My last two blogs were about Mr. A, the gentleman that we did an upper All-on-Four on about 2 weeks ago and who is waiting for hyperbaric oxygen treatment, so I can proceed with the same on the lower. I saw him Monday and he is continuing to do well with the upper.  I’ll keep you informed as Mr. A’s treatment continues. 

I began another interesting case last week. As this is our second case report we will, with great originality, call this Mrs. B. Mrs. B is a 75 year old woman in good health who came to me with missing back teeth and a fixed bridge on the upper and lower that went from the eye tooth on one side to the eye tooth on the other; 6 unit bridges.  Decay had gotten under all 4 crowns on the eye teeth and the bridges or teeth could not be saved. 

To make a long story short, it turned out that Mrs. B wanted her remaining teeth removed and wished to have the All-on-Four procedure on the upper and lower, i.e. full sets of upper and lower non-removable teeth made of 4 upper and 4 lower implants. The problem here was that the front teeth that were replaced by the upper fixed bridge had been extracted many years ago and the bone in that area had dissolved, leaving a ridge of only 4 millimeters in width.  Mrs. B’s previous dentist told her that there was not adequate bone volume for implants and that she would either need extensive bone grafting, using her hip as a donor site or just give up and wear dentures.  These were not attractive alternatives to Mrs. B so she came to me for a consult.

We now have a couple of bone grafting materials that work just about as well as natural bone, possibly better, that require no secondary surgery to harvest material for a graft. But as it turned out, Mrs. B could be treated adequately without bone grafting of any nature, so I’ll talk about the new bone grafting materials in another blog.  When teeth are removed, the bone remaining that once held the roots of the teeth is called a ridge. To place a large enough implant to secure a non-removable set of teeth, the ridge needs to be a least 7 millimeters wide. As I mentioned, Mrs. B‘s ridge was only 4 mm wide. Keep in mind that bone has a consistency more like wood than concrete, so it is possible in certain circumstances to “stretch” or expand it.  In this case, by making a very thin incision in the center of the bone ridge and then placing a small tapered screw into the bone, I was able to expand it to 7mm and place the implants. This saved Mrs. B two additional surgeries, months of healing time and a lot of expense.   Though the success rate for this procedure is very high, it is not without possible complications, so I’ll let you know how it goes.

Visit http://www.nodentures.com/ to learn more about the All-on-Four Dental Implants procedure.

More on Dr. Wayne Brueggen

Good morning everyone. I promised a report this week on the case I mentioned last week. That was the patient requiring full mouth reconstruction with the All-on-Four technique because of rampant and uncontrollable tooth decay as a result of head and neck radiation therapy for oral cancer.  We’ll call this gentleman Mr. A as he is the first of our case reports.  As you may recall, I decided to do the upper only and proceed with the lowers later after appropriate hyperbaric therapy.  Mr. A arrived at 8AM Monday morning to begin his sedation.  At 9AM, the surgery had begun. Under conscious sedation, 8 upper teeth were extracted and 4 dental implants were placed. The surgery was completed at 11:15 AM and we began making a new set of teeth. Mr. A rested comfortably and at 4PM we let him see his new smile. Mr. A loved it and reported the following day that he was pain free and working in his garden. I expect a continued uneventful recovery. Regarding the need for hyperbaric oxygen treatment before I proceed with the lower, there is an interesting side note. This has often been a major inconvenience for my patients because of the expense – often in excess of $10,000.00. Mr. A found that Medicare will cover the cost. That’s a welcome development.  As this case moves to completion, I’ll keep you up to date. Mr. A’s next visit will be in about two weeks. We’ll check on healing and give him oral hygiene instruction. I’ll let you know how he is. Visit www.nodentures.com to learn more about the All-on-4 procedure.

Dr. Wayne Brueggen