Case Gallery

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

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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

• 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

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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

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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

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