extraction, immediate implant placement

Loma Lin da Un iversity

Patient Presentation Seminar

PATIENT PRESENTATION

Prepared by Dr. ChauLong Nguyen, DDS,

November 12, 2015

Healed Site Immediate Loading

Veneer Provisional on Abutment

D r. auLong NguyenDDS, MAGD

My office- reception desk to the left

Reception Area & Hall Way to Treating Rooms

We have 16 windows around the office.

Treating rooms

Why most Africans have white teeth?

In November 2013, I went to Africa for safari gaming tour in Boswana, Cape Town South Africa, Zimbabwe, and Zambia for a month.

Behind the elephant is the toothbrush tree/bushes.

Receptioin area Chobe National Park

Toothbrush tree= Salvadora persica

From Wikipedia, the tree encyclopediaIt is also known as Arak, Pilu, mustard tree. It is a species of Salvardora. Salvadora

persica has antiurolithatic (anti-urinary stone/calculi) properties. It is used for centuries

as natural toothbrush. Its fibrous branches have been promoted by World Health

Organization for oral hygiene use. Researches suggest it contains a number of medically

beneficial properties including abrasives, antiseptics, astringent, detergents, enzyme inhibitors, and Fluoride.

Salvadora Perci=sica = toothbrush Salvadora persica= toothbrush tree

Healed Site Immediate Loading

Veneer Provisional on Abutment

D r. auLong NguyenDDS, MAGD

Loma L inda Unive rsity

Patient Demographics

• Gender: female• Age: 67• Race: Caucasian• Marital Status: Single• Employment Status:

Administrator assistant at Stanford University

Frontal & Profile View At rest

Ms. Sue

Smile in Frontal and Profile View

Chief Complaint

“I had 4 dentures for this tooth and many bonded procedures but it didn’t stay. I want to have something fixed.”

Medical History• BP 99/47; P= 67• ASA II• Patient has asthma, arthritis,

hypertension, stomach ulcers, gout

Medical History

She is taking 1.Amlodipine2.Lisinopril3.Pentoprazole4.Vitamin B125.No Inhaler6.Allergic to Benzocaine

Dental History• Sue has several gold and PFM crowns and root

canal therapy in posterior teeth. They are all in good conditions.

• Teeth #s 14 & 15 have extensive recurrent caries with guarded to poor prognosis so she wanted to wait until they bother her then take care of them.

Dental History

• Acquired missing Tooth # 11 has adequate bone volume BL = 7mm; MD = 8mm; inter-occlusal space = 5mm;

• Cusp tips of #s 21 & 22 would be reduced to give 1mm of interocclusal space.

• Type III bone

Anterior View

Protrusive View

Occlusal Views

Maximum Intercuspation Views

Right Left

Working Side Views

Right Left

Extra-oral Findings• Head and neck: WNL• Facial asymmetries:

None • TMJ: Normal, healthy• Lymph nodes:

nonepalpable

•Soft tissue exam: mild to moderate gingival inflammation around all molars

Intra-oral Findings

• Hard tissue exam: moderate bruxism with uniform wear on enamel and crowns of all teeth

• Missing tooth # 11• Several posterior teeth have gold

and PFM crowns.• Moderate to severe recurrent

caries in #s 2M, 18M, 14DB, #15 M.

• Several

Intra-oral Findings

• Occlusal Scheme:

• Angle Class I occlusion

• Skeletal class I.

Occlusal Findings

Perio Exam09/01/15

• AAP: Generalized healthy with localized chronic mild to moderate gingivitis around all molars.

Periodontal Findings

Radiographic Presentation

June 26, 2015

• Acquired missing tooth # 11 causes esthetic and functional problems.

• Type III bone• BL= 7mm• MD= 8.5mm• Inter-occlusal space = 5mm• Mild to moderate bruxism

Diagnosis

• Good to excellent for implant • Fair to Good for prosthesis due to mild to

moderate bruxism

Prognosis

• 1. Take photos, xrays, scan, take bite registration & alginate impression

for tx plan presentation

• 2. place implant Nobel Biocare 3.5mm*10mm

• 3. Immediate placement of Ti-esthetic custom abutment

• 4. Reduce cusp tips of #s 21 & 22 for proper occlusal clearance

• Take bite registration, final impression with PVS and send to lab

• 5. Make bonded provisional veneer with sand blasting F of abutment

• 6. Deliver crown by cementation; Night Guard

Proposed treatment plan

Implant and immediate veneer provisional

placed on 8-11, 2015 X-ays of Implant placed 8-11,

I1 week post op 8-18- 2015

Custom abutment placed 8-11, 2015

Provisional veneer, 9-1, 2015

Provisional veneer placed 8-11, 2015

Provisional veneer placed on 8-11-2015 Outof

occlusion

Provisional veneer placed 8-11, 2015 Out of occlusion

Lily in the Okavango Delta River

• Sand Blasting abutment for final cementation

Abutment after provisional was removed

PFM crown was cemented on September 1, 2015

FiNnal PFM crown placed 9-1, 2015Out of lateral excursion

CBCT Radiographic PresentationOctober 19-2015

2 month 8 days after Implant placement

Radiographic Presentation

CBCT Scan

Follow up post placement of PFM crown on November 6, 2015

Mauna Laani Coconut grove

• An exposed root is my ideal surgical guide.

Extraction,Immediate Implant

Placement

• Gender: male • Age: 86• Race: Korean• Marital Status: Married• Employment Status: Retired

English Professor

Front View at Rest and Smile

Mr. Kim

Profile View at Rest and Smile

Chief Complaint

“My bridge is loose. I have many old gold crowns. I want strong teeth to chew. Fixed whatever you think wrong.”

Medical History1.BP= 136/87; P= 672.ASA I3.Pt has hypothyroidism &

Gastroesophageal reflux disease-GERD.

4.He is taking Levothyroxine & Femetidine.

Dental History Pt has failed PFM bridges #s 2 to 4 & 11-15;

•Teeth #s 19, 31 have recurrent caries under gold crowns

•Pt wanted to have successful implants placed for #s 11, 12, 14 in 2006

•He would like to have teeth #s 2, 3, 4, 19, 31 implants and crowns.

•Pt has fair oral hygiene but doesn’t floss often.

Anterior View

Occlusal View

Maximum Intercuspation Views

Right Left

July 10, 2006

• Bridge #s 11 -15 was removed and sectioned.• # 15 PMF was re-cemented.

• Implants were placed for teeth #s 12, 14 on September 15, 2006 & # 11 on December 1st, 2006.

Pano was taken on August 15, 2006

July 10, 2006

• 12- 1, 2006 9-16-2015

9 Years Comparison

• 8-15-2-06 9-16-2015

9 years post Implant & prostheses placement

• Teeth #s 2, 4, 15, 19, 31 were removed and implants were placed immediately at extraction time

• Puros cancellous particulate bone graft• There was no primary closure of gingiva at

extraction site• Used chromic resorbable gut interrupted

sutures

Implants placed on7-31, 2014 & 9-16, 2015

January 16, 2014

• 3-24-2014 9-16-2015

1.5 Years Post Extraction, Immediate Implant Placement #s 2 & 4

• Annual Recall visit 9-16-2015

Extraction and Immediate Placement of # 31 on 9-24-2015

• 1. Abscence of infection 2. Soft tissue Closure

• 3. Space maintenance 4. Graft Stability

• 5. RAP= Regional Acceleratory Phenomenon

• 6. Host Bone blood supply 7.Growth Factors

• 8. BMP=Bone Morgenetic Proteins

• 9. Healing time

• 10. Defect size and tophography

• 11. Transitional prostheses

Surgical Keys to Bone GraftingCarl Misch- 3rd Edition-Chapter 36-page 839

•An exposed root is my ideal surgical guide.

•Puros Cancellous Particulate bone graft & Biomend membrane

Extraction,Immediate Implant

Placement

• Gender: male • Age: 63• Race: Iranian• Marital Status: Married• Employment Status:

Mechanical engineer

Front View at Rest and Smile

Mr. Riazati

Profile View at Rest and Smile

Anterior View

Protrusive View

Occlusal View

Radiographic Presentation 2-2-2015; #s 12, 13

Radiographic Presentation 2-2-2015; # 19

Radiographic Presentation 2-2-2015; # 31

7 month post implant placement

7 month Post Implant, healing cap removed from # 19

• 2-2-2015 9-4-2015 11-6-15

• Teeth #s 12, 13

Extraction, Immediate placement, a predictable result

• 2-2-2015 9-4-2015 11-6-15

• Tooth # 19

• 2-2-2015 9-4-2015 11-6-15

• Tooth # 31

• MIP-Right side• After Implant and prosthesis

Post-Prosthetic delivery PFM # 31

• MIP-Left side• After Implant and prosthesis

Post-Prosthetic delivery PFM #s 12, 13, 19

Radiographic Presentation2-2-2015, 9-4-2015, 11-6-2015

Radiographic Presentation 11-6-2015, Post PFM crown delivery

• I wish you all peace and happiness.

Thank you for your attention.

extraction, immediate implant placement

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