Reconstructive and Implant Dental Center - Kansas City                                                                                            dental-implants@dr-amet.com          Phone: 913-492-2233          Fax: 913-492-2234                 Office Information Video              

ADVANCING THE ART AND SCIENCE OF DENTISTRY

                                   

   

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 .

 

Dental Reconstruction of the Severly Atrophic Mandible    Dental Reconstruction of the Severly Atrophic Mandible 1

Pre-Operative Photograph                                             Pre-Operative Radiograph

 

Dental Reconstruction of the Severly Atrophic Mandible 2 

Pre-Op CT scan Over View Study

 

Dental Reconstruction of the Severly Atrophic Mandible 3      Dental Reconstruction of the Severly Atrophic Mandible 4

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

 

Dental Reconstruction of the Severly Atrophic Mandible 5      Dental Reconstruction of the Severly Atrophic Mandible 6

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

 

   Dental Reconstruction of the Severly Atrophic Mandible 7      Dental Reconstruction of the Severly Atrophic Mandible 8

    Pre-Op CT scan Axial View                                     Pre-Op CT scan Cross Sectional ViewShowing Advanced Bone Atrophy                         Start First Year4.8mm 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.

 

Dental Reconstruction of the Severly Atrophic Mandible 9          Dental Reconstruction of the Severly Atrophic Mandible 10

                       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.
 
 
§

Dental Reconstruction of the Severly Atrophic Mandible 11          Dental Reconstruction of the Severly Atrophic Mandible 12

                        Minimal Residual Keratinized Tissue (Pre-Op)    Increased Residual Keratinized Tissue (Post-Op)
 -                       -2mm Keratinized tissue                                           Physiological increase Keratinized tissue  from 2mm to 5-7mm 

 

 

Dental Reconstruction of the Severly Atrophic Mandible 13          Dental Reconstruction of the Severly Atrophic Mandible 14

                                                 1.5 mm Minimal Residual Keratinized Tissue
Technique for Preservation of Keratinized Tissue Around Implants

 

Dental Reconstruction of the Severly Atrophic Mandible 15         Dental Reconstruction of the Severly Atrophic Mandible 16

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

 

Dental Reconstruction of the Severly Atrophic Mandible 17          Dental Reconstruction of the Severly Atrophic Mandible 18

       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

 

Dental Reconstruction of the Severly Atrophic Mandible 19

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.

 

 

Dental Reconstruction of the Severly Atrophic Mandible 20         Dental Reconstruction of the Severly Atrophic Mandible 21

      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

 

Dental Reconstruction of the Severly Atrophic Mandible 22         Dental Reconstruction of the Severly Atrophic Mandible 23

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                                                                                            

 

Dental Reconstruction of the Severly Atrophic Mandible 24         Dental Reconstruction of the Severly Atrophic Mandible 25

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

Dental Reconstruction of the Severly Atrophic Mandible 26          Dental Reconstruction of the Severly Atrophic Mandible 27

          One Day Implant Placement                                                     Five Days Post-Op Attachments
     and Immediate Loading

                       

 

Dental Reconstruction of the Severly Atrophic Mandible 28

10-14 Days after Surgery

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

 

 

Dental Reconstruction of the Severly Atrophic Mandible 29          Dental Reconstruction of the Severly Atrophic Mandible 30

Three weeks Post-Operatively

 

Dental Reconstruction of the Severly Atrophic Mandible 31          Dental Reconstruction of the Severly Atrophic Mandible 32

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

 

Dental Reconstruction of the Severly Atrophic Mandible 33

8.75mm Mandible

Bone Regeneration Over Nerve Post-Op 1 Year CT scan Cross Section

 

 

Dental Reconstruction of the Severly Atrophic Mandible 34     Dental Reconstruction of the Severly Atrophic Mandible 35

    Pre-Operative Photograph                                              Post-Operative Photograph

 

10801 W. 87th Street - Ste. 100 - Overland Park - KS - 66214

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