A 39-year-old female presented to the office with a chief complaint of "my lower left bridge is loose." The patient had a medical history significant for anxiety and she was taking Effexor (Pfizer) with no known food or drug allergies. Her dental history included the placement of a large span fixed bridge from teeth Nos. 17 to 21 four years before the case presentation. Because of inadequate embrasure form, she was unable to keep her bridge clean and she developed recurrent decay under tooth No. 21.
My diagnosis was that teeth Nos. 17 and 21 were deemed restoratively hopeless and slated for extraction. In addition, a horizontal and vertical bony ridge defect existed because of longstanding edentulism in site Nos. 18, 19, and 20.
Clinical records were taken, including preoperative radiographs using DEXIS Digital X-Ray System (DEXIS) and a diagnostic wax up (Kuota Dental Labs). From the diagnostic wax up, a radiographic guide was created and the patient was sent for a mandibular CBCT scan. Based on that scan, the patient had 3 mm of residual horizontal crestal ridge with 6 mm of vertical height above the inferior alveolar nerve. In addition, the patient denied temporization with a removable appliance at any time during her treatment.
Treatment options were reviewed with the patient and the patient opted for a fixed restoration supported by implants (all restorative work done by Dr. Neil Cohen). The patient was treatment planned for ridge augmentation surgery with the placement of temporary implants for provisionalization. After guided bone regeneration was completed, 4 dentals implants were treatment planned with immediate provisionalization and load. The patient accepted this treatment because at no time during treatment was a removeable appliance scheduled for use. A 4-unit implant supported splinted porcelain-fused-to-metal bridge was fabricated to complete the restoration.
The patient was very happy with both the esthetics and function of this restoration.
