Case presentation is the cornerstone of a technologically up-to-date practice. The most successful practitioners are those who communicate easily with their patients. A thorough examination and careful diagnosis, combined with a comprehensive treatment plan that makes sound use of modern technology, are very powerful tools in patient acceptance. With help from technology, the most precise treatment possible is within reach of every dentist who offers an implant solution to their patients.
Case report
A lady who used to speak from behind a raised hand, with a bashful attempt at a closed-lip smile has become an openly happy person, ever keen to exchange a smile or laugh.
Px (a 55 year old lady) had worn dentures for most of her adult life, extremely self-conscious and painfully embarrassed to remove her upper partial denture even in the dental surgery. We had made aesthetically acceptable dentures six years previously which had helped a little, but the patient's self-esteem remained low.
The remaining upper teeth were the lightly restored 17, 27 and teeth 13, 23 had been decoronated, root filled and were being used overdenture abutments.
Thirty-five plus years of denture wear had caused significant resorption in the anterior maxilla and the OPG showed pneumatisation of the maxillary sinuses (fig 1).
The patient had been told previously that implant placement and a fixed prosthesis was not possible due to the lack of bone. Yet the patient's greatest wish was to have fixed teeth, as close to the real thing as possible.
CT scanning with a Barium Sulphate marking on a copy denture allowed investigation of proposed implant sites. The situation was challenging as shown by fig 2a and 2b. The potential risks and benefits were discussed and appropriate consents obtained. The resultant treatment plan was to place 10 maxillary implants in tooth positions (16-15-14) (13-11-21-23) (24-25-26) with the necessary hard tissue augmentation to provide sufficient bone volume for the chosen implant sites. The planned restoration would be three porcelain-bonded bridges. This would achieve the greatest aesthetics/most retrievability given the biological challenges we faced.
Bilateral sinus elevations and augmentations were performed using the lateral window technique, these were two of the most technical (and satisfying) sinus elevations I have performed in my career. The procedure was made significantly easier, more efficient and therefore less stressful with the use of Acteon's Piezotome unit. Both sinuses had curving, wave- like septae reaching approximately 10-12mm up from the sinus floor - essentially the Piezotome helped with four sinus elevations on one patient (Fig 3 a-c). The presence of septae make the perforation of the the Schneiderian membrane a greater probability and the patient must be forewarned of this risk. Information from the CT scan allowed me to mark to position of the lateral windows, taking into consideration the presence of the septae. The Schneiderian membrane was raised uneventfully, in part due to the gentle, tissue caressing action of the Piezotome and the septae were successfully negotiated to allow augmentation with Bio-Oss one to two mm particles.
3D imaging
The second product of note is Acteon's X-Mind 3D. It gives practices the benefit of 3D imaging, with more accurate clinical information and treatment planning tools. It combines low dose, fast imaging and high diagnostic accuracy, with value for money.
The 3D image brings efficiency to implant planning and minor surgical procedures, giving more accurate information regarding bone structure, fractures, impacted teeth, third molars, TMJ and abnormal anatomy. You can choose from two fields of view and two resolution selections – standard or high.
Digital radiography has been revolutionary in terms of communication between dentists, specialists and dental technicians. The ability to email digital information ensures that the receiving dentist has all of the necessary information by the time the patient arrives. For laboratories, a digital image can say a lot more than a written explanation. As the outcome of aesthetic dentistry relies on accurate communication between you and your technician, digital imaging and radiography have been superb innovations. Great technicians are invaluable to a great outcome and I'd like to thank mine, without whom none of this life-transforming treatment would be possible.
With digital technology, the number of visits needed for a specific treatment is reduced significantly. The patient can participate through the process. As the images of the possible results are available for your patient to review before the treatment is even started, they can engage with and commit to their treatment plan, with a more satisfying outcome for everyone.