of the final prosthesis were constructed and, following a try-in appointment, they were inserted. The final prosthesis comprised three sections (Fig 8a, 8b). The first section was a cast framework passively fitted to the existing implant posts and tooth 11 (Fig 9). This framework was designed to

Fig 4a. OPG radiograph.

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Fig 5. Removal of old bridge in sections.

Fig 6. Situation after bridge removal.

Fig 7. Temporary bridge.

Fig 8a. Individual final components.

Fig 8b. Assembled final components.

Fig 9. Cast substructure.

Fig 10. Individual crowns on substructure.

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Fig 11a. Finished cast with periodontal veneer.

Australian Dental Journal 2001;46:3.

The periodontal veneer is removed to allow for brushing and flossing and is left out at night during sleep. At a review appointment, the patient reported no problems and complete satisfaction with the prosthesis. CONCLUSION While not an ideal treatment plan in that there is a chronic periodontal condition (peri-implantitis) which will probably result eventually in further bone loss, this treatment has provided the patient with an aesthetic and functional prosthesis without surgical intervention and a probable removable prosthesis. This case illustrates that practitioners should examine all options when considering treatment plans for what appear to be terminal cases.

Fig 11b. Finished cast smile.

permit the placement of individual metal ceramic crowns to replace the missing teeth (Fig 10). To replace the missing soft tissues, an acrylic periodontal veneer was positioned. The overall result was aesthetically acceptable to the patient (Fig 11a, 11b).

Address for correspondence/reprints: Dr DH Thomson 217 Wickham Terrace Brisbane, Queensland 4000

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