Featured Case 08/20: NO MORE DENTURES - IMMEDIATE TEETH WITH DENTAL IMPLANTS

Patient:

Ron

The problem:

“My dentures are loose and I cannot eat well nor enjoy food.”

Patient History:

• Ron lost his teeth many years ago and was forced into dentures.
• This was a significant compromise in his general quality of life and confidence.
• Over time the dentures became more loose and ill-fitting.
• Chewing, tasting or enjoying foods, and confidence in social circles were all compromised.
• He had 2 implants placed to help secure the lower denture, but that did not resolve the mobility when eating.
• He found himself in a place where his life was significantly impacted.
• He could no longer go to a restaurant and order what he wanted but look for what he could eat with his loose and ill-fitting dentures.

Pertinent Information:

• Healthy teeth maintain the bone and jaw structure.
• When teeth are lost, the bone atrophies (shrinks) from a lack of function.
• Dentures rely on the bone (like a saddle) to remain in place but become progressively loose as the bone shrinks.
• Dentures simply sit on the toothless gums and cause even more atrophy.
• The only way to maintain the bone is to replace the function within the bone like a tooth root.
• An implant is the only current tooth replacement option that preserves bone.

Implants as a challenge and a solution:

• Implants require sound bone as a foundation for anchoring.
• As the jaw bone shrinks after losing teeth, there is less bone in which to anchor the implants. The loss of bone becomes so extreme that traditional implants are difficult to place as regional nerves (inferior alveolar for lower lip sensation) and the sinuses (air cavities in the upper jaw) are closer to the surface as a result of bone loss.
• This was precisely Ron’s challenge. He had such bone loss that his dentures were too loose and traditional dental implants were nearly impossible.

• Bone graft reconstruction in this type of case can require extensive surgery, a long arduous recovery (6-10 months), and unpredictable long-term success.
• Only after bone healing are implants considered. The total time for treatment in the bone-grafted approach can be 1-2 years.
• Ron had such bone loss that there was insufficient bone above the sensory nerves (inferior alveolar) passing within the lower jaw (pink solid line).
• His 2 lower implants were failing from too much rocking movement of the denture.
• He also had such loss of bone in the posterior upper jaw that it encroached on the sinuses where little structure remained for implants.

• Typically, implants of about 8-10mm long are desired and should remain 2 mm above the nerve (requiring a total of 10-12 mm above the nerve) for safety and mechanical security.
• Ron had less than 5mm.
• In such cases, implants can be tilted away from the sinuses or the nerves while engaging the remaining bone for stability and support.
• Another novel approach is to use longer implants that traverse the sinuses and fixate into the zygoma or cheekbones.
• These tilted and “zygomatic” implants have been well-established modalities of treatment for the patients with very little bone that requires immediate stability.

• Utilizing these stable graft-less implant techniques, patients can have implants placed and temporary teeth attached on the same day.

Procedures:

• Ron had both failing lower implants removed.
• Concurrently, 4 implants were placed in the lower jaw while avoiding the inferior alveolar nerve with tilted posterior implants.
• In the upper jaw, 4 implants were placed in the sound bone anterior to the sinuses.
• In the thin and lower-density region of the posterior upper jaw, 2 zygomatic implants were placed.
• All implants were very stable by optimal use of the available bone anatomy.
• No bone graft reconstruction was performed nor indicated.
• Dr. Gilbert performed all surgical procedures on the same day under anesthesia.

• Temporary dental prostheses were attached to the implants on the same day while Ron was comfortably sedated.
• He left our facility with secure and aesthetic teeth that were attached on the very same day as his surgery.

Treatment Course:

• Ron enjoyed those temporary prostheses (teeth) for 4 months while everything healed nicely.
• He then saw his restoring dentist who prepared and delivered final implant-retained prostheses.

Commentary:

• This was a true and nearly immediate transformation for Ron.
• Utilizing very specialized surgical techniques, Ron was able to have a solid set of teeth in an extremely expedited manner.
• Extensive experience and a “well-orchestrated” team approach are critical to the success of these procedures.
• It is a true privilege and honor for our healthcare team to positively impact a patient’s life in a sustainable and predictable way.
• We are so grateful and thrilled that we were able to restore Ron’s confidence, comfort, and general quality of life.