Blending digital dentistry and implant prosthodontics

Posted by Dr. Thomas Balshi and Joanne Balshi on Jan 30, 2017 4:41:16 PM

ACP Messenger (Winter 2017)

 

3-soccer.jpgBlending digital dentistry and implant prosthodontics

Thomas J. Balshi, DDS, PhD, FACP
Joanne Balshi

Blending digital dentistry and implant prosthodontics

I first met Michael Frank on a job site where he was artistically and meticulously setting tile for a designer kitchen. Mike exuded energy and had an admirable work ethic. He had a good technician’s eye and measurable pride in accomplishment, but the first time I saw him smile, I knew I could contribute something very valuable to the rest of his life. 

At the age of thirty-three, Mike had a lot going for him. Besides his talent; he was a vivacious athlete with a great sense of humor and an uncommon warmth. Married with two young daughters, he worked a sixty-hour week and played soccer in his spare time. A smile was the only part of his signature that simply did not fit. 

It was not difficult to convince Mike to allow me to evaluate him clinically and present him with a treatment plan. His evaluation revealed advanced periodontitis with extensive bone loss around his remaining teeth in the maxilla and mandible, most likely the result of his heavy smoking and excessive consumption of soda for quite a few years.

Mike's clinical presentation demonstrated extensive flaring of the mobile anterior teeth. Diagnostic casts were made and articulated at the appropriate vertical dimension. These models were scanned digitally and the data files transmitted to a milling center for the construction of the fully milled monolithic PMMA resin provisional dentures. The anterior teeth were repositioned vertically in the 3-D planning software prior to production.

Fig 1: Before -- Fig 7: AfterOn the day of surgery twenty cc's of blood were drawn and Platelet Rich Plasma (PRP) was produced for use during surgery. Local anesthesia was administered to both maxilla (upper jaw) and mandible (lower jaw), and all remaining teeth were extracted. Alveoloplasty was performed in preparation for future implant placement.

In the mandibular arch, full tissue flaps were reflected to identify the mental foramina. The anterior loop of the mental nerve was measured and noted. Beginning with the posterior implant placements in the mandibular right and left sides, a precision drill introduced the initiation of osteotomies (bone drilling). These were placed at a forty-five degree angle posterior tilt.

 Four implants were coated with PRP and installed according to the All-On-4®treatrnent concept protocol. Autogenous (host) bone was gathered during all of the osteotomy preparation procedures and reintroduced into the extraction sites. Angulated multi-unit abutments were installed on the posterior tilted implants and 1mm straight abutments were placed on the anterior axially placed implants.

Following the Teeth in a Day® procedure, special multifunctional copings were installed with guide pins on all four abutments. The rubber dam was then installed to the base of the copings. Using autopolymerizing acrylic resin, the monolithic conversion prosthesis was connected to the multifunctional copings. It was then removed and refined chairside.

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Figures 4, 5, and 6

Fig 4: All-On-4® implants to support non-removable teeth in the lower jaw.

Fig 5: Three months after implant surgery, the final digital upper denture and the All-On-4® monolithic fixed (non-removable) prosthesis for the lower jaw ready for delivery to the patient.

Fig 6: Completion of treatment changes Mike's life.


Flap closure took place with multiple interrupted sutures. The Teeth in a Day conversion prosthesis was then installed using prosthetic screws. The upper monolithic fully milled removable denture was relined, adjusted, and delivered at the same time.

Mike was given post-operative instructions and medications. One week following surgery, he returned for suture removal and minor adjustments to the maxillary immediate complete denture. At ten weeks post-surgery the patient presented for final impressions, initiating the construction of his mandibular fully milled implant-supported prosthesis reinforced with a milled titanium frame. New occlusal records were made and a reline impression made in the maxillary removable immediate digital complete denture.

Both arches were scanned and the data transmitted for the construction of a new fully milled monolithic maxillary removable digital denture and an All-On-4® final prosthesis with milled titanium framework for the mandibular arch. 

Three weeks following the impressions, the final prostheses were delivered to an ecstatic patient whose sparkling personality and boundless energy went up still another notch, proof that at any age, a healthy, esthetic smile is a priceless asset.


Thomas J. Balshi, DDS, FACP / Joanne BalshiThis article was published in the ACP (American College of Prosthodontists) Messenger (Winter 2017) and written by Dr. Thomas and Mrs. Joanne Balshi.

Dr. Thomas J, Balshi maintains a private practice in Fort Washington, Pennsylvania, where he blends clinical care with scientific research, education, and philanthropy. 

Joanne Balshi has served as Director of Marketing and Public Relations for the Pi Dental Center over the last thirty years. She is a freelance writer and authored Smile Your Heart Out, a coffee table book about the value of a healthy smile and dental makeover.

 

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Terminology: 1acpmessenger.jpg

  • All-On-4 Dental Implant Treatment - uses a prosthesis strategically supported by four dental implants that are biomechanically positioned for maximum stability. 
  • Anterior teeth - front teeth
  • Conversion prosthesis - An interim fixed-prosthesis that the patient wears from the time of uncovering of implants until the final prosthesis is completed. This prosthesis is made from the removable denture or temporary prosthesis that the patient has been wearing since first stage surgery. This removable prosthesis is modified into a fixed prosthesis. It allows the patient to experience the benefits of dental implants immediately after the implants are uncovered.
  • Digital dentistry - dental treatment that includes utilization of CAD/CAM software enabling the dental specialist to visualize the patient's dental structures in 3D format
  • Mandibular - referring to the lower jaw
  • Maxillary - referring to the upper jaw
  • Monolithic - formed of a single large block of material.
  • Occlusal record - a record of the way teeth come together - a registration of the opposing occluding surfaces of the teeth
  • PMMA - Poly(methyl methacrylate) - a clear plastic
  • Provisional denture - a temporary removable denture
  • Posterior Teeth - back teeth
  • Teeth In A Day® - Click here

 

Tags: digital dentistry, Teeth In A Day, bone loss, All-On-4 dental implant treatment

Dental Implant Treatment with an AvaDent Prosthesis: Part 1

Posted by Chris Raines on Nov 8, 2016 11:04:16 AM


ken-post-treatment-smile.jpgKen was diagnosed with rare disorders called Osteogenesis Imperfecta and Odontogenesis Imperfecta
when he was a child. As a result of these disorders, Ken’s dental condition deteriorated over the years requiring frequent dental treatment. 

Osteogenesis Imperfecta (OI) is a rare disorder affecting the connective tissue and characterized by extremely fragile brittle bones that break or fracture easily, often without apparent cause. The specific symptoms and physical findings associated with OI vary greatly from case to case. The severity of OI also varies greatly, even among individuals in the same family.

Odontogenesis Imperfecta is a developmental disturbance of one or of several adjacent teeth, characterized by deficient formation of enamel and dentin. Such teeth exhibit delayed eruption into the oral cavity.

In an interview, Ken explained how he came to Pi Dental Center and described his viewpoint about the dental treatment he received from Dr. Balshi, Dr. Wolfinger and the clinical team.

Ken began by describing his early dental treatment, “I went to a cosmetic dentist. We tried braces when I was very little.  It wound up making most of my teeth very loose.  So we took the braces off and went through the entire process of letting them get reaffirmed.  So that was the last time my mom, my dad, or I tried to fix it, because of the Osteogenesis Imperfecta. At least that is what we were told.”

“I started reading about dental implants. I went to a dentist who said, ‘No, this is not the way to go.’ He suggested crowns, a million dollar smile and said I would be good for the rest of my life.  They were not.”

Indicating Pi Dental Center, Ken said, “That was when I sought you out.  I started doing research, and my sister-in-law, who worked for Pi Dental Center, said that is exactly what he does, he pioneered it. That summed it up for me.”

Ken had six implants placed in the maxillary arch using the guided implant surgical procedure and All-On-Four® treatment in the mandible.  Pi Dental Center provided AvaDent Tissue Integrated Prostheses (TIP) for the upper and lower arches.

Mr. Swinehart talked about the look and comfort of his final teeth in comparison to his temporaries, “Esthetically everything is fantastic.  The most significant thing for me was how the teeth felt. With the temporary prosthesis, I used to be able to feel flex, whether it was eating pizza or steak.  Not movement, just flexing.  I don’t feel any of that now.  Where I thought it couldn’t feel any better than it did, it feels that much better. I don’t feel that flexing anymore.”

“These feel like they have been my teeth since birth.  I’ve had absolutely no issues. I’ve gone through plenty of steak, lots of beef brisket, when I was down in Memphis, corn on the cob, you name it. I don’t feel hampered by anything.  Including some of the frozen stuff that I was known for breaking my temporary appliance for, I’ve been able to get through without any damage. Steve told me, ‘Go do everything.’  Chocolate chip ice cream - I went through the whole gamut.”

“I am happy for myself and I am happy that I found the doctor who could fix my issues.”

Dr. Balshi mentioned, “It’s not just the doctor, it’s the entire team including the staff, the laboratory support, the engineering, the behind the scenes, the stuff that’s going on in Scottsdale with AvaDent, and in the Netherlands with the AvaDent technology. It takes a lot to put this all together including the robots.”

Ken agreed, “But you’re right, it does take a team. I have never ever felt better or in better hands as a patient regardless of who I saw while I was here.  Be it yourself, or Dr. Wolfinger, or Stephen, or whoever has come into the room.” 

“There is one thing that sticks out, that my parents wanted me to tell you that they’ve seen.  I’ve always thought that I’ve been self-confident to the point of cocky, regardless of what my smile looked like.  The one thing that they’ve picked up on, that I wouldn’t see from the inside out, is the self-confidence and the amount of smiling that I do now versus before. Before, I was just very restrained because I was so insecure of my smile. I was looking for ways to cover it up, glass in front of the mouth, napkin in front of the face, or hand over the mouth, whatever had to be done. I don’t do that stuff anymore. I know I’m not doing that stuff anymore.  So, now, there is an outward self-confidence that I don’t think people see as cockiness. Because people can see that I’m smiling. I’m 46 years old, if I don’t do it now, I never will.”

To learn more about AvaDent Dental Implant Supported Prostheses, treatment for people with congenital dental disorders or guided dental implant treatment, contact us.

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More about Osteogenesis Imperfecta:

http://www.oif.org/site/PageServer?pagename=Dental

Tags: osteogenesis imperfecta and dental implants, Odontogenesis Imperfecta and dental implants, AvaDent with dental implants, All-On-4 dental implant treatment