![]() ![]() 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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