Identity of dental implants and treatment options?

Last Updated: Jun 20, 2014

This 75 year old attractive vivacious female with no medical issues desires an improvement over many failed bridges during her lifetime. The latest $16K fiasco is a less than 2 year old fractured failed bridge that demonstrated NO teeth on the left side even with a protracted smile. She sought out a lip reduction by a plastic surgeon to no avail. There is no maxillary vestibule. The L maxillary bridge segment is mobile. It is also fractured between #6 and 7 [maxillary right canine and lateral incisor; 13, 12]. The mandibular right implant bridge is loose. i cannot yet determine if it is the bridge or the sub-periosteal implant due to hyperplastic tissues. The mandibular anterior bridge is being worn with Polygrip [oral appliance adhesive]. Her preceding dentist was going to place another implant between the sub-periosteal implant and the buried root form implant. She has asked me to remake the mandibular anterior bridge. The mandibular left implants are mobile.

My first thoughts are to identify the implant systems used. I plan on removing her maxillary bridges and determining what is salvageable, I then plan to construct a provisional implant based overdenture and a mandibular acrylic removable partial denture to give maxillary balance. I anticipate many of these implants will be removed. I plan to use acrylic teeth only from now on. I am planning a maxillary hybrid [fixed detachable]. Can anybody identify these implants? What components will I need?. Some of these are ZImmmer and I think Tatum. I made a cosmetic overappliance using a FBT mounted case to determine initial incisal edge position and plane of occlusion. She approved. Now I need to translate that to her mouth. I am constructing an entry level denture with arch room to retrofit whatever it is I discover and securing it is an unknown. I am hoping for some stability from any of the existing implants to secure the appliance. I am open to any recommendations for treatment planning. Thanks.

![]Turner-C-pan-Small](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2014/06/Turner-C-pan-Small.jpg)

9 Comments on Identity of dental implants and treatment options?

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CRS

06/21/2014

Aside from taking her to Lourdes, I would suggest an all on four in the maxilla combined with a conventional mandibular denture with a couple of locators wherever you can place them. In this case the factors which led here are many including patient factors and iatrogenic factors. I would be concerned about pathologic fracture,paresthesia and prosthetics. If it were me, I would refer this to an experienced prosthodontist working with an Oral Surgeon who can treat any future sequela and complications. Just a word of caution before entering the abyss. The maxilla is heading for zygomatics and the mandible does not have much to salvage. Complicated case for experienced hands in a team approach. Just my take based on what is presented and the questions you are asking. Good luck.

rsdds

06/23/2014

In my opinion this is not a case for a gp you will marry this healthy pt for a long time..

Richard Hughes, DDS, FAAI

06/24/2014

I would remove the lose mandibular implants and right unilateral sub and place a mandibular sub that was grafted over with PRP and an alloplast. The major issue is soft tissue closure with the new sub.

CRS

06/24/2014

Good point on the soft tissue closure may need a skin graft taken from the thigh.

Peter Fairbairn

06/24/2014

Agree rdss I would be wary of "marrying" this case life is too short .......must be getting older and maybe wiser Peter

Bill Woods

06/24/2014

I did not see my last post so I am reposting. If it suddenly appears, I apologize for the redundancy in advance. Thank you for your comments and advice. While I have been placing root form implants following the AAID Maxicourse in 2003 and Pikos in 2004, I have not attempted zygomatic implants, as they were not part of the live surgical program at that time. Nor would I do so without adequate training. I have existing subs in my practice but do not place them. I have a very good pros lab and while I am not a prosthodontist, I am very capable of rehab short of zygomatics and subs. I do have someone in mind should she choose that route, but not in my hometown. She is not very likely to consider travel and surgery. That being said, I do have a CBCT for advanced planning and we are not yet at any decision point. The locator suggestion has already been discussed to address her maxillary arch on a provisional level. Nothing has been decided in stone. Please keep your thoughts and ideas forthcoming. I sincerely thank you again. Billl

CRS

06/24/2014

It is not so much about placing implants, there is just not much to work with and any intervention could be heading for complications. I 'll keep you in my prayers! But honestly the patient needs to be realistic. The lip reduction option is a little scary!

Richard Hughes, DDS, FAAI

06/25/2014

CRS, Help me to understand something! Why would you put the patient through a skin graft, when one can buy and use Alloderm etc without the associated donor site morbidity.

CRS

06/26/2014

If the skin graft is done optimally there is little donor site morbidity. I don"t feel the results are as good using cadaver dermis. Depends on how much coverage is needed, I would assume this would be done in the OR. My point is that this patient is heading for a reconstruction if the same path is being taken. There is significant shrinkage with dermis and the floor of the mouth may need to be repositioned.Honestly I would need to see a clinical photo with muscle attachments for the pre-prosthetic surgery. However what make or breaks these cases is the prosthetic planning the surgery must be respectful of that.

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