Dr James Lee
Dr George Chatzopoulos
Multi-disciplinary Treatment Planning for Optimal Aesthetics and Function (USA)
Dr James Lee (United Kingdom) : Initial Surgery, Prosthodontics, Laboratory Work
Dr George Chatzopoulos (Greece) : Implant Surgery
Summary
This case presentation outlines the importance of prosthetically driven implant treatment planning to provide an optimal biological and prosthetic outcome. A 66 year old male presented with the chief complaint, “I want to have a very natural looking smile with improved function.”
Following a full clinical examination and discussion with the patient of his aesthetic desires. the patient opted against having any removable partial prostheses and wanted a predictable treatment outcome. Therefore the patient elected to have his remaining dentition extracted and complete denture therapy with the view of having implants placed in the mandibular arch.
Due to the lack of interocclusal space, loss of posterior support, an inferiorly located occlusal plane and an over eruption of the mandibular anterior teeth, an initial alveoloplasty was required to allow for the development of a proper occlusal plane necessary for a balanced occlusion.
Following a period of 3 months of healing, new interim complete dentures were fabricated to position teeth to allow for optimal aesthetics and function. Once this has been approved by the patient, the required amount of alveoloplasty can be accurately determined to allow optimal implant positioning for long-term prosthetic success.
Since Branemark(1) introduced the Tissue integrated prostheses for the severely debilitated ridges, a wealth of long-term literature supports this treatment modality(2-6). A recent retrospective study (7) reported 88% of fully edentulous implant-supported prostheses were free of implant failure at 20 years.
Radiopaque markers were placed upon the interim prostheses, A CBCT scan was obtained and a fully guided surgical approach that dictated the level of alveoloplasty and placement of the implants. A minimum space of 15mm is required for a mandibular fixed hybrid in order to allow adequate space for oral hygiene, denture tooth, titanium bar and acrylic resin.
5 Straumann BLT 4.1 x 12mm RC implants were placed in the mandibular arch anterior to the mental foramen in order to accommodate for flexure of the mandible.(8) The prosthesis was immediately loaded.(9) The implants were allowed to integrate for 3 months.
The patient is now currently in the final restorative phase of treatment and will have his final maxillary complete denture opposing mandibular fixed acrylic resin hybrid on a titanium bar delivered within the next four weeks.
References
(1)Brånemark PI, Zarb GA, Albrektsson T. Tissue-integrated prostheses: Osseointegration in clinical dentistry. 1st ed. Chicago: Quintessence Publishing Co.; 1985. p. 199-209.
(2) Adell R, Eriksson B, Lekholm U, Branemark PI, Jemt T. Long-term follow-up study of osseointegrated implants in the treatment of totally edentulous jaws. Int J Oral Maxillofac Implants 1990;5:347-35.
(3) )Lindquist LW, Carlsson GE, Jemt T. A prospective 15-year follow-up study of mandibular fixed prostheses supported by osseointegrated implants. Clinical results and marginal bone loss. Clin Oral Implants Res 1996;7:329–36.
(4) Ekelund JA, Lindquist LW, Carlsson GE, Jemt T: Implant treatment in the edentulous mandible: A prospective study on Branemark system implants over more than 20 years. Int J Prosthodont 2003;16:602-8.
(5) Attard NJ, Zarb GA: Long-term treatment outcomes in edentulous patients with implant-fixed prostheses: The Toronto study. Int J Prosthodont 2004;17:417-24.
(6) Astrand P, Ahlqvist J, Gunne J, Nilson H: Implant treatment of patients with edentulous jaws: a 20-year follow-up. Clin Implant Dent Relat Res 2008;10:207-17.
(7) Dhima M, Paulusova V, Lohse C, Salinas TJ, Carr AB. Practice-based evidence from 29-year outcome analysis of management of the edentulous jaw using osseointegrated dental implants. J Prosthodont 2014;23:173–81.
(8)Goodkind RJ, Heringlake CB. Mandibular flexure in opening and closing movements. J Prosthet Dent. 1973 Aug;30(2):134-8.
(9)Branemark, P. I., et al. (1999). “Branemark Novum: a new treatment concept for rehabilitation of the edentulous mandible. Preliminary results from a prospective clinical follow-up study.” Clinical Implant Dentistry & Related Research 1(1): 2-16.
