IMPLANT RECONSTRUCTIVE DENTISTRY

Surgical and prosthetic complications could arise in implant dentistry, even with meticulous planning and ex*****on by dental specialists. In this case a functional mandibular fixed dental prosthesis that had been in use for 7 years, lost its far left implant, most likely due to excessive occlusal loads and parafunction. The fixed prosthesis was modified to allow the removal of the failing implant. Two more implants were placed on the lower left segment. Once these integrated, we transitioned to a 3d printed fixed prosthesis. We realized that the most distal implant couldn’t be used to its limited restorative space and cheek biting concerns. We also realized that we were really tight on site #21 as the provisional kept on breaking, even without a cantilever. It was decided to fabricate a two piece fixed prosthesis, with a titanium substructure with metal occlusals and a Zirconia suprastructure. This screw retained prosthesis minimizes the fracture risk. Being a board certified prosthodontist is not only about proper planning and positive outcomes but also knowing how to problem solve and come back from difficult situations. Another happy patient.

The incidence of dentoalveolar trauma in young individuals is relatively high. This patient had trauma on one of her maxillary central incisors, that eventually needed a root canal. Consequently she had this tooth restored with a series of composites resin that were changed frequently as they fractured or got darker. She was referred to us for a definitive restoration, as the patient had recently turned 18 years old. Her case was unique as we had reduce enough tooth structure to make our lithium disilicate crown thick enough to prevent the darker color of the preparation to show through. For aesthetic cases like this one, we always capture the stump shade and ask our lab technician to see the patient for a custom shade recording. When trying in the crown, we use different shades of try- in pastes, in order match the color of the adjacent tooth the best possible. Another happy, functional patient.

All on X, is not always the ideal treatment of choice.  Bar retained overdentures provide almost the same chewing efficiency of fixed dental prosthesis, with the added benefit of being able to clean the implants and the teeth more efficiently, consequently improve the implants long term prognosis. The only disadvantage is frequency of maintenance, as we have to change the plastic retention inserts at least once a year,  as they wear down. This patient’s priority was ability to clean and implant survival.  We decided to splint the implants with a bar for improve long term prognosis and do a removable prosthesis to allow for better, more efficient hygiene.  The patient is very happy with the outcome.
Another happy patient! 😊🦷

Implant Reconstructive Dentistry
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