Securing excellent primary stability in soft bone

Waseem Noordin describes how he restored a patient’s ability to eat and talk effectively with an implant-retained three-unit bridge using Axiom Multi Level.

An 85-year-old retired gentleman was referred to The Park Dental Practice for the restoration of his missing lower left and upper right premolar and first molar teeth (LL4-LL6 and UR4-UR6) with dental implants.

The patient lost these teeth more than eight years previously and had been managing, reluctantly, with removable upper and lower acrylic dentures. His medical history was clear and he was fit and healthy. The patient’s initial priority was to have the missing lower left posterior teeth restored, as he did not want to wear a lower denture any longer. We discussed the possibility of a removable lower cobalt-chromium denture, but he wished to have fixed teeth, so he could enjoy eating again.

Challenging diagnosis

A thorough clinical examination was undertaken. The presence of small bilateral lingual mandibular tori in the first premolar (LL4 and LR4) region made the wearing and retention of the lower denture difficult. Intraorally, the remaining dentition was sound, with a healthy and stable periodontal condition.

The lower left alveolar ridge had undergone resorption with loss of bone height and buccal width.The OPG radiograph confirmed the absence of any pathology in both jaws (Figure 1). A CBCT scan of the lower jaw was taken to accurately assess the anatomy and position of the inferior dental nerve (Figure 2).

The scan confirmed loss of buccal bone and shed some light on the compromised density of the trabecular bone, especially in the first and second premolar regions (LL4 and LL5).

A diagnostic wax-up was prepared and a surgical stent constructed on the diagnostic set-up to mark the position of the implants on the ridge during placement.

Angulated implant placement

Due to the patient’s…