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Case study: Digital implantology overdenture for maxillary edentulous with jaw bone defect

Preface

A patient presenting with partial jaw defects was struggling with everyday activities, such as chewing, swallowing, and pronunciation. The patient has also become more self conscious and it has begun to affect them negatively. Given that the mouth and nasal cavity are connected, and the support of the remaining tissue is insufficient, there are some difficulties to be experienced in clinical treatment: taking impressions and getting an accurate occlusal relationship, insufficient facial soft tissue recovery, and poor fixation of the prosthesis. The development of digital technology improves the treatment of such cases.

Today’s case was provided by dentist Shi Yong, a deputy director of physician, who graduated from Air Force Medical University, now working at Stomatological Hospital of Southern Medical University. In this case, the doctor used intraoral scanner, face scanner, CBCT, electron face arch, intraoral functional impressions to get accurate information, made radiation guide plate, implant guide plate and temporary restorations, and 4 implant bodies. After three months, the final repair of this complex case was completed: digital implantology overdenture for maxillary edentulous with jaw bone defect.

Case information

Patient’s information:60 years female  

Chief complaint:After a surgery 2 weeks ago, the patient had difficult in chewing, so she came and required a treatment.

History of present illness: Due to caries, periodontitis and other factors, the patient had a long history of maxillary tooth loss and movable denture restoration. One month ago, owing to the black gingival plaque of the left upper posterior teeth and jaw bone defects, she took a partial maxillary resection surgery in hospital.

Medical history: No history of allergies or any other disease.

Fig1, Fig2: The facial morphology before treatment

Intraoral examination

The maxilla #17~#27 was missing(Fig3),alveolar ridge absorption in the edentulous area was moderate and severe;

The left posterior part of the maxilla was missing, a leakage in genyantrum oral and nasal cavity (Fig3)

Fixed bridge restoration in lower jaw,#44~#47 were looseness in I degree(Fig4,Fig5)

Bad oral hygiene

Diagnosis

Partial defect of left maxilla

The upper jaw was missing

Defect of lower jaw

Treatment Plan

Step one: Periodontal system treatment

Step two: Determine the treatment plan, after comprehensive consideration and discussion with patient, the final treatment plan was prosthesis together with locator implantation supports overdenture restoration.

Treatment process

Fig6 and Fig7: Captured the intraoral data using intraoral scanner
Fig8, Fig9, Fig10, Fig11: Printed the models, make temporary base and wax occlusion rim

Fig12: Capture facial data, get information about vertical distance of one third of the patient’s face

Fig13 and Fig14: Confirmed the CR position with the help of electron face arch,recorded occlusion relationship with articulator

Fig15: Made a functional wax occlusion rim with data simulation as a reference

Fig16, Fig17: Second functional impression
Fig18 and Fig19: Made radiation guide plate and implant guide plate
Fig20: Executed implant surgery, implant 4 implant bodies, it shows the CBCT panoramic image after implant surgery
Fig21 and Fig22: After 3 months, dentist examined the bone osseointegration using ISQ, carried out the second stage operation
Fig23, Fig24: intraoral data Scanned and a 3D implant model printed
Fig25, Fig26, Fig27: The implantation support overdenture restorations
Fig28: Digital verification of facial morphology and functional movement were performed after treatment

Summary

The combination of digital technology and intraoral functional impressions can not only improve the accuracy of restorations, but also reduce the chairside time.

Non-contact digital impression can simplify the technical operation in patients with maxillary defects and avoid the stimulation of the wound.

The whole process is assisted by digital technologies, record the data accurately before and after treatment. It can restore the patient’s maxillofacial contour, shorten the waiting time and reduce their treatment cost.

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