Case Study on Dental Implants

Are you interested in how Dental Implants can change your life? Dental implants can replace 1 tooth, or an entire arch. With the advances in Guided Surgery, dental implants can be placed very precisely, making the procedure very predictable.

Dental implants have come a long way from when they were first introduced. There was a time when the shape of the bone dictated where the implant could be placed, making the prosthetics¬†(crowns) sometimes difficult to place in an esthetic and functional position. Now with the many available bone grafting procedures we currently have, we can “create bone and tissue” to enhance the correct final implant position to enhance the final outcome. As a team, I work closely with my surgeons, and we plan our cases together. With the use of mounted dental casts, xrays, and a CT Scan, we can very predictable work up a case to mimic what we want as a final outcome.

Lets look at how a case is worked up.

Patient presents to our office with 4 implants and broken bridge that was attached to these implants. Poor placement and treatment planning probably attributed to its failure. Following xrays and a CT Scan it was determined that these implants needed to be removed. Prior to removing the implants a full upper denture was fabricated so patient would not be without teeth., This would also function as a guideline for correct tooth position.

Full upper denture opposing full lower arch provisional

After 3 months of healing, marker were placed in the denture, and a CT Scan was done. Using the surgeon’s software, we established the ideal implant position, determined by tooth position from our denture, and available bone support on CT Scan. All this information can than be used to fabricate a surgical guide.

Duplicate denture with markers for scan
Planning implants on software
Go to this link on You Tube:
https://www.youtube.com/watch?v=ShaW7L7bZ2c
Planning guided surgery and provisional restoration to place day of surgery

After implants are placed, a fixed PMMA restoration is screwed retained onto the Multiunit Abutments

Our patient was put on a soft diet for the next 3 months. Now we are ready to start our final restoration. My choice of material is zirconia with a reinforced titanium bar for additional strength. The first step I like to do is take a closed tray impression. I have the lab fabricate a jig using open tray impression copings. The jig is placed and confirmed for passive fit (xrays and Sheffield Test). If the fit is not passive, cut through the resin, and lute with GC resin. Once you have confirmed  a passive fit, proceed to take an open tray impression with a custom tray. The lab can now fabricate a new model, and will process a titanium bar. Again, we try in the bar to be absolutely sure it fits passively. Otherwise, problems such as breakage to screws, bone loss around the implants (leading to periimplantits), or fracture to your restoration can occur. The bar is returned to the lab, and the final full contour zirconia bridge is fabricated.

Closed tray impression copings placed for initial impression
Impression with analogs in place
Jig in place and ready for open tray impression
Final model
Titanium milled bar
Try in bar
View of final restoration on model
Completed case
A very happy patient

I hope this gives you an idea of how implants can change your life. Please feel free to contact me at any time at drlangerdds@gmail.com or call us at 718-339-6544

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Posted in: Brooklyn Cosmetic Dentists, Brooklyn Dentists, Cosmetic Dentist Brooklyn, Cosmetic Dentistry, Dental Implants, Smile Makeover, What are dental implants?


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