A COST EFFECTIVE APPROACH FOR FACIAL

A COST EFFECTIVE APPROACH FOR FACIALREHABILITATION WITH DENTAL IMPLANTSRobert, a 49-year-oldjournalist came to Pi foran opinion on his smile.His profession requiredfrequent face-to-face interviews.His chief complaints were theembarrassment he experiencedwhen smiling, painful chewing, verypoor esthetics and highly mobileteeth. He wrote in his medicalhistory, “It would be nice to smileagain”. Robert was in a severe autoaccident in 1980, which left him witha chronic painful condition in hisneck, his back and his jaws.Robert’s initial clinical examinationnoted multiple fractured teeth,extensive dental caries, apicalabscesses, and extruded teeth, whichcreated a severe malocclusion. Therewas a heavy plaque and calculusaccumulation, which combinedwith smoking, contributed toadvanced periodontal disease. Athis initial visit, he smoked one packof cigarettes a day, but desired tostop. Robert was advised of theeffects of smoking, not only on hisgeneral health, but also on his dentalcondition. He was strongly advisedto quit smoking immediately. Robertdid admit he was “a very bad dentalpatient” due to his high level ofanxiety.Historically, extensive periodontaltherapy followed by prosthodontictreatment may have been indicatedto maintain and restore Robert’snatural dentition. However, with allthe clinical findings and the currentcondition of the patient’s dentition,pidentalcenter.com

traditional dental treatment had a poor prognosis. With his advanced periodontal disease and his poor compliance,orthodontics to improve the dental malocclusion was not a viable option.Robert was presented with a treatment plan addressing all his concerns in an expedient manner. Cost was aconsideration for the full mouth reconstruction. Some doctors would recommend less expensive implant prosthetictreatment using an implant overdenture. At Pi Dental Center we have found that patients are rarely satisfied withthe removable implant overdenture as they are with the fixed implant prostheses. We found that there are manyadditional visits, as well as added costs associated withmaintenance of the overdentures. Recent studies havecollaborated our findings (see abstract on page 3).The philosophy at Pi Dental Center is to providepatients with the most effective and efficient approachto solving their dental problems. The Teeth In A Day procedure is an excellent alternative for patients witha failing dentition who need to make the transition toan implant supported prosthesis. Historically, it wouldtake several months or even years to see the benefits ofimplant treatment. Fifteen years of research pioneeredat Pi Dental Center has enabled patients to enjoy thebenefits of immediately loading the implant-supportedteeth on the same day that their decayed teeth areremoved and the implants installed. This acceleratesthe entire clinical process.Pre-treatment lateral cephalometric radiograph showssevere bite collapseThe early research for Teeth In ADay was accomplished in patientswhere larger numbers of implantswere placed to provide a verypredictable solution for prosthesisstability. Recently, studies have beenpublished that show comparablepredictability using fewer implants.The latter may prove to be a morecost effective treatment approachfor patients in need of implantreconstruction.For Robert’s treatment all theperiodontally compromised teethwere extracted, six implants wereplaced in the maxillary arch,four implants were placed in themandibular arch and prostheses forboth arches were put into immediatefunction following the Teeth In ADay protocol. While the patientwas encouraged to adhere to a softdiet for the first three months, thetemporary teeth proved to be muchstronger than Robert’s natural teeth.The esthetic improvements werepidentalcenter.comPre-treatment panoramic radiograph reveals extensive bone loss,advanced caries and periodontal diseasePre-treatment full mouth series of radiographs show advancedcervical caries and advanced bone loss.2

Pre-treatment views prior to Teeth In An Day immediate. Three months after the implantplacement the bone healing had stabilizedand the final implant reconstructions weredelivered.The patient went through a completemakeover to improve his overall esthetics. Dr.George Zavitsanos, a board certified plasticsurgeon, provided improved facial esthetics bysurgically correcting the deviation in Robert’snose in conjunction with multiple soft tissueenhancements. Following facial surgeryhealing and the Teeth In A Day treatment,Robert agreed to a style makeover andexperienced his first hair cut since 1969. Anew prescription for corrective lenses offeredyet another cosmetic improvement with hisstylish new glasses. Robert’s satisfaction withthe Teeth In A Day procedure is extremelyhigh. He has noticed a dramatic improvementin his psychological well-being and has foundit easy to smile and be more outgoing. Asa news journalist for a Washington, DCnewspaper, he feels more comfortable at pressconferences in the highly political public eye.Prosthetic complications with dental implants:from an up-to-8-year experience in privatepractice.Int J Oral Maxillofac Implants. 2006 Nov-Dec;21(6):919-28.Nedir R, Bischof M, Szmukler-Moncler S,Belser UC, Samson J.A study was conducted at Department of Stomatology and OralSurgery, School of Dental Medicine at the University of Geneva,Switzerland. An evaluation of prosthetic complication was performedon 236 patients treated with 528 implants in an 8-year private practiceexperience. The study sample included 55 overdentures and 265fixed partial dentures. The study found that patients with removableprostheses had more complications than those with fixed ones,66.0% versus 11.5%; the difference was significant (P .001). In theoverdenture group, the ball-retained prostheses had a significantlyhigher rate of complications than the bar-retained ones (77.5% versus42.9%; P .04). In the fixed partial denture group, complicationswere not recurrent; most occurred during the first 2 years, and therate of complications did not increase with time. In the OD group,1.3 incidents per prosthesis were recorded. Incidents were oftenrecurrent, and the rate of complications did not decrease with time.In the removable group, adjustments and foreseeable complicationswere numerous, recurrent, and usually easy to manage. Bar-retainedFrom a dental standpoint, the periodontalprostheses had fewer complications than ball-retained ones. In thedisease has been eliminated and the patientfixed group, complications were limited in number and did notnow has a completely healthy, functional,stable and esthetically pleasing reconstruction. increase with time.All-On-Four Mandibular Prosthesis3pidentalcenter.com

AP Cephalometric Radiograph taken afterthe Teeth In A Day procedure and prior toplastic surgery shows deviated septumPost-operative AP cephalometricradiograph with corrected deviated septumand final implant reconstructionsTime for a change!Patient smiles wearing the final restorationwith handsome esthetics.Post-operative lateralcephalometric radiographshowing improved facialsupportpidentalcenter.com4

Immediate rehabilitation of the completely edentulous jaw with fixed prosthesessupported by either upright or tilted implants: a multicenter clinical study.Int J Oral Maxillofac Implants. 2007 Jul-Aug;22(4):639-44.Capelli M, Zuffetti F, Del Fabbro M, Testori T.The aims of this study were to assess the treatment outcome of immediately loaded full-arch screw-retainedprostheses with distal extensions supported by both upright and tilted implants for the rehabilitation of edentulousjaws and to compare the outcomes of upright versus tilted implants. At 4 study centers, 342 implants wereconsecutively placed in 65 patients (96 implants were placed in 24 mandibles and 246 implants in 41 maxillae).The 2 distal implants were tilted by 25 to 35 degrees. Provisional full-arch restorations made of a titaniumframework and acrylic resin teeth were delivered within 48 hours of surgery and immediately loaded. The finalprosthesis was delivered after 3 months of healing. Three implants failed during the first year and another 2 within18 months of loading in the maxilla. The cumulative implant survival rate for the maxilla was 97.59% for up to40 months of follow-up. No implant failure was recorded for the mandible. The prosthetic success rate was 100%.Marginal bone loss around upright and tilted implants was similar. Patients were satisfied with their esthetics,phonetics, and function. Thepreliminary results of thisstudy suggest that immediaterehabilitation of the edentulousmaxilla and mandible by ahybrid prosthesis supported by6 or 4 implants, respectively,may represent a viable treatmentalternative with respect to moredemanding surgical procedures.The clinical results indicatethat immediately loaded tiltedimplants may achieve the sameoutcome as upright implants inboth jaws.Post-operative panoramic radiographProsthodontic Insights ispublished by Pi Dental Center anddistributed without charge toindividuals. Please request asubscription on yourorganization’s letterhead.AcknowledgementInsights Newsletter Staffand Contributorsthanks Robert Winkelman,CDT, MDT, director ofFort Washington Dental Lab formaking an exquisite porcelainfused to gold prosthesis. Thanksto CM Ceramics for making asuperb mandibular prosthesis.Thomas J. Balshi, DDS, FACPGlenn J. Wolfinger, DMD, FACPJohn J. Thaler II, DDSJames R. Bowers, DDSStephen F. Balshi, MBERobert Winkelman, CDT, MDTChristine Raines, Layout EditorDental Center467 Pennsylvania Avenue, Suite 201Fort Washington, PA 19034 USATEL: 215-643-5881FAX: 215-643-1149piteam@pidentalcenter.comGlenn J. Wolfinger,DMD, FACPThomas J. Balshi,DDS, FACP5John J. Thaler II,DDSJames R. Bowers,DDSpidentalcenter.com