Printer Friendly Email Article

The full lower denture is arguably the most dissatisfying dental procedure for both dentists and patients. Using multiple impression materials with proprietary trays to achieve perfect bite registration for a special occlusal scheme simply won’t produce a satisfactory result.

Root-form implants can greatly improve the success rate in restoring the lower arch with a fixed prosthesis, but there are many patients who have too little bone for these implants. Only a wealthy few can afford the time and money it takes to have the necessary bone grafts for a fixed restoration on an atrophied mandible. As a result, there are many denture wearers who must suffer the pain and embarrassment of a full lower denture for life.

The small diameter option

	WATCH THIS!
	Click here  to watch a demonstration of the FixtTeeth™ technique Click here  for an interview with Dr. Letcher

The FixtTeeth™ procedure—which can be completed in one appointment—is one solution for these patients. This technique involves using small-diameter implants, such as MDL from Intra-Lock (intra-lock.com), to support a full arch of resin teeth, which are rigidly fixed in the patient’s mouth.

The following case illustrates how I used this technique to give a patient an esthetic lower denture that feels and acts like real teeth.

The initial visit

A woman in her 50s presented with an unsatisfactory lower denture (Fig. 1). She was told she was not a candidate for implants without some serious bone grafting and that it would take 18 months to complete her restoration. Her mandible had atrophied to the point that the inferior alveolar nerve was on the crest of the mandibular ridge.

At the initial patient visit, we took a CT scan with the i-Cat from Imaging Sciences (imagingsciences.com) to see the density and shape of the mandible (Figs. 2 and 3). At the same appointment, impressions were made of the upper and lower arches to establish the vertical dimension and the centric bite for a new lower denture. The denture teeth were set with a minimum wax and no flanges. Then, a plastic mold was made of the denture set-up and surrounding soft tissues.

The procedure

At the next appointment, which can be as soon as the next day, 10 mini-implants (2- to 2.5-mm diameter) were placed in the mandible without incisions (Fig. 4). The information from the i-Cat makes this possible. An impression was made of the lower arch and poured in quick-setting stone. The plastic mold of the denture set-up was filled with hybrid Renamel by Cosmedent (cosmedent.com) and fitted to the stone model (Figs. 5 and 6).

The resin was then cured and removed from the stone model. The resin teeth were defined and polished before they were tried in the mouth and the occlusion adjusted.

Finally, additional resin was placed on the intaglio surface of the teeth and inserted on the implants. Excess resin was removed and the teeth cured to the implants. The lower border of the teeth was trimmed to keep the bucco-lingual dimension of contact between the resin and soft tissues to a minimum (less than 4 mm). This allows cleansing with a toothbrush and a water-irrigating device.

The result

The patient came back 10 days after the procedure to have her teeth polished and her bite adjusted (Figs. 7 and 8). She was thrilled with her renewed ability to chew and needed no further adjustments.

THE PATIENT PRE-OP
1 A female in her 50s presented with a lower denture that was unsatisfactory.	2 Pre-op panoramic x-ray with CT scan slices, taken with the i-CAT from Imaging Sciences.	3 Pre-op 3D image of the mandible.
4 The mini-implants were placed in the mandible.	5 Gingival shade was added to the hybrid resin teeth.	6 The resin teeth on a model.
THE PATIENT POST-OP
7 Post-op panoramic with teeth inserted.	8 The final restoration.