Tuesday, February 21, 2012

New Materials, New Methods, Patient Wins, Dental Technician Wins, Doctor Wins

Patients who have long standing bridges, tend to have bone loss, tissue loss and most importantly tooth loss. As time passes Reconstructing a patient's mouth is not an easy task. Here are the difficulties one runs into:
1)Cost of the Procedure: Prosthetic costs Sky Rocket due to the rising costs of Gold
2) Timing of the Procedure: These patients are not used to walking around without teeth ever and more importantly are not responsive to wearing a removable prosthesis
3) Large Reconstructions on Implants: When doing these cases Metal Support can get expensive and Porcelain can chip very easily. Over time these are not easy to do and to fix.
4) Transition of the tooth borne to implant borne prosthesis

So we need an approach. Here is the Patient at initial presentation









Consult is done and patient requests only fixed. We discuss options and immediate load is prescribed. Patients do not want to wear dentures during the healing period. Whenever they due they are pressed for healing time, they put pressure on the office and doctor. Not a good situation. With fixed temporaries they are better then when they came in and they are happy on the way out. Impressions are taken for BIOTEMPS to be Fabricated.

Biohorizons implant used due to thin tissue patient has and the LASERLOK feature to maintain tissue.




Biotemp is fabricated as open trench and placed in an essix retained for use as surgical guide and abutment height adjustment guide. palate lets us know if it is seated.




All Upper teeth are extracted and GuideTemp Tried in.




Implants placed, Sutures, abutments. No Flap











Post Reline of Biotemp


Immediate post op. Contour will be played with as healing goes.



Patinet Smile Day 1 of Surgery



Post op X-rays







Two Week Post Op



10 week  removal and Impression Closed Tray






Temps are Duplicated with Essix ( or use the original essica made at surgery) Fill with clear bite reg and Bite and Kois taken. Midline Noted.




Polyether Impression




Titanium Undercasting Tried in and NEw BR taken




 New Kois with Metal Taken









MOdel!





Final Restoration on Model.GC Gradia. Easily repairable. Beautifully Constructed









WOOPS> Midline is off!


Info Transfered to Lab



Final Restoration after Midline Fixed.



















Enjoy
Jonathan Abenaim DMD DICOI
Uwe Mohr MDT

3 comments:

  1. Very well documented...big case. I'm curious Dr. Jonathon, how long did this all take, and do you sit these type of patients down and explain to them that this is a process..and it takes a little while to get to the final result?

    ReplyDelete
  2. Thanks for the comment. We started the case on 9/22/11 and finished on 2/17 12 so about 5 months. The reason it took so long was purely logistics in terms of the laser welder and the argon gas being delivered. We could have finished this case in 3 months. That being said I always tell my patients it will be a journey together and they must have patience as certain things may come up like shipping or materials being backordered or implants failing etc. etc. SHe actually was an amazing patient and was very easy to work with as she understood before. Underpromise Over Deliver. The truth is that they key to the success of the management of the case was the fixed temporary. If it would have had a denture it would have been a nightmare.

    ReplyDelete