Patients often require phasing of treatment to complete the necessary steps to improve the condition of their dentition. I will provide a complete examination and explain all treatments required to bring them back to health, but we can proceed as fast or as slowly as they desire based upon their psychological capabilities and their budget. In this case, both budget and psychological restraints prevented the provisionalization of a hopeless maxillary dentition with an immediate complete upper denture. This necessitated maintaining a failing dentition until the patient was emotionally ready to move forward with a removable overdenture that would be retained by 4 implants. This article will outline the steps taken to complete the transition to an implant-retained prosthesis.
The patient, a very anxious 50-year-old female, presented for a consultation with multiple maxillary teeth being mobile, hyper-erupted, and uncomfortable when chewing. The gingival tissue bled readily upon probing and she was unhappy with the esthetics of her smile. No professional dental maintenance had been performed for many years prior to our initial visit. Clinical examination, periodontal examination, and a full set of Schick 33 (Schick by Sirona) x-rays were completed and reviewed. Considering the extensive breakdown of the periodontal support, I obtained a 3D scan with GALILEOS Comfort Plus from Dentsply Sirona. Clinical findings and the 3D images were used to communicate the extensive nature of the periodontal disease as we discussed her options.
The decision was made not to attempt to retain questionable teeth with extensive periodontal surgery and utilize a removable partial denture. Not enough natural tooth support would remain for full-arch crown and bridge. Her budget did not allow for sinus lifts and future implants to retain a full-arch fixed case. We constructed a pragmatic treatment plan to transition her dentition from natural teeth to a BioTemps fixed provisional (Glidewell Laboratories) on strategically retained natural teeth, into a fully edentulous arch restored with an implant-retained overdenture.
Impressions were obtained after teeth Nos. 2, 3, and 15 were extracted and bone grafted. Multiple in-office temporaries were fabricated until teeth Nos. 5, 11, and 12 were extracted and bone-grafted with Puros allograft bone (Zimmer Dental) in preparation for implants. These treatments went well, giving her confidence in my ability to improve her poor dental health. The integration of CEREC and GALILEOS (Dentsply Sirona) facilitated the production of a SICAT Surgical Guide (Dentsply Sirona) used to immediately implant teeth Nos. 7 and 10, along with the placement of implants in teeth Nos. 5 and 12. Guided implant surgery reduced the surgical time by half and allowed for precise, safe, and accurate implant placement. A BioTemps fixed provisional was prepared and cemented on teeth Nos. 4, 6, 8, 9, and 13. Appropriate time passed for these implants to fully integrate. The remaining natural teeth were removed and bone-grafted while the LOCATOR abutments (ZEST Anchors) were installed on 4 implants. LOCATOR male processing housings were picked up using Quick Up (VOCO) material, which completed the transition to an all-acrylic overdenture. This interim overdenture was esthetically pleasing and fully functioning, and created a new advocate for 21st-century dentistry in my patient.
