Fixed Screw Retained Prosthesis

Published Date 05/13/2013

A 77-year-old female patient had a chief complaint that she was unable to wear her upper denture.

She also could not eat whatever she wanted anymore.

A comprehensive examination was performed, including a clinical examination, a digital panoral, full-mouth radiographs, and photographs. I also performed an oral cancer screening using VELscope Vx (LED Dental) with negative findings. My standard of care for any patient considering implant treatment is to include a cone-beam scan with KODAK 9000 3D CBCT (Carestream Dental). The scan confirmed a severely resorbed maxillary ridge. I determined that grafting procedures would be needed to attain the patient's desire for a screw-retained implant prosthesis.

The first treatment option we discussed was to create an upper anterior and premolar bone graft using Bone Morphogenetic Proteins (BMPs), followed by the placement of 6 implants and a fixed restoration. Another option included using autogenous bone grafts taken from the patient?s ramus, chin, or hip. A third option included placing fewer implants and using a removable overdenture.

The patient chose the first option?to create an upper anterior and premolar bone graft using (BMPs)?because she wanted a fixed solution. She also did not want a bilateral sinus lift or autogenous graft procedures.

A challenge that I encountered during this case was that I did not have enough bone to use without grafting, which added time and additional procedures. Using CBCT allowed me to know what I needed before starting the case, which made the result more predictable in getting what the patient wanted.

The final outcome was successful, and the patient was very happy because she could eat anything she wanted.

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