ASSC/Center for Advance Dental Studies

• Treatment Planning Case – December 4, 2012

Patient

• 39 year old female• Concerned about –– Missing teeth– Spaced out lower teeth– Dissatisfied with upper removable partial• Poor retention• Clicks when in function

– Dissatisfied with “flatness of mid-face”

Medical History

• No Significant Medical History• Not On Any Medications• No Allergies

Diagnosis

• Dental – Missing teeth #’s 2,4-14,16,19,30,32– Caries #’s 18,29,31– Overhanging restorations 3, 15,20– Generalized mild marginal bone loss 1 – 2mm– Apical periodontitis # 29– Inadequate / Failing restorations• Teeth #’s 1,3,15,20, 31

Diagnosis

• Skeletal – Maxillary hypoplasia A/P, Transverse, Vertical– Severe resorption of maxillary alveolus– Enlarged maxillary sinuses

Treatment Planning Exercises

• Assume that there is no financial restrictions• From a removable prosthetic standpoint what

are the problems and restrictions that this patient presents? How would one best design a removable partial or full denture with this skeletal relationship without using implants? – What are the limitations?– What is the long term prognosis?

Treatment Planning Exercises

• How can dental implants be used in this patient to facilitate a partial denture?

• How can implants be used to facilitate a removable full denture?

• How can implants be used to develop a full fixed restoration?

Treatment Planning Exercises

• What are the limits and restrictions that the patient has regarding her present dentition and skeletal relationship that limits or prevents the previous treatment modalities?

• Can these relationships be managed to allow for a workable, stable prosthetic solution, establishing acceptable occlusal and functional relationship?

• How?

Acknowledgement

• I understand that this is a very complex case, and the actual treatment of it is not so important (although we will review it)

• What I am looking for in our discussion is to develop understandings on how we deal with a challenging skeletal relationship and the thought process in removal prosthetic design as well as utilization of modalities such as implants if possible to facilitate a stable result.

Teams

• We will divide the group in to three teams to discuss these options. Again, regardless of the option, there are no monetary or medical restrictions.