Every now and then, a case lands on the bench that makes you pause, scratch your head, and say, “Right… what’s really going on here then?” This was one of those cases. Not because it was overly complex on paper, but because it refused to behave in a predictable, textbook way.

A dentist reached out to us at Bremadent Dental Laboratory after trying multiple labs. The feedback she kept getting was vague at best. No one could clearly explain why the case kept failing. The patient had an existing denture and originally retained a single premolar on the upper left-hand side. That one tooth was eventually extracted, and an addition was carried out.

From that point onwards, everything changed. The bite was completely off. A new denture was prescribed. Same issue.
Another lab tried. Same result again.

Presenting Complaint:
Patient has a removable F/F denture and would like implants placed in the maxilla and mandibular for a fixed prosthesis at Herts Dental Implant Clinic in Watford. The patients previous denture was loose, ill fitting and difficult to wear during function. The patient has had X6 OSSTEM ® implants placed in the lower arch and the success of the lower arch to determine the upper arch.

Presenting Complaint:
Patient has severe mandibular bone loss and one LR7 tooth present. The patients previous denture was loose, ill fitting and difficult to wear during function . X3 implants was placed in the LLHS at Luton & Dunstable Hospital. The implant denture was made with locators and caused problems as the denture was lifting on the LRHS upon function and was not stable.

Diagnoses:
Bremadent was presented with this case that was unsuccessful with a previous dental laboratory. Once assessed, we found that the reason for the lifting of the denture was determined by the retention and reciprocation of the implant locators the LLHS thus causing the LRHS to lift on function due to severe mandibular bone loss and lack of retention which eventually dislodges the removable locator implant denture.

Treatment Plan:
The treatment plan given was to create a Swissedent removable implant denture that utilizes precision attachments to clip onto a milled implant screw retained CM bar with the bar cantilevered to aid reciprocation . The Swissedent protocols would be used for aesthetics, hygiene and function whilst the screw retained CM bar and precision attachments would be used in conjunction for retention and reciprocation to create a aesthetic and functional prosthesis.

We accepted the case and prescribed the following treatment plan :

• Replace the implant abutments (Southern implants 3.5mm) with new implant abutments (Astra 20 Degree uni 3.5 Aqua).
• Special tray secondary impressions with bite registration
• Try in of prosthesis in wax
• Designed & Milled an Atlantis implant screw retained 0.9mm CM bar on new implant abutments
• Provide a removable implant retained denture with precision attachments to clip and seat onto the implant screw retained CM bar.
• Swissedent style prosthesis for natural looking aesthetics, hygiene and optimum function.