Having the ability to take a patient from point A-Z in a fewer amount of appointments within your practice allows you to position yourself as a provider that can fulfill your patient’s surgical and restorative needs. With the proper training, a dental provider may provide extraction, grafting and implant placement within one appointment at one location. Not only does this allow you to reduce the amount of visits for the patient, but this type of service also helps stay within their budget. Most importantly, this enables the dental provider full control of the surgical and prosthetic outcome. Depending on the patient’s desires, the clinical conditions of the oral environment present and the skills of the provider, a dentist may choose to extract teeth, level bone, and graft with dental implant placement.
Figure 8: OCO Biomedical Guided Kit
Figure 9: Tokuyama Soft reline
Figure 10: Postoperative smile
Figure 11: Postoperative retracted view
The patient illustrated here, presented in severe pain due to multiple rampant caries and generalized advanced periodontal disease (Figures 1 & 2). Having already visited multiple providers for a consultation, she was very frustrated with the treatment options offered due to varying treatment plans that were segmented by different disciplines. Since many of these options did not complement the other, the patient decided to come to us for full treatment (A-Z) after being referred to us by one of our patients who had already undergone a Total Dental Solutions Reconstruction.
When presenting cases like this to my patients, I will always use the Dine Digital Solution camera (Lester Dine) (Figure 3). Not only is this camera small, light and waterproof it also is very effective and clear in taking closeup photos as well as full face shots. Additionally, I will always offer my patients a third party payment option like the Lending Club (San Francisco, CA) for their treatment. Lending Club Patient Solutions provides patients great funding flexibility with very low rates and high approvals.
Before the surgical appointment, a CBCT scan was taken to accurately treatment plan this case to make certain that no complications would arise from doing all the procedures (extract, graft and implant placement) in the Total Dental Solutions protocol. CoDiagnostix software was used through 3D Diagnostix virtual assistance to precisely plan the placement of six Engage (OCO Biomedical) dental implants in the maxillary arch as well as seven Engage (OCO Biomedical) dental implants in the mandibular arch (Figures 4 & 5) followed by fabrication of the surgical guides (Figures 6 and 7).
In order to be effective, efficient and more proficient during these Total Dental Solution Reconstruction procedures, I will utilize IV sedation. Not only does it make the appointment easier for me, patients prefer to get everything done in one visit. Since they are sedated, a mouth prop is needed to keep their mouth open. Because of this, I will routinely extract teeth in quadrants starting from the upper left to the upper right and then down to the lower right and lower left. This allows great time savings as it is easier to keep the patient’s mouth open and be able to proceed around the arches.
Once the teeth are extracted, I will reflect the tissue in order to get the surgical guides seated and fixed with their respectful retention pins. Using these universal surgical guides provided by 3D Diagnostix, the sites for the implants were begun with a 2mm pilot drill utilizing the Mont Blanc surgical handpiece and Aseptico surgical motor at a speed of 1200rpm with copious amounts of sterile saline (Figure 8).
Once the osteotomies were complete, an implant finger driver was used to place the dental implants until increased torque was necessary. The ratchet wrench was then connected to the adapter and the implants torqued to final depths reaching a torque level of about 40-50Ncm. Extended healing caps were hand-tightened to the implants. A post-operative radiograph was made of the implants and the healing caps to ensure complete seating. The immediate dentures were soft relined with Sofreliner Tough (Tokuyama) (Figure 9) for 4 months until the implants were ready to be restored permanently. By using the extended healing caps with the soft reline, the immediate dentures were much more retentive. The soft tissue and implants were evaluated clinically after one week. The patient stated she had very little post-operative discomfort or swelling.
Approximately four months after the initial placement of the dental implants, the patient returned for the definitive porcelain fused to metal restoration impressions. Within three weeks of the impressions, the porcelain fused to metal restorations were inserted and a Panorex taken (Figure 10 & 11).
More and more patients are presenting to dental practices requiring this type of reconstruction. By providing multiple services in a shorter number of visits under one roof, the dental provider will find more patients who will accept treatment. In doing so, not only are you helping patients get to proper form and function, but you are also helping achieve a Total Dental Solutions Reconstruction in a fewer amount of appointments.
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Dr. Nazarian maintains a private practice in Troy, Michigan with an emphasis on comprehensive and restorative care. He is a Diplomate in the International Congress of Oral Implantologists (ICOI). His articles have been published in many of today’s popular dental publications. Dr. Nazarian is the director of the Reconstructive Dentistry Institute. He has conducted lectures and hands-on workshops on aesthetic materials and dental implants throughout the United States, Europe, New Zealand and Australia. Dr. Nazarian is also the creator of the DemoDent patient education model system. He can be reached at (248) 457-0500 or at the Web site www.aranazariandds.com