AEGD Case Studies

Case #1

By: Junior Cruz, DDS

A 71-year-old male patient presented to the AEGD program at OU College of Dentistry. His chief complaint was “I do not like my smile.” The patient presented with high blood pressure and diabetes controlled with medications. Dentally, the patient had congenitally missing laterals, retained primary canines distal to permanent canines, class II mobile teeth, decreased vertical dimension, vaulted palate with narrow arch form, and thick gingival biotype. The patient’s collapsed arch form created an uneven plane of occlusion on the maxilla; however, the mandibular teeth plane of occlusion was normal and mandibular arch was stable (Figure 1).

Treatment options provided to patient included

1) increasing patient’s occlusal vertical dimension with crowns on the maxilla, 2) an implant-supported fixed-detachable complete denture prosthesis on the maxilla, or 3) an implantsupported Atlantis Conus overdenture. Though the patient desired the implantsupported fixed hybrid prosthesis, he opted for the more affordable overdenture. I explained to the patient that his implants can be placed now with the ability to convert to an implant-supported hybrid prosthesis in the future.

The patient opted for the Atlantic Conus overdenture while respecting the surgical and prosthetic space requirements for a fixed-detachable complete denture prosthesis.

AccuDent XD alginate impressions of the patient’s maxilla and mandible were made for the fabrication of a maxillary immediate denture. The patient desired whiter teeth than his current dentition. Once his case was completed and received back from Express Dental Laboratory, the patient was appointed for extractions, alveoloplasty, and immediate denture delivery. After 3 months of healing with appropriate follow-up care, up-to-date three-dimensional imaging was made. Radiographic markers were placed on the immediate denture. Two scans were completed: 1) the maxillary denture by itself with radiographic markers, and 2) the patient wearing the denture intraorally with radiographic markers present. The two DICOM files were electronically sent to Express Dental Laboratory to assist in the digital planning of this case restoratively, and surgically for alveolectomy and implant positioning to allow for 15mm of restorative space.

The surgery was completed using a guided surgery system with stackable surgical guides fabricated by Express Dental Laboratory. The stackable guide system consisted of a mounting guide with horizontal anchor pins, a nested guide for alveolectomy, and a third guide for implant placement. Surgically, a full-thickness flap was reflected; a retraction suture was placed through the palatal tissue to allow for easier seating of the bone reduction guide and implant placement guide (Figure 2, 3, and 4). Four implants were placed (Astra PrimeTaper) in the maxilla. Chromic gut sutures were placed, and the patient left with his existing maxillary immediate denture. Suture removal and a soft reline were completed at his twoweek post-operative follow-up appointment.

Three months post-surgery, the maxillary implants were uncovered. Impression copings were placed and splinted with acrylic resin. After proper border molding, an implant-level final impression was made.

Three months post-surgery, the implants were uncovered, impression copings splinted with acrylic resin to capture final impression. Next appointment included a record base with wax rim used to mark midline, high smile line, low smile line, overjet, overbite, tooth mold, verification jig created, Custom Conus Atlantis abutments try in. Final prosthesis was completed and the patient was happy with the outcome of their smile journey.

References

Carpentieri, J., Greenstein, G., & Cavallaro, J. (2019). Hierarchy of restorative space required for different types of dental implant prostheses. Journal of the American Dental Association (1939), 150(8), 695–706. https://doi.org/10.1016/j.adaj.2019.04.015

Chaware, S. H., & Thakkar, S. T. (2020). A systematic review and meta-analysis of the attachments used in implant-supported overdentures. Journal of Indian Prosthodontic Society, 20(3), 255–268. https://doi.org/10.4103/jips.jips_368_19