Esthetics For Patient With Diagnosis Of "No Bone In The Upper Arch."

Posted by Thomas Balshi, DDS FACP on Apr 19, 2011 1:57:00 PM

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Patient Treatment Using The "No Bone Solution" for Dental Implant Treatment

AGAINST ALL ODDS

 Post Treatment Patient Photos

Patient Profile

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.

Pre-treatment condition

Clinical Exam

Following a thorough oral examination, which included assessment of the existing prosthetics, diagnostic casts, panorex and AP and lateral cephalometric radiographs.

Treatment Photos

Patient Profile

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.

Final Prosthesis

Clinical Exam

Following a thorough oral examination, which included assessment of the existing

prosthetics, diagnostic casts, panorex and AP and lateral cephalometric radiographs

 

Radiographic Study

Following a 20-second cone beam i-Cat scan the DICOM files were converted to 3-

D planning files using the Nobel Biocare Procera software. Evaluation of the bone

volume confirmed the original “no bone maxilla” diagnosis. (Fig. 2) The anterior

maxilla suffered combination syndrome exacerbated by the mandibular anterior

implant supported overdenture. The maxilla at the floor of the nose ranged from 0.5

to 2mm, except for an 8mm island of bone at the midline. The posterior maxilla also

exhibited extreme atrophy with expanded antra bilaterally. The left sinus was

previously grafted with a xenograft in the area of the failing mini implants. The bone

at the floor of the sinus in all other areas was less than 3mm.

 

Clinical Course

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 screw retained 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. 

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