Prosthodontic Case Study 1

 John is a 64-year-old Caucasian man with no significant medical history other than hypertension which he is on medication for.

His dental history however is extensive with multiple missing teeth in the anterior maxilla and posterior mandible. Although the condition of his periodontium is sound the teeth were in a failing state with broken root tips, incomplete root canals, and heavily damaged teeth that have fallen out or been repeatedly repaired over time. His bite was in angle’s class I occlusion however the anterior teeth were in 6-7 mm deep overbite which restricted his mandibular protrusive movements that may have contributed to the spasm of his muscles of mastication and in turn the development of bruxism that led to the destruction of his teeth.        

The plan of action is to replace the missing teeth with dental implants and restore esthetics and function, and more importantly to provide him with an occlusion that allows him to function with a freedom of movement in function. This involved opening his bite and the buccal faring of the mandibular anterior teeth to establish a mutually protected occlusion with even centric contacts points in the anterior and the posterior with total dis-occlusion on lateral movements. By opening the VDO, not only I had more space for dental implant components, but consequently this reduced the anterior overbite, thus allowing anterior dis-occlusion of the posterior teeth on anterior guidance and freedom of movement in centric.  

Here, teeth in position #29 and #5 were extracted for simplifying the treatment plan, reducing the overall cost and expediting the overall treatment. Wisdom teeth 17 and 16 were also extracted the same day the implants were installed.    

The implants were placed immediately and the patient was immediately loaded in the maxilla with temporary teeth. 

 After 8 weeks the permanent teeth were installed. An old professor of mine used to say “you don’t save a single tree in the forest but you save the entire forest”. 

Overall treatment time was less than three months with a total of six visits including the one year follow up appointment.

Author: Dr. Safa Tahmasebi DDS, MS, Prosthodontist,
Metro-Charlotte Clear Choice Dental Implant Center
Fort Mill, South Carolina, USA