Clinical cases report: Achieving higher standard in implant therapy

By Dr Paresh Patel

INTRODUCTION

As the baby boomer population ages, the numbers of edentulous and partially edentulous patients increase since tooth loss and age are related.

Whether it is due to neglect, caries, medications or other systemic reasons, patients are coming to practices all over the country needing extractions. Most of the time, this eventually leads to completely edentulous arches that need implant supported restorations.

These patients often have aesthetic concerns from missing teeth, ill-fitting or loose partial or full dentures, and the inability to eat or function as they once did with natural teeth.

Because of these concerns, it is important to incorporate some type of implants into the plan as described in the following clinical cases.

Implants, whether narrow or traditional width, allow patients to smile, eat, and function much more effectively.

CASE 1

A 54-year-old female patient requested to have a more secure denture. She presented with combination syndrome, which commonly occurs in patients with a completely edentulous maxilla opposed by a bilateral distal-extension removable partial denture.

This syndrome poses a considerable challenge to dentists and usually consists of severe premaxilla and mandibular bone loss, tuberosity overgrowth, and alveolar ridge canting (Fig. 1).

All of this render prosthetic treatment more difficult, and the preferred course of treatment is to use dental implants for functional support.

Axiom® REG Implants was selected for good primary stability as well as for easy conversion to fixed bridgework at a later date if elected. To avoid additional grafting, the Axiom REG 6.5mm length was selected for the posterior region.

Treatment

The Simplant® treatment plan was executed for the six Axiom REG implants in the posterior areas where bone is available for overdenture (Figs. 2-3).

With the resorbed premaxilla (Fig. 4), a surgical guide was fabricated from 3D conversion by Simplant (Fig. 5). Flapless surgery with minimal trauma to bone and soft tissue was done (Figs. 6-7) followed by optimal positioning of “short fat” implant 4,6x8mm (Fig. 8) for overdenture (Fig. 9).

After the selection and placement of healing caps (Fig. 10), the overdenture was fabricated with metal frame and the artificial teeth was set in wax (Figs. 11-12). This procedure was done to verify the aesthetics clinically (Figs. 13-14) before curing the final overdenture (Figs. 15-16).

On the day of denture delivery, the tissue health was checked before the placement of locator abutments (Figs. 17-18). Final overdenture was installed and post-operative radiograph was taken (Figs. 19-20).

Conclusion

This case delivered a high-quality overdenture without the need for bone graft and sinus lift by using a short fat implant. Using surgical guide, the placement of six implants allows for easy conversion to fixed bridgework if the patient chooses that option in the future.

About the Author

Dr Paresh Patel received his Doctor of Dental Surgery degree from the University of North Carolina at Chapel Hill, United States, in 1996. He is also a graduate of the AAID Maxi course from the Medical College of Georgia, United States, in 2009.

Continue reading here. Published in Dental Asia March/April 2021 issue.