Comprehensive Dental Rehabilitation
This lovely patient presented with a history of dental neglect, resulting in multiple fractured and failing teeth, a compromised upper central incisor implant, significant tooth-wear and a destructive bite affecting the anterior teeth. Determined to regain stability in his oral health, the patient sought our assistance.
The Goal
Our overarching goal was to eliminate pathological conditions while restoring both aesthetics and functionality. To achieve optimal function, it was clear that we needed to increase the occlusal vertical dimension.
The Challenge
Given the patient’s strong gag reflex, traditional dentures posed a challenge. A CT scan was performed to evaluate the feasibility of dental implants. Unfortunately, there was minimal to no bone height in the upper molar regions, necessitating sinus grafts for implant placement. Fortunately, there was adequate bone in the upper anterior arch to support implants; however, we opted to delay placement due to the existing infection, initiating a stabilisation phase first.
Treatment Plan
Phase 1: Stabilization
- Removal of infected and hopeless teeth. This included extracting all upper teeth, including the failing dental implant, which exhibited 70% bone loss. Additionally, both lower second molars, which were mobile and significantly infected, were also removed.
- A temporary denture was fabricated; however, the patient struggled with its use due to his gag reflex.
Before Treatment
Before Treatment
Before Treatment
Phase 2: Fixed Provisionals and Bite Reconstruction
- Six weeks post-extraction, we placed four dental implants, conducted bilateral sinus grafts, and performed buccal onlay grafts. An immediate provisional bridge was created, restoring function from premolar to premolar.
- Lower molar and premolar implants were placed in a separate appointment without immediate loading.
- The lower worn teeth were restored with composite material to cover exposed dentine, re-establish anterior guidance, and begin restoring the patient’s bite in centric relation.
After Dental Implants
After Dental Implants
After Dental Implants
Phase 3: Six-Month Follow-Up
- Upper molar implants were placed.
- Upper arch connective tissue graft was performed to improve keratinised tissue around the upper implants and increase sulcus depth to help improve longer term hygiene.
Phase 4: Four Months Later
- A final Upper Zirconia bridge was constructed, utilising all six upper dental implants. Adjustments were made to the lower composites, and crowns were placed on the lower premolar and molar implants.
After Treatment
After Treatment
After Treatment
Conclusion
This structured approach ensured a comprehensive and effective restoration of the patient’s oral health and function.
