Thursday, August 23, 2007
Case Background
A 67-year-old male was referred to the Pi Dental Center at the Institute for Facial Esthetics with a prior diagnosis of “no bone in the maxilla.” His desire for treatment included “fixed teeth” and improved esthetics. The following medical conditions were detrimental to the long-term prognosis of his case, but not insurmountable. He presented with diabetes, emphysema, high blood pressure, as well as dry mouth. To make matters worse, he smoked 2 packs of cigarettes a day and admitted to an intense parafunctional habit of clenching.
Case Treatment
Following a thorough oral examination, which included assessment of the existing prosthetics, diagnostic casts, panorex and AP and lateral cephalometric radiographs and pre-operative clinical photographs, the following treatment plan was developed using the “No Bone Solutions™” protocol:
- Removal of non-integrated “mini” implants in the area of teeth #13 and 14 (Fig 1)
- Fabrication of complete maxillary denture incorporating radiographic gutta-percha markers to be used in conjunction with an i-CAT scan.
- Teeth In A Day® guided surgery for placement of five traditional Brånemark implants and freehand placement of four zygomatic implants, to support an interim all-acrylic screw-retained fixed prosthesis.
- After 8 to 12 weeks of healing and osseointegration of the implants, the final screw-retained fixed ceramic prosthesis is to be fabricated.
Post Operative
The non-integrated mini implants were easily removed by reverse turning. Five implants were placed using Nobel Biocare's guide protocol. In the anterior, 2 paranasal Brånemark 3.75mm diameter implants and one midline implant were placed. Additionally, 2 pterygoid implants were also placed with the aid of the surgical guide.
Following the guided implant placement, the surgical guide was removed and full thickness flaps elevated to permit a lateral viewing window to be opened in both sinuses. Four Brånemark zygomatic implants were securely placed followed by flap closure and the construction of the -screwretained fixed Teeth In A Day® all acrylic interim prosthesis. (Figs. 3 and 4)
Our illustrations attest that he patient's goals were achieved. Not only did he leave the day of surgery with an implant supported Teeth In A Day® prosthesis, but his esthetics, speech and quality of life were immediately enhanced.
Pre-op Panoramic Radiograph With Failing Mini Implants
Pre-Treatment i-Cat scan converted to 3D model using Procera
Maxillary Teeth in a Day® Supported by “Quad” Zygomatic Implants
Teeth in a Day® Post-op Panoramic Radiograph