Case 1 - Simplified One Appointment Reconstruction of the Severely Atrophied Mandible

Case 1: RECONSTRUCTION OF THE SEVERELY ATROPHIED MANDIBLE

"Classic"

§1. All teeth missing.

§2. Advanced bone loss mandible.

§3. Long term use of complete dentures.

§4. OVD less than ideal, needed to change.

§5. Facial aesthetics needed improvement.

TREATMENT GOALS: RECONSTRUCTION OF THE SEVERELY ATROPHIED MANDIBLE

Single stage surgical approach for implant placement with grafting and immediate implant loading with transitional prosthesis.

Bone regeneration utilizing “Banked” cancellous bone from human cadaver vertebra with Platelet Rich Plasma and Minimal Invasive Surgerical technique.
Patient always has prosthesis (teeth) during healing for function & aesthetics .

Pre-Operative Photograph Pre-Operative Radiograph

Pre-Op CT scan Over View Study

Pre-Op 3-D Moveable Translucent Image Showing Advanced Bone Atrophy

Pre-Op CT scan Panoramic View Pre-Op CT scan Cross Sectional View

            Pre-Op CT scan Axial View                                   Pre-Op CT scan Cross Sectional View
                                                                                             Showing Advanced Bone Atrophy
                                                                                             Start First Year 4.8mm Mandible

TREATMENT GOALS: RECONSTRUCTION OF THE SEVERELY ATROPHIED MANDIBLE

Single stage surgical approach for implant placement with grafting and immediate implant loading with transitional prosthesis.

Bone regeneration utilizing “Banked” cancellous bone from human cadaver vertebra with Platelet Rich Plasma and Minimal Invasive Surgerical technique.
Patient always has prosthesis (teeth) during healing for function & aesthetics .

Lingual Tunneling Technique and Creation of Irradiated Cancellous Bone & Marrow

Vascularized Site for Bone Graft Placement

Healing with PRP

WHAT IS PLATELET RICH PLASMA (PRP)?

§Platelet Rich Plasma (PRP) is composed of platelets and plasma. Platelets are tiny cells that are partially responsible for causing blood to clot. Platelets also contain large reservoirs of natural growth factors. While a normal concentration of platelet circulating in your blood is 200,000 per micro liter, the platelet count in PRP can exceed 2 million platelets per micro liter.

WHAT ARE GROWTH FACTORS?

§Platelets contain potent growth factors necessary to begin tissue repair and regeneration at the wound site. Growth factors derived from platelets initiate connective tissue healing, bone regeneration and repair, promote development of new blood vessels, and stimulates the wound healing process.

TREATMENT GOALS: RECONSTRUCTION OF THE SEVERELY RESORBED MANDIBLE

Single stage surgical approach for implant placement with grafting and immediate implant loading with transitional prosthesis.

Bone regeneration utilizing “Banked” cancellous bone from human cadaver vertebra with Platelet Rich Plasma and Minimal Invasive Surgerical technique.
Patient always has prosthesis (teeth) during healing for function & aesthetics.
Increase zone of attached keratinized tissue around implants.

Minimal Residual Keratinized Tissue (Pre-Op) Increased Residual Keratinized Tissue (Post-Op)

- 2mm Keratinized tissue Physiological increase Keratinized tissue from

2mm to 5-7mm

1.5 mm Minimal Residual Keratinized Tissue

Technique for Preservation of Keratinized Tissue Around Implants

1.5mm Keratinized Tissue Divided to                       Minimal Tissue Opening to Allow Access
Allow Increased Formation of Keratinized                and Elevation of Soft Tissue for Creation of
Tissue to Surround Implants                                      Implant sites with Grafting

       Lingual Tunneling Technique to                               Implants placed prior to Bone Grafting and
             Allow Soft Tissue Dissection and                          Healing Screws Placed for Low Height and Access
    Prevention of Inferior Alveolar Nerve Injury           to Grafting Site Then Changed to O-ring Abutments

Lingual Tunneling Technique and Creation of
Vascularized Site for Bone Graft Placement

TREATMENT GOALS: RECONSTRUCTION OF THE SEVERELY RESORBED MANDIBLE

Single stage surgical approach for implant placement with grafting and immediate implant loading with transitional prosthesis.

Bone regeneration utilizing “Banked” cancellous bone from human cadaver vertebra with Platelet Rich Plasma and Minimal Invasive Surgerical technique.
Patient always has prosthesis (teeth) during healing for function & aesthetics .

Increase zone of attached keratinized tissue around implants.

§Two week healing with interim prosthesis, then implant connecting bar placed without loading contact of the grafted and regenerating area with definitive prosthesis.

Interproximal Sutures with Attachments Interproximal Sutures with O-ring Attachments
Placed Day of Surgery Placed Day of Surgery with Rubber Dam in Place Beneath Attachments for Acrylic Pick-Up

Interim Prosthesis with O-ring Attachments                        Pre-made Interim Prosthesis with
Picked Up Chair side c Additional Acrylic Resin                  O-ring Attachments & Occlusal View
Rubber Dam in Place Beneath Attachments

Pre-made Interim Prosthesis with One Day Post-Operative
O-ring Attachments Frontal View

One Day Post Implant Placement with Five Days Post-Operative
O-ring Attachments and Immediate Loading

10-14 Days after Surgery

• M.I.S. Allows for final impression for implant connecting bar
• Polyether material of choice for impression.

Three weeks Post-Operatively

Three Months Post-Operatively Pre-Op CT scan Cross Sectional View
Start First Year 4.8mm Mandible

8.75mm Mandible

Bone Regeneration Over Nerve
Post-Op CT scan Cross Sectional View One Year

Pre-Operative Photograph Post-Operative Photograph

Email our office at dental-implants@Dr-Amet.com or call (913)-492-2233 to schedule a no cost consultation