Restoring multiple implants in posterior quadrants – Dr Susan Tan

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  Posted by: Dental Design      27th October 2019

Dr Susan Tan explains how she collaborated with a trusted referral clinic to ensure the success of dental implant treatment in her patient’s upper arch.

In 2013, I began treating a 61-year-old male patient who suffered from severe bruxism and had been wearing a nightguard since 2009. The patient’s UR8, LL8 and LR8 were missing, as were all his first premolars, but this did not result in any gaps. There was only one gap in the URQ where the patient’s first molar had been.

In addition, there was advanced horizontal bone loss around the UL8. This tooth was extracted in order to improve the periodontal prognosis of the UL7, which had deep distal pocketing. The UL6 was also root treated and had a failing amalgam restoration, but was deemed unrestorable due to insufficient remaining sound tooth structure. Therefore, the UL6 was left in-situ as the retained tooth roots were asymptomatic.

Despite my best efforts to manage his periodontal health over the years, the patient presented to the practice in early 2018 with a furcation defect on the UR7, which had a hopeless prognosis and was also indicated for extraction. Without any molars and only one premolar in the URQ, it became necessary to consider replacing the UR7, as well as the missing UR6 and the UL6, as it had a hopeless prognosis. By the time the patient later lost the last molar in the URQ, he had already made it quite clear that his preferred option for restoring his teeth was dental implants.  


Referral consultation and implant placement

The patient was referred to Dr Nikhil Sisodia at Ten Dental+Facial for a dental implant consultation. During further discussions of his treatment options, the patient expressed that he was keen to achieve greater masticatory function with a fixed solution. He consented to having three dental implants placed to restore the UR7, UR6 and UL6. Implant treatment was planned according to the CBCT scans, which indicated that a bilateral sinus lift procedure would be required.

As the patient was uncomfortable with sitting in the dental chair for extended periods of time, the surgical aspect of the procedure was delivered under IV sedation. The DASK tool kit was used to perform treatment in the URQ, while an internal lift was carried out in the area of the UL6 using Versah instruments. Three Ankylos implants and inorganic bovine bone grafting material were placed during the surgical procedure. The implants were then exposed 6 months later, before a healing abutment was fitted.

Implant restoration

Once Dr Sisodia had confirmed that the implants were healthy with no complications, he notified me of the patient’s progress and referred him back to me to complete the restorative aspect of treatment. The patient’s tooth shade was assessed, before a closed-tray impression – which is ideal for a single prosthetic platform – was taken. This was sent to the laboratory to fabricate the final restorations. Three titanium, custom-milled Atlantis®abutments were placed, before screw-retained crowns were fitted and torqued to 15Ncm. The screw access was sealed with PTFE/composite.

As I restored all three implants within one appointment, the patient was surprised by how straightforward the restorative process was. He had expressed that he was a little cautious of using his newly restored teeth for the first few days following placement of the restorations, but he quickly forgot that he had dental implants and was very happy with the final results.

Implant restoration training and the referral process

I attended Ten Dental+Facial’s Implant Restoration Course (IRC) in 2013. It is a modular programme, with each module being taught over the course of one day during the year. I have completed three of the four IRC modules, which were really enjoyable and straightforward to follow. The course itself is very informative and practical, and you are able to get hands-on with different models and tools.

Although it was a slow start introducing dental implant restorations to my patients, once I started restoring implants, there seemed to be regular uptake on this excellent option for replacing missing teeth. I now routinely offer dental implant restorations to my patients when the need arises, referring the surgical aspect of the procedure to Ten Dental+Facial. I work really well with Dr Sisodia and his team. I think he is really supportive and delivers a seamless referral service. He always keeps me up-to-date on each case and provides detailed instructions on what I need to do throughout the referral process. If I have any problems, Ten Dental+Facial is always there to offer trusted advice and guidance.  

I think it is important to understand how dental implant treatment works, but the actual skill set required to restore implants is not as complex or extensive as those that are required to, for example, prepare a tooth. Referring dental implant surgery to Ten Dental+Facial and restoring the implant yourself is easy. Plus, patients are always happy with the final treatment results and I am able to benefit from increased job satisfaction. For this reason, I would definitely recommend Ten Dental+Facial and its dedicated IRC.



Figure 1 Panoramic radiograph pre-implant surgery

Figure 2 Radiograph of the UL6 prior to extraction

Figure 3 Radiograph of the UR6 and UR7

Figure 4 UL6 post-implant placement

Figure 5 UR6 and UR7 post-implant placement

Figure 6 Full mouth view prior to restoration

Figure 7 Radiograph of UL6 implant

Figure 8 Radiograph of UR6 and UR7 implants

Figure 9 Full mouth view of restored teeth

Figure 10 The restored UL6

Figure 11 The restored UR6 and UR7

Figure 12 Radiograph of the final restored UL6

Figure 13 Radiograph of the final restored UR6 and UR7

Figure 14 Final result post-restoration


For more information about Ten Dental+Facial and the Implant Restoration Course (IRC), email: office@tendental.comor call 020 7622 7610



Author bio:

Susan graduated from the University of Western Australia in 1993. For five years, she worked for the Department of Health in Western Australia in Community Service, before she relocated to the UK in 1998, where she has worked in various mixed NHS/Private practices. She currently enjoys caring for her long-term patients at a practice in Battersea where she has been working for the last 16 years.


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