Investigating an unknown case

…or the impossible is resolved immediately , we need to wait a few days for the miracles…

A previous colleague of mine got in touch with me in 2011, to solve the long-standing dental problem of her friend, who lives in England. Despite the fact, to promise anybody anything before I saw it, is against my principles, I undertook to solve this case, due to the fact that I have always been attracted by special tasks.

The situation was the following: The patient, aged 55, was diagnosed with a slight prognathism and overbite ; her teeth were provided with old metal ceramic augmentations in the upper and right upper quadrants , which edge close was very criticisable. In the lower right region , there were tooth deficiencies in the 5-6 places and in the 7 place there was a remained tooth, with the old, single metal ceramic crown on it.

According to the narration of the patient, the two implants were inserted approximately 11 years ago: they were provided with a fixed tooth augmentation for 2 months, which loosened and when she returned with her problem, the doctor simply removed the tooth crowns, implanted the locking screws and left the patient alone with her problem referring to praxis sale. The patient weren’t bothered until she had seen the combined tooth augmentation in the mouth of her friend, which urged her to search us asking for the same restoration of chewing ability. Due to the short time of the consultation and caution, we have decided that the best solution would be if the revision and the possible removal were performed in England.

 Later, it turned out, that the patient had found her previous doctor , who stated, that the implants didn’t have the need to be removed , because it was enough to fix them, but the doctor didn’t recommend fixed tooth augmentation, but the removable one, which pressed the teeth and broke weekly and the patient didn’t get accustomed to it , these were told by the patient.

All in all, the patient was in the same stuation in January 2012 as she was in 2011 summer ( except that she was provided with a root canal with removing her 47 teeth, which was exceptional, but because of excessive precaution she was told to not to have a bridge , because it is not suitable for bigger load-bearing. )The prosthetic rehabilitation was started in the upper regions of her mouth. The bridge of the metal ceramic was replaced; the pillars found under them were in an exceptional condition , thus the status wasn’t practically changed.

The complications were in the lower regions!

Firstly, we had to convince the patient, that all of her 47 teeth would be suitable for bridge pillars on the long run: it was obvious after removing the old crown, thus the bridge was inserted here as well. The hardest situation was with the lower region and the time available was dangerously little. Naturally, during these works in the other regions of the mouth cavity , we were active in trying to find out the characteristics of the implants ( there was no passport to include these data) and find a same or a compatible system. With the help of the patient we managed to get in touch with doctor, who said these were „Dentos” type implants, which are only produced in India nowadays.

According to the statement of the collegue, the system was compatible with the Nobel Biocare, but this was not the case. In my final despair , I turned to Dr. Kádár László, whose instructions led me to the BIONIKA company. After this, the events had been accelerated!

We firstly „removed” the already moving locking screw (2. image)at the advice of Hajdú József, the executive director, and we tried to mould the inside of the implant with a tapping imprint acquisition method (Uniklip root pin + Oranwash) (3.image).

4. image: Straight and axle correctional heads inserted into the implant

Due to the axis deviation, the 36 abutments were made with axle correction(4. image).

The stubs created in this way were sampled with closed canal method. ( Zéta+ Oranwash). A separate key was made of plastic (Pattern resin) , which ensured the adequate position of the stubs in the mouth.

As not only the relative situation of the implants , but the distance of the remained natural teeth was not according to the standard and the fact that these were without loadness for 11 years, thus we didn’t know about the real loadness of them, and the principle was important to not to make fixed tooth augmentation with a mixed groove; lead the way to the solution, that for the 33, 34 teeth and for the 35,36 implants , the bridge parts were made separately, of course with a close contact point ( 5. image).

6. image: The finished teeth

As shown in the picture, we were trying to uplift the bite during the restoration, with this and with the night bite lift, which was not exceptionally made for the upper but for the lower dentition, we tried to confirm the protection of the remaining natural teeth. According to our information, the patient is safe and sound, actively wears the bite liftand happy to be able to chew everything, with the finished teeth on the 6. image.

As described above, this is not only my merit. Hereby I want to thank you the BIONIKA Medline Orvostechnikai Kft, Hajdú József, the execuitve director and my dental technicians: Langó Zoltán and Széphalmi Csaba, for succesfully transacting the procedure despite the fact that the implants were unknown in the patient’s mouth.

Dr.Takács Krisztina
dentist