How to Say Goodbye to Dentures and Have Patients Smiling
New materials and technology give patients strong, esthetic options for restorative solutions.
Today, many older patients are increasingly likely to have all or a majority of their natural teeth.1,2 These patients have spent a lifetime trying to preserve and restore their teeth in the hope that they will not lose all of their natural dentition and require dentures.
However, no matter how vigilant these patients have been about taking the time, effort, and expense to preserve their teeth, multiple factors can irreversibly damage a patient’s remaining dentition.3 Medical conditions and diseases such as diabetes, high blood pressure, and cardiac conditions and their attending medications that cause dry mouth can affect oral health.4 For these patients, stabilizing their physical health takes precedence over dental health concerns and may delay dental treatment. The COVID-19 pandemic exacerbated the delay of dental care over the past 2 years, preventing many patients from addressing their dental concerns. When they finally presented to the practice, their dentition often had deteriorated to the point that extraction and denture prosthetics were required. Fortunately, myriad choices in treatment approach and materials are available. They are supported by digitally driven design and production for precision fit using materials formulated for strength and esthetics, providing alternatives to the traditional denture of the past.
Case Report
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Figure 1
This 75-year-old man was a perfect example of a patient who has spent a fortune during his lifetime trying to preserve and restore his teeth (Figure 1).
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Figure 2
However, when he presented to the dental practice, he was partially edentulous, and much of the dental care he received in the past had broken down primarily due to health issues—diabetes, heart disease, high blood pressure, and renal disease—that required multiple medications (Figures 2-5).
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Figure 3
However, when he presented to the dental practice, he was partially edentulous, and much of the dental care he received in the past had broken down primarily due to health issues—diabetes, heart disease, high blood pressure, and renal disease—that required multiple medications. (Figures 2-5)
Figure 4
However, when he presented to the dental practice, he was partially edentulous, and much of the dental care he received in the past had broken down primarily due to health issues—diabetes, heart disease, high blood pressure, and renal disease—that required multiple medications (Figures 2-5)
Figure 5
However, when he presented to the dental practice, he was partially edentulous, and much of the dental care he received in the past had broken down primarily due to health issues—diabetes, heart disease, high blood pressure, and renal disease—that required multiple medications (Figures 2-5)
Figure 6
Preop CT scan of the patient. For the past few years, treating his health issues had become the primary focus and he had put his dental needs aside until his health improved and his dental problems could no longer be ignored.
The patient sought help from general dentist Dr Huntsman, who examined the patient and suggested he see Dr Domingue for implant consultation. At the record-taking consultation visit, Dr Domingue took a series of photos as well as intraoral scans, x-rays, and CT scans (Figure 6).
Figure 7
CT scan reveals restricted airway due to narrow lower jaw. It was clear that he had undergone extensive root canal and restorative work to rehabilitate his natural dentition. Several teeth had been extracted, leaving him partially edentulous.
Reviewing the data, the practitioners discussed possible restorative alternatives to removing all of the patient’s teeth. However, at the second patient visit in consultation with the patient and his wife, it was agreed that because of the patient’s high rate of tooth decay and broken and missing natural dentition, the best restorative solution would be to remove all of his teeth and offer a fixed long-term solution that would reduce the dental expenditures he had incurred in the past while trying to save his now terminal dentition. The patient wanted a solution that would restore his ability to chew naturally and smile with confidence. An implant-supported solution also would allow opening up his bite to correct his narrow airway (Figures 7-9), which was restricting his ability to breathe during the night and further exacerbating his heart condition.
Figure 8
It was clear that he had undergone extensive root canal and restorative work to rehabilitate his natural dentition. Several teeth had been extracted, leaving him partially edentulous.
Reviewing the data, the practitioners discussed possible restorative alternatives to removing all of the patient’s teeth. However, at the second patient visit in consultation with the patient and his wife, it was agreed that because of the patient’s high rate of tooth decay and broken and missing natural dentition, the best restorative solution would be to remove all of his teeth and offer a fixed long-term solution that would reduce the dental expenditures he had incurred in the past while trying to save his now terminal dentition. The patient wanted a solution that would restore his ability to chew naturally and smile with confidence. An implant-supported solution also would allow opening up his bite to correct his narrow airway (Figures 7-9), which was restricting his ability to breathe during the night and further exacerbating his heart condition.
Figure 9
It was clear that he had undergone extensive root canal and restorative work to rehabilitate his natural dentition. Several teeth had been extracted, leaving him partially edentulous.
Reviewing the data, the practitioners discussed possible restorative alternatives to removing all of the patient’s teeth. However, at the second patient visit in consultation with the patient and his wife, it was agreed that because of the patient’s high rate of tooth decay and broken and missing natural dentition, the best restorative solution would be to remove all of his teeth and offer a fixed long-term solution that would reduce the dental expenditures he had incurred in the past while trying to save his now terminal dentition. The patient wanted a solution that would restore his ability to chew naturally and smile with confidence. An implant-supported solution also would allow opening up his bite to correct his narrow airway (Figures 7-9), which was restricting his ability to breathe during the night and further exacerbating his heart condition.
Figure 10
Preop STL scans of the patient’s upper and lower jaw. The CT scans of the patient’s current oral situation were imported into Blue Sky Bio’s implant planning software for placement planning (Figures 10 and 11).
Figure 11
STL scan files were imported into software for treatment planning. Highlighted are sites #6 and #11 with a thin buccal plate, which buckled when the teeth were extracted and thus had to be placed at lateral sites #7 and #10. The CT scans of the patient’s current oral situation were imported into Blue Sky Bio’s implant planning software for placement planning (Figures 10 and 11).
Figure 12
CAD design for the 3D printed surgical guides. The scans were also used to design MoonRay 3D printed surgical guides for use during the placement procedure (Figure 12).
Figure 13
Postop photos of the upper and lower jaws after implant placement surgery. At the next appointment, teeth in the patient’s upper and lower jaws were extracted at the implant sites and MegaGen implants placed (Figures 13 and 14).
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Figure 14
Postop photos of the upper and lower jaws after implant placement surgery. At the next appointment, teeth in the patient’s upper and lower jaws were extracted at the implant sites and MegaGen implants placed (Figures 13 and 14).
Figure 15
CAD design of the digital wax-up of the final case. Intraoral scans of the upper and lower jaw (with teeth extracted) were sent to the Louisiana Dental Implant Lab for CAD design of the digital wax-ups of the final case. The goal was to open the bite in the lower jaw, which would open up his restricted airway, and to bring his upper and lower jaws into an ideal occlusion (Figures 15 and 16).
Figure 16
CAD design of the digital wax-up of the final case. Intraoral scans of the upper and lower jaw (with teeth extracted) were sent to the Louisiana Dental Implant Lab for CAD design of the digital wax-ups of the final case. The goal was to open the bite in the lower jaw, which would open up his restricted airway, and to bring his upper and lower jaws into an ideal occlusion (Figures 15 and 16).
Figure 17
Milled immediate-load provisionals milled chairside and seated. Immediate loaded provisionals were milled chairside with the TrüMill X250 out of polymethacrylate and seated (Figures 17-20).
Figure 18
Milled immediate-load provisionals milled chairside and seated. Immediate loaded provisionals were milled chairside with the TrüMill X250 out of polymethacrylate and seated (Figures 17-20).
Figure 19
Milled immediate-load provisionals milled chairside and seated. Immediate loaded provisionals were milled chairside with the TrüMill X250 out of polymethacrylate and seated (Figures 17-20).
Figure 20
Milled immediate-load provisionals milled chairside and seated. Immediate loaded provisionals were milled chairside with the TrüMill X250 out of polymethacrylate and seated (Figures 17-20).
Figure 21
Implants after 3-month healing time. The 3-month healing time would allow the patient to test the functionality and esthetics (Figure 21).
Figure 22
Implants with restorative abutments. After 3 months of healing, the patient returned to the practice to receive his final temporary restorations. The upper and lower jaws were scanned to make any esthetic changes requested as well as to assess the amount of gingival shrinkage that had occurred during the healing period, and measurements were taken. The intraoral scans were sent to the Louisiana Dental Implant Lab for CAD design and milling of the final temporary restorations out of polymethacrylate. CT scans also were taken to confirm that the adjustments made in opening his bite had positively affected his once-restricted airway. After wearing the final provisionals for several weeks, the patient reported he was pleased with the function and esthetics of the prosthetic. The laboratory then milled the final zirconia full-arch screw-retained restorations from IPS e.max ZirCAD Prime (Figures 22 and 23) and delivered the prosthetic to the practice for the seating appointment.
The patient later reported to the practice that he feels like a new person. He is more energetic because he is sleeping better at night and also can finally chew without pain. Most importantly, he can now smile and socialize with confidence again.
Figure 23
The final screw-retained, implant-supported prosthetic was milled from IPS e.max Prime. After 3 months of healing, the patient returned to the practice to receive his final temporary restorations. The upper and lower jaws were scanned to make any esthetic changes requested as well as to assess the amount of gingival shrinkage that had occurred during the healing period, and measurements were taken. The intraoral scans were sent to the Louisiana Dental Implant Lab for CAD design and milling of the final temporary restorations out of polymethacrylate. CT scans also were taken to confirm that the adjustments made in opening his bite had positively affected his once-restricted airway. After wearing the final provisionals for several weeks, the patient reported he was pleased with the function and esthetics of the prosthetic. The laboratory then milled the final zirconia full-arch screw-retained restorations from IPS e.max ZirCAD Prime (Figures 22 and 23) and delivered the prosthetic to the practice for the seating appointment.
The patient later reported to the practice that he feels like a new person. He is more energetic because he is sleeping better at night and also can finally chew without pain. Most importantly, he can now smile and socialize with confidence again.
Download Issue: Dental Products Report September 2021
