Complex Full Mouth Rehabilitation

123 Rating(s).


Posted on By miguel stanley In Full Arch & Dentures

In this case that I originally presented at the dental XP summit last August at NYU but did not show the final results, we pretty much used the entire armamentarium currently available to us dentists. Many different procedures and protocols were applied in this complex case and I will post the full presentation on my expert page, here on dental XP.
The technology used here covered many different areas from CBCT, digital x-ray, I PRF, Versah condensation burs, Smart dentine Grinder, Megagen Anyridge system, Mega ISQ, Piezo surgery to name a few.
The patient's main concern was long-lasting natural results. As you can see from the initial photographs and x-rays she was in a bad state to start out with, and have been a heavy smoker for 50 years and now was suffering from emphysema.
We decided to take no shortcuts and to really practice as many gold standard procedures as possible and thankfully she could afford the treatment. We are very happy with the outcome, might not be perfect but she is very happy. It has been six months now since we finished and everything is quite stable and according to what we have been seeing here on XP and in the literature should remain quite stable for a long time. We maintain a rigid program of five checkups a year.

initial
surgical phase

Gum modulation
Provisionals


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17 Comments

Miguel

Simply amazing case.
Did you condense the dentine w the Densah drills before the implant was placed?

If so, did you use just the root dentin or the whole tooth?
Can you also post the ISQ numbers for the whole case...

Thanks

Rocco


Reply

Hey Rocco, thanks for the questions.

I tried to avoid using the smart dentine adjacent to the implants and preferred bone.
We condensed before placing the implant, using autologous and xenograft.

We used the whole tooth, following the guidelines from the manufacturer.

ISQ according to mega Torque (Ostell) was above 72 for all implants. The reason here is we choose the implant in function to the bone and always make sure we have the right thread and diameter. This can help boost ISQ numbers.
So shifting from a 4.0 platform to a 4,5 diameter can boost ISQ by about 15.

hope thats helps


Reply

Digital Applause....remarkable outcome. Thanks for sharing Maurice


Reply

Thanks Mo. As my mentor that means a lot.


Reply

Beautiful work Miguel!


Reply

thank you Paul


Reply

I had the oportunity to see this case at August Dentalxp Summit, and was fantastic. Miguel, here planification is the most important part and it is perfectly executed.
Thanks for posting
Regards
Jorge


Reply

Thanks Jorge. I guess all that we forgot was a socket shield on a few anteriors.


Reply

Miguel,
Good case!! and results!! Good planification for good outcomes,
Planification is mandatory!!
Well done
Thanks for sharing
Vladimir


Reply

Miguel,
Good case!! and results!! Good planification for good outcomes,
Planification is mandatory!!
Well done
Thanks for sharing
Vladimir


Reply

Could have gone for pink ceramics but wouldn't have been as much fun. If we dont love what we do, then why do it?


Reply

Dr. Stanley,
Excellent planning and execution on this case! The end result is superb! I have a couple of questions:
1: How was the case provisionalized? Lab fabricated provisional's, chair side provisional from wax up, material ect..
2. If you did the case again would you do anything different... i.e. root submergence or socket shield or anything else?
Again Great job on the case!


Reply

Thanks for your comments:

the provisionals were done by taking a open tray impression immediately after the surgery. the patient had a removable denture for 24 hours then we placed the screw retained PMMA from Zirkohnzan.




as for if i would have done anything different. I would have done some sockets shields on some of the teeth I extracted on the upper arch.

i am particularly happy we saved her bottom teeth.


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beautiful


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Miguel,

Fantastic work - function& esthetics on point -love the before and after patient photo your work is always clean and your presentation is always dynamic

Cheers,

Richard


Reply

Amazing results and terrific case planning. Thank you for posting. Your philosophies are truly expressed in your work. Regards, Naheed


Reply

Miguel. Exceptional work my friend! Yes indeed you must love what you do to achieve this type of result you, because we know cases like this don't just happen without much thought and skill. Congratulations! Best wishes. Chuck.


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