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Dental implants - Lower jaw

Preliminary note: We currently provide the upper and lower jaw with implants and fixed teeth in the time frame of four days. The way to reach this end result differs considerably from upper jaw to lower jaw. Indeed both jaws have their own particularities, need their own different approaches, and have their own aesthetic and functional accents and demands. Therefore Dr Defrancq prefers to discuss the upper and lower jaw separately.
Facial Sculpture Clinic - Dr Joël Defrancq - Jaw surgery and implant reconstructive surgery The lower jaw is simply ideal for implants and fixed teeth. Almost any lower jaw is suitable for immediate loading.

The procedure is simple, straightforward, and fast. In the upper jaw the surgeon focuses on doing everything in due measure. In the lower jaw, for Dr Defrancq the focus lies more on direct comfort. It is easier to achieve good aesthetics in the lower jaw, but attention to function and straightforwardness is much more the issue in question.

During the last twenty years, Dr Defrancq has provided literally many hundreds of patients with a fixed immediate loading on four to six implants in the lower jaw.

  • Those people had their teeth removed at the same time as the implant placement.
  • Or those people were edentulous from the first visit.
  • Sometimes those people had the most caricatural bone resorpsion.
  • Sometimes those people were in their 90-ties and were so happy with their decision afterwards.

All those patients were loaded immediately with a resin or porcelain construction.
Question: Why are implants in the lower jaw often placed anteriorly?
Facial Sculpture Clinic - Dr Joël Defrancq - Jaw surgery and implant reconstructive surgery In the back, the alveolar nerve, which provides sensibility to the lower lip, runs into the bone, while more anteriorly the nerve runs into the lip. The implants in the lower jaw are placed in the available bone areas. If the lower jaw loses its teeth, then the jaw resorbs through the pressure of direct mastication and the rubbing of the removable prosthesis. In the lower jaw, the alveolar nerve runs inside the bone from the back to its exit in the middle of the jaw. This nerve gives sensibility (feeling) to the lower lip and damage to the nerve is annoying and should be avoided.

This is probably the most essential and critical detail of the surgical implant planning. There is the area in front of the mental nerve, and there is the area behind it. At the front, the nerve is already out of the bone and running into the lip. At the back the nerve runs into the bone. If the lower jaw is substantially resorbed, the nerve in the back area becomes more and more superficial until it reaches the surface between the bone and the overlaying soft tissues. From a practical point of view, the implants can always be placed in front of the mental nerve exit, and only more exceptionallybehind.
Question: Is it feasible to load the implants directly with a zirconium-porcelain bridge instead of a chrome cobalt -resin structure?
Yes, Dr Defrancq does this quite regularly if all parameters are obvious and clear. It saves some costs and some time, but we need to be confident of the occlusion, the bite, and the bone quality. Minor adjustments on the gum side can be fixed a few months later, but, as a rule, we prefer to load with a provisional structure (i.e. chrome cobalt - resin).
Question: What is the minimum bone height for the lower jaw to receive implants?
Dr Defrancq regularly provides implants with immediate loading on mandibles that are labelled as extremely resorbed (7-10mm). In his opinion, it is extremely rare for a lower jaw to need bone augmentation. During the grafting surgery, the mental nerve is easily affected by feeling disturbances in the lower lip. Furthermore, bone grafts in the lower jaw are highly sensitive to melting away. This lower jaw case illustrates that, even in the most resorbed cases, implants can still be placed. It is important in the planning to respect large spaces between the implants in order to avoid a bone fracture. If a fracture occure, this happens not during the surgery, but in the following weeks. Hence the importance of the immediate loading, that further acts as a splint.
Facial Sculpture Clinic - Dr Joël Defrancq - Jaw surgery and implant reconstructive surgery
Question: My mother has advanced Parkinson’s disease. She eats with nursing help, but not with dentures. Is it feasible to provide her with fixed teeth on implants?
Dr Defrancq performs those interventions regularly on disabled patients under local or general anaesthesia. A good indication, f.e are patients with Parkinson’s disease.Those patients have difficulty keeping their removable prosthesis in position and chewing becomes impossible with a denture. The procedure can be done under local anesthesia. Following the intervention, within four days, the teeth on the implants are provided. Special mouth care is necessary afterwards, but this is certainly not impossible if there is somebody around to care for the patient. 

This patient has Parkinson. The implants were placed under local anesthesia, and the provisional teeth were provided a couple of days later.
Facial Sculpture Clinic - Dr Joël Defrancq - Jaw surgery and implant reconstructive surgery
Question: Is the same solution possible for patients who are mentally retarded or have a muscular spastic disease?
Absolutely, Dr Defrancq does this during two general anesthesias:

  • The first general anesthesia to place the implants and perform the further recordings. 
  • The second general anesthesia to place and fix the teeth a few days later.
  • Sometimes, a third anaesthesia can be necessary if things are a bit more difficult, but this is the exception.

In those spastic clenching people Dr Defrancq uses resin teeth, but they are reinforced with gold foil on the occlusal and incisal surfaces. This means that the contact between teeth is gentle and silent during eating and clenching periods. Those cases, very simply, are not like other cases, but there are a lot of helpless people in the world. Dr Defrancq has learned to master these techniques, and has helped this boy and many others so far. It is simply a thankful and personally rewarding task. It is understood that the will to organise the aftercare and mouth hygiene should be considered seriously by relatives or the institution.
Facial Sculpture Clinic - Dr Joël Defrancq - Jaw surgery and implant reconstructive surgery
Question: Is it feasible to provide patients with implants, who are irradiated in the oral region?
Absolutely! This is another category with rewarding cases for Dr Defrancq, namely patients with radiation in the mouth area after tumour disease. It is a wonderful indication because a lot of patients have extremely painful and sensitive teeth after radiation. It means so much to these patients, not only functionally but also for their comfort and overall sense of dignity.

A meticulous working method is required in order to extract the teeth as atraumatically as possible. Dr Defrancq has worked on up to half a dozen of those patients and had no noticeable difficulty with any of them. Dr Defrancq also prefers to load those patients with porcelain. Remember, those patients often have an extremely dry mouth and under those conditions porcelain is so much more comfortable than resin.