Case Study: Long-Term Success with Bone Grafting and Implant Therapy involving a patient who had been wearing dentures for over 20 years
by Dr. Chong Lim, Specialist Periodontist & Hon. Assoc. Professor.
Background
In 2011, Dr. Chong Lim was presented with a challenging case involving a patient who had been wearing dentures for over 20 years. The patient exhibited a strong bite coupled with thin alveolar bone, a common consequence of prolonged denture use. Fortunately, the patient displayed a low lip line, meaning that gum aesthetics were not a significant concern. Minimally invasive bone grafting was possible. The patient sought a more stable and aesthetic solution to replace their four front teeth.
Challenges
- Thin Alveolar Bone: Years of denture wear had caused significant bone resorption, limiting the available bone for implant placement.
- Strong Occlusion: The patient’s bite exerted considerable pressure, raising the risk of implant overload and potential failure.
- Patient Expectations: The patient desired a durable, natural-looking solution with minimal long-term complications
Solution
Dr.Chong devised a sequential treatment plan to address the complex requirements of the case:
- Bone Grafting Procedure & Implant Placement: To regenerate sufficient bone volume for implant placement, simultaneous bone grafting was performed at time of implant placement. This provided a stable foundation and improved the long-term prognosis of the implants. Two Straumann NNC Roxolid implants were strategically placed to support a prosthetic replacement for the four missing front teeth.
- CAD CAM screw retained 4 unit bridge. The placement was planned to allow the fabrication of a 4-unit bridge with passive fitting that could be easily removed for future inspection and servicing. We were able to optimise load distribution, ensuring durability under the patient’s strong bite.
Mitigating Factors
- Oral Hygiene: The patient demonstrated excellent oral hygiene (OH) throughout the treatment process, critical to the success of both grafting and implant therapy.
- Regular Follow-Up: The patient adhered to a strict follow-up schedule, allowing for close monitoring of the implants and surrounding tissues. This included professional cleaning and routine checks to maintain peri-implant health.
Outcome
Now, 13 years later, the implants continue to perform exceptionally well. The patient’s oral health remains excellent, with no signs of bone loss, peri-implantitis, or prosthetic complications. This case highlights the importance of:
- Comprehensive Treatment Planning: Addressing foundational issues such as bone volume before implant placement.
- Patient Commitment: Good oral hygiene and regular follow-up are vital to ensuring long-term success.
- Collaborative Care: The ongoing relationship between the clinician and the patient contributed significantly to the excellent outcome.
Key Takeaways for Dentists
- Bone Grafting Is Essential: For patients with significant bone resorption, bone grafting can be a game-changer in enabling implant therapy.
- Load Management: Strong occlusion requires careful planning to distribute bite forces effectively across implants.
- Follow-Up Matters: Long-term success is a shared responsibility between the clinician and the patient. Regular maintenance visits are non-negotiable.
This case highlights how implant treatment techniques combined with evidence based components and biomaterials when used in a compliant patient, can deliver remarkable results that stand the test of time.
