Treatment phase II – dental implant surgery
Antecedents:
- During the previous treatment all his upper teeth and all but 6 of his lower molars were extracted.
- An immediate (provisional) denture was fabricated for the 3 months of healing.
- Dental implants were opted for that would support a fixed tooth restoration.
Treatment phase II – dental implant surgery, reline of provisional denture (3 workdays)
After 3 months of wound healing the treatment could be resumed with the mounting of implants. A CBCT (Cone beam computed tomography) scan was recorded to examine post-healing bone mass in 3 dimensions prior to the intervention.
CT scans of the maxilla in which the density of the bone mass can be examined in 3 dimensions and based on which the site and size of the implants can be assigned:
On examination of the CT scan it was determined that in the wake of the tooth extractions the upper jawbone did not heal adequately. The height of the bone mass would have been adequate, its width, on the other hand, was not. For an implant surgery to be successful, a major bone graft would be necessary.
CT scans of the mandible in which the density of the bone mass can be examined in 3 dimensions and based on which the site and size of the implants can be assigned:
Based on the CT scan the mandible is perfectly suited for mounting 2 implants in each quadrant.
After discussing the possibilities at length with the patient, the patient arrived at the conclusion that he did not want a major bone graft surgery. Therefore, we placed no implants in the upper jaw bone but fabricated a full-arch overdenture (removable denture) at the next treatment session. In case he cannot get used to wearing a full-arch overdenture he may still undergo a bone graft surgery a year later. Since the lower jawbones posed no obstacles to implant surgery, he opted for 2 implants to be installed on each quadrant that would support a fixed tooth restoration.
The implants installed at the sites of the premolars read torque values less than 30 Ncm, and were therefore sealed with cover screws, the stability of implants mounted at the sites of the molars, on the other hand, allowed for gingiva formers to placed inside.
Follow-up panoramic radiograph of implants secured in the lower jawbone
The provisional dentures provided after tooth extractions were relined following implantation in line with the altered anatomical relations for ease of wear.
The treatment will resume after 3 months’ healing time with the exposure of implants installed at the sites of lower teeth 34 and 44 and covering them with gingiva formers. The permanent replacement teeth can be installed one month thereafter.