Minimal restorative intervention

In this second case there is a more extreme utilisation of this advanced technology (for the first case see The Dentist, October 2010, page 126).

Mr Y presented after 30 years without visiting a dentist due to his fears about dental treatment and long standing dental phobia (fig 10 and X-ray 1). This dental phobia, however, was overcome by the severe problems of periodontal disease and halitosis together with aesthetically unappealing lower front teeth. After the initial examination and X-ray, the patient underwent investigative cleaning and debridement together with the extraction of multiple roots, caries removal, and construction of mounted casts. This procedure was performed with local anaesthetic and intravenous sedation due to the patients extreme gag reflex and intense dental phobia. 

The second stage then involved a mock-up of a desired tooth arrangement for the planning.

Stage three was the surgical implant placement of 12 Biomet 3i implants in their desired positions. Localised augmentation was placed into the sockets, the flaps then apposed and the soft tissue was measured with a periodontal probe to assess the correct height of the Encode healing abutments. It was necessary to place Encode healing abutments of sufficient stature so no tissue revision would need to be undertaken at any stage in the future due to the difficulty of impressions compliance. The flaps were then closed around the Encode healing abutments. The patient did not require a temporary restoration as aesthetically he was already significantly improved from the first stage of treatment. The patient then underwent 14 weeks of healing and a post-op X-ray was taken to check seating of the healing abutments. The LR7 healing abutment was not completely seated and it was noted that it would require revision at the next stage of treatment. The patient then underwent extensive hygiene appointments to build a rapport and improve the oral hygiene around both the Encode healing abutments and also the residual teeth.