Fixed implant bridges: What can I expect from this treatment?

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Cosmetic and Restorative Care
BSc, BDSc (Melb)

fixed implant bridgesIndividuals, who are missing all their teeth in one or both jaws, or whose remaining teeth have a poor prognosis, now have the option of having a functioning immediate acrylic bridge.

This fixed implant bridges is supported across a whole arch in as soon as 3 days after implant placement. This procedure suits those individuals who need most or all of their remaining teeth in one or both arches replaced.

Your suitability for this procedure depends on several factors including your general health.

The Procedure: Fixed implant bridges

CT Scans Consultation appointments

Initially a three dimensional CT scan (X-ray) is required of your jaws to allow us to assess the available bone volume for successful implant placement.

Dental implants are titanium or titanium alloy screws that are surgically placed into your jawbone. The average implant is 4mm in diameter and approximately 10mm in length. Usually, implants require 3 months of healing before they may be loaded in oral function.

However, there are special circumstances where it is possible to load implants immediately without significantly impacting their survival/success rates. This is in situations where we are placing adequate numbers of implants in good quality bone where the implants are being joined together with a rigid prosthesis within a few days of the implant surgery. This requires a minimum of 4 implants in the lower jaw and 6 implants in the upper jaw.

You may have the CT scans done on site at the Collins Street Specialist Centre.

You will then be scheduled for a consultation appointment to discuss your specific needs. 

Pre-treatment workup

Should you be a suitable candidate, some initial records/measurements are required to prepare you for your surgery and to enable us to do the initial preparatory work so that we can deliver your implant bridge to you within two to three days after surgery.

This involves some impressions of your teeth, a bite registration for an accurate recording of how your teeth/jaws come together and some diagnostic photographs. These records are used to generate the guides used by our clinician to allow placement of the implants in the correct positions, and also to carry out the initial tooth position setup of the bridges.

In some instances, if you are missing all or most of your teeth already in one or both jaws, then a try-in visit prior to surgery date may also be advised and organised. 

Surgery

You will be assessed prior to surgery by our team of clinicians. Should you be suitable, the operation is normally performed under general anaesthetic usually as a day-surgery procedure. You will need to allow for at least 3-4 days off work so that you are available to have fitting and insertion visits so that the immediate acrylic bridge can be inserted shortly after surgery. Very rarely, you may need to be admitted to hospital overnight to be monitored, this would depend upon your medical history and general health profile.

Under general anaesthetic, the surgeon will prepare your jawbone for implant placement. In some individuals, this may involve a procedure where the jaw bone is augmented by for instance reducing the vertical height of the jaw bone and re-contouring it to optimise the underlying tissues for your bridge. Four to six implants are then placed in each arch as required.

Whilst you are under general anaesthetic, our Prosthodontist who will also be in attendance will take some impressions of your implants and bite registration records.  These are then sent to the laboratory for construction of your immediate bridges. 

Recovery 

You will not be able to wear any dentures immediately following the surgical procedure and will be restricted to a very soft diet until the immediate bridge is inserted two to three days later.

Immediate bridge delivery

Usually the next working day after surgery, you will have the initial setup of the bridge verified.  Acrylic teeth are setup in wax and this is screwed into the implants to allow us to check that the teeth are in an acceptable position.  This process may take around 2-3 hours.

Once we are satisfied with the setup position of the teeth, the acrylic bridge is processed and finished. The bridge is attached to the implants the following day in our consulting rooms. This involves rigidly screwing the bridge into the implants after which the bridge should not be removed or disturbed for a minimum of 3-6 months.  This is to allow proper healing and integration of the implants.  This will be verified with further routine X-rays after around 3 months. The bridge will also be detached after a suitable period of healing to allow inspection and testing of the implants.

You may commence on a soft diet once the fixed bridge has been inserted. We would ask that you maintain a reasonably soft diet for the first 6-8 weeks after surgery.

Some patients may not be suitable for immediate loading of the implants due to certain dental and medical reasons.  In such cases patients may require their final bridge to be inserted 3-6 months following implant surgery. A provisional immediate denture will be provided so that you will not be “without teeth” at any stage. This provisional denture will usually require relining 6-8 weeks after surgery.  Our specialists will advise you whether immediate or delayed loading is most appropriate for you.

Follow up treatment 

In most instances, the immediate acrylic bridge will become the definitive final prosthesis for the patient. These bridges are made entirely of acrylic which is why we are able to manufacture and deliver them so rapidly. Some individuals choose to have a metal reinforced bridge which has titanium reinforced framework on which acrylic is processed and is therefore substantially stronger. The titanium reinforced framework also allows for easier maintenance and possible future repairs as the acrylic can be adjusted or even replaced without replacing the entire bridge framework.

Some patients may have such strong bites that they cause cohesive failure or fracturing of the acrylic teeth.  Some patients may also choose to have the ultimate in aesthetic outcomes that only porcelain teeth can give.  In these circumstances you may need to consider a metal-ceramic bridge. This style of bridge uses gold-alloy framework that supports very aesthetic porcelain teeth and gums. It is the strongest and most cosmetically pleasing appliance available. This ceramic bridge is sometimes made as three pieces and the gold-alloy framework attaches to a titanium-reinforced bridge framework.

Long-term maintenance of bridges 

As all of these bridges are permanently fixed to the implants, you will not be able to remove them. You will be instructed on proper home care and cleaning procedures and supplied with a complimentary Oral B Care Centre with Oxyjet. As with natural teeth it is important that the implants are professionally cleaned twice a year.  At these check ups, your bridge may be disconnected and you will be seen by a dental hygienist to have a clean around your implants and any of your own remaining natural teeth. The bridge may also be cleaned and re-polished whilst you are being seen by the hygienist.

You should also be aware that with acrylic bridges, the teeth may wear and discolour over time. The tissue fit of the bridge may also need to be adjusted with a reline procedure as the jawbone continues to change shape.  On average this is required every 5-7 years.

Bridges with ceramic teeth, may also be susceptible to chipping and fracture over time.  The bridge would need to be removed and repaired or porcelain remade as requested.

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