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Last week was interesting. Most of my days are consumed doing the traditional all on 4 procedure where I extract the remaining teeth, place implants, and build a complete set of new teeth all in the same day. Sometimes as this morning it is just one arch, upper or lower, other times both arches. Last week was unusual in that we only did two all on four cases. The rest of the week was consumed doing bone grafts in preparation for future implant placement. I have mentioned previously that there are a couple of new products on the market to facilitate bone regeneration; Osteocell, a stem cell product, and Infuse, a bone morphogenic product. About 6 months ago I reported on a case where a young man had a bicycle accident that caused severe damage to the front of his mouth. Three teeth were lost and the damage to the supporting bone was extreme. We placed a temporary non-removable bridge and grafted with Infuse contained with a titanium mesh membrane. Last week I uncovered the surgical site to remove the membrane. After removing the temp I noticed that under one of the bridge pontics {replacement tooth for a missing tooth} the mesh was exposed. I had not noticed that previously or I would probably have removed the mesh at 4 months. After reflecting the tissue I found extremely hard, dense dental bone except under the exposed area. There was plenty of bone there as well but less mature. After removing the mesh I harvested some soft tissue from the palate {roof of the mouth} and achieved excellent coverage and enough plumping of the tissue to form a little “tissue anatomy” with the pontics. I had hoped to place implants but decided to let the tissues mature for 2 months as it will help ensure a cosmetically pleasing result. All things considered I have never seen a graft deliver such a high quality and quantity of bone. This is consistent with previous cases I have treated with Infuse. I uncovered an Osteocell graft with a membrane about to expose and did two extensive grafting procedures, one with Infuse, the other with Osteocell last week as well. I’m leaving for Hamburg on Friday to attend an ICOI meeting and study with some exceptional dental implant specialist. If I get a break I’ll report on those other cases before I leave and hopefully I’ll have something new and exciting to report about dental implants when I return.
Case of the Week Infuse
Removing Failing Subperiosteal Dental Implants & Replacing with All-On-4 Dental Implants
This morning, at the Brueggen Dental Implant Center, we did a lower All-on-4 dental implants case for a 60 yr old gentleman from Colorado.
He was in town on personal business and learned about us from a T.V. ad. His medical history was non-contributory. Dentally, he was wearing an upper and lower denture. There was a mobile and failing unilateral subperiosteal implant on the lower left, and one had previously been removed on the lower right. Subperiosteal implants are placed beneath the “gums” and rest on, but not in, the bone.
Subperiosteal implants are used when there is inadequate bone volume to place a dental implant into the bone, and the treating doctor is not aware or trained in other options. They experience a very high failure rate. I have removed a number of subperiosteal implants but have never placed one.
These implants were placed in Colorado about 15 years ago when the upper and lower dentures were made. It was the doctor’s hope to attach the lower denture to the subperiosteal implants, but unfortunately, that was never possible.
This patient was displeased with the fit of his false teeth. Even with thick denture adhesives, he was unable to eat, and the lower was unstable even in speech. He was a very active gentleman and very frustrated with his situation because his previous dentist had told him that he did not have enough bone for dental implants.
We took a cat scan (a very sophisticated x-ray designed to allow precise measurements of bone in all dimensions) and determined that he did have enough bone for dental implants if the All-on-4 dental implants (a full set of upper or lower teeth fixed to 4 dental implants) technique was used.
Consultation revealed that financially doing this on the upper and lower was not feasible, so we elected to do a new denture on the upper and the All-on-4 dental implant procedure on the lower. Our in-house lab pre-made the upper denture, so when he arrived this morning, we were able to deliver that before I began the surgery.
Using conscious oral sedation, I began the surgery at 9:30 A.M. The failing subperiostel implant was removed, 4 endosseous dental implants were placed, and the surgery was completed at 10:55 A.M.
Impressions were taken for the lab and at 4:30 P.M., the patient was ready to leave with his new upper denture and new lower non-removable teeth attached to 4 implants.
His healing and recovery should be uneventful, and I anticipate making his final set of teeth in 6 months.
Dr. Brueggen