Indication 6, Case 1

Extended edentulous space mandible

Dominik Hofer, D.D.S. (Dr. med. dent.)
Private dentist & Clinical instructor
Department of Periodontology and Fixed Prosthodontics
School of Dental Medicine, University of Berne.
Dental Technician: Beat Heckendorn, Berne

Introduction
This case presentation demonstrates the reconstructive phase of acomplex perioprosthetic treatment. Using implants, strategically important abutment teeth could be replaced after completion of periodontal therapy.The 22-year-old patient was referred to the Department of Periodontology and Fixed Prosthodontics of the University of Berne for a complete restoration of his periodontal status. The patient complained of excessive movement of teeth in both jaws, and additionally, he wanted to achieve an esthetic improvement in the anterior maxilla.

	Initial situation In this picture, the severe inflammatory changes of the periodontal tissues, tooth displacement, plaque and calculus build-up are easily recognizable.

	The mandibular gingiva was significantly swollen on the lingual aspect. Periodontal supportive tissue was almost completely destroyed.

	X-ray 36 The radiologic and periodontal examination confirm the clinical diagnosis of a rapidly progressing generalized jurenile periodontitis. As some teeth the supportive bone had been destructed up to 90

	X-ray 26 The periodontal status showed generalized deepened pockets with probeing values ranging up to 19 mm. The average probing depth equaled 8.34 mm, and the average loss of attachment was 8.25 mm. Only 14% of the sites showed probe depths of 1-3 mm.

	Six months after completion of the periodontal treatment (hygiene phase, surgical revision and extractions of the teeth not suitable for treatment), four ITI full-screw implants were inserted in the mandible. Tooth 43 was later removed due to prosthetic and periodontal consid-erations.

	From a prosthetic standpoint, the axis of tooth 43 demonstrates a disadvantageous inclination.

	In spite of massive loss in the periodontal supportive tissue, the bony crest was nevertheless ideal in both transverse and horizontal aspects which, from a prosthetic standpoint, enabled optimal implant placement.

	Screwing-in of the solid abutment occurred five months afterimplantation.

	In the posterior area, only a slight amount of attached gingiva was available.

	An impression was taken using transfer copings to protect the peri-implant soft tissue.

	Overview of the tooth-borne full bridge in the maxilla: 17 x x x 13 x x x x 23 24 25 x 27.

	Using the implants in the mandible, three smaller bridges could be in-corporated: x I46 x I44, x I42 x I31 x, x 35 x 37. This also reduced the risk of a technical failure.

	The interdental spaces were specifically shaped so that cleaningcould be performed with interdental brushes. Constructed in order to aid interdental cleansing.

	The peri-implant tissue demonstrated healthy conditions.

	The patient's primary requests, specifically, immobilization of the unstable teeth and esthetic improvement, could be satisfactorily.