I treatment planned a patient for extraction of his remaining maxillary teeth, temporary restoration with a complete denture and final restoration with an implant supported full arch zirconia bridge. I extracted the 5 remaining maxillary teeth and placed an immediate denture. After 4-5 months, I placed 6 implants and modified the immediate maxillary denture to connect it to the implants. After six months, a PMMA bridge was placed over the implants: all necessary prosthodontic protocol was observed, including verification jig. The PMMA bridge fit very comfortably and had no pressure or pull on the implants. The patient was very happy. He was told that if the PMMA bridge was comfortable, we would fabricate the final zirconia fixed fridge. Patient was monitored monthly.
In two months, the patient said that the PMMA bridge was very comfortable in all aspects and that he was ready for the zirconia bridge. I insisted that he better not rush with the final bridge. I told him to continue using the PMMA bridge for another two months. When the patient had used the PMMA Bridge for a total of 4 moths and was entirely comfortable with it, I ordered the zirconia fixed bridge and inserted it within minutes, very passive, with absolutely no pull or pressure. The patient was very happy.
About two months later, the patient had a stroke. After some recovery, the patient came to the office complaining of pain in the bone on the left side. I could not find anything wrong. The patient kept coming back a few more times, so I told him I will replace the zirconia fixed bridge with the PMMA bridge, especially since that had been comfortable with that bridge for over four months. When the PMMA bridge was screwed in, patient felt almost the same as with the ziconia bridge.
About 5 months later, patient’s wife called, said they were examined by a senior doctor in a local dental school as he was still experiencing pain. She said they were told that the bridge was not made right and should be remade.
The senior doctor, an Assistant Chair in Dept. If Prosthodontics, wrote to me that the implants were well osseo-integrated, the tissues under the bridge were pink and not inflamed, but that the patient felt relief on removing the screws and felt pain and pressure on screwing the PMMA bridge back on. He said the bridge did not have a passive fit and should be remade.
My question is, if the PMMA bridge was comfortable for over 4 months and the zirconia bridge was comfortable for another 2-3 months, could his stroke have caused any changes to affect the fit of both bridges?