Full mouth guided immediate implants in a patient with generalized aggressive periodontitis?

Hi, This is a tough one. However got to be done? I would call teeth guided and computer assisted. You cannot predict fully the extraction outcome. Unless all or almost all-alveolar bone shaved down and you follow “Prettau” or all in 4/6 protocol. It would be almost impossible to avoid denture flanges on the prostheses. However with somewhat ridges preservation, not to shaving them, you can minimize chance for this patient getting dentures for life. Staging and grafting sinuses and posterior mandibular areas, you can give patient posterior occlusion. You can make a fixed interim prosthesis with temporary anterior occlusion and later do a full implant supported with posterior occlusion, having implants in a first/second molar area with minimal cantilevers. Similar to this case. I will post some more, if there is an interest. Regards, mike

Age of patient, medical and dental history, hygiene history. Periodontists chime in with all those saliva test etc since that is your area of expertise. If the etiology of this is unclear any implants will fail. That bone is full of bacteria some of it under the cortical bone. The alveolus is gone so an all on four-six or denture with locators is future plan but control the pathology first, jumping in for the big implant case is not prudent in this case. Treat the cause first not the result can any of these teeth be splinted and treated to get the patient on board with hygiene responsibility prior to pulling the full mouth extraction trigger. Remember that perio disease is often painless and the patient will need to keep the implants clean! Often what I see is that the patient is either resigned to losing everything or is litigious that they were not told they had perio, I'm assuming that you worked up this case and documented everything well. This is the typical "Clear Choice" case, be careful more complex than it looks.

Hi CRS, this case has some info you are interested in: http://www.osseonews.com/immediate-extraction-implants-placement-and-function/ Regards mike

i strongly recommend putting this patient on amoxicillin and flagyl for two weeks prior to extractions and implantation.

in these cases I prefer staging the process. First do extractions, curette all granulation tissue and osseous grafting with PRF. Place temp denture. Let healing occur for 3-4 months...then place implants. Whether guided or full flap placement...immed. load or not. In my hands this is much do predictable over the long haul.

Thank you all for sharing your experiences. How about placing transitional implants and loading them while final implants are healing.

Full mouth guided implants usually succeed. The jokers in this particular hand..... I mean case are "immediate" and "generalized aggressive periodontitis". Reminds me of "Fools rush in where angels fear to tread". Landmines and pitfalls all over the place. There are also a few other variables like whether you can get good primary stability with the bone in flux due to ongoing inflammatory conditions, how accurate is your guide and how firm you can stabilize it for it to be useful ....... and so on. I would concur more with the wisdom of Don Rothenberg.... one step at a time in phases. In this case, the uppers are probably quite unsavable. The lowers..... lower anteriors and last molars have a good chance of preservation. I am of the school of Saving naturals As Far as is Expedient(SAFE). I did a similar case but in phases and preserving as many naturals as possible. Lower teeth are easier to safe usually because the bone is denser I think.

Everybody is jumping the gun on this case. What is the basis for your diagnosis of aggressive periodontitis? Need to control etiologic factors first. Take bacterial samples and submit to a laboratory (USC or Pennsylvania). Treat with systemic antibiotics based on culture & sensitivity. Re-test and treat again if necessary. Perform scaling and rootplaning with administration of systemic antibiotics. Once you get the etiologic factors under control, you can proceed with implants. Otherwise, you are doomed to failure and infected implants.

I suggest that you do a tooth by tooth analysis to check the clinical attachment loss for all the teeth. Bring the periodontitis under control, extract teeth with clinical attachment loss of more than 75% together with consideration of factors such as fur cation involvement : www.ceodental.com.au/media/treatment-planning-2.pdf. Do removable partial dentures and evaluate plaque control and soft tissue response. If you are satisfied that the patient is disease free and has adequate plaque control then proceed with implants on the missing teeth. I have a problem with extracting teeth to suit a certain protocol, implants should not replace teeth but rather, implants should replace missing teeth. A lot us have seen teeth with moderate clinical attachment loss being sacrificed only to be replaced with an implant of the same length or slightly longer than the removed root. Natural teeth are by far resistant to periodontal disease than implants. One step at a time Doc,clearing everything is irreversible.