When black OR white are not the only solutions

When black OR white are not the only solutions”

As a dentist, you are often faced with situations where black or white, prosthesis or implant, are not the only options. This is a case study of a telescope implant treatment (Kennedy Class 1) in the upper jaw of a female patient. Ulrich Heker (Master Dental Technician) describes the treatment of a UK patient with a completely detachable prosthesis based on telescopic implants, combining the best of both technologies to provide an optimal solution for the client, at a reasonable cost.

Case history

The patient presented a unique challenge for the dentist. The 55 year old female had worn a classical gold/gold telescope prosthesis for many years. The original elegant work had evolved over the years through repeated extensions and relining. Finally, with a base completely covering the palate, it had mutated into a full denture. The patient did not want to wear a full denture under any circumstance, so now implants appeared to be the only alternative. However, from an oral surgical point of view, both sides were unsuitable for implants due to the lack of bone material. The patient had also rejected the necessary but expensive augmentation of the molar areas to place two further implants for a fixed bridge, only removeable by the dentist. Individual attachments were also out of the question as the patient wanted a palate-free prosthetic solution.
The Situation

Dental Status

Fig.1: Status

Normally it is not possible to make an attachment solution for both sides, without having a connection bar across the pallat. A rss solution will become too bulky. After thorough consideration, the decision fell in favour of a combination of implants with individual abutments and a detachable, bar-free telescope prosthesis RN-Variobase RN-Variobase secondary part



The cost would have been exorbitant if I had followed the conventional route of using high- (gold/platinum content) or semi-precious alloy to make all the inner and outer parts. I estimated it would need 25 – 30 grams of high concentration gold or gold-reduced alloy, such as Degulor® MO, to guarantee sufficient material thickness/strength. The alternative consisted of primary parts made from non precious alloy (NPM), capped with 0.2 – 0.3 mm of gold as secondary crowns. These would then be bonded to a CrCo tertiary structure using two-component cement. CrCo also allows a less bulky construction than using gold alloys, whilst also reducing the need for soldered connections. As there were to be no transversal connectors, the design of the tertiary structure was critical. The patient was fitted with Regular Neck (RN) implants. After a successful healing-in, the RN implants were exposed and a pick-up impression taken with an individual tray over the impression posts. The author recommends using an open special tray which is rigid, to allow access to the retaining screws of the pick-up impression.

Situation after exposure

Fig.2: Situation after exposure

Leave a Reply

Your email address will not be published. Required fields are marked *