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Special Issues
January 2018
Volume 39, Issue 1
Peer-Reviewed

A Temporary Bridge to Develop a Patient’s Smile for Fixed Maxillary Implant Restorations

Marius Steigmann, DDS

Developing an ideal implant-prosthetic therapy for an edentulous maxilla can be difficult when phonetic, functional, and esthetic deficits are present. Despite precise planning, after insertion of the definitive maxillary full-arch fixed restoration, the outcome is often less than optimal. This problem can be alleviated and a predictable result obtained by prototyping the patient's final smile, function, and phonetics using a temporary bridge that is easy to fabricate, insert, and remove—a technique that can be accomplished with the use of the LOCATOR F-Tx® Fixed Attachment System (Zest Dental Solutions, zestdent.com).

Many details must be addressed when creating a final fixed prosthetic restoration in an empty space. After tooth loss and the subsequent bone resorption and soft-tissue changes that accompany it, typical use of a full removable denture with pink acrylic changes the patient's phonetics and esthetics, as well as the muscular tension needed to hold a total removable denture. Ultimately, successful treatment involves many more factors than the osseointegration of the implant(s). Patients expect full function, good esthetics, and natural phonetics after a denture is replaced with a fixed implant-supported restoration. Fabrication and use of a temporary restoration can help ensure that these goals are attained.

Often any mismatches between the maxillary restoration and the facial aspect appear only after the insertion of the final high-cost restoration upon completion of treatment or when patients complain in the months following treatment. Flawed esthetics, phonetic deficiencies, or inadequate function are some of the shortcomings that can result, and these can be difficult to predict in advance when converting a patient from a conventional denture to a full-arch fixed restoration. The elimination of the labial flange, for example, can be a problem for patients who had been wearing a full denture in the maxilla; the flange that supported the lip for many years is no longer present. When the implant bridge is inserted, the lip support is lost. The face appearance changes, as do aspects of the soft tissue in the oral cavity. Such complications must be taken into consideration during the course of therapy and are especially problematic if the definitive restoration has already been inserted.

Long-term provisionals, which can be modified according to the facial esthetics, can be used to overcome these issues, and the LOCATOR F-Tx Fixed Attachment System can simplify the process. The fixed maxillary restoration can be precisely planned and is easy to both insert and remove by the dentist. The patient is afforded the opportunity to “test drive” the fixed bridge with regard to esthetics, function, and phonetics. Moreover, musculature and soft tissue are conditioned. Also, subjective factors on the part of the patient are determined during this trial period and modifications can later be incorporated into the final restoration.

In the case presented (Figure 1 through Figure 10), the patient had a denture that was insufficient in the upper jaw. The prosthesis did not offer adequate support due to problems with reduced retention, nor did it meet the patient's esthetic desires. After a consultation with the patient it was decided that six implants would be inserted in the upper jaw. During the osseointegration period the patient wore the existing denture.

After osseointegration was achieved, a fixed metal-reinforced temporary bridge was fabricated using the LOCATOR F-Tx system, according to the patient's ideal occlusion, esthetics, phonetics, and function. The patient would need time to adjust to the new situation without a labial flange, as changing directly to the final fixed restoration could be a risk to both esthetics and phonetics. With the LOCATOR F-Tx solution, the patient is able to use the long-term temporary to get a feel for what the fixed implant-supported bridge will be like. Changes to facial expressions and phonetics, improvements in the outcomes of soft-tissue papillae, and midfacial soft-tissue contour are among the factors that can be determined and fine-tuned during the time the patient wears the long-term temporary bridge. Moreover, all of this is achieved without cement or screws, allowing for quick and easy removal of the temporary bridge for any desired adjustments to the prosthesis during the trial period prior to designing and finalizing the definitive fixed prosthesis.

ABOUT THE AUTHOR

Marius Steigmann, DDS
Private Practice, Neckargemünd, Germany

Fig 1. The patient presented with a partial denture retained by two telescopic crowns, with those two teeth failing and the denture becoming mobile. She wanted a fixed implant-retained bridge, but first it had to be determined whether such a solution was possible based on her anatomical situation and desired esthetic outcome.

Figure 1

Fig 2. Before surgery the smile was prototyped in the ideal situation. This prototype was then used to position the implants in an ideal prosthetic position and help the clinician decide if a fixed implant-retained restoration was possible.

Figure 2

Fig 3. Cast after implant-level impression, with LOCATOR F-Tx abutments inserted.

Figure 3

Fig 4. The design of the teeth for the long-term temporary bridge, developed in the laboratory.

Figure 4

Fig 5. After the ideal teeth positioning had been determined, acrylic veneers were connected to a metal frame.

Figure 5

Fig 6. After insertion of the housings on the LOCATOR F-Tx abutments and making them parallel, they were welded in the dental lab with a titanium wire for cross-arch stabilization and reinforcement of the temporary bridge.

Figure 6

Fig 7. Final metal-reinforced temporary bridge was fabricated with the ideal smile designed. This bridge was then prepared for insertion on the LOCATOR F-Tx abutments.

Figure 7

Fig 8. Final bridge with the black processing balls for the initial positioning of the bridge.

Figure 8

Fig 9. The processing balls were then replaced with the blue retention balls to provide fixed stability for the bridge, but allow for easy clinician removal for adjustments.

Figure 9

Fig 10. Ideal smile and lip support 6 months after insertion of the LOCATOR F-Tx supported bridge. By allowing the patient to test phonetics, function, esthetic outcome, and muscular adaptation, a new definitive bridge can be fabricated

Figure 10

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