4: Case Presentations

CHAPTER 14 Case Presentations

Advanced Procedures

Complete Anodontia

An 18-year-old woman presented with complete anodontia. She had the dentoalveolar development of a 6-year-old in an adult skeleton. The lack of dentoalveolar development resulted in inadequate anterior-posterior (AP) support for the upper and lower lips. The patient had a decreased vertical dimension of occlusion (VDO) and a “wandering” acquired bite consistent with perpetual posturing of her mandible. She had partial primary dentition in her maxillary arch and used a removable prosthesis to replace the missing teeth at positions 8, 9, and 10. She had a full complement of primary mandibular teeth with stainless steel crowns on her anterior mandibular teeth (Figures 14-1 to 14-3).

Her panoramic radiographic examination revealed the presence of zones I and II bone in the maxilla and adequate mandibular bony volume.

To plan treatment with an implant-supported prosthesis, it was paramount to establish the proper VDO, AP tooth position, and a stable and reproducible occlusion. To accomplish this goal, maxillary and mandibular overdentures were fabricated. Occlusal adjustments were made during the next 4 months to establish a reproducible occlusion (Figures 14-4 to 14-8).

Prior to planning treatment with implants, cone beam radiographic studies of the temporomandibular joints were completed. These studies demonstrated an absence of pathologic conditions in the joint and established a baseline study for comparison with future cone beam radiographic studies of the patient’s joint (Figure 14-9).

Clear duplicated maxillary and mandibular dentures were made for systematic evaluation of an implant-supported prosthesis.

Systematic pretreatment evaluation of the patient:

Treatment plan:

Maxilla

Mandible

Ectodermal Dysplasia: The Zygoma and Tilted Treatment Concepts

A 24-year-old healthy man presented with ectodermal dysplasia. The facial form indicated collapse of the nasolabial and labiomental angles. In the treatment planning phase, careful consideration must be given to the transition line of the final prosthesis. The intraoral presentation demonstrated partial maxillary and mandibular malformed teeth. A flat maxillary vault and advanced horizontal atrophy of the mandibular residual alveolus were also apparent. The patient maintained maxillary and mandibular removable partial dentures, which were not functional (Figures 14-27 to 14-31).

The patient’s panoramic radiographic examination demonstrated a prominent premaxilla and advanced resorption of the posterior maxillary alveolus. The mandible had moderate to advanced resorption in the vertical dimension with retained cuspids only. The presence of zone I bone only indicated that the zygoma treatment concept was appropriate for reconstruction of the maxillary dentition with a fixed profile prosthesis. The tilted implant concept may be considered for treatment of the mandible with a fixed, implant-supported prosthesis (Figure 14-32).

Jan 7, 2015 | Posted by in Implantology | Comments Off on 4: Case Presentations
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