Full-Mouth Reconstruction with Implants and Fixed Bridges
The patient presented with multiple caries and localized periodontal disease. He was severely apprehensive and had not been to the dentist in more than 20 years. Because of pain and discomfort, the patient realized it was time to get treatment. Using the Internet, he sought treatment in a practice where he could be sedated and have all the necessary surgical treatment performed at one site, by one provider, and in the least amount of appointments. Ultimately, he found my practice and gained the courage to present for an evaluation. From the initial visit, it was apparent that not only was this patient apprehensive, but he was also ashamed of his current condition. My goal was to offer him the best treatment available to restore his smile to proper form and function. Without prejudging this patient because of the condition of his mouth, I offered him a variety of treatment plans ranging from dentures to full-mouth reconstruction with implants. The patient chose full-mouth reconstruction with fi xed bridges and dental implants.
The first phase of treatment consisted of extracting the patients entire dentition atraumatically with Physics Forceps (Golden Dental Solutions). The extraction sockets were fi lled with grafting material to rebuild the maxillary and mandibular ridges for ideal implant placement.
After approximately 5 months of healing, the patient was scanned with an iCat (Imaging Sciences) using a scanning appliance fabricated by Glidewell Dental Lab. With the dentist on staff, Dr. Brad Bockhorst, we devised a virtual treatment plan using the Blue Sky Bio Plan software (Blue Sky Bio). Our goal was to place 8 implants in the maxillary ridge and 8 implants in the mandibular ridge abiding by the key implant positions as taught by Dr. Carl Misch (Contemporary Implant Dentistry, Third Edition). Using surgical guides fabricated by Glidewell Lab, I placed 16 Internal Laser Lok implants (BioHorizons), 8 in the upper arch and 8 in the lower arch.
When the implants integrated 4 months after placement, full-arch impressions were taken with a quick setting polyvinyl siloxane impression material (Take One Advanced, Kerr) as well as a full-arch bite with a registration material (Take One Advanced Bite, Kerr). These impressions, along with the bite registration and measurements were forwarded to Glidewell Dental Lab for fabrication of the final restorations.