Project description

  • Preoperative front view: 41 yr old presented with a failing 3 unit bridge (restorative failure). The bridge was extracted and a 3 unit implant supported bridge was planned. 2 stage technique was chosen with bone level implants.  Patient wore a temporary acrylic denture as a provisional.
  • 3 Sided full periosteum flap raised with direction indicators in initial osteotomy sites
  • Finished osteotomy site with motorised drill sequence
  • x2 bone level implants placed in-situ with cover screws
  • Resorbable porcine collagen membrane (Bio-Guide) attached to the periosteum with resorbable sutures
  • Hard tissue grafting done with bovine derived xenograft (Bio-Oss) on the buccal aspect resorbable collagen membrane placed under the periosteum to help stabilise the particulate graft
  • Closure of the full thickness flap to gain primary closure. Fixing the membrane to the periostium helps to close the flap without disturbing the position and function of the collagen membrane.
  • Primary closure with intermittent resorbable sutures
  • Area was left for 12 weeks to heal and a separate exposure appointment was undertaken to placed healing abutments to assist soft tissue contour. Image shows healing abutment in-situ 4 weeks post exposure.
  • Occlusal view of the implant heads 16 weeks post-placement .
  • Customised abutments in-situ. A decision to place a cement retained bridge was based on patients wishes for optimal aesthetics.
  • 3-unit cement retained implant supported bridge in-situ. Bridge was cemented with temp bond
  • Postoperative view. Pink porcelain was used to compensate for the soft tissue loss. The reason for the loss was due to the acrylic partial denture. Patient refused further soft tissue surgery to improve aesthetics. Gap below the prosthesis was created to help facilitate cleaning.