Converting Bad Dental Implant Overdentures To Fixed Full Arch Bridges -Review Of Complex Case

Here is an interesting full double arch dental implant case that I took over from another dentist.  This patient desired full mouth dental implants.  When he presented to my office he already had 10 implants but could not use his teeth.  He paid a lot of money only to be disappointed with the removable over dentures that were made for him.

initial x-ray when I first met the patient--10 implants that would not work for over dentures

initial x-ray when I first met the patient–10 implants that would not work for over dentures

initial presentation when I first met the patient with his existing 10 dental implants and over dentures that would not work.

initial presentation when I first met the patient with his existing 10 dental implants and over dentures that would not work.

pre-existing condition when I met the patient-upper jaw

pre-existing condition when I met the patient-upper jaw

pre-existing condition when I met the patient-lower jaw

pre-existing condition when I met the patient-lower jaw

bulky, huge dental implant over dentures...poorly done

bulky, huge dental implant over dentures…poorly done

poorly made overdenture attachment connection

poorly made overdenture attachment connection

poorly made overdenture attachment connection

poorly made overdenture attachment connection

 after healing on the lower arch dental implants

after healing on the lower arch dental implants

after healing on the upper arch dental implants

after healing on the upper arch dental implants

after healing on the 17 dental implants--the Gold abutments aren't locators used by the previous dentist attempt at making teeth.

after healing on the 17 dental implants–the Gold abutments aren’t locators used by the previous dentist attempt at making teeth.

impression transfer on the upper 10 implants

impression transfer on the upper 10 implants

impression transfer on the lower 7 implants

impression transfer on the lower 7 implants

screw retained full arch temporary dental implant bridge

screw retained full arch temporary dental implant bridge

screw retained full arch temporary dental implant bridge

screw retained full arch temporary dental implant bridge

narrow gum the sulcus channelson the existing implants towards the front of the mouth

narrow gum the sulcus channels on the existing implants towards the front of the mouth

fully biting into full mouth fixed temporary implant Fp1 teeth

fully biting into full mouth fixed temporary implant Fp1 teeth

PMMA double arch full mouth dental implant fixed temporaries--other side

PMMA double arch full mouth dental implant fixed temporaries–other side

PMMA double arch full mouth dental implant fixed temporaries--side view

PMMA double arch full mouth dental implant fixed temporaries–side view

PMMA double arch full mouth dental implant fixed temporaries

PMMA double arch full mouth dental implant fixed temporaries

x-ray of the 17 implants during the process. Some of the implants were placed by me in some by previous dentist.

x-ray of the 17 implants during the process. Some of the implants were placed by me in some by previous dentist.

Handsome smile with temporary upper and lower full arch teeth.

Handsome smile with temporary upper and lower full arch teeth.

You can see on the preoperative x-ray that he had 6 upper dental implants and only all on 4 lower dental implants.

The implants were mostly well placed from a spacing standpoint and might have been able to be used for fixed dental implants such as a Prettau zirconia full mouth dental implant bridge.  Rather than having a fixed bridge or an all on 4 fixed bridge, the dentist chose to make an overdenture!! 

The overdentures never worked for him.

 They were way too bulky and had a tremendous thick pink area we call a flange.  The crazy thing is that there is no way overdentures could have ever worked because all the implants were placed way too shallow!  In order to have overdentures, you must have enough room from top to bottom (inter-arch space) to fit the dentures and plastic abutment attachments that make them snap into place.  The gold attachments are called locator abutments which typically work well on the lower jaw only.

He never wanted to have removable teeth but that is NOT what he got.  He was not able to wear the overdentures at all and came to me for a better solution.  He had gone 3 years like this.  The teeth were even made twice and then he gave up.  He told me I was his last hope. 

After evaluating him carefully I determined that the implants were placed in a shallow position more ideal for “regular implants.”  We refer to this in dentistry as an “Fp1” prosthesis.  That means there is no reason or room for the pink portion which most patients need because they are missing bone and gum.  This patient actually had excessive bone which is very rare and in retrospect if he really wanted an overdenture should’ve had a bone leveling alveoloplasty procedure.

This very well could have been a communication problem between the restorative, tooth making dentist,  and the implant surgeon.  In this case, there were 2 different people who started the procedure.  I am a strong believer that these complex dental implant procedures should be done from start to finish with a *single* skilled provider or a very tightly connected and experienced partnership duo.

The upper implants unfortunately were all squished in the front, without any dental implants in the molar back tooth positions with minimal inter-arch space.  On the lower jaw they were well spaced but there was too much space between implants for the regular/crown and bridge/Fp1 type teeth. 

The solution was to add four additional implants into the molar regions on the upper with some simple internal sinus lifting.  On the lower jaw I added 3 implants in strategic locations to shorten the spans of the bridges.  If the span is too long, and the zirconia material is not thick enough, the teeth will break…yikes!!!!   The additional implants will support the material.  This will allow him to have basically regular teeth back again without any of the pink porcelain or pink plastic.

In a single appointment, I added these additional 7 implants with minor sinus grafting under IV sedation at my office in Burbank, California.  The implants were allowed to heal for approximately 4 months prior to starting the restorative process.

Fabricating his teeth was very complex because of 2 different implant systems and at least 4 different proprietary screwdrivers and parts.  The locator abutments also had a very narrow “sulcus” which would be too small at the tooth neck for regular size teeth.  I actually had to custom alter make all of the special titanium implant impression transfers to fit into the overly narrow gum channels.

A verification jig was 3D print milled to be certain that all 17 implants had a very accurate impression so that there is no misfit of the new teeth.  I also created a screw retained wax rim teeth in order to  select tooth size, color, position, bite level and a host of other factors.

In these photographs what you are seeing is a temporary PMMA double arch bridge.  This is not the final although it may look like a final bridge! 

All teeth were designed using 3-D  3shape software.  I had my very skilled lab technician digitally create wider gum channels so the teeth at the neck appeared more of a normal size so they would not have mushroomed stalks.  At the delivery appointment for the temporaries I had to surgically open his gums to fit the teeth.  This will allow any papilla or gum triangles to fill in as needed and “groom the gum tissue” to fit the new teeth.  The PMMA is a milled plastic/acrylic material so the bite can be adjusted and refined.  I will then take all of this information and translate that to the final restoration.

I usually allow my patients to wear the screw retained PMMA full fixed implant temporary bridge for a few weeks to a few months depending on how much testing and adapting the patient needs.  Some people adapt very quickly with speech while others need a bit more time to learn where there teeth are in space.  This testing duration also allows the TMJ jaw joints an adaptation period.  Also the bone can progressively be given bite strength with this softer material and gradually get to the solid monolithic zirconia restorations.

Sorry for the blood in some of the photos as they were taken on the day of surgical delivery of these temporary restorations.  The finals will look very similar to this except even better 🙂

I hope this explain some of the highly complex procedures that go into recovering such a difficult situation.  Unfortunately a lot of what I do nowadays is correcting and redoing bad situations which could’ve been done right the first time with better planning.

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry


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7 thoughts on “Converting Bad Dental Implant Overdentures To Fixed Full Arch Bridges -Review Of Complex Case

  1. Barbara barnhart

    I have full upper and lower snap- in dentures-4 implants top and 2 bottom. For the last 2 years Ive had several

    Reply
  2. Tim

    I just received my upper all on 4 hybrid denture in the roof of my mouth the acrylic was sharp and on both sides I was biting my cheeks he removed some of the material and polished my denture which helped some on the biting of the cheeks but when he polished the roof part I now have a big gap and when I talk I talk through my front teeth sounds like I have dentures he told me that they would be screwed in and cemented over the screw the he tells me that snap on is a better way to go my right side fits well teeth line up with bottom teeth and have less pink material feels great with my tounge on the left side it is thick and teeth don’t line up the upper plate flexes when I bite down the left side that doesn’t line up has some pain I complained about the material he removed on the roof of the plate and he said that when he polished it probably removed to much but you are stuck with it I hate the way these teeth feel in my mouth but people say you will get used to them and the Dentist told that when you bite your cheek it will get tough should I complain more or seek another Dentist.

    Reply
    1. RamseyAminDDS Post author

      I am hoping that this is just a temporary restoration for you. I would hope that you are not being provided the final restoration on the same day of surgery. Routinely I provide same day all on X implants and provide same-day immediate teeth but these are just temporary. There is no way to work out all the details for aesthetics, phonetics, bite all on a single day surgery. After healing for a few months with the temporaries, I will convert patient to final solid zirconia Prettau Bridges. Here is how the process works on the lab design side. none of this is done for the same-day procedure until the gums and bone have healed enough. Hang in there and in the meantime be sure to stay on a very soft diet.

      Reply
  3. james a lewton 6161 eastview ave, north ridgeville ohio 44039-1541

    I HAD THREE MISSING TEETH, THAT WERE ROTTED-OUT AND PULLED AFTER BEING FIXED,TWICE, MY ORAL AND FACIAL DENTIST WANTED ME TO PUT DENTAL-IMPLANTS,IN RIGHT AWAY. I DIDN’HAVE DENTAL INSURANCE AND TOLD HIM, I COULD’N DO THIS NOT @$ 2,600 PER
    TOOTH, ITS BEEN ABOUT 2-YEARS NOW AND I HAVE BEEN IN THE HOSPITAL EMERGENCY ROOM
    TWICE NOW SCREEAMING @ THE TOP OF MY LUNGS WITH LEFT-JAW PAIN THINKING I WAS HAVING A HEART ATTACK, THEY TOLD ME NO I WAS’NT,WENT BACK TO MY DENTIST AND HE NUMBED MY LEFT-JAW, JAW PAIN WAS STILL THERE,HE SAID I HAD TMJ, SAW THREE-DOCTORS,
    ABOUT THIS GAVE-ME PAIN PILLS.3-22-2017 I LOOKED IM MY OWN-MOUTH,GUM-LINE BELOW THE
    CHEWING-TEETH, I HAVE JAW BONE ATROPHY,GETTING WORSE,GOD-BLESS YOU FOR ARTICLE
    SHOWING HOW YOU WOULD FIX-THIS. MY DENTIST-ORAL FACIAL REPAIR,TOLD ME NOTHING
    ABOUT WHAT WAS GOING TO HAPPEN TO ME ,IF I DID’NT GET THE TEETH-FIXED,YOU ARE A ANGEL FROM HEAVEN,FOR PUTTING THIS ARTICLE,WITH PICTURES, ON HOW TO FIX THIS PROCEDURE. “god bless you” always

    Reply
  4. gg

    You have shared here almost every aspect of bad dental implants and the good impact of full arch bridges. But I want to know that is it possible in every case?

    Reply
    1. RamseyAminDDS Post author

      Every case is different and unique. There is no cookie cutter response to every problem. I treated every patient as individual and work towards a proper diagnosis and then an appropriate treatment plan.

      Reply