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LEADERS IN NORTH TEXAS DENTISTRY CREATING UNFORGETTABLE SMILES
As in Life , Choosing Your Core Team Keeps Things Simple
A case presentation from Dr . Sloan Hildebrand
John , one of the most sincere and thoughtful patients in our practice , had neglected his dentition for many years and presented to our office to restore his smile and ability to function normally again . He had reached a point where there was no other option than to extract all of his teeth and start planning for the next chapter of his life . Restorative options presented included complete dentures , Locator attachment implant supported prostheses , All-on-4 hybrid prostheses or fully implant supported fixed partial denture prostheses . After reviewing all options , John decided that he wanted his teeth back and was willing to go all in to make that happen .
Treatment
Dr . Ron Stukalin and I pre-planned this case very carefully as we do for every implant case we work on together . I am a big believer in cultivating a team of likeminded individuals that you can fully rely on and know that you are all on the same page when it comes to preplanning implant placements from a restorative endpoint in mind . Dr . Stukalin and I initially used a cone beam computed tomography ( CBCT ) i-Cat scan to properly identify anatomical landmarks , bone quality and quantity and ultimately precisely plan where we were going to place the 12 Straumann Bone Level dental implants for the six fixed partial dentures . We used iMD viewing software , digital imaging and communications in medicine ( DICOM ) files and communication to create a 3D implant treatment plan specific for John ’ s case . These computer guided implant placement tools assisted Dr . Stukalin and me in specifically choosing where each implant would go in order to ensure the most predictable integration and more importantly , proper restorability post integration . Upon removal of John ’ s dentition , Dr . Stukalin placed implants in sites # 3 , 6 , 7 , 10 , 11 , 13 , 19 , 22 , 23 , 26 , 27 , and 30 . I fabricated screw-retained mx / md provisionals fixed directly to the implant fixtures to allow the patient to begin to masticate and function normally again . These provisional cylinders were hand tightened and occlusion was carefully monitored during the integration phase . Final fixture-level custom impressions allowed us to capture the proper emergence profile and tissue sulcus depth required to properly pick the correct multi-unit abutment heights and duplicate the proper emergence profile . Implant supported fixed partial dentures were fabricated in segments to restore # 3-6 , 7-10 , 11-14 , 19-22 , 23-26 , and 27-30 . We chose to place an implant in site # 13 vs . # 14 due to the lack of bone present in site # 14 and therefore we had a distal cantilevered pontic fabricated in site # 14 . Proper implant placement was also of utmost importance in this case in order to ensure that all access holes were through the occlusal or lingual portions of the final restorations .
Laboratory Expertise
I sought out my friend , the late , great Mike Hamouch , to join our team for his laboratory expertise in developing John ’ s final prostheses . A full contour wax up was created , cut back , cast and then tried in as segments for precise fit intraorally . Ultimately , porcelain was fired to the cast frameworks and the final restorations were torqued to the implants at 35Ncm .
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