![]() Tips to follow prior to sealing the access holes at the final bridge seating: Overdentures aren’t sexy and can be removed, which can be unappealing to patients, but they are way easier to clean if hygiene will be an issue. If your patient’s follow-through with hygiene is a genuine concern, then I recommend using a bar-supported overdenture.Could you have used six, five, or even four implants in cases where hygiene is a concern? Fewer implants lessens support, but the implants will be easier to clean. If a patient has struggled for a lifetime with maintaining his or her oral hygiene and you decide to place eight implants under a fixed bridge, you have to ask yourself if it is reasonable to assume that the patient will keep the bridge clean. Plan the proper number of implants to balance support of the bridge with the patient’s ability to keep the bridge clean.If they are absolutely necessary for support of the denture teeth or for esthetics, keep them 2 mm to 3 mm or less in height and only on the facial. Ensure that the intaglio surface of the bridge is convex and hygienic.Planning tips to set the stage for adequate hygiene: This is a bridge that can be easily maintained by the patient and hygienist.įigure 3: Inflamed tissue from an inability to clean under the bridgeįigure 4: Ideally convex intaglio surface for easy cleaning Note the smooth and flowing intaglio surface in Figure 4. This could have been avoided with better presurgical preparation, adequate bone reduction, and proper vertical space development, which would have allowed the lab to make a hygienic intaglio (figure 4). The patient’s tissue was inflamed (figure 3), and she had developed a fungal infection. I removed the bridge to find the intaglio packed with food debris. The speech issue was legitimate in my opinion (that’s a story for another day), but I was concerned about the sensation of pain. ![]() Three months later, the patient presented to my office. The dentist told her everything was normal and that she needed to adapt to the bridge. The patient whose bridge is shown in Figure 2 returned to her dentist after the final bridge was placed complaining of speech difficulty and pain. Aside from this resulting in fractures of the bridge, it is also the primary source of creating a concave intaglio surface (figure 2).įigure 2: Concave intaglio = hygiene nightmare A common origin of these complications is inadequate vertical height for the bridge. Patients are often referred to my practice with complications after the delivery of their final prosthesis. One of the most important steps that you can take to improve the chances of patients adequately maintaining their oral hygiene is to set up your plan for success from the beginning. If you are looking for a protocol for your practice, I recommend using this one as a quick baseline program and then developing your own customized practices over time. ![]() I simply developed this protocol after having treated and maintained hundreds of full-arch fixed implant bridges, and this is what works in my practice. I don’t offer any clinical research to support my protocol. In this article, I will share the follow-up protocol I have used over the last 13 years, as well as some of my reasonings for doing so. ![]() There seems to be a wide spectrum as to how clinicians treat patients after their final All-on-4 bridge is delivered, and I am sure that many options exist to adequately manage these patients in the dental hygiene department. MY COLLEAGUES FREQUENTLY ASK ME what my hygiene follow-up protocol is for full-arch All-on-4 fixed bridges (Nobel Biocare figure 1). ![]()
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