Case Gallery
Case Study 1 - Dental implant.
History
- Medically fit and healthy, good periodontal condition, compliant patient
- Chief complaint; “want to function and don’t want to be toothless at 40”
- Multiple restorations
- Previous crowns in all 4 quadrants
- Oral hygiene reasonable
- Bruxer, clinical crowns worn quite flat
- Periodontal condition good
- 47 extracted 8 years ago as overerupted due to 17 extracted many years earlier
Diagnosis and Plan
- Surgical/Radiographic guide needed to position head of implant,ConeBeam (CBVT) taken with radiographic guide in place
- Plan for 5.0 Astratech Osseospeed TX implant 11mm long, single stage surgery.
- Standard loading after 3 months
- Prosthetically limited opening so screw retained crown planned followed by an occlusal splint
Procedure
- Surgery carried out under local anaesthetic
- Astratech OsseospeedTX 5.0 x11mm placed and positioned according to the surgical guide
- Implant fully torqued to 35N/cm
- 6.5mm wide healing abutment placed and soft tissues sutured into position
- No temporary
Result
- There is more treatment continuing in the remaining quadrants to address the bite and function
- Implant specific reviews every 6 months along with hygiene
- X-ray at 12 months to check bone level
- Hygiene appointments every 4 months in first year then 6 monthly
Case Study 2 - Lower overdenture.
History
- 66 year old fully edentulous male
- Lost teeth due to periodontitis over a long period of time, severely resorbed lower ridge
- Had a full lower denture(FL), not very happy with it
- Remaining upper teeth extracted about 3 years ago
- Chief concern “wants to be able to chew and stabilize dentures“
- Made him new FU/FL dentures which are not retentive as ridge severely resorbed.
- Can function in new dentures but the lower moves and top drops down anteriorly
- Patient not concerned about aesthetics just speech and function
Diagnosis and Plan
- Place two lower implants(Nobel Active 4.3x13mm) with Locator abutments to stabilize lower denture
- Medically compromised patient with difficult access. Single stage surgery under GA
- Load implants after 2 months.
Procedure
- Constructed well fitting FU FL dentures
- After 1 month denture function and bite balancing, copied dentures to make up clear acrylic FU FL
- Placed radiographic markers on the lingual of canine sites and obtained a Cone Beam Volumetric Tomogram(CBVT).
- Drilled 2mm pilot drill holes in the guide adjusted accordingly from the markers on the CBVT
Result
Remaining Treatment- Fit Locator abutments
- Remake FU/FL reset teeth lingually as patient has had 10 months of new dentures and should be able to cope with teeth set back
- Fit locators to FL chairside with GC Unifast resin
Case Study 3 - Posterior bridge and single molars.
History
- 62 year old male
- Healthy, non-smoker, compliant patient
- Good periodontal condition
- Patient wants to restore posterior function and does not want to wear down anterior teeth more than naturally would occur
- Tried Partial dentures a few years ago but was not happy.
Diagnosis
- Old OPG revealed maxillary sinuses will complicate treatment
- Obtained CBVT to help in diagnosis from another implant surgeon
- Study models
- Constructed radiographic guides which convert to surgical guides and arranged a CBVT with guides in place
- Planned on Nobel Clinician
Procedure
- All implants placed under GA
- All implants fully torqued to 35N/cm
- Sinus augmentation via lateral window approach using Bio-Oss and Bio-Gide
- 2nd quadrant implants placed 2-stage surgery method
- All other implants 1-stage surgery method
- Astratech Osseospeed TX implants used 5.0x9mm for all except 24 and 25, 4.5x11mm
- Performed under LA
- Modified Pallaci flap with a connective tissue graft (same site)
Result
Case Study 4 - Replacement for dental implant.
History
- 11 failed implant in a female 59 yo
- Implant removed by another periodontist and an immediate bone graft attempted.
- Smoker otherwise healthy. Periodontal condition good for a smoker, no pockets etc
Diagnosis and Plan
- Proposed Astratech implant to be placed gently. May need to be grafted
- primary closure
- pedicle flap
- Close for 6 months then provisional crown and
- leave for a couple of years and see.
Procedure
- Performed with local anaesthetic and IV sedation
- Astratech Osseospeed TX placed, labial bone grafted with Bio-Oss and Bio-gide and sutured closed
- Left for 6 months and exposed
Result
- Expose implant at 6 months and fit a long term provisional implant crown and temporary crown on the lateral



Case Study 5 - Sporting accident.
Diagnosis and Plan
- Figure 1 Sporting accident, no mouthguard worn on this one occasion, elbow to the teeth 11 12 resulting in a complex root fracture.
- Central incisor not salvageable, needs extraction and an immediate implant placement
- Lateral incisor needs to be endodontically treated and a crown
Result